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Inspection carried out on 21 October 2020

During an inspection looking at part of the service

About the service

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 inspecti

Inspection carried out on 18 November 2019

During a routine inspection

About the service

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.

Inspection carried out on 2 May 2017

During a routine inspection

This inspection was announced and took place on the on 02, 03 and 04 May 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service to ensure the registered manager would be available for our inspection.

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 admi

Inspection carried out on 5 September 2016

During a routine inspection

This inspection was announced and took place on the on 05, 06 and 09 September 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service to ensure the registered manager would be available for our inspection. The last inspection took place on 04 February 2014 and the provider was compliant with the regulations we checked.

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 bee

Inspection carried out on 1 November 2013

During a routine inspection

We found Waterside House had approximately 150 people currently accessing the reablement service with 129 front line staff 114 working a variety of hours to meet their care needs. The reablement package which is a short term intervention was available for up to six weeks following discharge from other care environments.

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".

Inspection carried out on 26 June 2012

During a routine inspection

We spoke with two people who use the service. They told us that the staff were helpful and supportive.

People told us they were happy with the care they received and had no concerns. They also told us they were kept involved in the review of care plans.