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Curtis Weston House Inadequate

The provider of this service changed - see old profile

Reports


Inspection carried out on 30 June 2020

During an inspection looking at part of the service

About the service

Curtis Weston House is a residential care home registered to provide personal care and accommodation for up to 44 younger and older adults. People using the service had a physical disability, sensory impairment, dementia, mental health needs and a learning disability or autistic spectrum disorder. At the time of our inspection there were 34 people using the service.

Accommodation is split across two floors accessed by a lift. Communal areas include lounges, bathrooms and toilets.

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

Concerns related to protecting people from abuse had not been resolved since the last inspection. There was ineffective management and intervention. Risk assessments did not provide sufficient information and guidance to enable staff to respond consistently when supporting people with distressed behaviours.

Care plans had been rewritten and reviewed since the last inspection but were not person centred. Conflicting information was reported in some records which meant people may not be supported in the most appropriate way. Staff recording was, at times, inaccurate and therefore an accurate picture of support could not always be determined.

Analysis of incidents and accidents were not always effective. Timely action was not consistently taken to identify root cause and measures that could reduce the risk of further incidents of harm for people. People were not always supported to achieve positive outcomes from their care.

Governance remained an on-going concern following on from the last inspection. Audits, although completed, were not always effective in accurately capturing information or driving improvements. Although we found some improvements since our last inspection, these were not yet embedded into working practices to demonstrate they could be sustained.

The provider had appointed a new care manager who intended to apply for registration with the Commission. They had begun to make improvements within the service and staff and people spoke about the positive impact they had made in a short space of time.

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 Inadequate (supplementary report published 16 April 2020) with a number of breaches of the regulations identified. As a result the service was placed in special measures. We imposed conditions on the provider's registration in March 2020 that they must ensure a) must not admit any new service user without the prior written agreement of the Commission, b) must ensure all care plans and risk assessments for service users are updated and disseminated to staff, c) must ensure all staff who support service users with nursing or personal care have received training in safe breakaway, sexuality and relationships, positive behaviour support and safeguarding adults and d) must ensure if children from a nursery visit that all care staff involved have received safeguarding children training and appropriate risk assessments are in place. The provider completed an action plan after the last inspection to show us how they would meet these conditions. A monthly report was sent to the Commission detailing progress. At this inspection not enough improvement had been made or sustained by the provider, therefore the service was still in breach of regulations. The service retains an Inadequate rating.

Special Measures

The overall rating for this service is 'Inadequate' and the service remains 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 m

Inspection carried out on 2 March 2020

During a routine inspection

About the service

Curtis Weston House is a residential care home providing personal care to 40 younger and older adults. People using the service had a physical disability, sensory impairment, dementia, mental health needs and a learning disability or autistic spectrum disorder.

The care home accommodates up to 44 people across two floors, each of which has separate adapted facilities.

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

People and visiting children were not protected from the risk of harm of abuse as the systems and processes in place to safeguard people were not effective. Incidents of abuse were not always identified, reported to safeguarding, the police or notified to the Care Quality Commission. Opportunities to learn from accidents and incidents were missed as not all incidents were reported.

The registered manager was not always present in the service. There were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care. Quality assurance systems and processes failed to identify concerns relating to safe care. Where issues had been identified the service did not act in a timely manner to address these.

Care plans did not always reflect people’s dietary requirements and people’s risk of malnutrition had not been properly assessed. Not all staff working with people had the necessary training to support them safely. Staff had not had training to safely manage challenging situations.

Care plans and risk assessments did not contain adequate information for staff to know how to support people. Staff did not have time to read people’s care plans, or time to spend with people which meant care was task focussed. People told us there was not enough to do. People’s privacy and dignity was not always protected. People’s preferences and wishes for the support they wished to receive at the end of their lives was not always detailed in their care records.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Policies and systems in the service did not always support this practice. People’s mental capacity assessments and best interest decisions had not always been undertaken and DoLS conditions were not always met.

We received positive feedback about the meals available and found health advice had been sought when concerns arose about people’s health deteriorating. Staff were kind and caring in their approach and knew people well. They enjoyed spending time with people but had limited opportunities outside of meeting people’s basic care needs.

