Curtis Weston House

Curtis Weston House is a residential care home providing personal care to 26 younger and older adults. People using the service had a physical disability, sensory impairment, dementia, mental health needs and a learning disability or autistic spectrum disorder.

The care home accommodates up to 44 people across two floors, each of which has separate adapted facilities.

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

Quality assurance systems were not always effective in identifying gaps in information. Care plans required more detail so that staff were fully aware of people’s preferences as to how they wished to be cared for and supported.

People did not always have the stimulation and access to meaningful activities they needed to live as full a fulfilled life they may wish.

People could be assured they were cared for safely as staff knew how to keep people safe and protected people from harm. Staff were recruited safely and there were enough staff to support people. Medicines were managed safely, and people could be assured they received their medicines at the correct time.

People were supported to maintain a healthy diet and had a choice as to where, when and what they ate. They had access to other health professionals when needed. They had their own personal space and access to a garden.

We have made a recommendation about the environment for people living with dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were caring and compassionate and knew people well. People spoke positively about the care and support they received, and they were treated with respect.

People were listened to and knew how to raise a complaint if they needed to. People and staff were confident the manager and provider would act upon any concerns they raised.

Staff felt supported and spoke positively about the new manager and the improvements being made in 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 and update

The last rating for this service was requires improvement (published 8 June 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about care not being person- centred, identifying and responding to risk and staffing. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Curtis Weston House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Curtis Weston House is a residential care home registered to provide personal care and accommodation for up to 44 younger and older adults. People using the service had a physical disability, sensory impairment, dementia, mental health needs and a learning disability or autistic spectrum disorder. At the time of our inspection there were 23 people using the service. Accommodation is split across two floors accessed by a lift. Communal areas include lounges, bathrooms and toilets.

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

Risks associated with people’s care were not consistently managed. The service was not consistently well led. The manager and provider acknowledged there were still improvements to make and had an action plan in place to support them to manage this.

Risks associated with the service environment were assessed and mitigated. The service was clean, and we were assured people were protected from risks associated with infections. People received their prescribed medicines safely. Staff told us, and evidence showed that overall, medicines were documented, administered and disposed of in accordance with current guidance and legislation.

People and their relatives felt the service was safe. Staff understood how to recognise and report concerns or abuse. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences. There were enough staff to keep people safe.

The provider and manager understood their roles and had taken steps to put a wide range of improvements in place. People felt able to participate in planning and reviewing their care. People and relatives felt able to contact staff or the management team with and questions or concerns about the quality of care.

Staff spoke positively about the new manager and management team. Staff felt supported to work together to improve the quality of people’s lives.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 25 January 2021) and there were three breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 25 July 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 11, 17 and 23 November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Curtis Weston House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Curtis Weston House is a residential care home registered to provide personal care and accommodation for

up to 44 younger and older adults. People using the service had a physical disability, sensory impairment,

dementia, mental health needs and a learning disability or autistic spectrum disorder. At the time of our

inspection there were 27 people using the service.

Accommodation is split across two floors accessed by a lift. Communal areas include lounges, bathrooms

and toilets.

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

At the time of our inspection there was an outbreak of COVID-19 at the service. We found multiple failings in the service’s infection prevention systems and processes which increased the risk of the transmission of COVID-19, and placed people at increased risk of harm.

Concerns relating to safe care and treatment and protecting people from harm and abuse had not been resolved since the last two inspections. Whilst care plans were more person centred, they were not always reflective of people’s needs, and staff did not always follow them. Only senior staff had access to the most up to date electronic care records for people.

People were at risk of not receiving medicines as prescribed and at the time they needed them during the night as there were not always staff working at night that could give medicines.

There was no registered manager at the service, a new management team had been recruited and had recently commenced their roles. Initial feedback from staff about the new management team was positive.

Quality assurance systems and processes had not identified the concerns we found during this inspection. Care records were often undated or not timed. Information relating to the care that people received was stored in multiple locations and at time misfiled. This impacted on the management teams’ ability to maintain oversight of the service. Opportunities to improve care had been missed as audits of care records had not always been undertaken.

Staff were committed to their role. We observed kind and caring interactions throughout our inspection.

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 inadequate (published 11 August 2020) and there were multiple breaches of regulation.

Following our inspection (supplementary report published 16 April 2020) the service was placed in special measures. We imposed conditions on the provider's registration in March 2020 as they were in breach of the regulations. The provider completed an action plan after this last inspection to show us how they would meet these conditions. A monthly report was sent to CQC detailing progress. At this inspection and the inspection in (published 11 August 2020) not enough improvement had been made or sustained by the provider, therefore the service was still in breach of regulations. The service retains an Inadequate rating.

Why we inspected

We received concerns in relation to infection prevention, accidents and incidents, staffing, documentation, moving and handling and the leadership at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service remains Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Curtis Weston House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Curtis Weston House is a residential care home registered to provide personal care and accommodation for up to 44 younger and older adults. People using the service had a physical disability, sensory impairment, dementia, mental health needs and a learning disability or autistic spectrum disorder. At the time of our inspection there were 34 people using the service.

