Wellington House

Wellington House is a residential care home providing personal care to up to 10 people who have a learning disability or autism and/or have mental health support needs. The service is provided within one adapted building based in a residential area. At the time of the inspection 10 people lived there. Three people using the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People told us they were happy living at the service. However, we identified areas where people’s support needed to be improved.

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.

Based on our review of the key questions Safe, Caring and Well-led: The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence.

People were supported to express their views and make decisions about their care. People were supported to be independent and undertake tasks for themselves.

Right care:

• Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. For example, staff did not always follow people’s care plans to support people to make day to day choices.

Where incidents and accidents had occurred, they were not always well recorded or reported to the manager. Incidents where not always investigated to determine if there were safeguarding concerns. Action had not always been taken following incidents to reduce the risk of them re-occurring.

Staff knew how to support people. However, people’s care plans were not always up to date. Staff were not always aware what was in people’s care plans.

People’s privacy was respected.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives.

Staff did not always demonstrate a respectful approach towards people. For example, we had concerns about how some staff spoke or had written about people.

The registered manager had identified some issues in relation to staff culture, but these had not been quickly addressed. Checks on the quality of the service had not always been effective in leading to improvements.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Equipment used to support people with their medicine had not always been calibrated to ensure if was working effectively. Medicines were stored correctly, and administration records were completed. There were enough staff to keep people safe. The provider was recruiting more staff as people were not always receiving their one to one support hours.

Staff had not always been well supported after incidents where incidents may have resulted in staff being hurt. The registered manager was aware of their responsibilities under duty of candour and worked in partnership with other services. However, incidents were not always shared with partners. Safeguarding incidents were not always reported to CQC when they needed to be.

People were protected from the risk of infection.

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 insert date (published on 17 December 2020).

Why we inspected

We received concerns in relation to the culture at the service. As a result, we undertook a focused inspection to review the key questions of safe, caring 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 changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 Wellington House 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 in relation to safeguarding people from abuse, treating people with dignity and respect, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Wellington House is a residential care home providing accommodation and personal care for up to 10 people. People living at the service had a learning disabilities and some people had additional mental health needs. There were 10 people living at the service at the time of the inspection.

Each person had their own bedroom and one person had a flat within the main building. The communal areas included a lounge and lounge/diner.

People’s experience of using this service

People continued to be supported by sufficient numbers of staff. The provider had assessed safe minimum staffing levels in the event that there was a reduction in staff available. Staff were recruited safely and checked to ensure they were suitable to work at the service.

Staff knew how to recognise and protect people from harm or abuse. They were aware of the safeguarding procedures and who to report to if they had any concerns. They were clear about whistle blowing procedures and were confident they would use them if they needed to.

Risks associated with people's care continued to be assessed and measures were in place to reduce the risks so people could lead their lives in a way they wanted. Accidents and incidents were recorded and analysed to look for patterns or trends and adjust people's care and support to ensure they were as safe as they could be.

People were supported to take their medicines as prescribed by their doctor. They were encouraged to take their medicines as independently as they could.

The registered manager had been in post since March 2020 and had experienced a challenging time due to the pandemic. The registered manager was open and honest about things that could have gone better and lessons learned. There had been a change in the staff team which staff reported had improved the atmosphere in the service. People, the registered manager and staff were relaxed in each other’s company.

Checks and audits of the service continued to be robust and any shortfalls were identified and actioned. This ensured the service provided consistent, high quality, personalised care.

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.

We did not review all aspects of Right support, right care, right culture as the inspection only looked at Safe, and Well-Led. In the areas we covered in the inspection we found the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People’s independence was promoted through encouraging people to do things for themselves. People washed and dressed themselves with minimal support. Some people administered some of their medicines and checked their blood sugar levels. Staff took time to explain things to people so they were involved in their care. During the inspection people were treated with dignity and respect. There was clear leadership and values to treat people as equals which was disseminated to the staff team. This could be seen through animated conversations with people and staff and the exchanging of jokes.

