West View Short Term Break Service

West View Short Term Break Service is a care home that provides short term respite stays for people with a learning disability and autistic people. The service can support up to 3 people at any one time; there were 2 people staying there during the inspection.

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:

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 and their relatives were meaningfully involved in reviewing their care. Staff always checked people’s needs and wishes before a stay.

Relatives told us they had good communication with the service, before, during and after their family member’s stay there.

There were enough staff on duty to provide the support people needed, including going out and about in the local area as people chose.

Right Care:

Care plans were based on people’s up-to-date personalised assessments, including risk assessments. Identified risks were managed in line with people’s preferences.

Staff knew people well and understood the support they needed. Medicines were managed safely.

People and relatives said they and their loved ones felt safe and comfortable with the staff who supported them. Information about how to report concerns about care, including alleged abuse, was shared with people, relatives and staff. Systems were in place to protect people from the loss or theft of property.

Staff were recruited after thorough pre-employment checks. They had the skills they needed to work safely and effectively.

Right Culture:

People, relatives and staff spoke highly of the welcoming, respectful culture of the service. Good teamwork between staff translated into people’s and relatives’ positive experience of the service.

The registered manager and provider used the provider’s structured quality assurance processes to maintain an overview of the service, so they could be sure people received safe, person-centred support.

People, relatives and staff found the registered manager to be approachable, supportive and fair.

The service worked in partnership with health and social care professionals as needed, to ensure people’s health and wellbeing needs were met during their stays at the service.

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 4 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

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

West View Short Term Break Service 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.

West View Short Term Break Service is a short stay respite care home without nursing that accommodates up to three adults with learning disabilities at any one time. Accommodation is provided in individual ensuite bedrooms, two of which are downstairs and are adapted for people with mobility needs. Some people who use the service have complex learning and physical disabilities. They may also have different ways of communicating or making their needs known. At the time of the inspection around 20 people had planned short breaks at the service over the

year. They were all funded by statutory services.

The care service has been developed and designed 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 using the service can live as ordinary a life as any citizen.

The service had a registered manager. 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 were treated with kindness, respect and compassion. Their privacy, dignity and independence were respected.

Staff communicated with people in the way they preferred, calling them by their preferred names and being alert to signs that people were happy with whatever was going on at the time.

People were protected from abuse and neglect. Staff understood and met their responsibilities to safeguard people.

Risks to people's personal safety had been assessed and plans were in place to manage identified risks in the least restrictive way possible. People each had a personal emergency evacuation plan that set out clearly the assistance they would need from staff and emergency services personnel in event of a fire or other emergency.

The premises and equipment were kept clean and in good order. People’s individual needs were met by the adaptation, design and decoration of the premises. The ground floor and garden were wheelchair accessible. Both downstairs bedrooms had ceiling tracking hoists that extended into the ensuite shower rooms.

As far as possible people had the same room whenever they came to stay and the furniture was arranged according to the person’s preference. This helped them feel comfortable and familiar with things, and also to manage visual or mobility impairments as independently as possible.

Peoples' medicines were managed and administered safely.

There were systems to ensure that lessons were learned when things went wrong.

People’s assessments and care plans were reviewed and updated in consultation with them and their families prior to each stay. Assessments and care plans were comprehensive, detailed and individualised.

When people were referred to the service, information was obtained from them, their families and their professionals. They visited for meals and had trial overnight stays to help them, their representatives and the staff assess whether the service was suitable for them.

People received personalised care that was responsive to their needs. Care plans reflected people’s wishes and preferred routines for their stay. Where they wished, people maintained contact with their regular day opportunities such as day centres. At other times, staff supported them to do things at West View and in the wider community.

There was a small, well-established staff team, including bank workers who regularly worked at the service and knew people well. Enough skilled staff were on duty to provide the care people needed when they were not out at day centre. When someone came to stay who needed specialist care, such as food or medicines administered directly into their stomach via a PEG tube, there was always a member of staff on duty who was competent in providing this aspect of care.

Staff were supported to gain and maintain the skills and knowledge they needed to provide people’s care. They had regular supervision with their line manager.

People had the support they needed to drink enough and to maintain a balanced diet. Their dietary needs and preferences were catered for.

The registered manager and staff liaised with people’s health and social care professionals so they could care for people effectively.

People, and their relatives as appropriate, were supported to express their views and to be as involved as possible in decisions about their care.

The registered manager and staff worked to the requirements of the Mental Capacity Act 2005. People and their families were involved in mental capacity assessments and best interests decisions.

Information about how to raise a complaint was made known to people and their families.

