Waterside House

Waterside House is a supported living service providing personal care to people aged 18 and over with learning disabilities and/or autism provided by Trafford Metropolitan Borough Council. The supported living service provides supported accommodation to 22 people in seven supported living accommodation properties.

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

We received positive feedback from people and their families and staff who were enthusiastic about the value of the service in people's lives. We found the provider had addressed the areas of negative feedback which were raised during our last inspection.

Significant improvements had been made following the previous inspection in October 2020, this included improvements to promote the safety and wellbeing of people and the staff who supported them. They had

enhanced their quality assurance processes, drawing from best practice guidance to provide better oversight. There was a positive focus on learning from mistakes and ensuring action was taken.

New and improved systems and processes had been introduced for the reporting and recording of issues related to safeguarding and accidents and incidents. The management team and wider staff group fully understood their individual and collective responsibilities in this area.

Staff training and the quality of risk assessments and care plans had improved. In particular, the provider had invested in developing skills and resources to ensure the staff team were equipped to provide compassionate care to people.

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.

Medicines were managed safely, and greater oversight was introduced with new medicines auditing tools.

Improvements had been made to Infection prevention control (IPC) practices. Personal Protective Equipment (PPE), hand sanitisers and posters with key messages were at the entrance to the two supported living settings we visited. Any visitors to the service had to show a negative COVID-19 test 30 minutes prior to visiting. Staff were responsible for daily cleaning of all areas of the service including frequently touched and high reach areas. All staff had completed training in infection prevention and control.

Further work was still ongoing in respect to changing the culture at the service and the provider adopted the key principles of 'Right support, Right care, Right culture'. However, a small number of staff we spoke with were not familiar with this key guidance. We have made a recommendation within the well-led section of this report.

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.

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

Significant work had commended to ensure the support people received was outcome based, to allow people to focus on goals and priorities within their life and what they would want to achieve. People are treated as individuals and care were provided flexibly in line with their preferences. The management team and staff of Waterside House shared a renewed passion for supporting people which shapes the culture across the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 7 December 2020). The provider completed a detailed service improvement 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.

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since the last inspection. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of Safe and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The rating from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

This service has been in Special Measures since October 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Waterside House is a supported living service providing personal care to people aged 18 and over with learning disabilities and/or autism provided by Trafford Metropolitan Borough Council. The supported living service provides supported accommodation to 22 people in seven supported living accommodation properties.

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

Safeguarding processes were not effective, and people were put at potential risk of harm due to the poor management of safeguarding concerns. There had been some safeguarding events at the service which had prompted us to inspect. As a result of the number of safeguarding allegations the commissioners have placed Waterside House in a temporary suspension of new admissions to the service.

The provider's initial response to concerns raised has provided a level of assurance. We have been provided with an extensive action plan following our inspection, where the provider in some cases has taken immediate action.

The provider's incident management policies and procedures were not routinely followed. Opportunities to learn from incidents were missed, due to a lack of reporting systems in place. There was a closed culture where staff were reluctant to use the provider's whistle blowing procedure.

One of the supported living settings we visited we found two potential hazards to the environment. Risk assessments concerning these environmental risks had not been completed to minimise risks to people.

The providers approach to COVID-19 was inconsistent. The risk to staff and people using the service from COVID-19 had not been adequately assessed in a timely manner, with measures introduced to reduce the risk. The use of face masks to be worn by staff had only recently been introduced and key internal policies and procedures had not been devised in a timely manner to support to prevention of COVID-19 entering people’s homes. Shortly after the inspection safe systems were implemented.

The management of the service was not cohesive. The organisational structure was not followed, and reporting lines were unclear. Systems were disorganised and audits we requested had not been forthcoming in a timely manner due to this. The service was unable to demonstrate any analysis of themes and trends or how learning was shared with the staff team to ensure continuous improvement. The provider was looking to recruit a quality assurance manager that would support the service with the necessary improvements.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. There was a poor staff culture within a small number of the supported living settings which meant people were vulnerable to the risk of safeguarding incidents. Whilst the management team had completed some investigations into concerns about this culture, not all allegations were investigated appropriately or reported to the senior management 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 rating at the last inspection was good, the report was published on 6 December 2019. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Waterside House on our website at www.cqc.org.uk.

