Walberton (South Coast)

Walberton (South Coast) is a residential care home. The service consisted of four houses. Russett, Melrose, Pippin and Fortune. Russet and Melrose were bigger than most domestic style properties. It is registered to provide support for up to 33 people living with complex needs, learning disabilities and autistic people. Some people had additional health conditions including dementia, diabetes and epilepsy. There were 23 people, living at the service, at the time of the inspection.

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

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.

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

Some people had limited opportunities to build skills and participate in individual activities. Staff tried to focus on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Work had begun with some people but we were told there were not enough staff to provide this support consistently for everyone. Each person had their own room, which were generally personalised to meet their needs and preferences. Some people had access to an on-site day service and others had employment in the apple enterprise owned by the provider. People valued these opportunities and they did go some way to mitigate people living in large groups in houses that were not domestic in scale or staffed to maximise people’s independence.

The service worked with people to plan for when they experienced periods of distress so their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. Staff learned from those incidents and how they might be avoided or reduced.

Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making.

Right care

People experienced mixed quality of care. People and their families told us staff were kind and supportive but there were not always enough of them. We observed staff respecting people’s dignity and ensured people had the right to have their say on their care and support. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing. Staff and people worked together to assess risks people might face. Staff encouraged people to take positive risks.

Right culture

People did not always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the provider, management and staff. There was mixed understanding or opportunities to apply active support approaches. The provider had not fully considered people’s needs and wishes in the planning and deployment of staff, for example some people told us they wanted to cook their own evening meals, but this happened infrequently so others could have a turn. Managers and staff clearly tried to deliver person centred support but told us this was difficult when so many people lived together with differing needs and wishes. People had communication passports and staff knew people well. However, improvement could be made by providing staff with further training regarding autism and sensory needs of people. Managers and staff were trying to further develop these areas locally within the limitations of the layout and staffing structure of the service.

People received good quality health care, support and treatment because trained staff and specialists could meet their needs. Most staff knew and understood people well but there was a reliance on agency staff who did not always know people well.

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 02 May 2019) and there were breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found enough improvements had been made and the provider was no longer in breach of regulation 17, good governance. Systems are not all fully embedded so this does remain an area that requires improvement.

At this inspection we found a breach of regulation 18 staffing.

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.

We carried out an unannounced comprehensive inspection of this service on 19 February 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve 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, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained 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 Walberton (south coast) on our website at www.cqc.org.uk.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The home was clean and hygienic and there were cleaning schedules in place for people's rooms and shared spaces. We observed cleaning taking place during the inspection in line with best practice guidance. 'High touch' areas were regularly cleaned, and cleaning records reviewed daily to ensure schedules had been met and any concerns could be addressed. The buildings were generally well maintained and easy to keep clean, there were areas where paint had come away on door frames and the registered manager explained this had been reported to be scheduled for maintenance.

There were robust laundry systems in place to ensure contaminated laundry was kept separate from other laundry and was washed at a suitable temperature to reduce the risk of the spread of infection. Each house had personal protective equipment (PPE) by the entrance and at intervals in the corridors. We observed staff using PPE appropriately. Staff had received training and kept up to date with changes in guidance.

The home was following current visiting guidance. During the recent outbreak of COVID-19 relatives were kept informed and staff supported people to use video and audio call to keep in touch. Visiting had been resumed at the time of the inspection.

Staff supported people to be vaccinated using a range of communication methods to help people understand. Everyone had had both vaccinations and the vaccine booster. All staff had been vaccinated. We observed people confidant to be supported by staff wearing PPE.

During the outbreak the registered manager had adjusted the rota to ensure staffing was cohorted to each house separately. People with a learning disability and autistic people can find social distancing difficult so staff had arranged furniture to help people, for example replacing a sofa with armchairs set at a distance. People were supported to maintain good hand and personal hygiene. Staff increased observation of people to ensure shared spaces they had visited could be frequently cleaned to reduce the risk of cross contamination.

