Archived: Wadeville

Wadeville is a care home providing care and support to people living with learning disabilities, mental health and physical disabilities across two joined houses. The service was registered to provide support for up to 13 people, there were 11 people using the service at the time of our inspection.

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

Relatives told us they felt their loved ones were safe and happy at the home. The provider had taken action to address the issues we found at the last inspection. Work had been done to improve the cleanliness security and upkeep of the building.

However, we found a small number of fire safety and environmental risks which were acted on promptly following the inspection. The provider had not identified some areas of staff training to meet the specific needs of people using the service. Records did not consistently evidence relatives’ involvement in people’s care where this was appropriate.

Staff understood their roles in safeguarding people from harm. Other risks to people had been assessed and staff knew how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns.

There were safe recruitment practices that followed legal requirements. Medicines were safely stored and administered. The service had policies and procedures to respond effectively to Covid-19. The home was clean and free from odours. Staff mostly followed appropriate infection control practices to prevent or minimise the spread of infection.

People's nutritional needs were assessed and met. Staff liaised with health professionals to meet people's health needs.

Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People's needs in respect of their protected characteristics were assessed and supported.

Relatives said staff treated people with care and we observed this to be the case. Staff knew people well and treated them with dignity and respected their privacy. People were involved in a range of activities at the home in line with their preferences.

There were some systems to monitor the quality and safety of the service. The registered manger understood their role. Most staff were positive about the registered manager and said improvements had been made since the last inspection. Staff worked in partnership with relatives, health and social care professionals and voluntary organisations.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture (RSRSRC) is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: There were limitations to the building which was designed to accommodate a larger than recommended number of people and was not best suited to increasing people’s independence and skills. The provider told us the local authority, who owned the building were considering separating the house into two smaller units.

Some further improvement was needed to increase people’s choice and control across all aspects of their lives. People had a personalised plan for their care. However, improvement was needed to evidence that people were supported to develop skills achieve outcomes and integrate in the community.

Right care: Overall care was person-centred and promoted people’s dignity, privacy and human

rights. However, improvement was needed to evidence that people were encouraged and consistently supported to develop and maintain skills and that any goals and outcomes were regularly reviewed.

Right culture:

Improvements had been made to provide more accessible information about the service to people but these had not addressed the communication needs of everyone 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 and update.

The last rating for this service was requires improvement (published 30 November 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The last rating for this service was requires improvement (published 30 November 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

This was a planned inspection based on the previous rating.

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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wadeville is a care home providing care and support to people living with learning disabilities, mental health and physical disabilities across two units. The service was registered to provide support for up to 13 people, there were 11 people using the service at the time of our inspection.

The service didn’t always consistently apply 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.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, the service was not always suitable to meet people’s needs. People’s choices were not personalised in response to their change of circumstances due to Covid 19.

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

Risks to people were not managed safely. Medicines were not managed safely. Improvement was required to ensure safe staffing levels. Infection prevention control guidance in place was not robust to manage risks in relation to COVID19. Staff had not followed the MCA Code of practice. The service was not clean in places and some areas of the service appeared tired and run down. People had no access to easy read or pictorial information leaflets for complaints, and Covid 19 to explain social distancing in line with the Accessible Information Standard. People were not always supported enough to follow their interests and take part in activities. Systems to manage risk and monitor the quality and safety of the service were not robust.

We have made two recommendations about accessible information in relation to meal times, complaints, and Covid 19 to explain social distancing.

The registered manager took swift action to address the issues we found with the premises and records. They told us they would take action to address other areas of concern found.

People’s care records included risk assessments which included information for staff about action to be taken to minimise the risks to people. The provider had arrangements to deal with emergencies. Staff and external agencies, where necessary, carried out safety checks. Staff recruitment procedures were in place. There were procedures to reduce risk from any visitors to the home spreading infection at the entrance to the premises. Safeguarding alerts were monitored to enable learning from the outcomes of any investigation. The provider had a system to manage accidents and incidents and discussed in staff meetings and supervision, to reduce the likelihood of them happening again.

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 coronavirus and other infection outbreaks effectively.

People’s rooms were personalised. Staff understood the importance of gaining people’s consent before they supported them. People’s personal care reviews were carried out and the relevant decision had been made in their best interests, with the involvement of staff, relatives and healthcare professionals, where appropriate. People were supported to eat and drink safely. Staff supported people through a transition plan as part of the pre-admission process. Staff were supported through induction, training and regular supervision to ensure they had the appropriate knowledge and skills to meet people’s needs. Staff worked in partnership with GP’s and other health and social care professionals to plan and deliver the service. People received support to manage their healthcare needs effectively.

Staff received training on equality and diversity and people were treated with dignity and respect. People and their relatives had been consulted about the care and support they received. Staff respected people’s choices and preferences, such as the clothes they wanted to wear, their food and drink preferences. People’s privacy was respected, and their dignity was promoted. People were supported to maintain their independence.

People took part in a range of arts and crafts activities throughout the day, but activities were not personalised. they were group based. People had care plans that described their health and social care needs and included guidelines for staff on how to best support them. Care plans were kept under regular reviews to ensure people's changing needs were met. However, there was no detail plan for a person about how their specific goals and needs were being met. Staff knew people well to ensure their needs were met. People knew how to make a complaint and would do so if necessary. Senior staff had investigated and responded to any complaints in a timely manner and where necessary they held meetings with the complainant to resolve their concerns.

There was a clear management structure at the home. The registered manager and staff were aware of the roles of the management team. Staff described the leadership at the service positively. Relatives commented positively about staff and the registered manager. The provider had systems and processes to assess and monitor the quality of the care people received. The provider had worked effectively in partnership with a range of professionals and acted on their advice.

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 has been operating for many years but was registered with CQC on 30/10/2019 under a new provider Look Ahead Care and Support Limited and this is their first inspection.

The last rating for the service under the previous provider was Good, report published (11/11/2016).

Why we inspected

The inspection was prompted in part due to safeguarding and whistleblowing concerns. This service has not been inspected since its registration in October 2019. As a result, a decision was made for us to inspect all the five key questions safe, effective, caring, responsive and well-led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s risk management, medicines management, staffing levels, infection prevention control, mental capacity assessment, cleanliness, accessible information standards activities, and systems to manage risk and monitor the quality and safety of the service at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.