Welham House

Updated 12 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors.

Service and service type

Welham House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under 1 contractual agreement dependent on their registration with us. Welham House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who lived at the home and 2 relatives. We spoke with 2 members of staff while we were at the home and contacted others by telephone. We spoke with a senior care manager, a locality support manager and the registered manager from 1 of the providers other homes who visited to support the inspection.

We looked at the care and support plans for 7 people living at the home and the medicine administration records for everyone. We also looked at management records within the home to assess the safety of the service.

Updated 12 December 2023

About the service

Welham House is a residential care home providing personal care to up to 14 people. The home provides support to people with a learning disability or autism. At the time of our inspection there were 13 people living at the home.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The service did not support people to have the maximum possible choice, control and independence and control over their own lives. There were no assessments in place about what decisions they could make for themselves.

Staff failed to focus on people’s strengths and did not promote what they could do. People spent time sitting around with nothing to do. They were not supported to take part in household chores such as cooking or washing and care plans lacked information on how to increase people’s independence. The provider had not supported people to take part in activities and pursue their interests in their local area.

Staff expected people to become distressed and lacked information on de-escalation techniques for each person. This led to people being restrained. The provider did not monitor the level of restraint in the home and staff did not learn from incidents.

The service gave people care and support in a clean, well-furnished environment that met their physical needs. People had a choice about their living environment and were able to personalise their rooms.

Staff enabled people to access specialist health and social care support in the community. However, information provided by staff to healthcare professionals was not supported by documented evidence.

Medicines were not safely managed, and staff did not support people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care:

Staff did not understand how to protect people from poor care and abuse. The service failed to work well with other agencies to do so. Staff had training on how to recognise and report abuse but lacked the skills to put their training into practice.

Staff had received training, but this had not been of a suitable quality to ensure staff had the skills needed to meet people’s needs and keep them safe. Staff did not understand how to provide care in line with national guidelines and to reduce restrictions on people.

Risks to people were not properly identified and assessed. Therefore, care was unable to be planned to keep people safe from repeated incidents.

People were not offered activities or the opportunity to pursue interests that were tailored to them.

Right Culture:

There was a closed culture in the home, with a lack of transparency to external organisations. Staff did not raise concerns as they were worried about their jobs. Staff did not understand best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. Therefore, people received more restraint both physical and chemical than they may have needed.

Staff manipulated the homes routines to make their roles easier and failed to place people’s wishes, needs and rights at the heart of everything they did. There was no reflection on the quality of care provided and how it impacted on the people living at the home.

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 5 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about allegations of abuse within the home. A decision was made for us to inspect and examine those risks.

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

The provider has been responsive to concerns raised and has taken immediate action to mitigate risks in the home.

Enforcement and Recommendations

We have identified breaches in relation to the use of restraint in the home, the management of risks to keep people safe, the management of medicines, the number of staff on duty and their training, keeping people safe from abuse, assessing people’s capacity to consent, quality of information in the care plans, the level of activities offered to people and the governance of quality and safety of care at this inspection.

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

We have imposed conditions on this location to help keep people safe. The conditions require the provider to get external expertise in relation to medicines management and positive behavioral support as well as reducing risks to people when they go out of the home. We require the provider to submit monthly information to us so that we can monitor the quality of care they are providing.

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

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.