Archived: Walnut Villa

People’s experience of using this service:

People were not protected from abuse because staff did not have the skills to recognise abuse or know how to safeguard them. Risks to people were not assessed or action taken to mitigate them. The lack of emphasis focused on protecting people from abuse compromised the care they received. There were insufficient staffing levels to ensure people received a safe and effective service. Medicine management was unsafe, and people did not always receive their medicines as prescribed.

Decisions made on people’s behalf were not always in their best interests. People were cared for by staff who did not have the necessary skills and were not supported in their role by the registered manager. People were not supported by staff to prepare and cook their own meals.

The lack of emphasis focused on protecting people from abuse compromised the care they received. People could not be assured they would receive care and support specific to their needs because they were not involved in planning their care. Staff demonstrated a good understanding about promoting people’s right to privacy and dignity, but this was not always put into practice.

People’s lack of involvement in their care assessment did not ensure they received a service that reflected their preferences. People could not be confident their concerns would be listened to or acted on. People were supported by staff to pursue social activities although, some activities were not of people’s choice.

There was no clear management structure, and no one knew who was running the home. There were no effective systems in place to monitor the quality of service provided to people. The provider did not work closely with other agencies to ensure people receive person-centred care.

Hygiene within the home was maintained to a good standard. Where an accident had occurred, action had been taken to avoid it happening again.

Staff assisted people to attend their medical appointments.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support. This should ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. However, people living at Walnut Villa were not supported to achieve the best possible outcomes.

Rating at last inspection: The service was rated Good at the last inspection in April 2016.

Why we inspected: This was a scheduled inspection based on the previous rating.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.'

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Follow up: ongoing monitoring; possibly more about how we will follow up

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

Walnut Villa provides accommodation and personal care for up to 6 adults with a learning disability. At the time of our inspection 6 people were living there.

There was a registered manager in post at the time of our inspection, who was also the provider for Walnut House. 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.

There were sufficient staff to respond to people’s needs and support people safely. People were supported by staff who had been recruited safely. People were supported by staff who had the skills and knowledge to meet their needs and knew how to recognise and report potential abuse. Risks to the health, safety and well-being of people were identified and managed. Staff had a good understanding of how care and support should be provided in order to keep people safe. People’s medicines were stored and managed safely and people received their medicines as prescribed by their GP.

People had enough to eat and drink and were involved in the planning of meals. People were given choices of food and drink and were encouraged and supported to prepare meals for themselves. People had good access to a range of healthcare professionals when required. People were involved in their own care planning. Where necessary, the provider involved families and other professionals.

Principles of the Mental Capacity Act 2005 were understood and followed.

People and their relatives felt they were supported by staff who were friendly and caring. People’s individual needs were understood and met by staff. Staff supported people in a way that maintained their privacy and dignity and were aware of, and responded to, people’s anxieties. People’s independence was promoted.

Staff had a good understanding of people’s life histories and personal needs and preferences. People and their relatives felt involved in making decisions and choices about how their care was delivered and planned. People and their relatives knew how to complain and expressed confidence that any concern would be dealt with quickly and efficiently by the registered manager.

People and their relatives were involved in the development of the service and the registered manager used the information gathered from surveys to help to improve the quality of the service. There was good communication within the service and staff were well supported and had access to resources in order to help them to carry out their role. The registered manager was supported by an operations manager. The operations manager had effective systems in place to monitor the quality of service being provided and to drive improvements.

We spoke with three residents and one family member of a resident. People told us that they were very happy at Walnut Villa. One person told us that this was "the best care home I have ever been in" a family member told us that the care was "superb" and that they would give it "twenty out of ten". People told us they felt safe and confident that they could tell staff anything and that they would respond appropriately.

People were involved in the running of the home including cooking and cleaning as much as they wished and were involved in a wide range of social and community activities. People were supported to undertake the activities they wished as appropriate. People valued their independence and the staff supported their right to independence and making informed choices for themselves.

Care records were well organised and comprehensive and provided information to ensure people received safe effective care. Risk assessments were carried out ensuring risks were identified and action taken to minimise risk. The balance between risk and personal choice was appropriate.

The accommodation was very well maintained, clean and tidy whilst remaining 'homely'. People told us and others had written in the comments book about how well the accommodation was kept.

People told us that they took responsibility for making their own decisions and they gave us examples of when they had consented, or not, to care and treatment. Everyone felt in control of their lives.

We saw that people were supported to meet their individual assessed needs in ways that they preferred. People lived active lives with varying levels of support.

People told us that they enjoyed a varied and nutritious diet and records supported this.

People received medication when required and in ways that they preferred. People were involved in the process and effective administration records were kept.

Staff told us that they felt well trained and well supported. People told us that staff provided them with help and assistance when they needed it.

The home had an effective complaints procedure and people felt confident to share their worries and concerns with members of the staff team