Archived: Walby Hill (Adult Care Home)

Walby Hill (Adult Care Home) provides care, support and accommodation for up to seven people with a learning disability. At the time of the inspection there were four people living at the service. The service also provided an outreach service for one person living in the local community. We did not inspect this part of the

service because it was outside the scope of the regulations.

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

An effective infection control system was now in place. Improvements had been made following our last inspection regarding the use of PPE. Staff had undertaken training in the safe use of PPE. The provider had strengthened their quality monitoring system in relation to IPC.

People’s needs were met by the number of staff on duty. Medicines were managed safely.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a focused inspection. Based on our review of the key questions safe and well led; the service was able to demonstrate how they were meeting the relevant principles of the ‘Right support, right care, right culture’ under these key questions:

Right support:

People were supported to access the local community. Positive risk taking was encouraged.

Right care:

People’s dignity and privacy was promoted. People had their own key to their room.

Right culture:

There was a positive inclusive culture at the home. People were involved in their care and support such as goal setting and menu planning.

The service was changing from a care home to a supported living service. We have signposted the provider to further information regarding meeting the ‘Right support, right care, right culture’ in relation to becoming a supported living service.

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 requires improvement (published 25 May 2021). We carried out a focused inspection of this service on 29 January 2021. We identified two breaches of the regulations relating to safe care and treatment and good governance. We took enforcement action and imposed conditions relating to infection, prevention and control upon the provider's registration.

Why we inspected

We undertook this inspection to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Walby Hill (Adult Care Home) on our website at www.cqc.org.uk.

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.

Walby Hill (Adult Care Home) provides care, support and accommodation for up to seven people with a learning disability. At the time of the inspection there were three people living at the service. The service also provided an outreach service for one person living in the local community. We did not inspect this part of the

service because it was outside the scope of the regulations.

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

Government guidance relating to safe working practices regarding infection control, including the use of personal protective equipment [PPE] was not always followed by staff.

Checks to monitor the quality and safety of the service were carried out. However, an effective system to assess and monitor infection control was not fully in place.

People’s needs were met by the number of staff on duty. Medicines were managed safely.

Staff spoke positively about working at the home and the people thy supported. They explained they had worked as a team to help promote people’s wellbeing throughout the pandemic.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The location and layout of the home helped promote people’s independence and access to the community. We did not fully explore ‘Right support, right care, right culture’ at this inspection, this will be reported upon at our next inspection.

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 1 October 2019).

Why we inspected

We undertook this targeted inspection to look at infection control processes at the home. 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.

When we inspected, we found there was a concern with infection control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Walby Hill (Adult Care Home) on our website at www.cqc.org.uk.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so

We have identified breaches relating to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report. 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 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.

Walby Hill (Adult Care Home) provides care, support and accommodation for up to seven people with a learning disability. At the time of the inspection there were six people living at the service. The service also provided an outreach service for people living in the local community. We did not inspect this part of the service because it was outside the scope of the regulations.

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 received 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

People told us they felt safe. There were systems and processes in place to help protect people from the risk of abuse.

There were enough staff on duty to meet people’s needs. Staffing was provided by a stable and consistent staff team. Staff understood the needs of the people they supported well. Safe recruitment procedures were followed.

There was a positive approach to safety and risk which was not restrictive for people. 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 a choice and access to sufficient food and drink. Staff supported people to buy, prepare and cook healthy food for their well-being. People were supported to have access to a range of healthcare professionals to ensure they remained healthy.

People were treated with kindness. Most people had lived at the home for many years and had built strong relationships with other people and staff. There was a happy family atmosphere, people and staff cared about each other and enjoyed spending time together.

People's care was developed around their wishes, preferences and goals. Staff had explored what opportunities were available within the local community to promote inclusion and supported people to attend social events.

A range of audits and checks were carried out to monitor the quality and safety of the service. Action was taken if any issues or concerns were identified.

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.

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 10 February 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.

Walby Hill (Adult Care Home) provides personal care and accommodation for up to seven people who have learning disabilities. There were seven people living at the service at the time of the inspection. We last inspected the service in December 2015 and found three breaches of the regulations. These related to the need for consent, safe care and treatment and good governance.

At this inspection we found that action had been taken and the provider was now meeting all the regulations we inspected.

There was 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.

The premises were clean well maintained. A new bathroom had been fitted and a kitchen refurbishment was planned. Checks and tests had been carried out to ensure the building was safe.

People told us they felt safe. There were safeguarding policies and procedures in place. Staff told us that they had not seen anything that had concerned them. The local authority’s safeguarding adults team told us there were no safeguarding concerns regarding the service. Medicines were managed safely.

Safe recruitment procedures were followed including a Disclosure and Barring Service check (DBS) and references. There were sufficient staff on duty at the time of the inspection. Staff received appropriate training and support to enable them to care for people effectively.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. The registered manager had submitted DoLS applications to the local authority for authorisation in line with legal requirements.

