Weston House

Weston House is a residential care home providing personal care to up to 33 people. The service provides support to adults with mental health conditions. At the time of our inspection there were 27 people living in the home. People lived in 1 adapted building which consisted of 2 floors and a range of communal areas for people to enjoy.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Infection prevention and control was not effective throughout the building which meant people were at risk of catching and spreading infections. Quality checks were not always effective in identifying risks such as cleanliness and environmental safety.

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 always support this practice. People’s medicines protocols did not always contain enough information for staff. People’s care plans and risk assessments were not always accurate and kept up-to-date, however, they were person-centred. Staff recruitment processes were not always robust.

Staff knew how to keep people safe from abuse and lessons were being learned when things went wrong. Staff knew people well. People, staff and relatives felt positive about the home management. Staff worked in partnership with other organisations.

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 2 April 2020) and there were breaches of regulation. 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 improvements had not been made and the provider remained in breach of regulations. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We received concerns in relation to people’s care and safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

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 remains requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

The manager was responsive to feedback and addressed some of the environmental risks swiftly.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Weston House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to environmental safety, cleanliness, governance and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Weston House provides personal care for up to 33 people who have mental health conditions. At the time of the inspection there were 31 people living in the home.

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

The provider had failed to notify CQC of people’s outcomes in relation to their Deprivation of Liberty Safeguards (DoLS) which they are required to notify us by law.

Systems were not effective at identifying areas of improvement that were needed. There were no action plans in place to demonstrate the improvements the home was undertaking and there were no trends analyse for accidents or incidents to demonstrate people risks were mitigated.

We have made a recommendation about End of Life care planning.

People were at risk of not receiving their ‘as and when required’ (PRN) medication as there was lack of consistent guidance to support staff in recognising when people needed their medication. Weston House also did not recognise the importance of supporting staff to receive specific training in relation to people who may self-harm or be at risk of suicide.

The providers quality monitoring procedures were ineffective in identifying improvements to drive good care and support. This was due to people’s risks not being consistently recorded and the care plans did not give staff the guidance to refer to when and if needed. This meant there was a risk that staff would not always recognise when people’s mental health conditions were deteriorating.

Although people told us they felt safe at Weston House the systems and procedures were ineffective in mitigating risks to people. Monitoring systems did not identify areas of concern in order to make improvements.

People were protected from the risk of abuse as staff knew how to recognise this when and if it occurred. Staff were able to support people and actions were taken to mitigate further incidents to ensure people remained to feel safe.

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 had access to additional healthcare services when required and people were supported to maintain a healthy diet.

People received help and support from a kind and caring staff team and were supported to access the local community and activities within the home. Weston House had good links with the local community and involved neighbours in supporting fund raising during the summer months.

The home was clean and free from malodours and infection prevention and control measures were being followed.

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 outstanding (published 13 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risk management and governance systems which were not effective at identifying areas that needed improvement. Also, in relation to managers and staff being clear about their roles and understanding quality performance.

Please see the action we have told the provider to take at the end of this report.

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.

On the day of our inspection there was a registered manager in place. ‘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 supported to be safe because staff were knowledgeable and could identify the different types of abuse. Staff knew how to report any concerns they may have about people's well-being. Risks to people's safety were assessed with them to promote their independence. People had the freedom to live their lives as they wanted to. Staff were recruited in a safe way and there were enough staff to meet people's needs and to keep them safe.

Accidents and incidents were monitored and action taken to reduce further concerns. People had personal emergency evacuation plans (PEEPS) in place and environmental risks had been assessed. People were supported to have their medicines as prescribed.

People had an excellent relationship with the staff that cared for them. People were supported by passionate staff who were very kind and caring and treated them with the utmost respect and dignity. People were supported to live their lives as they wished. Staff celebrated diversity and enhanced people's confidence to be themselves.

People were provided with the information they needed if they wished to speak with an independent advocate to support them with decisions about their care. They also enjoyed kind and enabling support from all staff to make their own decisions. People's friends and relatives were able to visit whenever they wanted to and agreed processes were in place to support people with visiting their relatives.

People's support plans were developed with them. People's wishes and individuality were always at the forefront of the planning of their care and support. Staff approach was very person centred. People's individual care and support needs were regularly discussed and reviewed with them.

People were encouraged to take part in activities that were important to them and staff provided support if needed. They were also supported to learn new skills and pastimes. People were provided with the information they needed to enable them to make a complaint.

People who used the service were encouraged to provide their feedback on how the service could be improved. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided. The staff team respected and acted upon people's views at all times.

The registered manager was very passionate about the service provided to people. They were committed to encouraging people and staff to thrive and learn new skills. Feedback we received from community healthcare professionals showed that there was a very high level of respect and trust in the staff team to support people in crisis.

We saw that people's agreement was gained before staff provided care or support, and people were able to make choices about the support they received and the food they ate.

People were safe because the staff understood people's needs, and support was provided in a caring and professional manner, by staff who had completed the required training.

People were protected from the risk of infection because effective systems were in place to reduce, monitor and manage these risks.

We saw that there was a complaints procedure in place and people told us they would be happy to tell staff if they were unhappy with their care.

During our inspection we saw that people were treated with dignity and respect. People told us they felt involved in the planning of their care and the running of the home. We saw that people were supported and encouraged to participate in activities they enjoyed both at the home and in the local community.

We saw that people received their care in a positive and caring manner. We also saw that there was enough skilled staff on duty at all times. This ensured that people received the care and treatment they required.

We saw that there were systems in place to ensure that people received the medicines they required when they required them.

We saw that the provider had an effective system in place to regularly assess and monitor the service which focussed on service improvement.