Walnut House

Updated 10 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was completed by 1 inspector and a medicines inspector.

Service and service type

Walnut House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Walnut House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced on the first day of inspection and announced on the second day.

Inspection activity started on 14 March 2023 and ended on 03 April 2023. We visited the service on 14 March 2023 and 16 March 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with 10 staff including the nominated individual, The nominated individual is responsible for supervising the management of the service on behalf of the provider, the registered manager, members of senior management team and care staff. We spoke with 4 people living at the service and observed care provided in communal areas.

We reviewed a range of records, including 4 people’s care and medicine records. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We continued to seek clarification from the provider off site to validate evidence we found. We spoke with 2 people’s relatives by telephone, about their experiences of the care provided. We liaised with stakeholders after our inspection visit.

Updated 10 May 2023

About the service

Walnut House is a residential care home providing personal care to 4 people at the time of the inspection. The service provides support to people with a learning disability and or autistic people. Walnut House is a house, with bedrooms across the ground and first floor, and shared facilities for people to use.

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.

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

Right Support: Some improvements had been made to the care environment since our last inspection, whilst other areas still required further development at the time of our visit. Following our inspection, additional works were completed to improve the living experience of those being supported. Care plans were under review prior and following our inspection, we did however identify gaps in required information which the provider was taking appropriate steps to improve.

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.

Right Care: People were observed making their own choices over both days of our inspection visits and staff listened to people’s direction and followed their wishes. We continued to identify gaps in mandatory training of staff during our inspection, which poses a risk that staff may not have the required knowledge to keep people safe and ensure all staff were consistently promoting choices. Care records offered little involvement in their implementation of people, although monthly keyworker reviews alongside the person had been newly implemented.

Right Culture: The provider was currently implementing a change of senior structure within the organisation to improve oversight and timely action taken where areas of concern are identified. These roles were still being established at the time of our inspection. Our inspection highlighted that audits that had been completed, prior to these new roles being implemented, had not led to timely changes being made within the service. Although some improvements had been made since our last inspection additional input from the provider was still required to ensure people’s needs were fully met.

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 January 2023).

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 some improvements had been made but the provider remained in breach of regulations.

At our last inspection we recommended that improvements were made to monitoring and reviewing people’s MCA and DoLS applications. At this inspection, we found improvements had been made in this area and the registered manager was able to explain reasons for all applications made.

The last rating for this service was inadequate (published 25 January 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Exiting special measures

This service has been in Special Measures since 04 January 2023. 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

We carried out an unannounced focused inspection of this service on 29 November 2022. 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 safe care and treatment of people, staffing and good governance of the 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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements and to ensure the warning notice we served in relation to regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 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 Walnut House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to care records in the service not being fit for purpose at the time of inspection and timely action and meaningful audits had not been taking place 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 from the provider to understand what they will do to improve the standards of quality and safety. 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.