Westwood

Westwood is a residential care home providing accommodation and personal care to nine people at the time of the inspection. There were no vacancies. Some people have specialist needs associated with Downs syndrome, dementia, autism or mental health.

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 Care

There were not always enough staff to meet people’s needs in the evenings and at night. This was reviewed following our inspection and staffing levels were increased. Staff had the skills, knowledge and experience to meet people’s needs and more specialist training was being sought in relation to Makaton (a sign language) and Positive Behavioural Support. Agency staff were used to cover staff sickness or annual leave. Wherever possible the same agency staff were used which provided people with a consistent approach.

People’s medicines were stored safely, and people received their medicines in line with their prescriptions. Where appropriate, people were supported to manage their own medicines.

Right culture

There were good systems for auditing medicines, health and safety and care plans, and any shortfalls were addressed promptly. External oversight was not so thorough, monthly audits had not picked up on matters identified at inspection such as the impact of low staff numbers.

Although there were established systems to hear people’s views either through keyworker meetings, house meetings and surveys, records did not demonstrate how people’s wishes were being met. There were no recent surveys to seek the views of people’s relatives or staff. People told us they were happy living at Westwood. Overall, we received very positive feedback from relatives we contacted, and they spoke very warmly of the care and support provided at Westwood.

Staff told us they felt supported and they attended regular supervision meetings and staff meetings where they had opportunities to share their views on the running of the service.

Right Support

People were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There were systems to ensure people's needs were assessed and reviewed. Westwood was kept clean.

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 coronavirus and other infection outbreaks effectively.

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 remains Requires Improvement.

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 have identified a continued breach in relation to good governance at this inspection. We have also identified a new breach in relation to staffing.

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.

Westwood is a residential care home that provides accommodation and personal care for up to nine people who have learning disabilities and some associated physical and/or sensory disabilities. Accommodation is provided in a large house that is set over two floors.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. Eight people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

There were not always enough staff at weekends to meet people’s assessed needs. The quality assurance systems were not always effective and had not identified some of the shortfalls found at inspection. For example, daily records were not clear and open to misinterpretation. There were no formal systems to analyse and learn from incidents. Staff did not always feel supported in relation to the management of behaviours that challenged and had not received regular supervision this year. Staff told us staff meetings were negative and didn’t feel able to share their views.

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; the policies and systems in the service did not support this practice. This mainly related to some restrictions that had been taken in people’s best interests but there was no assessment to determine if people had capacity to make their own decisions in relation to these matters.

Although staff told us they did not feel supported in some areas of their work, they were clear that in other ways they felt well supported and were able to speak with the registered manager about a range of matters. Staff received training that helped them to deliver the care and support people needed. This included specialist training in Makaton and caring for people living with dementia and autism.

People received support from staff who knew them very well as individuals. Staff turnover was low, and relatives told us there was consistency in the staff team. People’s care and support needs were assessed and reviewed regularly. This enabled people to receive care that was person-centred and reflected their needs and choices.

The service applied the principles and values of Registering the Right Support and other best practice guidance. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. They were encouraged to take part in daily living tasks with support from staff in areas such as laundry, cleaning, cooking and hoovering.

People were supported to maintain their own interests. Staff supported people to take part in choosing activities to meet their individual needs and wishes. Two people loved drama and attended a local drama group. Others enjoyed attending day centres and making use of local facilities and amenities. People enjoyed cinema, and theatre trips and had opportunities to have annual holidays.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. The home was clean and tidy throughout. Recruitment procedures ensured only suitable staff worked at the service. People were supported to receive their medicines safely.

People's health and well-being needs were met. Where appropriate, staff supported people to attend health appointments, such as the GP or dentist and appointments for specialist advice and support. People’s nutritional needs were assessed. They were supported to eat a wide range of health, freshly cooked meals, drinks and snacks each day.

There was a detailed complaint procedure, and this was displayed so anyone wanting to raise a concern could do so. An easy read version was also available for people to refer to.

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 27 February 2017.)

The overall rating for the service has deteriorated to Requires Improvement. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, 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.

Follow up

We will request an action plan for 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.

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

The service had 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 2008 and associated Regulations about how the service is run.

People were safe. Staff understood the importance of people's safety and knew how to report any concerns they might have. Risks to people's health, safety and wellbeing had been assessed and plans were in place, which instructed staff how to minimise any identified risks to keep people safe from harm or injury.

There were suitable arrangements in place for the safe storage, receipt and management of people’s medicines. Medicine profiles were in place which provided an overview of the individual’s prescribed medicine, the reason for administration, dosage and any side effects.

There were sufficient numbers of staff employed to meet people’s needs and staff knew people well and had built up good relationships with people. The registered provider had effective recruitment procedures in place.

The registered manager and staff had received training to meet people’s needs and were knowledgeable about of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had not been completed for every decision taken for people who may not be able to consent.

Staff treated people as individuals with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. Staff were skilled to approach people in different ways to suit the person and communicate in a calm and friendly manner which people responded to positively.

Peoples' health was monitored and referrals were made to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into peoples' care plans.

People who wanted to be occupied had busy lifestyles which reflected their lifestyle choices and likes and dislikes. People’s privacy and dignity were respected and upheld by staff who valued peoples’ unique characters.

Staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout our inspection, such as staff sitting and talking with people as equals. People could have visitors from family and friends whenever they wanted.

People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. People led full and varied lives and were supported with a variety of activities often with one to one support.

Complaints were used as a means of improving the service and people felt confident that they could make a complaint that any concerns would be taken seriously.

There was an open, transparent culture and good communication within the staff team. Staff spoke highly of the registered manager and their leadership style. The management team had positive relationships with the care staff.

The registered manager took an active role within the service and led by example. There were clear lines of accountability and staff were clear about their roles and responsibilities. The provider had robust systems in place to assess and audit the quality of the service. However the quality checks that we could see were happening were not always written down in one document.

We spoke to four people who lived at the home. We spoke with three staff. We looked at three care plans and three staff files.

We found that people were involved in the planning of their care. People were treated with respect.

Care plans were up-to-date and reflected the care that was provided.

The building was seen to be safe and suitable for people living and working in the home and for their visitors.

The home had effective recruitment procedures.

The home had an effective complaints policy and procedure.

The people we spoke with told us they enjoyed living at Westwood. One person told us 'I love living here, I've been here a long time and it's home to me. I've had my room decorated just as I want.' Another person told us about how they felt about living at Westwood. She said 'I've no complaints and everyone's friendly. I have a job in town in a charity shop. I love my job.'

The staff we spoke with were knowledgeable about people's needs and what support they required.

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. The service had assurance systems in place to monitor the quality of the service provided and to gain the views of the people who lived there.