41 West Hill

Updated 11 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of 1 inspector and 1 Expert by Experience.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

41 West Hill is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. 41 West Hill is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

The inspection was announced on 25 and 26 October 2023. We gave the service 20 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. We returned unannounced on the 6 November 2023 due to receiving concerns from the public.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed people and their interactions with staff and each other throughout the inspection visits. We spoke with 1 person, 3 relatives/representatives and 4 health and social care professionals to gain their views. We also spoke with 7 members of staff including the registered manager, deputy manager, 4 care staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records, this included 2 care plans, 5 medicine records, incident records, daily records and 3 staff files in relation to recruitment. We reviewed a range of records relating to the management and oversight of the service, staffing, risk assessments, health and safety records. After the inspection we continued to receive and review health and safety records, information relating to training, and a range of policies and procedures.

Updated 11 January 2024

About the service

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.