Walsingham Support - London Supported Living

About the service

Walsingham Support- Brent & Harrow is registered to provide personal care. At the time of this inspection, the service was providing personal care to seven people living in a supported living scheme. People who used the service had autism and learning disabilities. The scheme consisted of three separate four bedded flats.

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

The service did not demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right care:

People’s human rights were not consistently upheld. They had not been meaningfully engaged so they understood their rights and responsibilities as tenants. Tenancy agreements were unlawfully signed. However, people’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had received training on how to recognise and report abuse and they knew how to apply it. However, systems around managing people’s finances could be improved.

Right support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There were examples of care that may have amounted to deprivation of liberties because some people were subject to continuous supervision. However, the provider had not requested relevant social workers or care managers to consider making an application to the Court of Protection for oversight. In addition, the model of care was not consistent with a supported living framework. Instead, the provider operated more like a traditional residential care service. The provider did not consistently meet a set of principles that are defined in the Reach Standards, which are based on people having their own homes and having control over who they live with, who supports them and how they are supported.

Right culture:

Staff had received training to meet people’s needs. They were aware of good practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. However, people did not consistently lead inclusive and empowered lives because they were not always meaningfully involved in other aspects of their lives, including decisions around finances and restrictions.

We have made recommendations about unlawful restrictions and accommodation rights.

The provider’s quality checks, and audits did not consistently find areas for improvement. Furthermore, where gaps had been found, improvements had not been implemented within reasonable time. For example, we raised concerns with the appointeeship system at our inspection of October in 2021. Whilst we have seen evidence that shows the provider contacted the local authority in August 2022, to arrange the transfer of appointeeship, we were concerned about the length of time taken to address the concerns. This has meant a delay for people’s monies to be managed as they should.

Following this inspection, we received an action plan from the provider, which showed the they had started to make improvements in a range of areas. However, it was too early to be able to demonstrate that these processes were fully embedded and that these improvements could be sustained over time.

There were adequate systems to assess, monitor and manage risks to people’s safety. Comprehensive risk assessments were carried out for people.

There were enough care workers deployed to keep people safe. Pre-employment checks had been carried out.

There were systems in place to ensure proper and safe use of medicines. We observed from records people received their medicines on time.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

There was a process in place to report, monitor and learn from accidents and incidents. Accidents were documented timely in line with the service’s policy and guidance. The system could be improved to facilitate dissemination of learning across the organisation.

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 good (published on 9 March 2019).

Why we inspected

We received concerns in relation to health and safety, the Mental Capacity Act 2005 and arrangements for managing people’s finances. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Walsingham Support - Brent & Harrow Supported Living on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to absence of robust systems to ensure people were protected from financial abuse and lack of an effective quality assurance system.

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 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.

Walsingham Support- Brent & Harrow is registered to provide personal care. At the time of this inspection, the service was providing personal care for eight people living in a supported living scheme. People who used the service had autism and learning disabilities. The scheme consisted of three separate four bedded flats.

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

People were protected from the risk of harm and abuse. However, the provider was an appointee for financial matters relating to some people receiving care. Although there was no evidence of financial misappropriation, we were not satisfied this arrangement was safe and transparent. Following the inspection, we received evidence the provider was acting to ensure sound financial management was practised so that relevant policies and procedures were followed.

There were effective systems and processes in place to minimise risks to people. Risks had been identified, assessed and reviewed. Care workers knew how to identify and report concerns. They had been recruited safely and showed good knowledge and skills in relevant areas including medicines administration and infection control. They demonstrated dignity, respect and compassion in interactions.

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 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 service demonstrated how they were meeting the underpinning principles of Right support, right care, right culture. People were supported to develop skills in order to do things as independently as possible. There was a structure to support a values-led culture. Notably, there was a strong emphasis on inclusion and creating opportunities for people to participate in ordinary activities and improving their personal dignity.

Whilst people were supported to develop skills, we judged more could be done by creating opportunities for people to have more control of their medicines and money within the limits of the provider’s own positive risk-taking policy. The service was receptive to this feedback stating assessments will be carried out in line with relevant policies.

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. The service used positive behaviour support approach, which was opposed to restrictive practices.

The provider had a range of quality assurance processes, including systems necessary to maintain safe environments. The registered manager and her deputy ensured policies and procedures met current legislation and were up to date. Relatives told us they were asked of their views about the quality of 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)

This service was registered with us on 13 July 2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on our timelines for inspecting newly registered services.

Follow up

We will continue to monitor information we receive about the service.