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 19 September 2017).

Why we inspected

We received concerns in relation to reporting safeguarding incidents, staffing levels and the overall management of the service. We also looked at infection prevention and control measures as part of CQC’s response to care homes with outbreaks of coronavirus. 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 Good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wellington House 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.

Wellington House is registered to provide accommodation and personal care for up to 10 people. People living at the service had a range of learning disabilities and mental health needs. Some people required support with behaviours which challenged. There were 9 people living at the service at the time of the inspection.

Downstairs there was a kitchen, dining room, lounge and several bedrooms. There was also a toilet and washroom. There were other bedrooms split over the remaining two floors. At the time of the inspection there were nine people living at the service.

The registered manager left the service on 31 March 2017 but had not been managing the service for some time. An acting manager had been running the day to day service for over a year. A new manager had been appointed and was in the process of applying to become the registered manager of the service. They were due to start at the service in September 2017. 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.

At the last inspection a requirement notice was given as staff had not responded to people’s health care needs in a timely manner. Recommendations were also made to improve the storage and administration of medicines, to give people the opportunity to share their views with staff and regular staff team meetings were not being held.

At this inspection improvements had been made and the requirement notice was complied with, the recommendations implemented and areas of improvement made.

Staff were monitoring people’s health care needs in a timely manner and sought the necessary health care advice when people needed further medical attention. All appointments were clearly recorded and followed up with the outcome of the visit.

Medicines were administered safely, with improvements to the storage and the way staff transported the medicines. Staff supported people to be involved with their medicines and take them as independently as they could.

Team meetings had been held on a regular basis and people had individual opportunity to feedback with the support of their key worker to ensure they had the opportunity to formally share their views.

Improvements had been made in the system to ensure that staff were aware of people’s changing needs. They signed and dated the information in the communications book to show they had read about the changes.

People told us that staff were around when they needed them. Staff told us they were flexible when it came to cover for absent colleagues and the shifts were covered by permanent staff. There was sufficient staff to enable people to access the activities they wanted to do or attend health care appointments.

Staff were recruited safely and checked to ensure they were suitable to work at the service. Ongoing training ensured that staff had the skills and competencies to perform their roles. Each staff member had an annual appraisal to assess their performance and identify any further training needs. Staff told us they were supported by the management team and had regular supervision to discuss the service and any concerns they may have.

Risks associated with people’s care had been assessed and measures were in place to reduce the risks to enable people to lead their lives in a way they wanted.

Accidents and incidents were recorded and analysed to look for patterns or trends and adjust people’s care and support to ensure they were as safe as they could be.

Checks were made on the premises to ensure it was safe. Regular health and safety checks were made on equipment and the environment to ensure it was safe. The systems in place to reduce the risk of fire were checked and regular fire drills were carried out.

Staff were able to tell us how they would recognise and protect people from harm or abuse. They were aware of the safeguarding procedures and who to report to if they had any concerns. They were clear about whistle blowing procedures and were confident they would use them if they needed to.

Staff understood the importance of people being supported to make their own decisions. They had knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. There were no DoLS in place and people were able to come and go as they pleased.

People told us they enjoyed the food and how staff supported them with their meals. People were encouraged and supported to prepare their meals and were involved in the menu planning. When people had special dietary requirements such as vegan or conditions like diabetes they were supported by staff to manage their diet effectively.

Staff were kind and caring. They took time to listen people and what they wanted. They spoke to people discreetly and confidentially when people indicated they wanted to speak with them privately. People were treated with dignity and respect and staff closed doors it they needed to speak with them confidentially.

People received personalised care which was regularly updated to reflect their changing needs. Before people moved into the service they were provided with appropriate information about the service. Where appropriate their relatives had been involved in planning their care.

