Wellfield Also known as Wellfield Pines and Wellfield Acorn

Wellfield is a children’s home which is registered for accommodation for people requiring personal or nursing care as well as treatment of disease, disorder, or injury. The service can accommodate two people. The service provides therapeutic psychological support to children and young people with mental ill health and additional needs, such as neuro-developmental disorders.

Ofsted are the lead regulator for services registered as children’s homes, however, the service was not registered with Ofsted at the time of our inspection.

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: Model of Care and setting that maximises people’s choice, control, and independence.

Right Care: Care is person-centred and promotes people’s dignity, privacy, and human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive, and empowered lives.

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

We had continued concerns that the provider had not always taken all reasonable steps to make sure that risk management plans contained sufficient information to support staff in making sure that young people who used the service were kept safe from avoidable harm.

Although records indicated that most medicines had been well managed, there was not enough information to support staff to correctly administer an ‘as and when required’ (PRN) medicine. On occasions when this had been administered, records were not clear why it had been needed.

The way in which safeguarding incidents had been managed had not been consistent and safeguarding referrals that had been made to the local authority did not always contain enough information.

Systems had not been established to make sure that incidents had been reported, investigated, and managed in a way that reduced the risk of similar incidents happening again. This was not in line with the provider’s own policies and procedures.

Although the provider had done a lot of work to update their policies and procedures, we found that important areas, such as information governance, were not covered. In addition, policies and procedures had not always been further updated to reflect the most up to date practice.

The provider had taken action to make some improvements following our last inspection. For example, more effective systems had been introduced to reduce the risk of absconding. Also, training records indicated that all staff had now completed appropriate safeguarding training for adults and children.

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 15 July 2022). This service had also been inspected on 1 and 2 June 2023 (published 21 July 2023) as well as 21 to 23 August 2023 (published 31 October 2023), and the service had previous breaches of regulations.

At this inspection, we found the provider remained in breach of regulations.

As this was a targeted inspection, the ratings from the last inspection have remained the same.

Why we inspected

The inspection was prompted in part due to concerns about the effectiveness of the provider’s systems and processes to keep young people who lived at Wellfield safe. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding and good governance.

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

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.

About the service

Wellfield is a children’s home which is registered for accommodation for people requiring personal or nursing care as well as treatment of disease, disorder, or injury. The service can accommodate two people. The service provides therapeutic psychological support to children and young people with mental ill health and additional needs, such as neuro-developmental disorders. At the time of our inspection there was one person using the service.

Ofsted are the lead regulator for services registered as children’s homes, however, the service was not registered with Ofsted at the time of our inspection.

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: Model of Care and setting that maximises people’s choice, control, and independence.

Right Care: Care is person-centred and promotes people’s dignity, privacy, and human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive, and empowered lives.

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

The provider had not always taken all reasonable steps to make sure that risk management plans had been updated when needed or had contained sufficient information to support staff in making sure that service users were kept safe from avoidable harm.

The way in which safeguarding incidents had been managed had not always been effective and effective safeguarding policies and procedures to manage allegations of abuse against staff were not in place.

The provider had not operated a system to assure themselves of the safety and quality of the services provided at Wellfield.

Systems had not been established to make sure that incidents had been reported, investigated, and managed in a way that reduced the risk of similar incidents happening again.

The provider had not always made sure that staff had received the required level of training to undertake their roles effectively.

The provider had taken action to make some improvements following our last inspection. This included making sure that most daily, weekly, and monthly safety checks had been completed as well as making improvements to the way that environmental risk was managed.

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 15 July 2022). This service had also been inspected again on 1 and 2 June 2023 (published 21 July 2023) and the service had previous breaches of regulations.

At this inspection, we found the provider remained in breach of regulations.

As this was a targeted inspection, the ratings from the last inspection have remained the same.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, good governance, and staffing.

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

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.

About the service

Wellfield is a children’s home which is registered for accommodation for people requiring personal or nursing care as well as treatment of disease, disorder, or injury. The service can accommodate two people. The service provides therapeutic psychological support to children and young people with mental ill health and additional needs, such as neuro-developmental disorders. At the time of our inspection there was one person using the service.

Ofsted are the lead regulator for services registered as children’s homes, however, the service was not registered with Ofsted at the time of our inspection.

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: Model of Care and setting that maximises people’s choice, control, and independence.

Right Care: Care is person-centred and promotes people’s dignity, privacy, and human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive, and empowered lives.

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

This was a targeted inspection that considered parts of the safe and well-led key questions. Based on our inspection of these areas, we found areas that the provider needs to make further improvements to keep children who use the service safe.

An admissions and discharge policy was in place, however, it was unclear how all information that had been made available from previous placements had been used in a way to keep young people safe upon admission to Wellfield.

Although many risk assessments and risk management plans had been completed, information contained in these plans was inconsistent and did not provide the most up to date information for staff to follow.

