Covenant Care - The Wheelhouse

The Wheelhouse is registered to provide care and support to a maximum of 10 people with a learning disability or who are living with autism, mental health difficulties, physical difficulties and/or sensory impairment. At the time of the inspection eight people were living at The Wheelhouse.

At the last inspection the service was also registered to provide personal care to people who live in their five supported living houses. In November 2020 the supported living side of the service had separated from The Wheelhouse and has registered as a new location.

In March 2019, we inspected the service where we identified three breaches of regulations in relation to safeguarding people from abuse, consent and good governance. Following this inspection, the Care Quality Commission (CQC) took enforcement action by imposing a condition on the provider’s registration. This required the provider to provide CQC with a monthly report outlining actions and progress towards making the required improvements. At this inspection we found improvements had been made and we have removed the imposed condition.

We made two recommendations at the March 2019 inspection, one in relation to infection control and one relating to following our publish guidance relating to submitting statutory notifications. At this inspection we found improvements had been made.

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

People were protected from harm. Safeguarding procedures were in place and were followed by the registered manager, this included informing the local authority. The registered manager was aware of their responsibility to notify the Care Quality Commission (CQC) of significant events in line with their legal responsibility.

There were significant improvements in leadership and quality monitoring systems, with evidence of improvement actions taken in response to training, safeguarding, restrictions, risks, supervisions and incidents and audits. The provider sent monthly reports to CQC, so we could monitor progress. Effective audits were in place to check the quality of the care provision and action was taken to address any concerns.

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 were supported by staff who understood how to keep them safe. People’s risks were assessed, and staff understood how to manage risk.

People’s medicines were administered safely

Staff wore Personal Protective Equipment (PPE) in line with current guidance and promoted good Infection Prevention and Control (IPC) practice. We discussed with the registered manager about how they could improve how people maximised social distancing within the home and how people coming to the service for respite could be admitted safely. The registered manager said they would review these areas. Staff helped people keep in touch with their friends and relatives throughout the pandemic, which helped alleviate their worries. Visiting had resumed with the appropriate testing and safeguards in place to prevent cross infection.

People’s needs, and choices were assessed, and care was delivered in line with their care plans. People were supported by staff who had the required training and the skills to meet their needs. People were encouraged to maintain a balanced diet. Staff worked alongside health professionals to deliver effective care to people.

Staff knew people well and people’s care was more personalised. People were supported by kind and caring staff who respected them and promoted their dignity. People were supported by staff who promoted their independence.

People were supported by staff who understood their communication and sensory needs. People were encouraged to engage in activities of their choice. A complaints policy was in place and was followed.

People were supported by a new registered manager and staff team who were proactive in empowering people to achieve their desired goals. Staff felt supported by the registered manager and deputy manager.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care used at Covenant Care, fully maximised choice, control and independence for people with a learning disability. The National Institute for Health and Care Excellence recommends residential care ‘should usually be provided in small, local community-based units (of no more than six people)’. This service is registered for ten people with three of these people having separate accommodation with their own kitchenette and lounge area. The main shared communal area for the other seven registered beds was spacious which enabled people to move around in safety and have their own space.

Right care:

The care and support provided, met the needs of people with learning disabilities. Staff had received the training needed on how to meet the needs of people with learning disabilities and autism and had the skills they needed to provide appropriate support. A consistent staff team had been established after a period of staff turnover. This meant people received care from staff they knew and trusted.

People’s care was person centred, planned with people having choice and control over how their health and care needs were met. Care plans were focused on people’s strengths, abilities and individual goals.

Right culture:

The ethos, values, attitudes and behaviours of the registered manager, deputy manager and care staff ensured people with learning disabilities led confident, inclusive and empowered lives. Staff had the skills needed and the environment was suited to supporting needs of people with learning disabilities.

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 (report published October 2019). 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 been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Covenant Care - The Wheelhouse 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.

There were aspects of the service that did not meet the values that underpin the Registering the Right Support and other best practice guidance. The values set out in the Registering the Right Support include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Although there was evidence the service was promoting community access, some independence and inclusion, there were aspects which did not demonstrate people made choices and have autonomy over their lives.

People’s experience of using this service:

At our last inspection in July 2016 we identified the quality monitoring systems were not fully effective because they were not identifying care plan reviews had not been carried out. During this inspection we found the quality monitoring systems had not improved and were still ineffective at The Wheelhouse. The systems in place had not identified all of the concerns identified during this inspection.