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 16 October 2018). The rating for the service has

changed from Good to Inadequate. This is based on the findings at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding service users from abuse and improper treatment. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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 have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, need for consent, person-centred care, good governance and a failure to send legally required notifications to the CQC.

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

The overall rating for

Inspection carried out on 25 September 2018

During a routine inspection

We inspected the service on 25 September 2018. The inspection was unannounced.

Curtis Weston House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Curtis Weston House is registered to accommodate 44 people in one adapted building. On the day of our inspection 34 people were using the service.

We previously inspected the service on 7 December 2015. We rated the service as `Good’ overall, but rated the key question ‘Safe’ as requiring improvement because risk assessments were not always reviewed and updated and aspects of medicines management were not consistently good. We found at this inspection that improvements to ‘Safe’ had been made and that all other key questions remained Good.

The service had a registered manager in place at the time of our inspection. 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.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm and they lived in a clean, hygienic service.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

The service had safe procedures to respond to outbreaks of infection which protected people, staff and visitors.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. 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.

People lived in a service which met their needs in relation to the premises and adaptions were made where needed. The provider had implemented a refurbishment plan for the premises at the time of our inspection.

People had access to information in a format which met their needs.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff listened to them and got to know them. People’s support needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

There was an open and transparent culture. People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided. People had access to a complaints procedure.

Inspection carried out on 7 December 2015

During a routine inspection

We carried out our inspection on 7 December 2015. The inspection was unannounced.

The service provides accommodation for up to 44 older people, including people living with dementia and similar health conditions. There were 37 people using the service at the time of our inspection.

The service had a registered manager. 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.

People felt safe at Curtis Weston House. This was because staff understood and applied the provider’s policies and procedures to guide them on their responsibilities to keep people safe and how to report any concerns on people’s safety.

Staffing levels were not always sufficient to meet people’s assessed needs.

People did not consistently receive their medicines as prescribed. Staff did not always evidence that they had followed given instructions when they administered people’s medication.

Staff were supported to meet the standards expected from them through training and regular supervision.

People were not deprived of their liberty. Staff sought people consent before they provided care and treatment. Staff understood the relevance of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards to their work. They supported people in accordance to the MCA.

People were supported to have a healthy and balanced diet. They had access to a choice of meals.

Staff supported people to have access to healthcare services when they needed them.

We observed that staff supported people in a caring manner, and promoted people’s dignity and privacy.

People felt that they mattered because staff listened to their views and acted on them.

Staff were knowledgeable about the individual needs of the people using the service. We saw evidence that they provided the support that met people’s needs including where people behaved in a way that may challenge others.

The provider had effective procedures for monitoring and assessing the quality of service that promoted people’s safety and continuous improvement of the service.

Inspection carried out on 14 August 2014

During an inspection in response to concerns

As part of this inspection we spoke with eight people who used the service, two relatives, seven members of the staff team and the registered manager. We were also able to speak with the provider�s compliance and care standards officer who was visiting the service at the time of our inspection. We looked at records including people's personal records, medication records and records kept in relation to the management of the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:

Is the service safe?

All eight people spoken with told us that they felt safe living at Curtis Weston and that they were treated well. One person explained: �I feel very safe here, there is always someone available day or night, you ring your bell and they are there.� Another person told us: �It is a marvellous place; the staff are wonderful they can�t do enough for you.�

Care workers spoken with knew what to do if they suspected that someone was being abused. One care worker explained: �I would report anything to the manager straight the way.�

We talked to care workers to determine whether there were enough staff on duty to meet the needs of those in their care. We were told that at times care workers felt rushed, and this wasn�t helped by the amount of paperwork they were required to complete. One care worker told us: �I feel frustrated because I feel that I�m not giving care to the residents because of all the paperwork we have to fill out.�

People who used the service told us that there were enough staff on duty to meet their needs. One person told us: �The staff always come when you ring your bell, they treat me very well.�

We noted during our visit that the people who used the service were left for large periods of time, particularly in the lounges, without seeing a member of the care team.

