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Weston House Requires improvement

Reports


Inspection carried out on 23 January 2020

During a routine inspection

About the service

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.

Inspection carried out on 11 May 2017

During a routine inspection

We carried out an unannounced inspection of the service on 12 May 2017. Weston House is registered to provide accommodation for up to 33 people who require accommodation and personal care, who were living with mental health conditions. At the time of the inspection there were 30 people living at the home.

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.

Inspection carried out on 9 March 2015

During a routine inspection

We inspected this service on 9 March 2015. This was an unannounced inspection.

The service was registered to provide accommodation and personal care for up to 33 people. People who use the service have a mental health needs.

At the time of our inspection 29 people were using the service.

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

People’s safety risks were identified, managed and reviewed and the staff understood how to keep people safe. There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety.

Effective systems were in place to protect people from the risks associated from medicines. People were enabled to administer their own medicines when this was appropriate.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People’s health and wellbeing needs were monitored and people were supported to attend health appointments as required. People could access suitable amounts of food and drink that met their individual preferences.

Staff sought people’s consent before they provided care and support. However, some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy. The staff were highly committed and provided people with positive care experiences. They ensured people’s care preferences were met and gave people opportunities to try new experiences.

People were involved in the assessment and review of their care and staff supported and encouraged people to access the community and participate in activities that were important to them.

People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive and inclusive atmosphere within the home and people were encouraged to be involved in their care.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with us.

Inspection carried out on 3 September 2013

During a routine inspection

During our inspection we spoke with 12 people who used the service, five members of staff and the manager. We also spoke with two people who visited the service. People told us they were happy with their care. One person told us, �The staff are very decent in their ways. They don�t rush you, they let you go at your own pace�. A person visiting the service told us, "I�m totally happy with it here and at ease. I know X is in a place that they are happy, which takes the pressure off me�.

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.

Inspection carried out on 8 February 2013

During a routine inspection

People told us they were happy living at Weston House. One person said, �It's lovely here. The food is lovely and the staff are lovely�. Another person said, �This is the first time I have felt �at home��. Relatives also told us they were happy with the care being provided. One relative said, �Its like a big family, everyone gets on�. Another relative said, �The manager is wonderful, the staff are loyal. I would recommend it to anyone�.

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.

Inspection carried out on 30 March 2012

During an inspection looking at part of the service

We carried out this review to check on the care and welfare of people using this service. We visited Weston House in order to up date the information we hold and to establish that the needs of people using the service were being met. The visit was unannounced which meant the provider and the staff did not know we were coming.

We visited the service and spoke to people using the service and staff. We looked at records of care, staff rotas, staff recruitment records and other documents. At the time of our visit there were 26 people resident in the home, with three others in hospital.

Before our visit we contacted other people who may have had an interest in the service such as fire safety officers, environmental health, and local involvement networks (LINks). LINks are groups of individual members of the public and local voluntary and community groups who work together to improve health and social care services. To do this they gather the views of local people. No concerns were identified by any of these agencies.

During our visit we observed how staff and users of the service interacted, and we talked to people about the things they did and what they liked about the service. One person said, "I like gardening and will be planting some flowers and vegetables." Another said, "The staff are great, they always listen to what I say and I can go to them if I'm worried about anything."

We saw that people had care plans in place that they were reviewed and evaluated, but commented that these would benefit from being more user friendly and person centred.

People told us they were happy living at the home, they showed that they were able choose what they wanted to do and the meals they ate.

The service promoted people�s opportunities to be involved in social and recreational activities. A full programme was evident with activity coordinators available throughout the week.

We looked at staffing levels to determine if sufficient staff were deployed to meet people's needs. And we checked that new staff were properly recruited and subject to correct pre employment checks.

Arrangements were in place for monitoring the quality of the service provided, and to seek the views of people using the service and other interested parties. Further work was needed to ensure people�s views are used to develop and improve the service and ensure people are informed of any proposed changes.

Reports under our old system of regulation (including those from before CQC was created)