Walc House

Walc 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.

The service is registered to provide accommodation for persons who require nursing or personal care. It is registered for up to four people with learning disabilities and autistic spectrum disorder. At the time of our inspection there were four people living in the home.

The home is a three storey detached property which has an open plan kitchen dining area, a bedroom, sensory room and communal lounge on the ground floor. On the first floor there are two further spacious en-suite bedrooms and a communal bathroom, laundry and staff office. The second floor comprises another en-suite bedroom. There is an enclosed garden to the rear of the property.

The care service had been developed and designed in line with the values that underpinned the Registering the Right Support and other best practice guidance. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could live as ordinary a life as any citizen.

The service had a registered manager in post. 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of seizures or behaviours which may challenge the service, staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

Where possible people had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People’s eating and drinking preferences were understood and their dietary needs were met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. 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.

Families and professionals described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People were supported and respected to express their views about their care using their preferred method of communication and were actively supported to have control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff. A complaints process was in place, people and families felt listened to and actions were taken if they raised concerns. The registered manager was starting to explore opportunities to identify and understand people’s end of life wishes and preferences.

The service had an open and positive culture. Leadership was visible and promoted good teamwork. Staff spoke highly about the management and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below.

manager at the service when we visited. The home is a residential care home and provides support and personal care for up to four adults. The home has three floors with stair and people had their own rooms. At the time of our inspection there were four people using the service. There was a garden at the back of the house for people to enjoy.

The home was last inspected on the 16 April 2014 and found not to be meeting the standards in the quality and monitoring of the service. We found that there were ineffective systems in place to capture feedback on how to improve the service.

At this inspection improvements had been made and people, their relatives and staff had been consulted through surveys and questionnaires. People had been supported to increase their involvement through meetings, questionnaires and newsletters. For example, feedback in 2015 was used to improve the service provided.

The manager who was a registered manager had been with the service since 2009. 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 who used the service had complex health and social care needs and used a range of methods for communicating. These included recognition of signs and pictures, use of non-verbal body language, including facial expressions, gestures, sounds and visual prompts.

The service was safe because people were at reduced risk of harm from abuse. This was because staff were aware of how to safeguard and protect people. Staff informed us of the safeguarding training they received to help prepare them for their responsibilities.

There were enough staff to safely meet people’s needs. Staff worked in teams to support people with meeting their individual needs and to provide assistance with carrying out their daily care and living activities. Both teams worked four days on duty and then had four days off duty. Teams were made up of a leader, an assistant supervisor, senior support workers and support workers. Staff were safely recruited using current legislation and had the necessary employment checks before they started work. The registered manager and team leaders were responsible for addressing unsafe practice which was highlighted and addressed in staff supervision.

Staff worked on a one to one basis when helping people to identify and discuss their risks. For example, one person was at risk of becoming unwell if their temperature increased and staff observed for this more frequently throughout the warmer season. People were cared for in a safe environment where health, safety, hygiene and maintenance checks had been completed. Staff described these checks which included an electrical appliance test, gas safety checks, fire safety audits and maintenance to repair faults and damage to the home or equipment. There were procedures for staff to follow in an emergency.

Medicines were managed safely. They were ordered, checked, administered and returned when not used safely and these were signed and recorded on people’s medicine administration records (MAR). Staff were assigned the responsibility of checking stock and auditing the process.

Staff were aware of, and worked within the principles of the Mental Capacity Act 2005 (MCA). They described how this impacted on the people they supported. The registered manager told us they had requested a review of assessment for people’s mental capacity from the appropriate authorities. Some people had received an assessment while others were waiting to be reviewed.

Staff spoke with people when supporting them with decisions about how their needs were met. We heard them explaining day to day activities with people and saw staff use opportunities to speak with people to gauge consent prior to assisting with care.

People were supported by staff who received regular training and development and whose performance was supported through guidance, supervision and appraisal. Staff had the qualifications, skills and or the experience to assist people when meeting their needs. Some staff were working towards leadership awards to support their roles and some had attended mental health awareness training through a national college of further education in 2015.

People were supported to maintain their health and this was provided by a variety of community health care professionals. One staff member described the health needs of two people at Walc House and gave examples of how these had been met, including appointments with opticians, dentists and speech and language therapists.

