Archived: Disabilities Trust - 25 Welby Close

Disabilities Trust - 25 Welby Close is a care home without nursing. The service supported three people with learning disabilities or autism. The service is situated in a quiet residential area of Maidenhead, Berkshire. The house has two

floors.

The service was not always 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 did not always receive 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

There were not always clear safeguarding systems in place to protect people from risk of abuse.

It was evident where a safeguarding incident had occurred, the management team had not always followed their policies and procedures and informed the local authority.

Risks to people were not always managed safely. People’s risk assessments were not reviewed on a regular basis to ensure they were kept up to date and reflected any changing needs.

Risk assessments were not person centred. All care files contained risk assessments for people which were all initially scored as medium risk. There was no clear matrix or scoring tool to help staff determine what risk rating the assessment should be scored.

Required staff recruitment checks including criminal checks with the Disclosure and Barring Service were carried out. However, the management team could not always evidence they had taken a full employment history of staff. We could not be assured staff were been supported by people who had undergone the appropriate employment checks.

Medicines were not always managed safely by the service. For example, where people were prescribed 'as required' (PRN) medication, the service did not always have protocols or guidance in place to ensure that staff knew when to administer PRN medicine.

We recommended the provider consider current legislation related to the safe management of medicines and update their practice accordingly.

The management team used systems and processes to monitor quality and safety in the service. However, We identified some inconsistencies in record keeping that had not been identified from their quality assurance processes

Services registered with Care Quality Commission (CQC) are required to notify us of significant events, of other incidents that happen in the service, without delay. The management team had not consistently notified CQC of reportable events within a reasonable time frame. Three incidents had been identified as being unreported.

People had an autism profile in their care files that clearly highlighted their social, physical, communication and sensory needs to help guide staff when engaging with people.

People were involved in decisions about the decoration of their rooms. All bedrooms were personalised and set out in the way that people wanted. All people had their own bathroom facilities to use.

All people had communication profiles so that staff could clearly see how a person liked to be supported.

People’s individual care and support needs had been assessed, with assessments in place for areas such as mental capacity, medication, communication and interaction profile.

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.

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 28 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive, effective and well led sections of this full report.

Enforcement

We have identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breach in regulation 12 (Safe care and treatment), regulation 13 (Safeguarding service users from abuse and improper treatment), regulation 16 (Receiving and acting on complaints), regulation 17 (Good governance) and regulation 19(Fit and proper persons employed). We found one breach of the Care Quality Commission (Registration) Regulations 2009. This was a breach regulation 18 (Notification of other incidents).

At the last inspection, the service was rated good.

At this inspection we found the service remained good.

Why the service is rated good:

People were protected from abuse and neglect. The service had good assessment, mitigation and documentation about risks to people. This helped prevent people from any harm. There were enough staff deployed to ensure people’s care was safe.

Staff received appropriate support to perform their roles. The service was compliant with the Mental Capacity Act 2005. 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.

We found the staff were kind. We saw that staff listened to what people had to say and held meaningful conversations with them. People’s right to privacy was respected and staff demonstrated dignity in the care they provided.

We found care plans were person-centred and contained appropriate details. People’s preferences, wishes and aspirations were identified and documented. Staff helped people to have an active life in the community.

The service had a positive workplace culture. There was good oversight of the service’s care from the registered manager and the provider’s representatives. The provider ensured that the quality of the care was regularly assessed. Where care to people could be improved in any way, the provider made appropriate changes to enable this.

Further information is in the detailed findings below.

Care was individually planned and specific to the person using the service. People's consent was sought before care or treatment was given. However, the provider may wish to note that the staff had not received any training in the Mental Capacity Act as this was not part of the mandatory training programme.

The premises were clean and tidy and there were arrangements in place to ensure that regular safety and maintenance checks were carried out.

Staff received regular supervision sessions and annual appraisals from their manager which allowed them to identify training and support requirements. We found care workers received training which the provider considered mandatory and training records were up to date.

The provider may wish to note that at the time of our visit there was no registered manager for the service. We were told the provider was making arrangements for a manger to register with the Commission.

The provider promoted people gaining skills for independent living. We saw one person had completed courses in cooking, gardening and living skills. Staff told us they encouraged people to then use the skills they learned in supporting themselves in the home.

We observed an individualised activities plan for one person. The plan contained a variety of activities the person liked to do including evening drama classes, visiting the day centre and shopping. One person was out on a walk to the local nature reserve when we visited.

At our previous inspection, we found the provider did not have adequate records regarding agency staff, which placed people using the service at risk. We found the provider had made improvements to ensure they had the right information on file about all staff who worked at the home.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.