People were not always protected from harm. Potential safeguarding incidents for people living in the Wheelhouse were not always reported to the local authority safeguarding team. The registered manager at the Wheelhouse was not fully aware of their responsibility to report safeguarding concerns. There were no safeguarding concerns identified at the supported living service.

The registered manager at The Wheelhouse was not aware of their responsibility to notify the Care Quality Commission (CQC) of significant events in line with their legal responsibility. The provider had failed to ensure there was sufficient oversight and governance at the service.

Risks were not always being fully managed at The Wheelhouse, and they were not always managed in a way that promoted people’s freedom, choice and control. There were risk assessments in place in relation to aspects of people’s care in both services.

Incidents and accidents were recorded by staff and reviewed by the registered managers. The registered manager at The Wheelhouse was not analysing incidents for themes and trends that might identify factors to prevent future incidents.

Some areas of The Wheelhouse were not clean on the first day of the inspection. We did not identify any concerns relating to cleanliness at the supported living service. There were enough staff to meet people’s needs and staff were recruited safely. People’s medicines were managed safely.

People’s rights were not fully protected because the correct procedures were not always followed when people lacked the capacity to make decisions for themselves at The Wheelhouse.

Some areas of The Wheelhouse were in need of updating and refurbishing. The provider had a refurbishment plan in place to address this.

Staff raised concerns about some people not always getting on at mealtimes in The Wheelhouse. The registered manager put a plan in place to address this.

People were encouraged to make food choices during a monthly review about their care. There was a good balance of different foods available to people. People were supported to access a range of healthcare professionals.

Staff received appropriate training to meet the needs of people. Staff said they felt supported by the registered managers and they received regular one to one supervision.

Interactions between people and staff at The Wheelhouse did not always demonstrate dignity, privacy and respect. Some of our observations of staff interactions at the Wheelhouse were positive. People were supported to maintain contacts with family and friends.

We saw example’s where people’s care was responsive to their needs and preferences and some areas where it was not.

Relatives commented positively about the staff team and support their family members received, they said they could visit anytime and were always made to feel welcome.

There was a complaints procedure in place. Where a complaint had been raised, this was responded to and actions implemented. Relatives felt confident any concerns they had would be addressed.

People’s feedback was recorded monthly during a one to one meeting with them. Relatives felt they were involved in their family members care.

Staff felt supported and involved. The service worked in partnership with other organisations to support care provision.

The provider listened to the feedback provided during the inspection and responded by taking immediate action and providing us with reassurances they would make improvements where required. They send us information relating to the actions they had/were taking.

We have made two recommendations, one in relation to infection control and one relating to following our publish guidance relating to submitting statutory notifications.

Rating at last inspection: Good (Report published August 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

Covenant Care – The Wheelhouse provides accommodation with personal care for up to 9 people with learning disabilities, autistic spectrum disorders or mental health difficulties. At the time of this inspection the service was in the process of seeking approval for one additional named person for the duration of their stay at The Wheelhouse.

The service also provides a supported living service to people living in their own homes in the local community. At the time of this inspection the service provided support to 10 people who were tenants in shared houses in the Wellington and Taunton areas (although many of these did not require support with personal care needs).

In the last year the management of the service has changed. The service now has two registered managers, one of whom manages the residential service provided at The Wheelhouse, and the other manages the supported living service to people living in the Wellington and Taunton areas. 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.

There were many elements of good quality assurance systems, although there were also areas where improvements could be made. The registered managers carried out checks on many aspects of the service to ensure people received a good quality of service. People were involved and consulted through questionnaires and house meetings. Care plans had been reviewed, but some monthly review dates had been missed and this had not been picked up by the provider through the quality monitoring process. The reviews did not always involve the person or their relatives or representatives.

People who used the service, relatives, staff and professionals spoke positively about the new managers. We heard about many improvements to the service since they had taken over their management roles. While our overall findings showed that people received a safe, effective, caring and responsive service, there were some aspects of the recording and quality monitoring systems that could be improved. Staff told us they had received a wide range of training, but this could not be fully evidenced by the training records we were shown. Training was also confirmed by people who used the service, for example, one person said “They are always going on courses. They are constantly expanding, learning new things as often as they can.”