Accommodation is split across two floors accessed by a lift. Communal areas include lounges, bathrooms and toilets.

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

Concerns related to protecting people from abuse had not been resolved since the last inspection. There was ineffective management and intervention. Risk assessments did not provide sufficient information and guidance to enable staff to respond consistently when supporting people with distressed behaviours.

Care plans had been rewritten and reviewed since the last inspection but were not person centred. Conflicting information was reported in some records which meant people may not be supported in the most appropriate way. Staff recording was, at times, inaccurate and therefore an accurate picture of support could not always be determined.

Analysis of incidents and accidents were not always effective. Timely action was not consistently taken to identify root cause and measures that could reduce the risk of further incidents of harm for people. People were not always supported to achieve positive outcomes from their care.

Governance remained an on-going concern following on from the last inspection. Audits, although completed, were not always effective in accurately capturing information or driving improvements. Although we found some improvements since our last inspection, these were not yet embedded into working practices to demonstrate they could be sustained.

The provider had appointed a new care manager who intended to apply for registration with the Commission. They had begun to make improvements within the service and staff and people spoke about the positive impact they had made in a short space of time.

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 Inadequate (supplementary report published 16 April 2020) with a number of breaches of the regulations identified. As a result the service was placed in special measures. We imposed conditions on the provider's registration in March 2020 that they must ensure a) must not admit any new service user without the prior written agreement of the Commission, b) must ensure all care plans and risk assessments for service users are updated and disseminated to staff, c) must ensure all staff who support service users with nursing or personal care have received training in safe breakaway, sexuality and relationships, positive behaviour support and safeguarding adults and d) must ensure if children from a nursery visit that all care staff involved have received safeguarding children training and appropriate risk assessments are in place. The provider completed an action plan after the last inspection to show us how they would meet these conditions. A monthly report was sent to the Commission detailing progress. At this inspection not enough improvement had been made or sustained by the provider, therefore the service was still in breach of regulations. The service retains an Inadequate rating.

Special Measures

The overall rating for this service is 'Inadequate' and the service remains 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.

Why we inspected

This was a responsive inspection based on the previous rating and concerns we had received about the service. We received concerns in relation to people's care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Curtis Weston House on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to Regulation 12 (safe care and treatment). Regulation 13 (safeguarding service users from abuse and improper treatment) and Regulation 17 (good governance). Existing enforcement measures will remain in place to support the provider to make the required improvements and demonstrate these can be sustained.

We are mindful of the impact of Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating. In addition, 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 with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Curtis Weston House is a residential care home providing personal care to 40 younger and older adults. People using the service had a physical disability, sensory impairment, dementia, mental health needs and a learning disability or autistic spectrum disorder.

The care home accommodates up to 44 people across two floors, each of which has separate adapted facilities.

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

People and visiting children were not protected from the risk of harm of abuse as the systems and processes in place to safeguard people were not effective. Incidents of abuse were not always identified, reported to safeguarding, the police or notified to the Care Quality Commission. Opportunities to learn from accidents and incidents were missed as not all incidents were reported.

The registered manager was not always present in the service. There were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care. Quality assurance systems and processes failed to identify concerns relating to safe care. Where issues had been identified the service did not act in a timely manner to address these.

Care plans did not always reflect people’s dietary requirements and people’s risk of malnutrition had not been properly assessed. Not all staff working with people had the necessary training to support them safely. Staff had not had training to safely manage challenging situations.

Care plans and risk assessments did not contain adequate information for staff to know how to support people. Staff did not have time to read people’s care plans, or time to spend with people which meant care was task focussed. People told us there was not enough to do. People’s privacy and dignity was not always protected. People’s preferences and wishes for the support they wished to receive at the end of their lives was not always detailed in their care records.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Policies and systems in the service did not always support this practice. People’s mental capacity assessments and best interest decisions had not always been undertaken and DoLS conditions were not always met.

We received positive feedback about the meals available and found health advice had been sought when concerns arose about people’s health deteriorating. Staff were kind and caring in their approach and knew people well. They enjoyed spending time with people but had limited opportunities outside of meeting people’s basic care needs.

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 16 October 2018). The rating for the service has

changed from Good to Inadequate. This is based on the findings at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding service users from abuse and improper treatment. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, need for consent, person-centred care, good governance and a failure to send legally required notifications to the CQC.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 of 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.

Curtis Weston House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Curtis Weston House is registered to accommodate 44 people in one adapted building. On the day of our inspection 34 people were using the service.

We previously inspected the service on 7 December 2015. We rated the service as `Good’ overall, but rated the key question ‘Safe’ as requiring improvement because risk assessments were not always reviewed and updated and aspects of medicines management were not consistently good. We found at this inspection that improvements to ‘Safe’ had been made and that all other key questions remained Good.

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

The service had safe procedures to respond to outbreaks of infection which protected people, staff and visitors.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People lived in a service which met their needs in relation to the premises and adaptions were made where needed. The provider had implemented a refurbishment plan for the premises at the time of our inspection.

