We carried out a review of the data available to us about Westbrooke Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Westbrooke Grange, you can give feedback on this service.
We found the following examples of good practice.
Personal protective equipment (PPE) was readily available, and staff were using PPE safely and in line with current guidance. Staff had received training in infection prevention and control and the use of PPE.
Visitors to the service had been restricted to essential visits only. To prevent visitors from spreading and catching infections, visitors were asked to consent to a rapid COVID-19 test, have their temperature checked, wear PPE, and wash their hands.
People were encouraged and supported to maintain contact with their relatives through use of mobile phones and video calls.
People and staff took part in regular COVID-19 "whole home" testing. People and staff who displayed symptoms and/or tested positive, followed national guidance and self-isolated for the required amount of time.
The premises were clean, uncluttered and free from malodors. Effective cleaning schedules were in place which included hourly cleaning of high touch surfaces such as handles, light switches and frequently touched equipment.
Staff helped people to socially distance when they used the communal areas.
Policies and procedures were in place to support safe management of COVID-19. Policies and contingency plans, including infection control policies, had been continually updated to reflect current national guidance.
Westbrooke Grange is a residential care home registered to provide care and support to five people who may have Autistic Spectrum Disorder (ASD) and/or mental health needs. At the time of the inspection there were four people living at the service.
Westbrook Grange is owned and operated by Modus Care Limited. The provider has over 50 small residential facilities for adults aged 18 to 65, as well as bespoke, individually tailored services for people with ASD across England.
The service comprised of five individual flats, with a shared kitchen and lounge. At the time of our inspection the service was undergoing substantial building work to help improve the design and adaptation of the premises.
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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
People’s experience of using this service and what we found
People were supported by kind and caring staff, who promoted their independence. People were supported to remain safe, but without unnecessary restrictions being imposed on them.
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.
People’s health and social care needs were robustly assessed, with their care and support being delivered in a person-centred way; keeping the person at the heart of their own care. Involvement by external professionals ensured people’s needs were managed in a holistic and multi-disciplinary way.
Staff received good support and relevant training to be able to meet people’s individual needs. New staff joining the organisation were inducted to the providers ethos of, “To enable people to have a fulfilling and purposeful life’ and policies and procedures”.
The manager was a role model and ensured the culture of the service was based on the providers values of, “Respect, choice, empowerment, and inclusion”.
Governance systems ensured improvements were highlighted so action could be taken promptly. Incident and accident reports were reviewed, and themes and trends were analysed to ensure the culture at the service relating to restrictive practices was appropriate.
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 Good (published 25 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Westbrooke Grange is a service for five people who have Autism and Learning Disabilities. The service was previously registered as a hospital, but registered as a residential service in 2013. The service does not currently provide nursing care. Any nursing or health services needed by people would be accessed via the local GP and community health services.
A registered manager was based at the service. 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 living at Westbrooke Grange had complex needs associated with their mental health and learning disability. All of the people in the home at the time of the inspection had in the past experienced living in a hospital setting where their choices and lifestyle had been significantly restricted. What was particularly evident at Westbrooke Grange at the time of the inspection was how much people were being supported to make choices and to experience a lifestyle not restricted and dictated by their behaviours and past experiences. People had the support they needed to express their views and wishes and when possible make decisions and choices about their care and lifestyle. People were trying new experiences, going on holiday, spending time with family and going out into the community.
Relatives and other agencies involved with the service said how impressed they were with the progress people had made. They said the registered manager was very good at supporting people with complex needs in a calm and sensible way, which had resulted in an improved quality of life for those concerned.
There was a positive culture in the service, the management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be run and had worked hard to embed this culture within the service. Individualised care was central to the home’s philosophy and staff demonstrated they understood and practiced this by talking to us about how they met people’s support needs. They spoke with commitment and used words like “individual” and “personalised” when they talked about people they supported.
Staff were motivated and inspired to offer kind and compassionate care and support. All the staff said they enjoyed their work and loved seeing people progress. We saw a number of examples of progress people had made since moving into the home. We saw how personalised care and a positive approach to managing behaviour had resulted in people having increased opportunities and enhanced well-being. One person who had previously been restricted within a hospital setting had attended a dance festival and had enjoyed spending time at Christmas with their family. Another person who suffered from episodes of severe anxiety had been supported to go out without support from staff, which had a positive effect on their well-being and self-esteem. Relatives said, “The staff have been really good at striking a balance between supporting people and allowing them their independence”.
People were supported to express their views and have their voice heard. Staff were creative in thinking of ways of helping people express their views and understand what was happening around them. One person who became very anxious when they were planning activities or trips out was supported to complete a book about their feelings and a story board before each activity to help ensure they had clear information and a time line about what was happening. The aim of this was to help ensure events were predicted and surprises were kept to a minimum. This approach had worked well and they had been gone out more in the past twelve weeks than the whole of the last year.
There were sufficient numbers of skilled staff to meet people’s needs and to keep them safe. Staffing levels were regularly reviewed and planned in line with people’s daily routines to help ensure they were able to do the things they needed and wanted. The provider had clear and effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe. Relatives said they believed and trusted that people were safe. People were protected by staff who knew how to recognise signs of possible abuse. Staff said reported signs of abuse or poor practice would be taken seriously and investigated thoroughly.