The culture of the service was positive, person-centred, open and inclusive, with a well-established and motivated staff team.

The registered manager and staff had a shared understanding of challenges, achievements, concerns and risks affecting the service. Staff had regular supportive discussions with their line manager to discuss their work, receive feedback, discuss their development needs and review goals.

Organisational values were clearly communicated to staff through the supervision process and through communications from senior management, such as the staff newsletter.

Quality assurance processes were in place to drive continuous improvement. Significant events, such as accidents, incidents, safeguarding and complaints, were monitored by the service and by the provider for developing trends. There was a programme of quality checks and audits. Results fed into the service’s continuous improvement plan. The registered manager and their manager ensured the appropriate actions were taken.

People's views and experiences were gathered and acted on to bring about improvements.

The service worked in partnership with other agencies to ensure they provided the care and support people needed.

The service had a registered manager who was the regional manager for the provider. This was a temporary arrangement until the new service manager, who had started in post two weeks before, applied to be registered. 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 inspection took place on 10 and 11 August 2017 and 14 September 2017. We announced our visit the day before to be sure the people we needed to speak with would be available. As there was no-one staying at the service on 10 August, we returned the next day to meet people who had arrived that day.

At a previous inspection in June 2016, the service had not been meeting the requirements of the regulations and CQC took enforcement action, issuing warning notices in relation to good governance and record keeping, and safe care and treatment. The service received an overall rating of Inadequate and the provider was placed into special measures by CQC.

We carried out a further unannounced comprehensive inspection on 6 February 2017. Actions had been taken in response to most of the shortfalls and serious concerns identified at the last inspection and the service was taken out of special measures. Whilst there had been significant improvements, breaches of legal requirements were found. There was an ongoing breach of the regulations in relation to good governance and record keeping. There were also two new breaches, in relation to suitably skilled agency staff and notifying CQC of incidents as required by the regulations. In addition, there were some areas for improvement. CQC took further enforcement action in relation to the ongoing breach, imposing a condition on the provider’s registration.

After the comprehensive inspection, the provider wrote to us saying what they would do to meet legal requirements in relation to these areas.

We undertook this focused inspection to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West View Short Term Break Service on our website at www.cqc.org.uk.

During this inspection the service demonstrated to us that improvements had been made and maintained to meet the regulations in relation to good governance, record keeping, staffing and notifications. We have therefore removed the additional condition we imposed on the provider’s registration.

The service had a well-established staff team, who knew people who came to stay at the service well. Agency staff were rarely used, as vacant shifts were usually filled by regular staff working overtime or the provider’s own bank staff. Agency staff profiles were held at the service. These showed the recruitment checks undertaken by the agency and the training they had had, including training and competence in handling medicines.

Action had been taken to ensure medicines administration records and care plans relating to medicines were up to date.

Minor improvements had been made to the premises and equipment had been acquired to help prevent accidents and the spread of infection.

Relatives and staff expressed confidence in the leadership of the service. Staff knew how to blow the whistle on poor care and expressed willingness and confidence to do this, should it become necessary.

Accidents and incidents were recorded and monitored to look for developing trends. The registered manager had notified CQC about an incident that had occurred, in line with the legal requirement to do so.

Quality assurance systems were robust. These included regular audits of aspects of the service. Action was taken in relation in relation to any issues that were identified.

Staff had regular supervision meetings to discuss their work and promote their skills, knowledge and ability. There were also regular team meetings for the service manager and staff.

There was a registered manager at the service who was the regional manager for the provider. This was a temporary arrangement until the new service manager applied to be registered. The service manager was responsible for the overall management of this and one other care home and two supported living services in the locality. 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 the last inspection in June 2016 the service was not meeting the requirements of the regulations and CQC took enforcement action. The service received an overall rating of Inadequate and the provider was placed into special measures by CQC.

This inspection was unannounced on 6 February 2017. There was one person staying at the service at the time of the inspection.

Whilst there had been significant improvements found at this inspection we also identified shortfalls. There was one ongoing breach, two new breaches of the regulations, and some areas for improvement. You can see some of the action we have asked the provider to take at the end of this report.

The governance systems in place were not yet fully effective, as they did not fully assess and monitor the quality and safety of the service, and did not fully assess or mitigate the risks to people. Some records were not accurately maintained. This was an ongoing breach of the regulations.

The agency staff on duty and some other agency staff that had been used were not suitably qualified and did not have the experience, skills and knowledge to support people using the service. Recruitment and training information was not available for three agency staff that had worked at the service over the last month. This was a breach of the regulations.

The service had not notified CQC of incidents as required by the regulations. This was a breach of the regulations.

