Welham House

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.

The service is in a rural setting in Lincolnshire near Spilsby.

The service provides accommodation and personal care to people with learning disabilities or autistic spectrum disorder. The care home can accommodate 14 people in one building. At the time of our inspection there were 14 people living in the service.

People's experience of using this service:

• People told us that they liked living in the service.

• The service provided a safe service.

• People were protected against abuse, neglect and discrimination. Staff members were aware of ensuring people's safety and acting when necessary to prevent any harm.

• Heating levels kept people warm in cold weather.

• Staff members knew people well and people appeared to enjoy the attention from them.

• People had a say in how the service was operated and managed.

• People's care was personalised to their individual needs.

• People were largely assisted to have choice and control over their lives and to choose their own lifestyle, though poor practice was identified with regard to how some staff dealt with behaviour that challenged the service.

• Audit processes were not comprehensively in place to ensure quality care. They had not identified poor staff practice or whether the service needed to always replace staff absence. Questionnaires had not recently been supplied to people’s representatives, staff and external professionals for their views of the service to see whether improvements were needed.

• We had not been informed of a potential safeguarding incident as required, to help us determine whether we needed to carry out an inspection at that time.

• A registered manager was in place, which is a condition of registration.

• The service met the characteristics for a rating of "Good" in key questions except well led, where it was rated Requires

Rating at last inspection:

• At our last inspection, the service was rated "Good". Our last report was published for the inspection of 29 June 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates.

Welham House is situated on the outskirts of Spilsby. It is registered to provide accommodation and personal care for 14 people with a learning disability or autism. There were 12 bedrooms in the house and separate flats. The flats were occupied by people who were able to be more independent but still liked the security of having staff close by. These were used by people as a step along the way to being independent. There were 14 people living at the home on the day of the inspection.

There was a registered manager for the home. 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 registered manager had identified the number of staff needed to meet people’s needs and ensured that the correct number of staff were available at all times. Appropriate checks had been completed to ensure that staff were safe to work with the people living at the home. Staff were supported to develop their skills needed to care for people safely through training and supervision.

Staff had received training in how to keep people safe from harm and knew who to contact to report any concerns. People living at the home were also supported to raise concerns about their safety. Risks to people were identified and appropriate plans were in place to keep people safe. Where people needed to be restrained for their own safety this was clearly recorded in their care plans and the person had agreed to the restrain. Risks around medicines were identified and medicines were safely stored and administered in a person centred way.

Where people faced restrictions on their liberty that they were unable to make a decision about they were appropriately referred for assessment under the mental capacity act deprivation of liberty safeguards. People’s abilities to make decisions were assessed and where needed people were supported with decisions made in their best interest.

Staff were kind and caring and supported people’s choices about their everyday lives and to be involved with their care planning. People’s privacy was respected and they were able to choose who they wanted to support them with their personal care. People were able to engage in activities both at the home and at the day centre and were supported to develop any hobbies.

There were effective systems in place to monitor the quality of care people received. People were encouraged to raise any concerns they had about the home and the care they received as well as any ideas on any improvements they wanted to see. People’s views of the service were gathered and used to identify areas for improvements.

The care records contained individual care plans and risk assessments which had been regularity reviewed and the provider's policies provided staff with detailed guidance.

One person who lived at the home told us, 'I like living here. I can do my own thing. They take me to the shops when I want to go. There are plenty of things to do. I like the holidays. I talk with the staff about my goals and how I can get them.'

A member of staff told us, 'I think that there are enough staff on duty to care for people, we do increase numbers to cover for trips out. I have undertaken a full induction and there are plenty of training packages available to us.'

We found that the provider was meeting all of the standards that we inspected.

Care workers responded to peoples' requests for assistance promptly, which showed that they were knowledgeable about people's diverse communication needs.

People told us that they like living in the home and they like the staff. One person said, "I like the food and the staff." One staff member said, "We know the residents very well and the standard of care is high."

People were seen in various places throughout the home including their own rooms where people had stated this was their preference. We were told, "Staff are very obliging." People told us they could have visitors when they wished and that they were made welcome by staff.