Why we inspected

The provider contacted us to state they had raised several safeguarding concerns, some of which had not been reported in a timely manner. As a result, we undertook a focussed inspection to review the key questions of safe and well-led only.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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.

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 how the service is managed, how safe people are at this service, and staff knowledge and practice.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We requested an action plan from the provider, which was promptly provided and detailed 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as

inadequate for any of the five key questions, it will no longer be in special measures.

Waterside House is a supported living service providing personal care to people aged 18 and over with learning disabilities and/or autism provided by Trafford Metropolitan Borough Council. The supported living service provides supported accommodation to 18 people in five supported living accommodation properties.

The service has been 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. The service supported people with learning disabilities and/or autism in line with these principles.

People lived in a houses that were situated in a residential area close to the town centre. The house fitted into the residential area and other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

The registered manager had a clear vision for the service to deliver individualised care and support. They were supported by an experienced staff team who were appreciated by people who used the service and their relatives

Risks were minimised and risks to people were identified and when needed a risk plan was in place. Staffing numbers were sufficient to meet people's needs. This meant people were supported safely. People told us they felt safe living at the service.

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 treated with respect and kindness and their privacy and dignity was upheld. People were involved in the planning and review of their care. Care and support plans were being reviewed to ensure they were reflective of people's needs.

There were systems in place to assess, monitor and improve the quality and safety of the service. The provider had recognised the need to make the medication audit more robust. Staff described the registered manager and other senior staff as supportive and approachable.

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 May 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.

When we last inspected the service on 05, 06 and 09 September 2016 we found the service was not meeting the required standards. At that time we rated the service as inadequate for well-led, with an overall rating requires improvement. At this inspection we found a number of improvements had been made by the provider.

Waterside House consists of two distinct service types: reablement service and supported living service provided by Trafford Metropolitan Borough Council. The delivery of the service was split into four geographical areas: Stretford and Old Trafford (north). Urmston, Flixton and Partington (west). Altrincham, Bowden, Timperley and Hale (south). Sale, Sale Moor and Ashton-on- Mersey (central).

The reablement service is designed to help people recover from a period of serious illness or injury which may have resulted in hospital treatment. The service provides a range of rehabilitation, care and support services for up to six weeks. At the time of our inspection 12 people were receiving the reablement service. The provider was in the process of closing the reablement service and no new admissions were being taken at the time of our inspection.

The supported living service provides supported accommodation to adults with a learning disability who require access to 24 hour support. 17 people received this service in six supported accommodation properties.

At the last inspection there had been no registered manager for approximately twelve months. We found there were no clear arrangements in place to determine who had overall responsibility for ensuring effective systems to assess, monitor and drive improvement in the quality and safety of the service. At this inspection we found vast improvements had been made, a registered manager was now in place and had a clear overview of the reablement and supported living service.

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 registered provider was now working within the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards in Domestic Settings (DoLSiDS). Staff sought consent to care from people they supported. Staff were now aware of the principles of the MCA and DoLSiDS. and how to support people effectively.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning.

There were appropriate procedures to safeguard people and the staff were aware of these. During discussions with the registered manager they were conducting a full disciplinary investigation, due to an allegation made towards a staff members conduct. We will review this safeguarding outcome once this has been investigated.

Staff were extremely caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person receiving the supported living service. People had developed very positive relationships with staff and there was a friendly and relaxed atmosphere.

Staff expressed confidence in the management team and in each other. There were regular staff meetings where staff could contribute their views.

Records showed the service acted upon the written complaints it had received in accordance with their complaints policy.

Information was available to staff about how to support people with their medicines and all staff had been trained in how to administer medication. Checks had been carried out to ensure people had received their prescribed medicines safely.

There were systems in place to ensure risks to people's safety and wellbeing were identified and addressed.

People's needs were assessed and care was planned to meet these needs. People's needs were reviewed throughout the time they received the service so future plans could be made if necessary if the person required longer term support and care.