People had nutritious meals and these were provided at regular times during the day to help people develop their routines. People were prompted to choose their meals although some people had allergies or were sensitive to certain foods and drinks. In these cases alternatives or healthier options were offered and staff supported them to select a meal or drink that was safe to eat.

Staff demonstrated respect and an understanding for the people they supported. Staff knew people very well and was able to meet their needs using a sensitive yet person centred approach. Staff respected people’s dignity during private time and were mindful of people’s dignity when carrying out personal care. Staff gave examples of how they protected people’s rights to privacy by closing doors and knocking on doors prior to invitations to enter people’s personal spaces.

Staff communicated respectfully with people by using their chosen names and encouraged mutual respect between people living at Walc House. People had support from staff to help them communicate their needs. This was clearly demonstrated when staff worked closely with people to help them individually and when interacting with others.

People shared time with others but also had one to one opportunities with their named keyworker. Time was spent planning activities, discussing holidays and food menu’s and reviewing care. People received care that was personalised to their interests and helped them achieve their daily activities.

People were enabled to maintain their relationships with people that were important to them. Some people had regular contact with relatives and visited their family for weekends or at holidays. People were listened to and their opinions were actively sought to identify any concerns or complaints. People were supported to raise their concerns and have them addressed. Walc House had a complaints policy and the process was made available to people using a brief picture and text flow chart.

Staff were listened to and valued for their contributions. They were involved in changes to the service and how the home was managed. There was a registered manager at Walc House who was supported by the service provider and team leaders. Staff felt motivated and supported by each other in their teams and by management, explaining that as they worked in small teams there was a greater level of transparency.

Management systems meant that regular checks took place to ensure that the service was operating safely and being monitored for quality. These checks included formal written audits of MARs, spot checks on medicine administration and health and safety checks. A recent fire safety inspection from the fire and rescue service showed that the service was meeting its fire regulations to a high standard of safety.

Below is a summary of what we found. The summary describes what people using the service, their relatives, staff and others told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe and suitable for their needs. Equipment designed to keep people safe was well maintained and serviced regularly. Staff personnel documents including the employment process and recruitment records contained the appropriate information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operations of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, staff had received some training to understand when an application should be made. We were told that further training was being arranged at the time of our inspection.

Is the service effective?

The relatives of three people told us that they were happy with the care they received and felt that people's needs had been met. Primary care staff told us that they had no specific concerns about the care people received at Walc House. From what we saw and from speaking with staff, it was clear that they understood people's care and support needs and knew them well. One staff member gave a detailed account of their role as keyworker to one person living at the home, including what mattered to the person, their personal interests, likes and dislikes. The relative of one person said "We've been very pleased at how well they support people, I've no complaints."

Is the service caring?

People were supported by staff who we observed to be kind and attentive. We saw that support workers were encouraging and provided support to people. One staff member described the health needs of two people at Walc House and gave examples of how these had been met, including appointments with opticians, dentists and speech and language therapists. One primary care staff member praised the support workers for their care and support of one person who had attended a routine appointment telling us that staff showed understanding of the person's needs and feelings.

Is the service responsive?

People's needs had been assessed before they moved into the home and senior staff showed us a document to evidence how this process had changed since the last inspection. Staff, who acted as keyworkers to people, told us that they met regularly with people to talk about what mattered to them and to address their concerns, interests and needs. We looked at records of house meetings where people had been encouraged to participate in these meetings and decisions in life at Walc House. Records confirmed people's interests, preferences and changing needs. People were engaged in activities that were important to them and were encouraged and supported to maintain important relationships with friends and family. We spoke with several staff from community based services who told us that staff working at Walc House were responsive and well organised when referring people to them or supporting them at appointments. One comment we received was "The staff are pro-active and keep me informed of any changes quickly."

Is the service well-led?

Staff had a good understanding about the purpose of the home and their roles and responsibilities at Walc House. There were a number of health and safety checks in place at the home. On the day of our inspection, people living at the home, their relatives and staff had not been given the opportunity to complete satisfaction surveys. This meant the provider could not clearly demonstrate how they regularly assessed and monitored the quality of the service provided or how they would use the results of such monitoring to improve the service. A compliance action has been set for this and the provider must tell us how they plan to improve the service.

The people are also involved in weekly meetings and stated they felt listened to.

Staff were supported through staff training to involve the people who use the service.

People's care records showed they were involved in choosing their activities. The care plans showed the support each individual needed to be kept safe and cared for appropriately