Systems had not been established to make sure that effective strategies used to mitigate identified risk to young people were in place and had been consistently followed.

The provider had not made sure that all staff had received the required level of training to undertake their roles effectively.

Systems had not been established to make sure that all environmental risks had been identified or mitigated as much as practicably possible. For example, ligature risks had not always been identified and information to support young people and staff to exit in the event of a fire had not been updated.

The provider had not operated a system to effectively monitor the care provided at Wellfield or effectively identify and manage risk.

The provider had not made sure that policies and procedures were available or up to date with the most current information. This meant that staff were not always supported to provide safe care.

Although incidents had been reported, it was not always clear how these had been reviewed in a way that would identify all areas that needed further improvement to reduce the risk of similar incidents happening again.

Staff and leaders at Wellfield had worked jointly with external partners when needed. This included working closely with social workers and practitioners from other services such as Child and Adolescent Mental Health Services (CAMHS).

The provider had taken action to make some improvements following our last inspection.

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 15 July 2022) and the service had previous breaches of regulations.

At this inspection, we found the provider remained in breach of regulations.

As this was a targeted inspection, the ratings from the last inspection have remained the same.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about how young people who lived at Wellfield were being looked after safely.

We use targeted inspections to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

During this inspection, we also followed up on actions we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches and have imposed conditions on the provider’s registration in relation to safe care and treatment, good governance, and safe staffing. Although the provider took actions to address the concerns after the inspection, further improvements are still required.

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

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.

About the service

Wellfield is a residential placement for young people aged 13-17-years with complex emotional, mental health and behavioural needs, as well as neuro-developmental disorders that require specialist psychological therapy and intervention. The provider can accommodate two young people at a time. The provider is currently registered with the Care Quality Commission (CQC) as a care home, for the regulated activities of ‘accommodation for persons requiring nursing or personal care’ (ANPC) (a regulated activity relating to adults aged 18 years and over) and ‘treatment of disease, disorder or injury’ (TDDI). Wellfield does not provide a service for adults, it is a service ‘wholly or mainly for children’, and functions as a children’s home. As such, the regulation of accommodation and care provided by Wellfield is the responsibility of Ofsted, as the regulator for children’s homes.

At the time of our inspection there were two young people using the service.

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

Young people were treated with kindness, compassion and respect by staff. We observed positive interaction between staff and young people, which supported dignity and respect.

Environmental risk assessments were individualised and incorporated into young people’s care plans.

Staff supported young people to explore and embrace their identity and provided care that was sensitive to equality and diversity.

Young people received thorough and detailed assessments, plans and interventions that were individualised to their needs and risks.

All staff at Wellfield were trained in minimum level 2 safeguarding children eLearning, with all leaders and staff involved in care planning trained to level 3. Each level required the successful completion of an assessment for the staff member to be signed off as competent. This level of training was compliant with Intercollegiate Guidance (2019).

Staff had all received accredited training in positive behaviour support and restraint at advanced level before carrying out any direct work with young people.

Young people living quarters were maintained to a good standard or repaired in a timely manner when damage occurred. They had choice and control over the décor of their accommodation.

The management and organisation of most record keeping in Wellfield was good. Recording of medicines administration and the disposal of medicines was not always completed in line with the service’s own guidance and protocol. For example, we saw instances where only one staff member had signed to confirm administration and disposal of medicines, limiting the assurance that young people received their prescribed medicines in a safe, and effective manner; and also not preventing the misuse of unused drugs.

Incidents were not always notified to CQC in accordance with regulatory registration. We found an example where a member of staff had been removed for professional misconduct whilst at work and several examples where notifications were not completed in a timely manner.

We expect health and social care providers to guarantee autistic young people and young 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 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.

The provider was able to demonstrate how they would meet the underpinning principles of Right support, right care, right culture:

Right support: Model of care and setting maximises young people’s choice, control and independence. The provider adopted the least restrictive practices underpinned by a positive behaviour approach. Right care: Care is person-centred and promotes young people’s dignity, privacy and human rights. Staff knew young people well and responded to them appropriately and sensitively. Young people took part in activities and pursued interests tailored to them. They gave young people opportunities to try new activities. Staff acted appropriately as advocates for young people when they were best placed to do so.

Right culture: Ethos, values, attitudes and behaviours of leaders and staff ensure young people accessing facilities lead confident, inclusive and empowered lives. Staff understood young people well. They got to know them and considered this a key element of personal care.

Young 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. Any courts orders depriving them of their liberty were adhered to.

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 provider was requires improvement (published 11 March 2021) but was not in breach of regulations.

At our last inspection whilst improvements had been made, the provider was not yet able to demonstrate over a sustained period that management and leadership was consistent, or that staff practice led to good outcomes for young people.

There was no registered manager in post. We were assured that staff would continue to receive oversight from the provider and other members of the senior management team until another manager was appointed.

