Archived: Westway Respite Ltd

The last inspection was on 27 July 2018 when we rated the service good.

We carried out the inspection of 20 and 23 November 2018 because we were alerted to concerns by one of the commissioning authorities.

Westway Respite Ltd is registered to provide two different services to adults who had a learning disability. There was a three-bedroom respite service, which offered short stay accommodation to adults with a learning disability. Up to three people were able to stay at the service at any one time. The provider is also registered to provide personal care to people living in their own homes. They were providing care to five people living in two supported living services and one person living in their own flat. However, as part of the concerns identified by the commissioning authority, the commissioners had suspended the service whilst they carried out investigations into the concerns. At the time of the inspection, two people were regularly using the respite service and a third person started using the service during the evening of the second day of our inspection.

There was a registered manager in post. 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 and associated Regulations about how the service is run .

People using the service were at risk of harm and abuse. The staff supporting them had not had the training or support to understand their needs and responded inappropriately to incidents where people were anxious or agitated. Records of incidents showed that the staff had used inappropriate restraint and restrictions. The provider had not investigated these incidents or taken any action in response to ensure people were safe and that staff learnt from these.

The provider did not ensure sufficient recruitment checks were made on staff to make sure they were suitable to care for people. They allowed staff who had not been checked, trained or had an induction to the service to support people with complex needs. This meant that people were not always getting the right support, were placed at risk of inappropriate care and treatment and their needs not being met.

The way in which staff recorded how they had cared for people indicated a lack of respect and understanding about their individual needs. There was a culture of blame where some people who used the service were seen as causing problems for the staff and were not cared for in a compassionate way.

The staff did not receive adequate training, support or supervision and the provider did not assess their competency or abilities to care for people. There was no evidence of reflective practice or support for staff to develop new skills. Whilst care plans, guidelines and risk assessments had been developed and incorporated information about people's needs, the staff did not always follow these.

Whilst some of people's needs had been met, they did not always have opportunities to live varied lives. There was limited evidence that people's sensory needs were being met, or that staff understood these. People were not supported to make use of the community and develop social interaction skills.

The relatives of people who were using the service told us they were happy with the care and support people received. They said that their relatives felt well cared for and liked the staff.

We identified breaches of seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, dignity and respect, safe care and treatment, safeguarding adults from abuse and improper treatment, good governance, staffing and fit and proper persons employed.

We are taking action against the provider for failing to meet Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Westway Respite Limited provides two types of services at the same registered location. This inspection covers both types of services. One of the services is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home has three bedrooms and shared dining, sitting, bathing and toilet facilities. Outside there is a well-maintained garden and an annexe building that is used for therapies and as a relaxation area.

Westway Respite Limited is also registered to provide care and support to people living in two ‘supported living’ settings, so that they can live in their own home as independently as possible. In that type of settings people’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; we only looked at people’s personal care and support. People living at the supported living settings had originally transitioned from the respite location and staff work between the respite location and the two supported living settings to provide continuity of care.

The service provides care and support to people with learning disabilities and autism. At the time of inspection there was one person living at the respite location, two people who had short term respite two people in one of the supported living settings and three people in the second setting. The service also provided some daytime outreach hours for two people who do not require personal care.

The service is required to have a registered manager. 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. The registered manager is also the registered person for the service and has been in post since the service first registered in January 2013.

Procedures were in place to help safeguard people against the risk of abuse. Staff understood the importance of keeping people safe and of reporting any concerns.

Risks had been assessed and clear action plans were in place to ensure staff understood the care and support to provide to each individual to minimise risks and keep them safe.

Staff recruitment procedures were in place and being followed. There were appropriate numbers of staff available to meet the needs of the people using the service. Recruitment was ongoing to ensure there was a pool of staff to draw from.

Medicines were safely managed for all those who required support with taking their medicines. Infection control procedures were in place and being followed.

The provider learned from events and took action to minimise the risk of recurrence.

People were assessed so their individual needs were known and comprehensive person-centred support plans put in place to meet their needs.

Staff received the training and supervision they needed to provide them with the knowledge, skills and support they required to care for people effectively.

Staff encouraged people to eat healthily and supported them with meal preparation. People’s healthcare needs were identified and they received input from healthcare professionals so these could be met.

The premises were appropriate to meet people’s needs and were being maintained.

Staff respected people’s right to make choices about their care and support and knew to act in their best interests. Where people’s liberty was restricted, the correct legal permissions had been applied for and granted, whether for people living in the care home or in the supported living settings.

People were happy with the care and support they received and staff treated people in a caring way, understanding their individual needs and how to meet these and promote their independence.

Staff understood the importance of respecting people’s privacy and dignity and of communicating well with each person.

Care records reflected the care and support people needed and were comprehensive and person-centred, to provide staff with a clear picture of each person and how to provide their care.

Activities were encouraged and provided in-house and people enjoyed going out into the community to take part in activities.

Procedures for raising complaints were in place and people and relatives were confident about how to raise a concern if necessary so it could be addressed.