People were provided with support to meet their nutrition and hydration needs. We observed positive interactions between people and staff. Staff promoted people’s privacy and dignity.

People were supported to access the local community and maintain their hobbies and interests. A complaints procedure was in place.

An effective quality assurance system was now in place to ensure that people received safe, effective and responsive care which met their specific needs and preferences. The provider was meeting the conditions of their registration.

Walby Hill (Adult Care Home) provides care and support for people who have learning disabilities. There were seven people living at the service at the time of the inspection. The number of people the provider was registered to accommodate was being reviewed at the time of the inspection. We last inspected the service in April 2014 and found they were meeting all the regulations we inspected.

There was 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.

We discovered some concerns with the condition of the premises. We noticed that the first floor windows had not been fitted with window restrictors. In addition, a wardrobe which was located at the top of the stairs had not been secured to the wall to prevent any accidents or incidents. A risk assessment had not been undertaken to assess these risks.

All providers of health and social care have to comply with the Code of Practice for health and social care on the prevention and control of infections, and related guidance. We found that criterion one of this code, which requires the provider to have systems to manage and monitor the prevention and control of infection was not being fully met.

Staff told us that they had to walk through the kitchen with soiled washing to access the laundry. This risk had not been assessed. There was no designated sluice facility or guidelines in place to ensure that staff followed correct procedures regarding the cleaning and disinfection of continence equipment to ensure that it was adequately cleaned.

People told us they felt safe. There were safeguarding policies and procedures in place. Staff told us that they had not seen anything that had concerned them. We found minor concerns with medicines management.

We spoke with one staff member who had been recruited in 2014. They told us that the correct recruitment procedures had been followed including a Disclosure and Barring Service check (DBS) and references. We found however, that the DBS had been obtained after the staff member had started work. The manager told us that the staff member had always shadowed an experienced member of staff and did not work alone. A risk assessment had not been completed to assess this risk or document the actions that had been put in place.

Following our inspection, the provider wrote to us and stated that an on line DBS adult first check had been obtained prior to the staff member starting work. A DBS adult first check will confirm if an applicant is on the barred list for working with adults; it is not a substitute for a full DBS certificate. The provider explained that two new people had moved into the service at short notice after the care home where they previously lived had closed. The provider stated that new staff had to be recruited in a timely manner to ensure people’s needs could be met.

There were sufficient staff on duty at the time of the inspection. Staff received appropriate training and support to enable them to care for people effectively.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. The registered manager had submitted DoLS applications to the local authority for authorisation in line with legal requirements. Documented evidence however, was not always available to demonstrate that staff were following the principles of the Mental Capacity Act 2005.

People were provided with support to meet their nutrition and hydration needs. Support was provided with patience and kindness. We observed positive interactions between people and staff. Staff promoted people’s privacy and dignity.

People were supported to access the local community and maintain their hobbies and interests. A complaints procedure was in place. No one raised any concerns about the service and no formal complaints had been received.

We found shortfalls in relation to infection control, some aspects of storage and recording of medicines, assessments of mental capacity mental capacity and individual care plans. Audits were not carried out to monitor these areas to ensure people received safe and effective care.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, need for consent and good governance. You can see what action we told the provider to take at the back of this report.

At this inspection, we checked whether previous shortfalls in the provision of fire safety staff training had been addressed. These issues had been identified during our last inspection at the service on 14 June 2013. We found that improvements had been made and the risks associated with the lack of recent fire safety had been reduced.

All staff had received comprehensive training in this area. This helped ensure people were safe because staff were trained to respond to emergencies.

We concluded that people's safety and welfare were protected by the way care was assessed, planned and delivered. People were protected from discrimination. One person said, "I like it here me."

Care was provided in safe and suitable surroundings.

Staff were supported through training and supervision to deliver care safely to people. However training with regard to fire safety was not up to date and this posed a safety risk for following emergency procedures in the event of fire.

Accurate records were maintained and securely stored so that people were protected against inappropriate care or treatment.

People we spoke with said, "I like it here", "I have lived here a long time, it is my home" and "It is nice and I like the staff."

People said they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said, "I am very busy, look at the things I have been making at the local sewing club" and "This is my home and has been for many years." People told us their home was clean, comfortable and warm. They said, "I like my room; I have my things and love my big bed".

They said staff were kind and caring and seemed to be well trained. People confirmed they were given the opportunity to comment on the service, change routine or raise complaints. They said their visitors were made to feel welcome and information sharing was good.

Staff told us they enjoyed working at Walby Hill. One member of staff said, "I really enjoy my job, we work together as a team, always aiming for the best we can do for people who live here." People, their families and advocates were given the opportunity to comment on the service, change routine or raise complaints.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.