The Withins

The Withins is a residential care home providing personal care for up to 17 people. The service provides support to people with a diagnosed mental health condition to provide rehabilitation support. At the time of our inspection there were 11 people using the service.

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

Oversight of training required for staff had improved. However, staff who had previously undertaken a vast number of online training courses in one day had still not refreshed this training. Furthermore, bespoke training on how to support people with mental health needs had not yet been provided to staff. An updated training plan was in place to ensure this would be provided to staff soon.

Although we found leadership and the general oversight of the service had improved. Audits continued to not be completed consistently. A robust governance framework had not yet been established.

The service outlined in their statement of purpose they would support people with a focus upon health promotion and rehabilitation. Although there were future plans in place to introduce a bespoke recovery model at the service, work in this area had not progressed since our last inspection.

Oversight of accidents and incidents had improved. But there was still a missed opportunity to complete analysis of incidents to establish if patterns or themes were emerging, in order to prevent or minimise reoccurrence of incidents.

Oversight of people’s medicines had improved, and people received their medicines in a person-centred and unhurried manner. However, we found there was still areas some areas of improvement required.

Since the last inspection, numerous changes were made to ensure people received safe care. People’s risk assessments and care plans were replaced, updated and made more individualised.

Risks connected to the safety of the premises improved and significant work was completed to ensure the service met the fire safety concerns identified. Potential ligature risks were assessed and made safe.

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.

Staff were recruited safely and there were enough staff to safely meet people's assessed needs. Staff told us they felt supported in their roles and felt the recent change in management had implemented positive changes.

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 25 August 2022).

This service has been in Special Measures since 25 August 2022. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Withins on our website at www.cqc.org.uk.

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 continued breaches in relation to staff training and good governance. Please see the action we have told the provider to take at the end of this report.

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

The Withins is a residential care home providing [regulated activity personal and nursing care to up to 17 people. The service provides support to people with a diagnosed mental health condition to provide rehabilitation support. It does not provide nursing care. At the time of our inspection there were 15 people using the service.

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

There were significant concerns with the management of people's health risks. People at risk of self-harm did not have robust risk assessments in place and the service was not equipped to manage one person's

care. We therefore raised a safeguarding referral.

Risks connected to the safety of the premises were poorly managed. We identified aspects of the premises did not meet fire regulations. Due to the seriousness of these concerns we made an urgent referral to the

Fire Safety Protection Team at Greater Manchester Fire and Rescue Service. There were ligature risks found and the basement of the home was found to be on one occasion unlocked, the basement contained several

hazards.

The water systems in the home were poorly managed. Testing of temperatures didn't take place in line with best practice and there was no environmental legionella risk assessment.

Aspects of the environment and culture adopted at the service could have been considered a closed culture. There was a large viewing window connected to the medicines room, this overlooked the dining room,

where people tended to relax. There was no reason for this level of observation at the service. The senior staff administering medicines would ask people to queue up for their medicines along the corridor and

medicines would then be administered from a hatch window. This went against good practice guidelines.

People's healthcare needs were not always met. No links had been made for people to have access to dentistry and podiatry care if this was required. We have made a recommendation the provider consults best practice guidelines around managing people's health needs.

The service outlined they would support people with a focus upon health promotion and rehabilitation.

However, further improvements were required to ensure the service was able to assess and track people's rehabilitation and recovery. We have made a recommendation the service implements a recognised rehabilitation support model.

Systems to determine safe staffing levels were not completed or considered appropriately. One person required 15-minute checks, we found staff were not always able to complete these checks due to undertaking other tasks.

Accidents and incidents were recorded, although this was inconsistent and did not always show appropriate action had been taken. Analysis of incidents did not take place to ensure learning could be implemented at the earliest opportunity to prevent reoccurrence.

There was ineffective oversight of staff training. We found a high number of staff completed a vast number of online training courses in one day. We were concerned how staff could retain this training. Bespoke training on how to support people with mental health needs was limited.

Medicines were safely administered. However, storage of medicines was not in in line with good practice guidelines. We have made a recommendation about the management of medicines.

There was a lack of leadership, oversight and governance at the service. Audits were not completed consistently, and when they had been completed, they did not always identify the issues we found at this inspection.

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 14 May 2021 this is the first inspection.

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 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 safe care and treatment, staffing and good governance at this inspection.

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

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.