Walberton (South Coast) is a residential care service. The service consisted of four houses Russett, Melrose, Pippin and Fortune. Russet and Melrose were bigger than most domestic style properties. It is registered to provide support for up to 33 people living with complex needs, a learning disability or autism. 31 people, both young and older adults, were living at the service, at the time of the inspection. This is larger than current best practice. However, the size of the service having a negative impact on people was lessened by people living across four houses and the building design fitting into the residential area. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People's support focussed on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service:

¿Quality assurance processes had improved since the last inspection. However, they failed to identify issues in relation to MCA and DoLS.

¿The registered managers and staff did not always have a good understanding of the Mental Capacity Act (2005) (MCA) or Deprivation of Liberty Safeguards (DoLS). Conditions on two people’s DoLS were not known or understood by the registered managers or staff. The registered managers had not fully implemented the providers policies and systems to effectively support this practice. ¿ ¿Capacity assessments and best interest decisions did not consistently take place and outcomes were not always documented.

¿People were supported to have maximum choice and control of their lives however it was unclear if staff supported them in the least restrictive way possible, as best interest decision meetings did not always occur. The policies and systems in the service did not always support this practice.

¿The registered managers were not fully aware of their regulatory responsibilities in relation to their registration with the Care Quality Commission (CQC).

¿People were safe from the risk of abuse. ¿There were sufficient numbers of staff to meet people's need. A relative told us, “He is safe at Walberton, the staff are there for him. I know he feels safe as he is happy living there.”

¿Staff had the skills and knowledge to deliver effective care and support. ¿People were supported to maintain a balanced diet and had access to healthcare services as and when needed.

¿People were treated with kindness and respect. ¿People's independence was promoted and their differences respected. People were supported to develop and maintain friendships.

¿Care was personalised to meet people's care, social and wellbeing needs. ¿People had access to a range of activities that met their interests.

¿People, their relatives and staff were complimentary of the management of the service and staff felt well supported. A member of staff told us, "The manager is always around and very approachable."

Rating at the last inspection:

Requires Improvement (The last report was published on 28 February 2018.) This is the second consecutive time the service has been rated as Requires Improvement.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

You can find the action we told provider to take at the end of this report.

Follow up:

We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

We carried out a comprehensive inspection of Walberton on 27 and 30 November 2017. The inspection was unannounced.

Walberton is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Walberton is registered to provide accommodation and personal care for up to 33 people with a learning disability across four properties. All of the properties were situated on the same site. The properties names were Melrose, Russett, Pippin and Fortune. At the time of the inspection there were 13 people living at Melrose, two in Fortune, 1 in Pippin and 10 in Russett. People living at the properties were all adults and there was a mix of younger and older adults across the service.

The provider ran a wood workshop and small apple juice production facility on the same site as the residential properties, along with a designated centre providing support with activities, which people could attend if they wished; these are not registered with the CQC as they do not provide any regulated activities under the Health and Social Care Act 2008 (regulated Activities) Regulations 2014 and were not inspected.

Walberton 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. We found Walberton conformed to this guidance and values in their approach to supporting people using their service.

There were two managers in post who were both currently in the process of applying to be registered managers for the service. An operations manager was supporting the service and undertaking some registered manager responsibilities until the managers had been registered. A registered manager is a person who has registered with the CQC 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.

We last inspected the service on 19 May 2015. At the previous inspection, we asked the provider to take action to make improvements as we found areas of the environment in all three properties were poorly maintained and not always clean which was compromising people’s dignity and quality and life. At this inspection we checked to see if the provider had taken actions to address these issues and found this still required improvement.

Two of the three properties were not clean on the first day of our inspection. All three properties were in need of maintenance works. The provider was aware of the outstanding maintenance work and a schedule of necessary repairs and improvements had been approved prior to our inspection and scheduled to take place.

The provider was not adequately assessing, detecting or controlling risks to people from infection and cross infection. Correct procedures for preparation and storage of food was were not being followed in two of the properties. Kitchens and the equipment in them was unclean. Hazardous waste was not always being disposed of correctly. Bathrooms and the equipment in them were not always clean.