People had access to information in a format which met their needs.

People were supported to maintain their nutrition and staff were monitoring and responding 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. People were supported to enjoy a social life.

There was an open and transparent culture. People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided. People had access to a complaints procedure.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:

Is the service safe?

All eight people spoken with told us that they felt safe living at Curtis Weston and that they were treated well. One person explained: 'I feel very safe here, there is always someone available day or night, you ring your bell and they are there.' Another person told us: 'It is a marvellous place; the staff are wonderful they can't do enough for you.'

Care workers spoken with knew what to do if they suspected that someone was being abused. One care worker explained: 'I would report anything to the manager straight the way.'

We talked to care workers to determine whether there were enough staff on duty to meet the needs of those in their care. We were told that at times care workers felt rushed, and this wasn't helped by the amount of paperwork they were required to complete. One care worker told us: 'I feel frustrated because I feel that I'm not giving care to the residents because of all the paperwork we have to fill out.'

People who used the service told us that there were enough staff on duty to meet their needs. One person told us: 'The staff always come when you ring your bell, they treat me very well.'

We noted during our visit that the people who used the service were left for large periods of time, particularly in the lounges, without seeing a member of the care team.

The manager completed a pre-assessment of people's needs before people moved in to the service. This ensured that they were aware of each person's care and support needs and they were confident that those needs could be met by the staff working at the service.

On checking the medication records we found that on a number of occasions, the senior in charge had failed to sign to say that they had dispensed people's medicine. There were also occasions where the senior in charge had signed to say that they had given someone their medication, when it was in fact still in the blister pack. This meant that the people who used the service were not always getting their medication as prescribed by their doctor.

Personal protective equipment was available for care workers to use including disposable aprons and gloves. This ensured that care and support was provided safely and in line with the services infection control policy.

Is the service effective?

We spoke with eight people who used the service to find out if they were satisfied with the care and support they received. They told us they were, though one person told us that just sometimes the care staff could be a little sharp. One person explained: 'I don't know what I would do without them; I have no worries what so ever, all of us have an immediate carer, who makes sure we have a shower.' Another person told us: 'The staff look after me very well.'

Relatives told us that they were happy with the care and support their relative received. One relative explained: 'My wife came here in January and I couldn't have asked for better.' Another relative told us: 'Sometimes I have to mention about a shower, but she always looks cared for and the staff are all very nice.'

Care plans provided care workers with information about people's care and support needs though these had not always been followed. This meant that people had not received the care and support they needed.

The provider had systems in place that demonstrated they co-operated with other health and social care professionals. This meant people received a person centred and coordinated approach to their health, safety and welfare needs.

Is the service caring?

We observed care workers going about their work. They treated the people they were supporting in a kind and gentle way and people looked relaxed and comfortable in the presence of staff.

The people who used the service told us that, on the whole they were treated with respect and we observed staff knocking on doors and calling people by their preferred name. One person told us: The staff mostly treat me with respect, but the odd one can sometimes be a little sharp.' Another person explained: 'The staff have a real way with us and they've always got a smile on their face.'

Is the service responsive?

The needs of the people who used the service had been assessed before they moved into the service. They and their relatives/advocates, had been involved in this process.

Relevant professionals had been involved in people's care. Records showed that visits had been arranged when necessary. These included visits from their doctor, the district nurse and the local speech and language team. This ensured that people who used the service received the care and treatment they required.

A complaints procedure was in place and a copy of this was displayed. This provided people with the information needed, should they wish to make a complaint about the service they received. One relative explained: 'We were made aware of the complaints procedure and they were always available to talk to if you needed to.'

Is the service well-led?

Staff meetings had been held. This provided the staff team with the opportunity to have a say on how the service was run. A meeting for the relatives and advocates of those who used the service had also been held. This gave relatives and advocates an opportunity to have a say about the service that was provided. The people who used the service were also given the opportunity to discuss any concerns on a day to day basis. One relative explained: 'I was allowed to attend meetings and comment, and any issues raised were always followed up.'

Staff felt supported by the manager and told us that they felt able to talk to someone should they have a concern of any kind. One care worker explained: 'I do feel supported by the manager, I love my job and I love being in care.' Another care worker told us: 'If there are enough staff on, it is a lovely place to work.' Another care worker explained: 'I feel supported, there is always someone to talk to should you need to.'

We also looked at four care plans. All had a care and support plan in place and contained risk assessments related to people's individual needs and information about how people wished to be cared for and supported.

We spoke with five staff and looked at three staff files. All the staff we spoke with had received training. They demonstrated a good understanding of the different types of abuse and were able to explain what they would do if they suspected someone was being abused and who they would report this to.

We saw evidence of appropriate checks being made on staff prior to employment and that staff received training and regular supervision.

We saw evidence of a range of measures designed to ensure the service maintained quality. People were regularly asked for their opinions and ideas for improvement through weekly 'listening forms'. People and their representatives were also invited to attend regular residents' meetings.