41 West Hill

41 West Hill is a residential care home providing regulated activity of personal care to up to 5 people. The service provides support to younger adults living with a learning disability and autistic people. At the time of our inspection there were 5 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. Staff failed to ensure they did everything they could to avoid restraining people. The manager failed to review incidents of restraint and did not have oversight. This meant the manager missed opportunities to reduce or avoid the use of restraint, and to hold staff accountable where required. People continued to receive restrictive practice.

There were not always enough staff deployed for people to receive their commissioned support. Staff did not have the right skills and knowledge to support people effectively and ensure good outcomes.

Governance processes were not always effective in providing good quality care and support.

Right Care:

Care was not person-centred and did not promote people’s dignity, privacy and human rights.

Staff and management did not always understand how to protect people from poor care and the risk of abuse.

Although there were good care plans in place, we were not assured these care plans were followed by staff and that people lived a meaningful and fulfilling life. People’s interests, hobbies and daily living was not prioritised by management or staff. We found the service was staff and task-led, rather than person-centred and this impacted on people’s dignity and human rights.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives.

Poor management and lack of governance systems meant there were closed culture concerns at the service. People were not supported to live safely and free from unwarranted restrictions and people's rights were not always respected. The provider did not have oversight to ensure that management were assessing, monitoring and managing people’s safety well. There was a lack of visible leadership and management, which meant people did not receive a service that was well-led. There were a lack of systems and processes to share relevant and honest information with relatives. Quality assurance systems were not in place to monitor and improve the quality and safety of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, caring and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for 41 West Hill on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, person-centred care and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm and they lived in a clean, hygienic service. People were supported by staff who sought to understand, prevent and manage behaviour that the service found challenging.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions to ensure their rights were respected.

People lived in a service which met their needs in relation to the premises and adaptions were made where needed. People had access to information in a format which met their needs.

People were supported to maintain their nutrition and staff monitored and responded to people’s health conditions.

People lived in a service where staff listened to them and got to know them. People’s support needs were recognised and responded to by a staff team who cared about the individual they were supporting. Information about people’s needs was shared between services to ensure people would be supported in other settings when needed. People were supported to enjoy a social life.

There was an open and transparent culture in the service where people were listened to and staff were valued. Systems were being developed to monitor and improve the quality of the service provided.