Management of risks to the safety of communal and personal spaces and the living environment required improvement. Restricted cleaning chemicals were not stored securely. Health and Safety and fire checks and audits for communal and personal spaces at the service were in place, but were not being consistently completed at all three properties. Where checks and audits had been completed and issues had been identified as possible risks to people, no action had been taken to rectify problems.

There were assurance and information governance systems in place to monitor the quality and safety of the service. However, we found there was not always effective action taken in response to areas identified as needing improvement.

The service had experienced some historical under-recruitment since the last inspection. At this inspection we found that the service had enough staff to support people to stay safe and meet their needs. The service followed safe recruitment practices. Staff received safeguarding training and knew of their responsibilities to keep people safe from abuse.

Risks to people in their daily lives were identified, assessed and managed appropriately. People had risk assessments in place for activities particular to their choices and needs. Risk assessments were reviewed regularly and some were in the process of being updated when we visited.

The service was committed to making sure the people who used their service were encouraged and empowered to raise any concerns or issues they might have about abuse, including any abuse relating to people’s protected characteristics under the Equality Act 2010.

Staff and seniors completed daily notes and accident and incident forms that allowed them to detail any concerns about people’s safety. Incidents were reported onto other relevant agencies, which the service worked in partnership with to keep people safe. Systems were in place for reviewing and communicating learning with staff following safety incidents. Medicine support for people at the service, including obtaining, recording, storing, disposing and administering, was being managed safely.

The premises were easily accessible to people and included large communal living areas where people could spend time together if they wished. People’s rooms were personalised to reflect their individual tastes and contained personal items, decorations and belongings. People had access to large outdoor areas if they wished to be outside. People were encouraged to have visitors and people’s families and friends regularly came to the services.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Staff had received training in the MCA and knew how to put the principles into practice. People’s consent to their care was sought and they, or appropriate people acting in their best interests, were involved in decisions about their care.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). Deprivation of Liberty Safeguards (DoLS) applications for people had been submitted. We checked to see whether any conditions on authorisations to deprive a person of their liberty were being met. For all of the people at the service none of these had yet been authorised. The managers were in the process re-applying for these on people’s behalf.

Staff received an induction that met the Care Certificate standards. The Care Certificate was introduced in April 2015 and is a standardised approach to training for new staff working in health and social care. It sets out learning outcomes, competencies and standards of care that care workers are nationally expected to achieve. Staff received training in subjects relevant to their role, including specific training to meet people’s individual needs. The service used inter-organisation departments and outside agencies to provide on-going guidance and training in specialist areas, such as behavioural support. Staff received regular supervisions, one to one meetings and appraisals to support them to understand their responsibilities.

People had support to maintain good health and had access to healthcare professionals and services. Staff had a good understanding of people’s health needs and monitored these appropriately. People had support to manage dietary or nutritional needs and were encouraged to be as independent as possible when preparing food and drinks. People had choice and control over what they ate and drank and when they did this.

Comprehensive assessments, often in partnership with other health and social care agencies and organisations, were undertaken to understand people’s needs. People had support plans that reflected their needs. Staff supported people to achieve outcomes based on the needs and choices in their care plans.

People were supported with compassion and empathy. The service communicated in accessible and meaningful ways with people. Staff used people’s preferred communication methods, including the use of technology, to enhance the delivery of care and promote people’s independence.

People were actively involved in making decisions about their care and had expressed their views about how they wanted to be supported. The service promoted people’s independence and privacy. We observed people were treated with dignity and people’s confidentiality was respected.

People were assessed to identify their individual support needs and wishes and their care plans reflected this. Care plans were regularly reviewed with people. Where it was appropriate and with the person’s consent, people’s families or other health and social care professionals were involved in the review of people’s care.

People were encouraged to follow their interests and achieve their life goals. People had individual activity plans and had support to access meaningful educational, vocational and social activities, both on and off the premises. People were supported to develop and maintain relationships with people important to them. The service was proactive about building strong links with the wider community to help people to do this.

The service provided accessible ways for people to understand and raise concerns. People and their relatives knew how to raise a complaint and felt confident to do so. Complaints were responded to a