Effective recruitment and selection procedures were in place and we saw appropriate checks had been undertaken before staff began work. This meant staff employed were suitable to work with vulnerable people.

The provider had arrangements in place to receive feedback from people who used the service and their relatives about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service

Records showed people had access to GPs, chiropodists and other health care professionals (subject to individual need).

Waterside House consists of three distinct service types: assessment and reablement service, rapid response service and 24 hour supported living service provided by Trafford Metropolitan Borough Council. The delivery of service was split into four geographical areas: Stretford and Old Trafford (north). Urmston, Flixton and Partington (west). Altrincham, Bowden, Timperley and Hale (south). Sale, Sale Moor and Ashton-on-Mersey (central).

The assessment and reablement service is designed to help people recover from a period of serious illness or injury which may have resulted in hospital treatment. The service provides a range of rehabilitation, care and support services for up to six weeks. The rapid response service works alongside the assessment and reablement service and provides short-term intervention (of up to 7 days) to people in a ‘crisis’ situation. The cause of this may be due to carer breakdown, a fall, sudden illness or a change in situation. At the time of our inspection 53 people were receiving the reablement / rapid response service.

The 24 hour supported living service provides supported accommodation to adults with a learning disability who require access to 24 hour support. 18 people received this service in six supported accommodation properties.

At the time of the inspection there was not a registered manager at Waterside House.

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.

During this inspection visit we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to MCA and DoLS, training, complaints and quality assurance and auditing systems. We are considering our options in relation to enforcement for some of these breaches of the regulations and will update the section at the back of this report once any action has been concluded.

Due to there being no registered manager for approximately twelve months, we found there were no clear arrangements in place to determine who had overall responsibility for ensuring effective systems to assess, monitor and drive improvement in the quality and safety of the service.

The registered provider was not working within the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff sought people's consent before providing care but people's capacity to make their own decisions was not assessed when needed. Some people were being deprived of their liberty to keep them safe but applications had not been made to ensure this was formally and legally agreed to be in their best interests.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. There were however, gaps in first aid; MCA and DoLS; fire safety; and infection control.

We saw a record of complaints dated 2009 had been recorded on file, but recent complaints had not been recorded to show how the provider had engaged with the complaint or ensured that it had been resolved to the person’s satisfaction. The registered provider had no system in place to log and analyse complaints and concerns to enable lessons to be learnt.

Information was available to staff about how to support people with their medicines and all staff had been trained in how to administer medication. Checks had been carried out to ensure people had received their prescribed medicines safely. However, we found some medicines assessments contained conflicting information.

Feedback received from people using the service was generally complimentary about the standard of care provided.

There were appropriate procedures to safeguard people and the staff were aware of these.

There were systems in place to ensure risks to people's safety and wellbeing were identified and addressed.

People's needs were assessed and care was planned to meet these needs. People's needs were reviewed throughout the time they received the service so that future plans could be made if necessary if the person required longer term support and care.

Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role. There were sufficient staff employed to meet the needs of each individual living at the service. Staff did not start work until checks had been made to make sure they were suitable to support people and keep them safe.

Records showed that people had access to GPs, chiropodists and other health care professionals (subject to individual need).

We found that the home was properly maintained to ensure people's safety was not compromised.

Organisations registered with the CQC have a legal obligation to notify us about certain events. This would include the resignation of the former manager who had been left for almost 12 months.

We also found the registered provider failed to notify CQC concerning safeguarding incidents.

We found all people using the service gave written consent and agreed to their reablement package at the outset of their care.

Reablement plans were person focused and were individual to the persons needs and had time scales for achievement of goals within them that were specific to the person.

All staff working within the service had been recruited via a robust recruitment process that ensured all relevant checks were carried out before the person started their role.

Waterside House had a robust quality assurance system in place to monitor the quality of the service delivered to people accessing the service.

We saw evidence of a robust complaints policy being in place managed by a complaints co-ordinator. People who accessed the service were given a copy of the complaints and compliments process when they started with the service.

People who used the service told us; "They are great they encourage me to do things but support me if I can't quite manage yet. They always ask what I am willing to try today and when they ask so nicely how can you not try?". "They are a great support to me I shall be sorry when I no longer need them".