Wendover House

Heathcotes Wendover House is a residential care home providing accommodation and personal care to people with a learning disability. The service can support seven people and at the time of the inspection six people were being supported.

Heathcotes Wendover House accommodates people in one adapted building. All of the bedrooms have ensuite facilities and people share a bathroom, lounge and kitchen/diner. There is a small separate sitting room which has been converted into a sensory area.

The service is also registered for the regulated activity personal care to enable them to support people in a two bedroomed supported living service, next door to the care home. At the time of the inspection the regulated activity personal care was not provided. Therefore, only the regulated activity Accommodation for persons who require nursing or personal care was looked at as part of this inspection.

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

Most relatives felt their family member was safe and happy living at the service. They commented “[family members name] is happy and most importantly not ill-treated, they are free to do what they want, independent, and can choose to say no if they do not want to do something,” and “ [Family members name] enjoys living there and all is good.”

Some relatives still felt there was a lack of continuity of staff and that activities, communication, meals and management of laundry could be improved. Those areas were being addressed by the provider.

Risks to people were identified and mitigated. Staff were aware of people’s risks and how best to support them. Risks around fluid monitoring and the environment needed further consideration. Action was taken to mitigate those findings.

Staff were suitably recruited, although recruitment files did not contain photos or risk assessments regarding the decision to employ a staff member, where this was required. The registered manager confirmed this would be addressed.

Auditing and monitoring of the service was taking place which enabled the provider to identify shortfalls in the service provided. Improvements had been made to records, with further improvements identified and being implemented.

Sufficient staff were provided with the service actively recruiting into vacancies which had reduced agency use. Staff felt better trained and supported in their roles with gaps in training and supervision identified through the providers auditing. This was being addressed.

Systems were in place to safeguard people from abuse and staff were proactive in recognising and reporting potential safeguarding incidents. Accident and incidents were recorded and showed debrief of incidents to prevent reoccurrence.

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.

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.

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

Right support: Model of care and setting maximises people’s choice, control and Independence. People were encouraged to make choices and the service was working to promote their independence.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights. The service was working to further develop person centred care. A dignity workshop had taken place and the provider continued to address practices where people’s privacy and dignity was not upheld.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. The provider was proactive in addressing the culture within the service with staff roles defined, further training provided, rota better managed to meet the needs of people within the service and action taken where staff attitudes and behaviours did not promote the right culture.

The registered manager had been proactive in improving the service and had a clear focus on what they wanted to achieve to further promote person centred care, sustain improvements and continue to develop the service. A relative commented “[registered managers name] is really trying to bring stability and change to the service, which is positive.”

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 8 December 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since November 2021. 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.

Why we inspected

We carried out an unannounced focused inspection of this service on 20, 21 September and 6 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding, staffing, recruitment practices, good governance and informing us of incidences without delay.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements and warning notices. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes Wendover House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathcotes Wendover House is a residential care home providing accommodation and personal care to people with a learning disability. The service can support seven people and at the time of the inspection seven people were being supported.

Heathcotes Wendover House accommodates people in one adapted building. All of the bedrooms have ensuite facilities and people share a bathroom, lounge and kitchen/diner.

The service is also registered for the regulated activity personal care to enable them to support people in a two bedroomed supported living service, next door to the care home. At the time of the inspection the regulated activity personal care was not provided. Therefore, only the regulated activity Accommodation for persons who require nursing or personal care was looked at as part of this inspection.

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

People told us they were happy with their care but then also gave us examples where they had not felt safe. Relatives were generally unhappy with the care provided. They indicated the service had a high turnover of staff, some staff were not suitably skilled, trained and sufficient staff were not provided to keep their family member safe and enable regular community activities to take place. Relatives told us communication with them was poor and felt the frequent manager changes had impacted on the care and service provided.

Risks to people were not always identified and mitigated. Safe medicine practices were not promoted, and people were not safeguarded from abuse.

Staff were not suitably recruited, and sufficient staffing levels were not maintained to ensure people were provided with one to one care and had regular access to community activities.

The service was not consistently managed and governance was not effective to ensure safe care was provided. Records were not accurate, always dated, secure and fit for purpose.

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.

Based on our review of key questions safe and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care, setting and insufficient staff did not maximise people’s choice, control and independence

Right care:

• Care was not always person-centred, and some staff practice did not promote people’s dignity and privacy.

Right culture:

• The lack of consistent management meant the ethos and values of the service were not embedded into staff practice, attitudes and behaviours to promote an inclusive service which empowered lives.

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 8 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding incidents and whistleblowing information about staff practice. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes Wendover House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding people, management of risks, medicine practices, recruitment of staff, staffing levels, record management, auditing of the service and failure to make the required notifications to us

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures:

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.

