Archived: Westway Respite Ltd

Updated 23 May 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 20 and 23 November 2018. We carried out this inspection because the London Borough of Harrow, who commissioned services for six people, told us they had serious concerns about the service. We told the provider the afternoon before our visit that we would be coming because the location is a respite service, therefore people and staff were not always available at the service.

The inspection was conducted by two inspectors on each day.

Before the inspection visit we looked at all the information we held about the service. This included looking at information from the provider, including notifications, which are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. We also spoke with the commissioning authorities and looked at the information they shared with us about their concerns.

During the inspection, we met the registered manager and a senior care worker. No one was staying at the respite service when we visited. However, we spoke with the relatives of two people who regularly used the service on the telephone to ask for their feedback following our visit. We looked at part of the care records for four people who had been in receipt of the service. We also looked at records of recruitment, training and support for all of the staff who had been working at the service, staff rotas, incident reports, audits of the service, records of care provided, records of medicines management and records of how people had been supported with their finances.

Following the inspection visit we also spoke with two external professionals who had been working with people who used the service.

At the end of our visit we gave feedback to the registered manager.

Updated 23 May 2019

The inspection took place on 20 and 23 November 2018. We told the provider the afternoon before our visit that we would be coming because the location is a respite service, therefore people and staff were not always available at the service.

The last inspection was on 27 July 2018 when we rated the service good.

We carried out the inspection of 20 and 23 November 2018 because we were alerted to concerns by one of the commissioning authorities.

Westway Respite Ltd is registered to provide two different services to adults who had a learning disability. There was a three-bedroom respite service, which offered short stay accommodation to adults with a learning disability. Up to three people were able to stay at the service at any one time. The provider is also registered to provide personal care to people living in their own homes. They were providing care to five people living in two supported living services and one person living in their own flat. However, as part of the concerns identified by the commissioning authority, the commissioners had suspended the service whilst they carried out investigations into the concerns. At the time of the inspection, two people were regularly using the respite service and a third person started using the service during the evening of the second day of our inspection.

There was 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 and associated Regulations about how the service is run .

People using the service were at risk of harm and abuse. The staff supporting them had not had the training or support to understand their needs and responded inappropriately to incidents where people were anxious or agitated. Records of incidents showed that the staff had used inappropriate restraint and restrictions. The provider had not investigated these incidents or taken any action in response to ensure people were safe and that staff learnt from these.

The provider did not ensure sufficient recruitment checks were made on staff to make sure they were suitable to care for people. They allowed staff who had not been checked, trained or had an induction to the service to support people with complex needs. This meant that people were not always getting the right support, were placed at risk of inappropriate care and treatment and their needs not being met.

The way in which staff recorded how they had cared for people indicated a lack of respect and understanding about their individual needs. There was a culture of blame where some people who used the service were seen as causing problems for the staff and were not cared for in a compassionate way.

The staff did not receive adequate training, support or supervision and the provider did not assess their competency or abilities to care for people. There was no evidence of reflective practice or support for staff to develop new skills. Whilst care plans, guidelines and risk assessments had been developed and incorporated information about people's needs, the staff did not always follow these.

Whilst some of people's needs had been met, they did not always have opportunities to live varied lives. There was limited evidence that people's sensory needs were being met, or that staff understood these. People were not supported to make use of the community and develop social interaction skills.

The relatives of people who were using the service told us they were happy with the care and support people received. They said that their relatives felt well cared for and liked the staff.

We identified breaches of seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, dignity and respect, safe care and treatment, safeguarding adults from abuse and improper treatment, good governance, staffing and fit and proper persons employed.

We are taking action against the provider for failing to meet Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.