People had a range of activities to choose from in line with their wishes. They were supported to change the activity if they changed their minds and encouraged to do something of their choice. People regularly attended social clubs, went shopping and ate out in restaurants and cafes in the local area.

There was a complaints procedure in place in a format that people could understand. There had been no complaints since the previous inspection.

Staff told us they thought the service was well led. They said the management team listened and acted on what they said. There was a homely, open and inclusive atmosphere in the service where people, staff and management were relaxed in each other’s company.

The Care Quality Commission (CQC) had been informed of any important events that occurred at the service, in line with current legislation.

The checks and audits of the service were robust and any shortfalls were identified and action. This ensured the service provided consistent, high quality, personalised care.

People, their relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service and continually improve the service. These results were summarised and any areas of improvement were identified and actioned.

There was an out of hours on call system in operation that ensured management support and guidance was always available when required.

Wellington House is registered to provide accommodation and personal care for up to 10 people. People living at the service had a range of learning disabilities and mental health needs. Some people required support with behaviours which challenged.

Downstairs there was a kitchen, dining room, lounge and several bedrooms. There was also a toilet and washroom. There were other bedrooms split over the remaining two floors. At the time of the inspection there were nine people living at the service.

The service had a registered manager in post; however, they were not currently in charge of the day to day running of 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. There were two deputy managers running the service and the area manager was based at the service regularly to offer them support.

The staff had not sought the necessary health care advice when a person had become unwell. Their condition deteriorated significantly. Staff had not recorded what action they had taken, if any and had not responded to the situation by seeking medical advice.

There had been no team meetings for the staff for a period of six months. People had not consistently had an opportunity to formally share their views with staff. The deputy manager said they had identified these shortfalls and was ensuring meetings were happening now.

Medicines were administered safely but improvement s were needed. The security of medicine storage could be improved. Staff transported medicines to people in open pots and there was a risk the medicine could be spilled. People were supported to be as independent as possible with their medicines.

Staff used a variety of methods to communicate about people’s changing needs. A communication book was used to share important information about the service and people. Staff signed this book when they had read it, but did not date it so it was difficult to tell when they were aware of new information.

Staffing levels were flexible depending on the needs of people and what was happening that day. Staff regularly covered shifts if colleagues were unwell or not in work. People were able to access the activities they wanted and any appointments as necessary. Staff were checked to make sure they were of good character and suitable to work with people.

Risks relating to people’s health, their behaviour and other aspects of their lives had been assessed and minimised where possible. Staff completed incident forms when any accident or incident occurred. Incident forms were collated and analysed to identify any pattern to check if people’s support needed to be adjusted. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were carried out.

Staff knew how to recognise and respond to abuse. The deputy managers and the area manager had reported any safeguarding concerns to the local authority and these had been properly investigated.

Staff had received induction, training, support and supervision to support people effectively. Staff had up to date knowledge on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. There were no DoLS in place and people were able to come and go as they pleased.

People were supported to eat healthily. They were involved in planning and preparing meals. When people had conditions like diabetes they were supported by staff to manage their diet effectively.

People and their relatives said that staff were kind and caring. People were treated with dignity and respect and had their own keys so they could lock their bedrooms when they were not there.

Staff were responsive to people’s needs. Before people moved into the service a detailed assessment was carried out and staff added to this as they got to know people better. There were behavioural support plans in place outlining potential triggers for behaviour that challenged and different strategies to deal with them. These were being followed by staff.

People accessed a variety of activities both inside and outside of the service. People regularly attended social clubs, went shopping and ate out in restaurants and cafes in the local area.

There was a complaints policy in place and people’s relatives said they knew how to complain if they needed. There had been one complaint in the past year and this had been documented and investigated fully. Staff and relatives told us they thought the service was well led. The Care Quality Commission (CQC) had been informed of any important events that occurred at the service, in line with current legislation.

The management team regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care. People, their relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. The results of these surveys were collated and any areas of improvement were identified and actioned.

There were breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. We are considering what action to take.