Wansbeck House

Wansbeck House is a care home for up to eight younger adults who have a learning disability and complex physical care needs. It is a self-contained flat on the second floor of a building which is part of the Percy Hedley Foundation. People used Percy Hedley facilities on-site, including educational facilities, as well as the provider's nearby college. At the time of this visit there were six people using the service on a permanent basis and one person on a respite basis.

The service had been developed in line with the principles and values that underpin Registering the Right Support. The registered manager and new manager demonstrated a keen awareness of this and other best practice guidance, and ensured the service was in keeping with such guidance as was practicable given the setting of the service. They had reduced the maximum occupancy from ten to eight and converted bedrooms into a chill out room and a bathroom.

The principles of Registering the Right Support 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 was appropriate and inclusive for them. People were able to live as full a life as possible and achieve the best possible outcomes. The service was geared towards helping younger adults develop independence alongside completing full time education courses.

The home was personalised and relaxed, with good communal and private spaces. It had been developed to meet people’s needs.

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

People interacted comfortably and in a trusting fashion with staff. Staff knew people’s needs well and helped keep people safe. Staff understood their safeguarding responsibilities and practicalities as they supported people at home and to their daytime activities.

The premises were well maintained and clean throughout.

Risk assessments were detailed and focussed on what people could do with support, rather than what they couldn’t do. People achieved good levels of independence and new experiences through this approach.

All relatives were confident in staff and their ability to keep people safe. Staffing levels were safe.

Meals were prepared and enjoyed communally. Staff helped people patiently and shared positive and jovial interactions where appropriate.

Staff worked well with a range of external healthcare professionals to ensure people’s needs were met and keep documentation up to date.

Staff received training regularly and to a high standard. They had been trained in a number of topics that enabled people to be more flexible with their time and activities. Staff were well supported through formal supervision and ad hoc support. Morale was high.

People's needs were comprehensively assessed and reviewed. Staff communicated clearly with people using detailed understanding of their needs and assistive technology.

Activities were flexible and planned based on people’s interests. There was a balance of group and individual activities.

Relatives and staff felt the service was well-managed, with a smooth transition from the registered manager to the new manager. The registered manager had moved into a regional oversight role so still liaised regularly with the new manager.

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. The culture was in line with the provider’s ethos of providing younger adults with the skills to be more independent and to enjoy the experiences of living with their peers and a supportive, encouraging staff team.

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 23 August 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.

Wansbeck House is part of the Percy Hedley Foundation. On the college campus there is residential accommodation for a maximum number of 10 people who have a learning disability and complex physical care needs. People who used the service also accessed the college facilities during the week. At the time of our inspection there were five people using the service.

The service did not currently have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was still working for the provider and a new manager had been in post for four weeks and was applying to be registered with CQC.

At our last inspection on 16 December 2016, we rated the service as Requires Improvement. There was a breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On this visit we found all regulations had been met and the service was rated as Good.

On our last visit we found there was not a robust quality assurance system in place. On this visit we saw staff did stock checks on medicines and counted to make sure medicines tallied through an audit process. We also saw a monthly management audit that checked staffing, care plans, health and safety and the environment.

The provider had undertaken quality surveys with people who used the service, their families and staff members as part of the quality improvement programme. We saw people were actively involved in choosing activities and menus.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met and nutritional screening was now in place.

People were supported to maintain good health and had access to healthcare professionals and services. People had hospital passports now in place and staff we spoke with were knowledgeable about people’s health needs and how to seek medical assistance if needed. Hospital passports provide an easy reference guide to record people's health and communication needs that can go with them in case of emergency.

Staff demonstrated a good understanding of safeguarding and the provider’s whistle blowing procedure. This included knowing how to report concerns.

Health and safety checks were completed regularly to help keep the building safe. Up to date procedures were in place to ensure people continued to be supported in emergency situations.

Staff told us they were well supported and trained appropriately.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s needs had been assessed and personalised care plans developed. These were reviewed to accurately reflect people’s current needs.

There was a clear complaints process in place.

We received positive feedback about the manager and staff said they were approachable. We also saw lots of positive feedback about the service from family members.

Staff were able to provide feedback about the service and people’s care. For example, through attending staff meetings and one to one supervisions.

Percy Hedley College is part of the Percy Hedley Foundation. On the college campus there is residential accommodation for a maximum number of 10 people who have a learning disability and complex physical care needs. People who used the service also accessed the college facilities during the week.

The home had 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.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. We saw that the registered provider completed an annual health and safety audit in November 2015, however no other formal health and safety audits took place at other times. Infection control audits were not completed. Care record audits were not completed. This meant that the service did not have the appropriate audit documentation in place to effectively monitor quality.

Staff did stock checks on medicines and counted to make sure medicines tallied, however no other formal auditing in respect of medicines was completed. The registered provider failed to identify that medicines had not been written up from a current prescription, that PRN [as required] protocols were not in place and that the temperature of the room in which medicines were stored was not taken and recorded to ensure that medicines were stored at safe temperatures.

The registered manager had not sought the views of people who used the service and relatives in the way of an annual survey since June 2014.

Parents we spoke with during the inspection told us they felt listened to but thought there should be a forum in which parents meet with the registered manager to share their views and ideas. At the time of the inspection there were not any formal relatives meetings.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Head of Adult Residential Services visited the service on a regular basis and from November 2015 introduced a quarterly audit to monitor the quality of the service provided. This audit links to the registered provider’s organisation wide Quality Framework, which is updated monthly.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. At the time of the inspection people had not been weighed on a regular basis and staff had not undertaken nutritional screening of people.

People were supported to maintain good health and had access to healthcare professionals and services. People did not have hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital. The registered manager contacted us after the inspection and told us they had commenced work on hospital passports.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing [telling someone] and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. However many of the residential services checks were mixed in amongst the main college checks which made it difficult to see at a glance that service checks were up to date. The registered manager told us after the inspection they were to take control of the storing of such records and in future they would be kept separate from the main college campus.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Care records had been personalised to each individual and covered areas of risk such as scalding, behaviour that challenged and moving and handling. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision twice yearly. Staff told us they had an annual appraisal; however records were held centrally in the main college which meant we were not able to see these.

One recently recruited staff member told us they had gone through induction; however records of this induction were not available for inspection. Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People told us that there were enough staff on duty to meet people’s needs. The registered manager understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful and patient with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw people’s care plans were very person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People and relatives said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

We saw that staff provided what was required by the people who used the service in a way that demonstrated their knowledge of each individual's needs. We spoke with the four staff on duty and the manager. All the interactions we observed between the staff and the people who used the service were open, respectful and courteous.

Staff supported people to make choices about their food and supported them to get ready as they went to classes.

Each person had their own bedroom which was personalised. We saw the provider had made suitable adaptations to meet people's physical needs. We observed that staff respected people's privacy and knocked before they entered their rooms. We saw that the people who used the service related well with the staff. We saw that the staff communicated well and appropriately with people in a way that was easily understood.

The manager had carried out a survey of the relatives of people who used the service. In the survey everyone said that the care at the home was very good and one person commented, 'My daughter has loved being a resident at Percy Hedley College. She has had fun, laughter and has learned to live away from home'.

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Other people we spoke to told us they were very happy at Percy Hedley College and that they felt well supported by the staff.

'I like it here, I also like activities outside.'

'It's alright here.'

We found that people who used the service had their care and welfare needs met.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that people's views were important and listened to by the staff. We found that there was an effective complaints system in place.