The service was in the main for younger adults and was not providing any end of life care at the time of our inspection.

Feedback from relatives indicated they were happy with the service and could contact the managers easily if necessary. Staff said the registered manager and deputy manager were approachable and supportive.

Systems were in place for monitoring the service and to identify areas for improvement so this could be achieved.

Westway Respite Limited provides respite (short stay) accommodation and personal care to a maximum of three people living with autism. The provider had recently registered to provide the regulated activity personal care. They were working with people transitioning from the location to supported living accommodation and staff from the location provided continuity of care. At the time of inspection there were three people living at the service and they were being accommodated for a longer period of time to allow an appropriate transition period to meet the people’s needs. The service also provided some daytime respite hours for one person.

The service is required to have a registered manager. 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. The registered manager is also the provider for the service and has been in post since the service first registered in January 2013.

Relatives, healthcare professionals and where they were able, people using the service, expressed their satisfaction with the service and the way people’s needs were being met.

Systems were in place to safeguard people against the risk of abuse and staff understood these.

Staff recruitment procedures were in place and being followed. There were enough staff deployed and staffing levels reflected the needs of the people using the service at any one time.

Risk assessments were in place for maintaining people’s safety and were followed. Servicing and repairs were carried out to maintain a safe place for people to live.

People were given the support they needed to take their medicines safely.

People were comfortable with the staff and we saw staff supported them in a gentle and friendly manner. People’s religious and cultural needs were identified and staff understood these and provided the support people needed to meet them.

Care records reflected people’s individual choices and wishes. Staff demonstrated a good understanding of the care and support each person required, communicated with them clearly and treated them with dignity and respect.

Care plans were in place for people’s identified needs and interests so staff had the information they needed to meet these. People’s care needs were reviewed to ensure changes were identified and could be met.

There was a complaints procedure in place and relatives said they would feel confident to raise any concerns and that they would be addressed.

The registered manager was experienced in the care of people with learning difficulties including those with autism. He identified and implemented effective ways to provide positive outcomes for people using the service.

There were systems to assess and monitor the quality of the service. The registered manager used his knowledge and followed good practice guidance to make improvements to the service they offered to people.

At this inspection due to people's individual needs we were unable to ask them about the checks carried out on the service. However, we saw that the registered manager, who was the provider, had made improvements to the checks and audits carried out in the service so that people and their representatives could be confident that the service was safe and provided quality care.

Satisfaction questionnaires had been sent to relatives in November 2014 and five had been returned. The registered manager had checked the comments to make sure if improvements needed to be made and the results had been positive. One person who had been using the service for a year had an annual review meeting to assess how their respite stays at the service had been and to make sure the service continued to meet their needs.

The questionnaire also asked if the person completing the form knew how to make a complaint and all five respondents said they knew about the complaints policy and how to raise a concern. The registered manager confirmed the service had not received any complaints since they registered in 2013.

Other health and safety checks were in place, for example there were checks on the medicines, legionella testing and people's care records. There was a fire risk assessment from November 2013 with confirmation of a review of this to take place on 4 February 2015. The audit plan dated July 2014 confirmed what checks were in place so that staff knew what areas needed to be looked at and how often. Monthly checks were carried out on different aspects of the service, for example, the environment was looked at to make sure it was safe, fire doors were checked to makes sure they closed properly. Bedrooms were assessed to see that they were safe and homely for people to stay in. The last check had taken place on 20 January 2015.

Below is a summary of what we found. The summary describes what relatives of people who used the service and the agency staff told us and the records we looked at.

Is the service safe?

There were up to date care and support plans in place for each person, which enables staff to provide safe and effective care.

The provider did not have permanent staff and relied on long-term locum staff. Locum staff had undergone criminal record checks. There was no evidence that locum staff had received an induction. Locum staff were trained in emergency first aid. Fire fighting equipment was available and regularly serviced. There was an evacuation procedure in place in case of an emergency.

Is the service effective?

Locum staff had the skills required to meet the needs of people who used the service. Locum staff had access to training courses to update their knowledge and become familiar with any changes in policies or procedures. A locum worker told us that they had access to training and had attended training in the past year.

Is the service caring?

People who used the service were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A Locum worker told us, "We always ask [people who used the service] what they want and give them choice."

Is the service responsive?

The service liaised with other health professionals to meet the needs of people who used the service. People’s individual needs were assessed. The locum staff we spoke with were aware of the needs of people who used the service. However, relatives were not aware of how to make a complaint and there were no quality audits.

Is the service well-led?

We saw evidence of handovers between staff at the end of each shift and there was good information sharing. Daily care records were also being completed.

We did not see evidence that there were processes in place to monitor and improve the quality of service delivery.

We found that the care needs of people using the service had been identified and care was delivered to meet their needs. People's preferences had been taken into account when delivering their care.

People were protected from abuse and staff were able to demonstrate how they would recognise abuse and the steps to take if they had any suspicions of abuse.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained.

Staff received appropriate professional development.