There were overall improvements in the safety of the service. The management, administration and storage of the medicines was safe. However, improvements were needed in people’s PRN ‘as needed’ medicines plans and the dating of when creams were opened. In addition there were some further areas of improvement needed in the safety and maintenance of the environment.

One concern had not been recorded in line with the complaints and concerns policy. This was an area for improvement.

Improvements had been made and people were supported to make decisions and their rights were protected when they lacked mental capacity to make a specific decision.

People’s needs were reassessed and care plans had been updated and included all the information staff needed to be able to care for people. Easy to access information about people was not available for agency staff. This was an area for improvement.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. Relatives told us staff had the right skills and knowledge to meet their family member’s needs. All the relatives spoke highly of the staff team and said staff were caring and compassionate. Staff kept relatives informed and made sure that people remained in contact with their families and cares during their stays at the service.

Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs. Staff employed by the provider were recruited safely.

The culture within the service was personalised and relatives and staff felt comfortable raising any issues and or concerns. Staff told us they now felt supported and invested in. This was a significant improvement because they felt they had not been supported by the management team and provider prior to the last inspection.

Actions had been taken in response to most of the shortfalls and serious concerns identified at the last inspection. Feedback from professionals and commissioner was positive.

As part of our enforcement action and regulatory response to the repeated breach of regulation 17 Good governance, we have imposed a condition on the provider's registration.

West View Short Term Break Service is a short stay respite care home without nursing for up to three people with learning disabilities. 15 people used the service and they were all funded by the local authority. The 15 people had planned short breaks through the year. Some of the people who use the service have complex learning and physical disabilities. They may also have different ways of communicating or making their needs known.

There was not a registered manager at the service. The manager had been in post since January 2016 and was in the process of applying for their registration. 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.

We inspected West View Short Term Break Service in April 2013 and did not identify any concerns. At this inspection we identified five breaches in the regulations and other areas for improvement.

We identified serious shortfalls in people’s medicines management and this placed people at risk of not receiving their medicines as prescribed. The storage and recording of medicines were not safe. The manager took immediate action in response to our feedback about the safety of people’s medicines. However, this did not mitigate the risks to other people who used the service and the shortfalls were remained a serious concern.

Any risks to people’s safety were not consistently assessed and managed to minimise the risks to them. People particularly at risk were those people with complex needs. In addition, some people were placed at risk of infection because of the lack of infection control systems in place for sterilising specialist feeding equipment. This was a breach of the regulations.

People’s needs were not reassessed when their circumstances changed and care plans were not updated or did not include all the information staff needed to be able to care for people. Staff did not always follow care plans that were in place for some people. These shortfalls were a breach of the regulations.

Some people were being deprived of their liberty unlawfully. This was because no Deprivation of Liberty Safeguards (DoLS) applications had been made. This was a breach of the regulations. The manager took action and applied for authorisations for the people who were next due for stays at the home.

Staff still did not fully understand or adhere to the principles of the Mental Capacity act 2005. This was because people’s capacity had not been assessed or any decisions recorded that were in people’s best interests. This was a breach of the regulations.

The home had not been well led following changes and uncertainty in the management at the home. The provider’s systems in place for assessing and monitoring the quality and safety of the service were not effective. This was because the shortfalls we found had not been identified and acted on by the provider. The improvement plan that was in place was not effective and did not mitigate the risks to people’s safety and well-being. There were multiple shortfalls in the records kept about people and this meant we could not be sure about the safety and quality of the care and support being provided. These serious shortfalls were a breach of the regulations.

There was a very stable staff group who knew people well and have supported them over many years. Staff were very kind and caring but had not benefitted from any consistent leadership or management over the last two years.

Staff had not received the formal one to one support sessions or annual appraisals they needed. Plans were in place for staff to have formal support sessions. The lack of staff having annual appraisals was an area for improvement.

Staff received core training and some specialist training so they had the skills and knowledge to meet people’s needs. Staff were recruited safely.

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.

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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There were two people staying at the service at the time of the inspection. We observed staff interacting and supporting both people as they arrived at the service. Both people had complex ways of communicating and did not communicate verbally. We spoke with one care worker, one agency worker and the manager.

We observed that staff and the two people were relaxed with each other; they laughed and enjoyed each others company. All staff knew each person's likes and dislikes and had good relationships with them. They understood how the two people communicated and responded to their non verbal cues and gestures.

Medicines were managed safely and people received their medicines as prescribed.

There were sufficient suitably qualified staff to support the people and the manager told us that staffing could be increased to meet the needs of individuals.

The records at the service were well maintained, accurate and securely stored.