The service supported people to receive a varied and balanced diet. People were involved and consulted as far as they were able in every part of the meal planning and preparation process. Staff understood each person’s likes, dislikes and dietary needs and offered people a choice of foods to suit their preferences. Those people who used the supported living service were supported to budget and plan their weekly menus and to shop, prepare and cook meals of their individual choices.

There were safe systems in place to make sure people received their medicines as prescribed. Medicines were stored safely. Records of administration had been accurately maintained. Those people who wanted to hold and administer their own medicines were supported by staff to do so safely.

Staff demonstrated a clear understanding of each person’s health and personal care needs. Care plans had been drawn up for each person and these had been improved in the last year and provided detailed information on every aspect of each person’s support needs. People were aware of their care plans, although they had not been given a copy in a format relevant to their communication needs. A member of staff described their workplace saying “It’s like home. I love the focus on the residents.”

People told us the staff were caring and supportive. Comments included “They are there to listen to us” and “They are very good,” and “It’s lovely.” One person said “We get on great” and “We have a good laugh.” They told us the staff were very caring, saying “They look out for us and we look out for them.” Comments from relatives included, “The service is caring,” and “They are very caring. Thoughtful. Good humor.” Staff spoke warmly and positively about each person.

There were enough staff to meet people’s individual needs and to care for them safely. People were protected from the risk of abuse and avoidable harm through appropriate policies, procedures and staff training. Staff told us staffing levels had improved in recent months. There was a positive, caring and happy atmosphere throughout the service. Staff told us they enjoyed their jobs and felt well supported. They gave examples of how they had helped people lead more active and fulfilling lives.

We have recommended that the service seeks guidance on ways of improving their quality monitoring systems.

At the time of this unannounced inspection there were nine people living at the Wheelhouse. Six people were accommodated in the main house and three people lived in three self-contained flat-lets adjacent to the main house. Some people could not communicate with us so we observed people's care and their interactions with staff in communal areas and in other areas, for example people's private accommodation.

The regulated activity of personal care was being provided to three people within a supported living service. CQC regulate the personal care people received but not the accommodation. We visited the three people using the personal care service. The support that people received was continuous and tailored to their individual needs. We spoke with the three people using the personal care service within supported living accommodation. People using this service told us they were very happy with the support provided to them. Comments included, 'I have no complaints about anything. They help me with my independence'; 'The staff motivate me, they help me to structure my day and get things done' and 'Staff understand me and support me well'.

On this occasion an expert by experience accompanied us on the inspection to the Wheelhouse. The expert by experience talked to people who used the service, informally observed daily life in the service and the interaction between staff and people; and looked around the premises.

The registered manager was on leave at the time of the inspection but we spoke with him on the phone during and after the inspection to clarify various issues. During the inspection we spoke with the provider, and five members of staff. We saw all of the people living at the Wheelhouse and we spoke with two people. As part of the inspection we also spoke with health and social care professionals, for example care managers, the Somerset Advocacy Service and a speech and language therapist.

Overall we found that staff had a good understanding of people's needs and preferences. The expert by experience observed, 'Residents clearly felt comfortable to tell others what they wanted or didn't want to do'. We found that people were protected from abuse as the provider had systems in place. There were sufficient skilled and experienced staff on duty to support people. Staff told us they were well supported by the training and supervision in place and that they enjoyed their job. There was a complaints system in place and people were given support to make comments or complaints where they needed assistance.

We found that the provider was meeting four of the six outcomes we inspected. We found that improvements were needed to ensure that where people did not have the capacity to consent, the provider always acted in accordance with legal requirements. We also found that people's needs were assessed but there was a risk that care and treatment was not always planned and delivered in line with people's needs.

We observed that people were offered choices throughout the day about how they wanted to spend their time and what they wanted to eat and drink.

We reviewed the care plans of nine people living at the home. We noted that each care plan had a detailed medical history of each persons mental health needs, a personal profile and information about each person's personal preferences. This ensured that people's care needs were identified and their care plan was developed in line with each persons individual care and support needs.

We observed that staff had attended up to date infection control training and were aware of the infection control policies and procedures at the home.

We observed during the day that staff were skilled at handling the challenging behaviours that were exhibited by people at the home. We saw that staff were able to engage with people in a kind and sensitive manner which ensured that people were able to participate as fully as possible in daily activities at the home.

We saw that a request had been expressed by two people at the home to go on 'big rides'. The home arranged a trip to a large amusement park and the people really enjoyed the experience.