Archived: Willowbeech Limited - 33 Ophir Road

Ophir Road is a residential care home providing personal care to people with learning disabilities and/or autism. The service can support up to five people. At the time of the inspection four people were living at the home.

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.

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

Relatives, staff and professionals felt people were safe living at Ophir Road. Relatives said that staff had a good understanding of their loved one’s needs and preferences. Risks had been identified and measures put in place to keep people safe from harm. Medicines were managed safely and administered by trained staff.

Leadership was visible and promoted good teamwork. People, professionals and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The registered manager, team leader and staff team worked together in a positive way to support people to achieve their own goals and to be safe.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve the service was noted and the registered manager was keen to make changes that would impact positively on people's lives.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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

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 9 June 2018).

Why we inspected

We received concerns in relation to the monitoring of the records staff kept daily on people’s wellbeing, self-harm and the use of mechanical restraints. As a result, we undertook a focused inspection to review the Key Questions of safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

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.

Willowbeech Limited was registered for up to five people. There were four young adults living in the home at the time of our inspection. People had a range of support needs related to maintaining their mental and physical well-being and needs related to the impact of their learning disabilities or autistic spectrum disorders. The people living in Willowbeech Limited had difficulties communicating their needs or managing their emotions and their experience of their environment. This meant at times they could become agitated and anxious. At times this resulted in verbal and physical aggression towards themselves or staff.

This announced inspection took place on the 4 and 5 May 2018. We made further telephone calls to gather evidence up until 11 May 2018 and received further evidence from the provider following our visits to the home.

There was a manager registered with Care Quality Commission 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. The person registered to run the service was no longer working there and a new manager was in the process of applying to take on this function.

At our last inspection in April 2017 we found breaches of regulation because staff had not been recruited safely, notifications had not been made and the oversight of the home was not sufficient. At this inspection we found improvements had been made and there were no longer regulatory breaches.

People were supported by staff who liked and respected them and understood how to support them. Measures to reduce risk reflected people’s preferences and people spent their time in ways they enjoyed and were meaningful to them.

Staff also knew how to identify and respond to abuse and told us they would whistleblow if it was necessary.

Staff encouraged people to make decisions about their lives. And this was supported and promoted by systems that reflected the principles and framework of the Mental Capacity Act 2005. Staff reflected on communication and discussed their interpretation of people’s wishes to promote the least restrictive option available.

People were supported by safely recruited staff who were committed, kind and enthusiastic. They had received appropriate training although some staff needed to learn to use person’s expressive communication tool. The provider told us this was being addressed.

Oversight structures and ethos of care were clear and quality assurance systems were largely effective. Changes were made to oversight in response to our inspection findings.

The environment was clean and well maintained reflecting the needs and preferences of people.

People ate food they liked and there were systems in place to ensure people had enough to eat and drink and that they were supported with this safely.

Staff were cheerful and treated people and visitors with respect and kindness throughout our inspection.

Willowbeech Limited – 33 Ophir Road is a care home for adults with a learning disability, including autism. It is registered for up to five people, although in practice only up to four are accommodated. Nursing care is not provided. Three people were living there when we inspected. Accommodation is provided in individual bedrooms with ensuite shower and toilet facilities. These are arranged in two flats, each with their own lounge and dining kitchen, one on the ground floor and the other on the first and second floors. The first and second floors are accessed via stairs. There is a parking area to the front of the house and a lawned garden to the rear.

The service is required to have a registered manager as a condition of its registration. 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. The previous manager had left at the end of 2016 and had applied to cancel their registration. The service was being managed by an acting manager, and a replacement manager had been recruited and was due to start in post in June 2017.

There were some shortfalls and areas for improvement.

There were enough staff to provide the support people needed. However, recruitment procedures were not robust in that full information was not available for all staff about past conduct in health and social care employment. You can see what action we told the provider to take at the back of the full version of the report.

Most accidents and incidents were identified, reported and investigated by staff. However, the system in place to monitor accidents and incidents at the provider’s level was not robust. Whilst the provider reviewed a monthly report of accidents and incidents to identify any trends or patterns, some incidents involving the use of restraint had not been included in this as they should have been. This meant the provider could not be sure that appropriate action had been taken and plans put in place to protect people in future. You can see what action we told the provider to take at the back of the full version of the report.

The provider did not have effective systems in place to monitor and improve the quality of care and support that people received. Quality audits were not fully accurate and therefore did not identify actions staff could take to improve the experiences of people living at the home. They had not identified some of the issues we found during the inspection. Where audits had recognised shortfalls and staff had requested action, this had not always happened. You can see what action we told the provider to take at the back of the full version of the report.

CQC had not been notified, as it should have been, about some significant events affecting people’s health and welfare. You can see what action we told the provider to take at the back of the full version of the report.

Internal health and safety audits had not identified hazards we found in relation to the premises. The acting manager addressed these when we drew them to their attention to make sure the environment was safe for people.

The arrangements for obtaining consent were not robust. The service did not routinely ask whether people had a representative with lasting power of attorney or powers delegated by Court of Protection to make decisions on person’s behalf. The acting manager had not been given additional training about the Mental Capacity Act 2005 to enable them to take the necessary action.

Complaints were recorded but the acting manager was unable to access details of investigations and outcomes for complaints that preceded their appointment. We have made a recommendation regarding the handling, recording of and learning from complaints.

Other findings were positive.

People had the individualised care and support they needed, from caring and respectful staff who understood them well. People were relaxed and comfortable in the presence of staff.

Care plans were clear, thorough, up to date and centred on the person. People’s individual risks were assessed and addressed through care plans.

People were encouraged to get involved in activities in the community and also to be involved in daily living tasks at home and in the community.

People were supported to visit and stay in contact with their families, and could receive visits at any time that suited them.

People were supported to manage their health, including consulting with health care professionals where needed. Care plans included Health Action Plans, which set out in a straightforward way their health needs and how these were to be addressed.

People were supported to have healthy diets with as much variety as they would accept, whilst respecting their food preferences. They were encouraged to get involved in food shopping and preparation.

Medicines were stored securely and managed safely.

Staff had the training they needed to give them the skills and knowledge to be able to support people. Staff told us they felt well supported by the acting manager, whom they said they could approach for advice or guidance at any time. Where there were gaps in training and supervision the acting manager had a plan in place to rectify these.

According to the provider’s policy, staff should have had regular supervision meetings, at least every six to eight weeks. The acting manager acknowledged this had fallen behind, although their supervision plan showed that most staff had had a supervision meeting since the beginning of February 2017.

We used a number of different methods to help us understand the experiences of some people using the service. This was because they had complex needs which meant they were unable to tell us about their experiences.

We pathway tracked two of the four people who lived at the home. This involved observing people's experience within the home, reviewing their records, and talking to staff involved in their care.

We found support plans showed people were supported to make day to day decisions and choices. A member of staff we spoke with about decision making told us, 'It's their choice'.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A member of staff told us people were, 'Getting a good life'.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

People's diversity, values and human rights were respected. We found bedrooms were personalised and reflected people's interests. We noted throughout the inspection care workers were polite, respectful and sensitive.

Care workers said care plans were 'personalised' and supported them to understand what help people wanted or needed.

People participated in activities. One care worker told us 'we try to offer diverse activities; I like to think people have fun'. Another care worker commented 'people get to do a lot of activities that they like to do, and we can see they enjoy them'.

People using the service were protected from the risk of abuse, because the provider had taken steps to identify the possibility of abuse and prevent abuse from happening.

People were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff received appropriate professional development. However, effective recruitment and selection processes were not fully in place.

The provider had an effective quality assurance system.