19 November 2014
During a routine inspection
This was an unannounced inspection, carried out on 19 November 2014 and was carried out by two inspectors over one day. One of the inspectors had specialist knowledge of people with learning disabilities, who may also have behaviours that challenge and communication needs
The service was incorrectly registered with the Care Quality Commission. Their registration stated they were providing accommodation and nursing or personal care in a further education setting. This was not the case; the service was not a further education setting. The service was also registered to provide a diagnostic and screening service when they were not providing this service. The provider is in the process of resubmitting their registration to correct this and this is being dealt with outside of the inspection process.
Westcliffe House provides accommodation, care and support for up to 14 younger adults with learning disabilities and hearing impairments. The service is a large period house divided into self-contained flats. The flats are arranged over three floors and there is a lift to assist people to get to the upper floors. There are two four bedroomed flats, one two bedroomed flat and four one bedroom flats. There were 11 people living at the service at the time of our inspection.
This service is provided by the John Townsend Trust. Concerns had recently been identified about another location managed by this provider so we went and inspected this service to make sure people were receiving safe, responsive and effective care and support.
During the inspection we met all the people who lived at the service and spoke with four people. We also spoke to four staff, the team leader and the registered manager of the service. The registered manager had been working at another of the provider’s locations for several months but visited the service to support the staff during the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
We observed care and support in communal areas, spoke to people in private with the help of a British Sign Language (BSL) Interpreter, and looked at care and management records.
The service had a registered manager, however they had been working at another of the providers services for several months and were not working at the service every day and so were not in day to day charge of the service. Staff were able to contact the registered manager by telephone and told us that they felt supported by her. A team leader who had worked at the service for several years and knew people and staff well was managing the service in the registered managers absence, they were supported by the registered manager.
People and their relatives were not asked for their views about the service they received. The complaints procedure was not provided to people in a format that they could understand. The provider had not taken action to understand people’s experiences of the service and then correct any shortfalls. People were involved in the running of the service on a day to day basis including helping with the cooking and cleaning.
People were not always protected against risks associated with the management of medicines. Checks on medicines had not been completed and the shortfalls we found had not been identified by the service.
There were sufficient staff on duty to meet people’s needs. Vacancies had been covered by staff people knew, however staff were not given enough time to complete all of their duties including management tasks which had previously been the responsibility of the registered manager. Recruitment checks had been completed to protected people from staff who were unsuitable to work at the service. Staff were able to identify signs that people may be at risk of abuse and knew how to inform the provider and other organisations about potential abuse.
Staff did not have all the skills they needed to meet people’s needs. The provider had not ensured that staff had completed training and qualifications to the level they required.
Records of people’s weight and other health records were not kept at the service. There was a risk that information was not available to staff and changes in people’s needs would not be recognised. People’s care and support was planned with them and provided to develop their independence and to keep them safe.
Staff supported people to make choices in ways they could understand, including meals, snacks and drinks. Staff knew about people’s religious choices. However, some religious and cultural needs were not met and the service had not considered how they could support everyone. Capacity assessments had been completed for decisions relating to people leaving the service only and there was a risk that people would not be supported to make decisions for themselves. People were not unlawfully deprived of their liberty.
People told us that they liked the staff and liked living at the service and were relaxed in each other’s company. Staff knew people well and encouraged people to be as independent as they could be. People were supported to manage their behaviour to keep themselves safe. People and staff communicated using speech and sign language. Staff listened to people and checked to make sure that they had understood.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the management of medicines, not assessing and monitoring the quality of the service and not having a complaints process that people could understand. You can see what action we told the provider to take at the back of the full version of this report.