Wistaston House

Wistaston House is a residential care home providing personal care to up to 7 people. At the time of the inspection 6 people lived at the home. The service offered a home like environment, each bedroom had its own en-suite shower room. There were a number of communal areas including a bathroom, lounge, kitchen, dining room, conservatory and a large garden area.

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

Right Support:

Improvements were needed to ensure medicines were managed safely. The providers policy needed updating to ensure that staff are clear regarding their responsibilities in this area.

Support plans were in place which provided guidance for staff on how a person wished to receive their care. However, improvements were required to ensure that information relating to risk was up to date and reflective of people’s care needs.

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.

Safe recruitment processes were followed. Staff received on-going training and development to support them in their roles.

People told us they felt safe living at Wistaston House. People were encouraged to have choice; support was personalised to their wishes.

Right Care:

People were positive about the care and support they received. People were treated with dignity and respect by staff who were knowledgeable about their support needs.

People were supported to be as independent as possible in the home and, where possible, out in the community. Where new staff had been recently employed, staff recognised people as individuals and developed good working relationships with people, understanding their care needs and how best to support them in these areas.

Staff spoke passionately regarding the people they supported and working for the provider.

Relatives were complimentary regarding the service and support given to people. This included support to ensure that loved ones have regular face to face contact with them.

Right Culture:

We identified areas of improvements were required regarding documentation of medicines, MCA, support plans and checks that the provider makes in the service.

People were positive about relationships with staff and told us staff treated them as individuals.

People were encouraged to have choice and control of their lives. Staff supported people promoting independence, which was observed throughout the inspection.

Overall Staff gave positive feedback regarding working at Wistaston House and the leadership of the home, this included the support given from the provider’s senior leaders.

The manager, senior leaders and staff demonstrated a person-centred culture which focused on meeting people's individual needs. The manager was passionate and committed to developing individualised support and to make continued improvements.

Rating at last inspection

The last rating for this service was requires improvement (published 21 November 2019). The service remains rated requires improvement.

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.

Enforcement and Recommendations

We have identified breaches in relation to oversight of medicines, support plans and management of risk. We also identified breach of management of audits and checks that the provider makes to ensure people were safe.

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

We made a recommendation relating to people’s communication plans, to ensure that staff have constant information on how best to communicate with people.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathcotes Wistaston House is a residential care home providing personal care to six people at the time of the inspection. The service can support up to seven people in one adapted building. Each bedroom had its own en-suite shower room and there was a number of communal areas including a bathroom, lounge, kitchen, dining room, conservatory and a large garden area.

We found the following examples of good practice.

The service had a dedicated staff team. People were supported in the service in accordance with national guidance.

They supported people and their relatives to understand the policies and procedures surrounding protection against COVID 19, the isolation processes and how the service could help them to keep people safe.

During our visit we observed the staff using Personal Protective Equipment, (PPE) safely. There were sufficient stocks of PPE available. A staff member said, “We have had plenty of PPE available for quite a while now.”

People living in the home and staff were tested regularly for COVID-19. There were no staff employed who had not been vaccinated as now required.

The home was clean and hygienic. Cleaning schedules were in place and PPE stations placed around the home. Additional cleaning protocols were in place to ensure all areas of the building were regularly sanitised.

Relatives spoke positively about visiting and the communication from the service. Comments included; "Staff bring [Name] home to visit and this works really well", "Communication is good" and "I always wear a mask when I visit."

Heathcotes Wistaston House is a residential care home providing personal care to four people at the time of the inspection. The service can support up to seven people in one adapted building. Each bedroom had its own en-suite shower room and there was a number of communal areas including a bathroom, lounge, kitchen, dining room, conservatory and a large garden area.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The building design fitted into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

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. We have made a recommendation however to review any legal restrictions affecting a person’s care.

During the inspection we identified one occasion where the registered manager failed to inform the CQC of a notifiable event. We have addressed this with the provider outside of the inspection.

We found that staff did not always receive all the training they needed to support people effectively. This was addressed by the registered manager during our inspection however we have made a recommendation about some of the training staff receive.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. People living at Wistaston House had previously lived in a variety of secure accommodation settings. Staff were motivated and worked in a positive way to develop trusting relationships to encourage people to live full lives as independently as possible. The service enabled people to pursue their leisure interests, maintain relationships with families and friends and develop independent living skills.

People we spoke to during the inspection spoke highly of Wistaston House and the care they received. Staff also felt supported in their role.

Support plans identified the needs of people during their stay and plans contained sufficient person-centred information to meet the preferences of people receiving care.

People had access to healthcare and the registered manager worked closely with other agencies to ensure successful outcomes were achieved.

Systems were in place to ensure the safety and wellbeing of people. These included systems to protect people from the risk of abuse, receive their medicines safely and to ensure that people could share their views on the service being provided at Wistaston House.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 25 January 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part by risks identified at other Heathcotes services. These included risks around risk management, staff training and governance. A decision was made for us to inspect and examine those risks as part of a comprehensive inspection.

We found there were no breaches in regulation, however we have found evidence that the provider needs to make improvements. Please see the effective and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.