Heathcotes Wendover House is a residential care home providing accommodation and personal care to five people, with one person on extended leave at the time of the inspection. The service can support up to seven people.

The service accommodates people in one adapted building. The service is set over two floors with three bedrooms on the ground floor and four bedrooms on the first floor. All the bedrooms have an ensuite shower with access to a bathroom for people who like to have a bath. The service has a small sitting area at the front of the property with a larger sitting room at the rear. There is a kitchen/ diner, laundry room and a rear enclosed garden.

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. 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

People and relatives felt safe care was provided. They acknowledged the new manager had made positive changes and new staff had been appointed, They found the new manager approachable and felt issues they had raised were or had been addressed. However, they felt there was still a lack of continuity of care and that communication between them and the organisation could be improved.

Systems were in place to safeguard people and risks to them were identified and mitigated. Safe medicine practices were promoted. Accident and incidents were recorded and reviewed to promote learning and prevent reoccurrence. Staff were suitably recruited. The service had a number of people on one to one staff support throughout the day and two to one staff support in the community. The rotas showed the required staffing levels were maintained through the use of their own staff, agency staff and staff from other services run by the organisation. They tried to use regular agency staff to promote continuity of care but the use of agency and staff from other services meant continuity of care was not always maintained. The provider was actively recruiting into the vacancies and two staff had been appointed subject to clearance.

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’s health and nutritional needs were identified. The menus viewed were not varied. We have made a recommendation to address this.

Staff were inducted, trained and supervised. The training and supervision matrices showed gaps in training and supervision. This had been identified by the manager and was being addressed.

Staff were observed to be kind, caring and had positive relationships with people. They promoted people’s privacy and dignity. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. The service was working towards providing people with opportunities for them to gain new skills and become more independent.

People had person centred care plans in place. Individual activities were encouraged. Their communication needs were identified and promoted. Systems were in place to enable people and their relatives to raise concerns.

The service has had inconsistent management since it was registered with us in August 2017. A new manager had been appointed in August 2019 and was not yet registered with the Commission. The provider and manager had systems in place to audit the service. They had identified areas for improvement and had an action plan in place to enable them to bring about the required improvements. Staff were positive about the manager and the changes they had already implemented which they felt benefited people.

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 11 October 2018).

Why we inspected

The inspection was prompted by a change in the manager of the service. At the previous inspection the well-led domain was rated as requires improvement as there had been three registered managers and one interim manager since the service was registered with us in August 2017. Another change in the manager of the service had the potential to increase risks and we made the decision to inspect and examine any potential risks.

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.

Heathcotes Wendover House is a care home (without nursing) which is registered to provide a service for up to seven people with learning disabilities. There were five people (including a person who was in hospital) living in the home on the day of the inspection. Some people had associated difficulties such as being on the autistic spectrum and needing support with behaviours.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Heathcotes Wendover House accommodates people in a large adapted building. Everyone had an en- suite bath or shower room. The service was run in line with the values that underpin the ‘’registering the right support’’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism can lead as ordinary a life as any citizen.

The service was registered on 08 August 2017 and this was the first inspection.

People were protected from abuse. Staff training in safeguarding people was provided and annual refreshers were planned to be provided. Staff fully understood their responsibilities with regard to people’s safety and knew what action to take if they identified any concerns. The service identified health and safety, safe working practices and individual risks to people. All aspects of safety were considered and actions were taken to assist people to remain as safe as possible.

People were supported by high staffing ratios which enabled staff to meet people’s specific needs, including any relating to diversity and/or special needs, safely. Recruitment systems made sure, that as far as possible, staff recruited were safe and suitable to work with people. People were supported to take their medicines, at the right times and in the right amounts by staff who were trained and competent to do so.

People were offered effective care by an appropriately trained staff team. They met people’s diverse needs including their current and changing health and emotional well-being needs. The service worked with health and other professionals to ensure they offered individuals the best care they could.

People were assisted 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.

The staff team were caring, patient and committed to meeting people’s complex needs with kindness and respect. They ensured they promoted people’s privacy and dignity and communicated with them effectively.

The service was person centred and responsive to people’s diverse, individualised needs and aspirations. Activity programmes met people’s needs, preferences and choices and were further improving to become more varied and imaginative.

Care planning was individualised and regularly reviewed which ensured people’s current needs were met and their equality and diversity was respected. The service was not always responsive to people’s family and friends and did not always identify and respond appropriately to complaints.

The service had a registered manager who was registered on 27 July 2018. This was the fourth manager since registration which had contributed to some instability in the service. The quality of care the service provided was assessed, reviewed and was being improved as the service stabilised. The management team did not tolerate any form of discrimination relating to staff or people who live in the service.