The manager completed a pre-assessment of people�s needs before people moved in to the service. This ensured that they were aware of each person�s care and support needs and they were confident that those needs could be met by the staff working at the service.

On checking the medication records we found that on a number of occasions, the senior in charge had failed to sign to say that they had dispensed people�s medicine. There were also occasions where the senior in charge had signed to say that they had given someone their medication, when it was in fact still in the blister pack. This meant that the people who used the service were not always getting their medication as prescribed by their doctor.

Personal protective equipment was available for care workers to use including disposable aprons and gloves. This ensured that care and support was provided safely and in line with the services infection control policy.

Is the service effective?

We spoke with eight people who used the service to find out if they were satisfied with the care and support they received. They told us they were, though one person told us that just sometimes the care staff could be a little sharp. One person explained: �I don�t know what I would do without them; I have no worries what so ever, all of us have an immediate carer, who makes sure we have a shower.� Another person told us: �The staff look after me very well.�

Relatives told us that they were happy with the care and support their relative received. One relative explained: �My wife came here in January and I couldn�t have asked for better.� Another relative told us: �Sometimes I have to mention about a shower, but she always looks cared for and the staff are all very nice.�

Care plans provided care workers with information about people�s care and support needs though these had not always been followed. This meant that people had not received the care and support they needed.

The provider had systems in place that demonstrated they co-operated with other health and social care professionals. This meant people received a person centred and coordinated approach to their health, safety and welfare needs.

Is the service caring?

We observed care workers going about their work. They treated the people they were supporting in a kind and gentle way and people looked relaxed and comfortable in the presence of staff.

The people who used the service told us that, on the whole they were treated with respect and we observed staff knocking on doors and calling people by their preferred name. One person told us: The staff mostly treat me with respect, but the odd one can sometimes be a little sharp.� Another person explained: �The staff have a real way with us and they�ve always got a smile on their face.�

Is the service responsive?

The needs of the people who used the service had been assessed before they moved into the service. They and their relatives/advocates, had been involved in this process.

Relevant professionals had been involved in people's care. Records showed that visits had been arranged when necessary. These included visits from their doctor, the district nurse and the local speech and language team. This ensured that people who used the service received the care and treatment they required.

A complaints procedure was in place and a copy of this was displayed. This provided people with the information needed, should they wish to make a complaint about the service they received. One relative explained: �We were made aware of the complaints procedure and they were always available to talk to if you needed to.�

Is the service well-led?

Staff meetings had been held. This provided the staff team with the opportunity to have a say on how the service was run. A meeting for the relatives and advocates of those who used the service had also been held. This gave relatives and advocates an opportunity to have a say about the service that was provided. The people who used the service were also given the opportunity to discuss any concerns on a day to day basis. One relative explained: �I was allowed to attend meetings and comment, and any issues raised were always followed up.�

Staff felt supported by the manager and told us that they felt able to talk to someone should they have a concern of any kind. One care worker explained: �I do feel supported by the manager, I love my job and I love being in care.� Another care worker told us: �If there are enough staff on, it is a lovely place to work.� Another care worker explained: �I feel supported, there is always someone to talk to should you need to.�

Inspection carried out on 10 April 2013

During a routine inspection

We spoke with four people who used the service and two relatives. All the people we spoke with gave positive feedback about the home. One person told us "I am perfectly satisfied with how I�m treated. Everyone is kind and considerate�.

We also looked at four care plans. All had a care and support plan in place and contained risk assessments related to people's individual needs and information about how people wished to be cared for and supported.

We spoke with five staff and looked at three staff files. All the staff we spoke with had received training. They demonstrated a good understanding of the different types of abuse and were able to explain what they would do if they suspected someone was being abused and who they would report this to.

We saw evidence of appropriate checks being made on staff prior to employment and that staff received training and regular supervision.

We saw evidence of a range of measures designed to ensure the service maintained quality. People were regularly asked for their opinions and ideas for improvement through weekly 'listening forms'. People and their representatives were also invited to attend regular residents' meetings.