Staff were well trained and said training was relevant to their role and kept updated. The organisation offered all staff the opportunity to undertake training specific to the needs of people they supported. Staff learnt about autism, learning disability and about people’s individual’s conditions and needs. For example, staff had undertaken training in Post-Traumatic Stress Disorder and Suicide Intervention training to help ensure they had the skills to support a person who had experienced a traumatic incident resulting in high anxiety and suicidal thoughts.
There was a behaviour support advisor employed by the company. They provided advice and staff training in supporting people’s communication and the techniques necessary to manage people’s behaviour that may challenge. The registered manager said this guidance and support would be provided in liaison with other specialist learning disability and mental health services.
Staff asked for people’s consent as they provided care. They described how they supported people to make their own decisions and choices. Staff had undertaken training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people were assessed as not having the capacity to make a decision, a best interest decision was made, involving people who knew the person well and other professionals, when relevant.
People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook training and understood the importance of the safe administration of medicines. People were helped to understand their medicines and were supported to take control of them as much as possible. People’s health and dietary needs were well met. People were supported to maintain good health and when required had access to a range of healthcare services
The service was very responsive to people’s specific and diverse needs. Support plans were extremely clear and detailed, providing staff with step- by- step guidelines about people’s needs, preferences and daily routines. All the staff we spoke with had a very good knowledge of the needs of people they supported.
The registered manager used effective systems to continually monitor the quality of the service and had on going plans for improving the service people received. There was a clear complaints procedure that was designed to enable people to express their views and were responded to in a way they could understand.
Emergency plans were in place so if an emergency happened, such as a fire staff knew what to do. Safety checks were carried out regularly throughout the building and the equipment to make sure they were safe to use.
We discussed people's care needs with staff and they told us about people's needs and how they liked their care to be delivered. One person we talked with told us that they felt supported and well cared for.
We observed good interaction between staff and people who lived at the service. We heard people being offered choices and being spoken with in a warm and friendly manner.
We talked with staff about the support they received at the service. Staff told us that they enjoyed working at the service but felt support could be improved. Two members of staff told us that they had not received supervision in over a year.
We spoke with the area manager about the way they ensured support to staff was provided. They told us that staff received support in the form of supervision, appraisal and day to day support. We were not able to see the staff records because the manager was away and nobody else had access to the staff records.
We saw that staff acted in accordance with people's wishes and provided care that was delivered with their consent. For example, we saw evidence that people had been involved in completing their care plans.
We discussed people's care needs with staff and they told us about people's needs and how they liked their care to be delivered.
We observed some good interaction between staff and people who lived at the service. We heard people being offered choices and being spoken with in a warm and friendly manner. However, the provider may wish to note that we saw staff who were less warm and friendly to another person who used the service.
We saw there were regular weekly and monthly audits carried out on the medication systems.
We looked at three staff files which showed us there were effective recruitment procedures in place.
We spoke with the provider's compliance manager about the way they ensured a quality service was provided. We saw the provider had moved to a computer based system that collated a series of audits that highlighted any concerns.
Since our last visit the hospital had been subject to safeguarding procedures which related to the care of one person who had moved from, but was now back at the hospital. The process had been closed and the hospital was working through an action plan with health and social care professionals.
We saw evidence in some people's care plans that they had been involved when their care plans had been reviewed. When we looked in people's care records, we saw that incidents were well recorded and incident forms had been completed. It was evident that the skills of the staff were matched to the individual needs of the people who lived at the hospital.
The two representatives we spoke with both felt that the service could do more to encourage their relatives to be more motivated and independent.
Patients told us that they knew about their care plan and had had some input into developing this. One patient told us that they were not interested in seeing it; however they did know a bit about their risk assessments.
We spoke with the relatives of all four patients. They said that Westbrooke Grange presented as a pleasant environment, with kind carers and very professional and knowledgeable managers who clearly made an effort to understand each patient's individual personality and traits to provide a good service. Relatives comments included, 'We are finally getting our old XXX back'... and 'XXX has lost all the weight they gained and isn't sedated all the time... my daughter is back' and 'XXX is very settled... I really don't want them to move'.
Patients told us that they liked living at Westbrooke Grange; they said it was pleasant and staff help them to make choices and do not force them to do anything. We were invited into two patient's flats and saw that they had access to their own computers, televisions, DVDs and music for relaxation and leisure time. Patients told us that they are offered activities; however some patients said they were bored and that opportunities to go outside of the hospital to the shops and seafront had been limited due to the expiry of the lease on one of the two vehicles used by Westbrooke Grange. We were informed that the company were still considering whether to renew the lease.
Patients talked to us about their experience of living in Westbrooke Grange. They said that they were aware of the types of abuse and that they had not experienced any form of abuse whilst living at Westbrooke Grange. However, one person commented that they were not happy with the way two members of staff spoke to them. The inspectors spent time discussing these concerns with this patient who gave us their permission to feed their concerns back to the manager. Following our visit the manager has informed us that that they have discussed the issues with them and is taking appropriate action with the staff involved.
Patient's relatives talked to us about their awareness of the use of restraint. Two relatives said they were aware that their relatives had been restrained in the past as part of their reactive behaviour management plans. Patients using the service told us that they were aware that they had restraint plans in place should their behaviour become challenging to themselves, others using the service or staff. They were clear that only trained staff were able to use restraint.
Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.
Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.