At this inspection we found management and leadership was much improved with a registered manager now in post.

Why we inspected

We undertook a full inspection of this provider prompted by a review of the information we held about this it.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wellfield on our website at www.cqc.org.uk.

Enforcement

We have identified breaches at this inspection and have issued a requirement notice

You can see the actions we have told the provider to take at the end of this report.

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.

About the service

Wellfield is a residential care home providing accommodation, care and support for up to two people. It is also registered for the regulated activity of treatment, disease, disorder and injury and can offer a therapeutic service to the young people living at Wellfield. At the time of our inspection there were two people living at Wellfield, both under the ages of 18.

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

People did not always receive safe care. Systems were in place but not operated effectively to keep people safe from harm or abuse. Before and during this inspection we identified numerous safeguarding concerns, which had gone unreported by the service. Risks to people’s care were not always managed safely and staff were not appropriately trained to deal with the complex behaviours displayed on occasions by the young people living at Wellfield.

We found widespread shortfalls in the way the service was managed. Quality assurance processes were not effective in identifying and addressing all the issues found at this inspection and in driving improvements.

There was a risk of people receiving inappropriate care. A registered manager of the service had de-registered from the post in April 2020. A new manager was in post and received registered manager status on the day of our inspection. The nominated individual did not always have good oversight of the day to day running of the service.

The service didn’t apply the full range of 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 as the young people had a lack of choice and control.

Staff did not support people in the least restrictive way possible and in their best interests. For example, an inappropriate method of restraint had been used on one young person with no legal authority in place. Policies and systems in the service indicated the need to give people maximum choice and control but this was not reflected in staff practice.

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

Rating at last inspection

This was the first inspection of this service since being registered with the Care Quality Commission in January 2020.

Why we inspected

Before our inspection we received information of concern in relation to the lack of appropriate training staff received in the use of restraint. We were told of the risks posed to the young people living at Wellfield and how the culture of the home impacted on their care. As a result, we made further enquiries with other stakeholders in the service, including two out-of-area local authorities commissioning care placements. Initially we planned to do a focused inspection to review the key questions of safe, effective and well-led but collected enough information and evidence during and after the inspection to produce a comprehensive inspection.

We found evidence during this inspection that people could be at risk of harm. We reported these concerns to the provider who took immediate action to make improvements and promote people's safety. We informed the host authority, two authorities commissioning care, clinical commissioning groups and safeguarding teams of our concerns. We found the actions taken by the provider had been effective in mitigating urgent risks, however other significant improvements were required.

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 monitor the service 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 of the Health and Social Care Act Regulations 2014 in relation to safe care and treatment, dignity and respect, safeguarding service users from abuse and improper treatment, premises and equipment, good governance and staffing. We also identified a breach of Regulation 18, notification of other incidents, of the Care Quality Commission Regulations 2009. A fixed penalty notice was served on the provider in relation to this breach and was paid.

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

Follow up

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

About the service

Wellfield is a residential care home providing accommodation, care and support for up to two people. It is also registered for the regulated activity of treatment, disease, disorder and injury and can offer a therapeutic service to the young people living at Wellfield. At the time of our inspection there was one person living at Wellfield, under the age of 18.

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

Systems in place to keep people safe from harm or abuse were now operated effectively. Changes had recently been made to risk tools. However, these needed further refining and embedding into practice to ensure all identified risks were appropriately mitigated against. Medicines were managed safely but stocks of medicines received into the home were recorded but not included on the medicine administration chart. We raised this with the provider who intended to improve their documentation to address this. A recent medicines error had been recorded and dealt with appropriately. We were assured that the service was keeping people safe during the COVID-19 pandemic with their infection control practices.

Staff were now appropriately trained and better equipped to deal with complex behaviours. A new building in the rear garden would provide facilities for staff when completed. Until this was finished the service was not looking to accept another person into Wellfield.

Whilst improvements had been made, the service was not yet able to demonstrate over a sustained period of time that management and leadership was consistent, or that staff practice led to good outcomes for people.

There was no registered manager in post. We were assured that the service would continue to receive oversight from the provider and other members of the senior management team until another manager was appointed.

Quality assurance processes were more effective at this inspection. The provider demonstrated lessons had been learned and had used the findings from our last inspection to introduce improvements needed to the service. These needed to be further developed, embedded into practice and sustained.

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 inadequate (published 15 December 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.

This service has been in Special Measures since 15 December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We carried out an announced comprehensive inspection of this service on 30 July, 3, 4, 5, 7 and 10 August 2020. Multiple breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the service in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, good governance, staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wellfield on our website at www.cqc.org.uk.

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 monitor the service

At the last inspection we recognised that the provider had failed to notify CQC of other incidents that had occurred in the service. This was a breach of Regulation 18 of the Care Quality Commission Regulations 2009 and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.