Weir End House

Weir End House is a residential care home providing personal care and accommodation for younger and older people with learning disabilities, autism and mental health needs.

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 was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. Ten people were using the service at the time of the inspection visit. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large 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. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Incidents involving people who used the service and unexplained injuries were not always appropriately reviewed and investigated by the registered manager and provider, as part of protecting people from potential abuse. The provider’s procedures for assessing and managing the risks to people were not sufficiently robust. People’s risk assessment and care plans were not always reviewed and updated in light of incidents and episodes of challenging behaviour. The provider had failed to inform us of three potential safeguarding incidents involving people living at the home.

Staff expressed mixed views on the management of the service. Some staff lacked confidence bringing concerns about people’s care to the attention of the registered manager. The provider’s quality assurance systems and processes were not as effective as they needed to be, and had not enabled the provider to address the shortfalls in quality we identified during our inspection. The provider and registered manager did not fully seek to engage positively with people and staff and involve them in the service.

Staff had received training in, and understood, how to identify and report abuse. Checks were completed on the premises and equipment in use to protect people’s health and safety. People told us there were enough staff on duty to provide them with prompt support when they needed this. Prospective staff underwent pre-employment checks before they started work at the home. People were supported to take and manage their medicines safely. The provider took steps to protect people, visitors and staff from the risk of infections.

People’s care plans were individualised and promoted a person-centred approach. People’s individual communication needs were assessed, reviewed and plans put in place to address these. People had support to spend time in way they found interesting and enjoyable, and to participate in their local community. People had been provided with accessible information on the provider’s complaints procedure, and they told us they would speak to staff and management about any concerns. People’s wishes regarding their end-of-life care were assessed, in order to address these at the relevant time.

People described the positive relationship they had with the registered manager and felt the home was well-managed. Staff and management sought to work collaboratively with community health and social care professionals to ensure people’s care needs were monitored and met.

Rating at last inspection

The last rating for this service was Good (report published 14 February 2019).

Why we inspected

This was a focussed inspection to assure ourselves the service was protecting people from abuse and avoidable harm and meeting people’s needs through effective leadership and management.

We reviewed the key questions of safe, responsive and well led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions, therefore we 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 deteriorated to Requires improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches at this inspection. These relate to the provider’s failure to implemented robust procedures and processes to protect people from abuse and to inform us of any safeguarding incidents involving people. In addition the provider’s quality assurance systems and processes were not sufficiently effective.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home was bigger than most domestic style properties. It was registered for the support of up to 13 people. Ten people were using the service at the time of the inspection. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything which suggested they were care staff when coming and going with people.

What life is like for people using this service:

• People enjoyed living at Weir End House and were cared for by staff who spoke warmly about them. People enjoyed friendships with other people living at the home, so they were not isolated.

• Staff were respectful to people they cared for and promoted people’s right to independence, dignity and privacy. Staff supported people to make their own decisions about their care and understood how people liked to communicate.

• Staff understood people’s safety needs well and supported them so their individual risks were reduced.

• The registered manager planned to review the systems they used to notify CQC about some important events which happened at the home, so they could be sure they were consistently meeting their legal obligations.

• People were confident to ask for assistance from staff when they wanted this, and there were sufficient staff to care for people.

• People were supported to have their medicines safely, by staff who were competent to do this. People’s medicines were regularly checked and reviewed.

• People were supported to enjoy the best health outcomes possible, and staff were supported to do this by the systems the registered manager had put in place to promote good working with organisations.

• People's, their relatives' and other health and social care professional’s views were listened to when people’s needs were assessed and plans for their care were agreed and reviewed. Staff understood people’s histories, what was important to them, and how people liked their care to be provided.

• Staff saw when people’s needs changed and adjusted people’s planned care, so people’s needs continued to be met.

• People were supported to keep in touch with relatives and friends who were important to them.

• The environment at the home was regularly checked. The risk of infections and accidental harm was reduced, as staff used the knowledge and equipment provided to do this.

• Staff had been supported to receive the training they needed and to develop the skills they required to care for people.

• 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.

• Staff supported people to have enough to eat and drink so they would remain well.

• People enjoyed a range of activities which reflected their interests. This included spending time in the community doing things they liked and to go on holidays.

• The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways [promotion of choice and control, independence, inclusion] e.g. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

• Systems were in place to take any learning from complaints and to reflect on people’s needs and to further improve people’s care.

• The registered manager sought suggestions for improving people’s care further and suggestions were listened to and acted on.

• The registered manager and staff reflected on the care provided, so improvements in people’s care would be driven through. The registered manger planned to continue to develop the facilities at the home and to further develop people’s access to information to enable people to continue to make informed choices about their care.

•We found the service met the characteristics of a “Good” rating in all areas; For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. The last report for Weir End House was published on 18 August 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 25 July 2016 and was unannounced.

The registered manager had left the home in February 2016 and consequently, there was an acting manager and an acting deputy manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People’s individual needs were known by staff, and how to keep them safe. People were involved in decisions made about keeping them safe. People were supported to maintain their freedom. People received their medicines from trained and competent staff.

People’s health and wellbeing were maintained and they received specialist input from a range of health professionals.

People were supported by staff who understood the importance of offering choices in the care people received. People were supported to eat and drink and enjoyed their meals.

People enjoyed positive and respectful relationships with staff. People’s privacy was maintained. People were involved in decisions about their care.

People’s changing health and wellbeing needs were responded to. People enjoyed group social events, leisure opportunities and outings, but could not always pursue their individual hobbies and interests. People knew how to complain as this information was provided to them in a way which was clear to them.

People took part in monthly meetings in which they were given the opportunity to make comments and suggestions about the running of the home and the service they received. People, staff and relatives benefited from an open culture in which the acting manager was approachable and inclusive.

The staff team knew people and their preferences well. People's wellbeing and any concerns were taken seriously. People had care plans that were reviewed. One person's change in circumstances had not been reflected in their care plan but the care was being delivered correctly.

There was a consistent staff team that were suitably trained and felt well supported. The team sought input from external professionals when needed and worked closely with them taking on their advice.

The senior management of the home had remained stable. The manager and provider formally monitored the quality of the service. There were effective leadership arrangements in place to manage the care service and monitor health and safety risks.

People were provided with a nutritious and interesting diet. They were also encouraged to take part in some food and drink preparation. Suitable systems were in place to support people with their daily medicines.

The home was homely, clean and effective systems were in place for infection prevention and control.

The staffing levels were adequate to support people while both at home and when out in the community. People felt able to tell the manager and staff if they were unhappy or had a concern.