The Waves

Staff had received training in safe infection, prevention and control, (IPC), practices and their competencies regularly checked. Personal protective equipment, (PPE), such as gloves, aprons and masks, were in good supply and used in line with government guidance.

The staff team, were fully engaged in both the COVID-19 vaccine and testing programmes.

A relative told us their loved one was safe and well cared for. They were confident the home was doing all it could to minimise the risk of a COVID-19 outbreak. They understood the importance of wearing masks to prevent the spreading of infection.

The service communicated well with relatives so they were aware of what was expected as per current Government guidelines. The service sourced objects of reference and pictures to explain the pandemic and why staff needed to wear PPE and would not be fearful of it.

Family, friends and professionals visiting the service were required to carry out a rapid lateral flow devise test on the day and were issued appropriate PPE. Professionals and contractors were also required to evidence they had been vaccinated or had an exemption.

Risks assessments had been completed for outings away from the home and when receiving visitors. Risk assessments demonstrated that government requirements were being met whilst ensuring people’s rights and freedoms were upheld.

The premises was visibly clean and in good order. We saw cleaning schedules included regular cleaning of touch points around the home, such as door handles and light switches. Appropriate disposal arrangements were in place for clinical waste.

Policies and procedures were in line with current government guidance and used to inform staff, people and their families. Governance arrangements ensured that IPC policies and procedures were met.

The Waves is registered to accommodate up to 3 people. At the time of our inspection there was one person living in the home. There were no plans for anyone else to move in. The person had moved in at the beginning of June 2018 and before that the home at been a dormant service for 8 months because no one was living there.

When we last inspected The Waves we had concerns about how the previous person living there was supported. There were breaches of regulation. At this inspection we found improvements had been made.

There was a registered manager in post. 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.

Staff cared about the well being of the person living in the home. We received positive feedback from relatives and professionals who worked alongside the home.

There were sufficient levels of trained and experienced staff who had worked to get to know the person well. Staff understood how to identify and report abuse and were well supported in their roles. Staff received training to enable them to carry out their roles competently.

The person was supported to make choices about how they spent their day. Staff had a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and promoted independence and choice. Where the person was not able to make a specific decision, staff acted in accordance with the MCA.

The person’s health care needs were met and staff supported them to see healthcare professionals when appropriate. They were supported to take their medicines safely by staff who had received the appropriate levels of training.

The person was encouraged and supported to take part in a range of activities within the home and the locality. Within the home the environment had been adapted to enable the person to spend their time doing activities that were enjoyable and meaningful to them.

Relatives knew how to make a complaint if the needed to and felt any concerns would be taken seriously and action taken straight away.

There were quality assurance systems in place to drive improvement and ensure the home offered a safe, effective, caring and responsive service.

At the last inspection in January 2017, overall the service was rated Requires Improvement. The ‘Is the service effective’ was rated Good.

The service does not have a registered manager. The acting manager is in the process of applying to be registered. 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.

The Waves is a care home without nursing in Poole for up to three people with learning disabilities. One person lives at the home and there were no plans for other people to move into the home.

At this inspection we found new shortfalls and breaches of the regulations. The person was subject to Deprivation of Liberty Safeguards (DoLS) and a condition of the DoLS had not been met. This potentially had a negative impact on the person’s behaviour because of their allergies. This was a breach of the regulations.

There were shortfalls in the person’s monitoring, incident and medication records and this was a breach of the regulations.

There were shortfalls in the staff skills and knowledge to be able to effectively support and care for the person. This was a breach of the regulations.

There was sufficient food and drink at The Waves on the day of the inspection. However, there were shortfalls in meeting Food Safety Regulations. We recommended the service follows the provider’s food policies in order to meet the Food Safety Regulations.

We recommended the person has a nutritional risk assessment completed and a weight management plan be put in place. This was because their planned weight loss had not been assessed and planned for.

The acting manager updated us following the inspection with the actions they had taken in response to the findings of the inspection.

The person was not able to tell us their experiences because they had complex communication needs. They were happy, animated and communicating freely using Makaton signs with one of the longstanding staff members during the inspection. The person communicated with the second new member of staff by gesturing and taking them to the place they wanted to go to or activity they wanted to do.

At this inspection we changed the rating for the key question ‘Is the service effective?’ from Good to Requires Improvement. The overall rating for the service remained ‘Requires Improvement’.

Further information is in the detailed findings below. Our previous comprehensive inspection from January 2017 provides information about the other areas that have previously been inspected.

The service does not have a registered manager. The previous manager left in September 2016. There was an acting manager in post who was responsible for The Waves and another home for three people in the local area. They were covering the post until a new registered manager could be appointed. 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.

The Waves is a care home without nursing in Poole for up to three people with learning disabilities. One person lives at the home and there were no plans for other people to move into the home.

The person was not able to tell us their experiences because they had complex communication needs. They were happy and communicating freely with staff during the inspection.

A relative told us their family member felt safe at the home. Staff knew how to recognise and respond to any signs of abuse.

The person received care and support in a personalised way. Staff knew the person well and understood their needs and the way they communicated. However, the recent changes in the staff team and high turnover of staff increased the risks of the person becoming unsettled as staff may not know the person and how they communicate.

Staff said they were supported by the acting manager. However, due to the nature of the staffing levels at the home there was little opportunity for staff to have breaks or supernumerary time to complete some tasks.

Staff were caring and treated the person with dignity and respect. The person and staff had a good relationship.

Medicines were managed safely and stored securely. The person received their medicines as prescribed by their GP. Staff knew when they should administer PRN ‘as needed’ medicines.

There was a range of systems in place to protect the person from risks to their safety. These included premises and maintenance checks, regular servicing and checks for equipment and risk assessments for each person living in the home. Staff knew how to support people with positive behaviour support plans in place.

Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs. However, some staff needed specialist training and or updates to be able to effectively support the person.

The culture within the service was very personalised and led by the person who lived at the home. Feedback from staff, a relative and a professional and the findings of the inspection told us the management of the home was reactive rather than proactive. We acknowledge that action was taken in response to any concerns or issues we fed back to the acting and regional manager. However, this remains an area for improvement.

The individual had complex needs and communicated with us and staff by using 'Makaton' a type of sign language. We spoke with two staff and the manager.

We saw that the individual was very relaxed with the staff. They laughed and Makaton signed with the staff. Staff understood the individual's needs and how they communicated.

Where people did not have the capacity to consent, decisions were made in consultation with people's representatives and health and social care professionals.

People experienced care and support that met their needs and protected their rights. Risks to people, staff and others were assessed and managed to ensure the safety of all parties.

There were systems in place to regularly check and monitor the quality of the service.

We looked at care and support plans and saw that the recording showed people had on most occasions not been consulted on Best interest decisions about the care and support provided to the individual. We found that the systems and safeguards to ensure people experience appropriate care and support and to protect there human rights were not in place.

We spoke with three staff who said they had accessed specialist training to meet peoples complex needs. We found that staff did not have the key training in some aspects of their roles. Three staff we spoke to told us they were not aware of there roles and responsibilities in relation to capacity and best interest decisions and this meant people could be at risk of abuse or neglect. We found that there were no arrangements in place to deal with foreseeable emergencies although all staff did explain who they would contact first.

We observed staff treating people with respect and supporting them to make choices during meal times and daily activities.