Archived: 31 Whitwell Road Also known as People First

At our last inspection carried out on 3 November 2016, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The concerns were: safeguarding issues had not always been reported to the local authority safeguarding team or notified to the Care Quality Commission; staff had not always completed the training they needed to carry out their roles; medicines were not stored appropriately and records for medicines were not always present. The provider had quality audit tools in place. However these had not identified the risks to people's health and wellbeing. The environment had not always supported people's privacy and dignity.

The provider sent us an action plan in December 2016 telling us they would be compliant with all the regulations by the end of January 2017.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

31 Whitwell Road is a care home without nursing and supports people with a learning disability. The service can provide accommodation for a maximum of nine people. There were eight people living at the home at the time of inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager advised us that they had appointed a manager with the intention that they will deregister and the new manager will apply for registration. The new manager was working at the home on the day of the inspection and it was their second day in post. We refer to the new manager as manager throughout the report, and the registered manager separately.

Relatives we spoke with were positive about the registered manager and new manager and staff and gave examples of person-centred care.

People were safe. Staff understood their role and responsibilities to keep people safe from harm. Risks were assessed and plans put in place to keep people safe. However staff still needed reminding about safety in the environment and there was an infection control issue.

Medicines were managed safely. Emergency systems had been put in place to keep people safe.

There were enough staff to safely provide care and support to people. The provider carried out safe recruitment practices to ensure staff were suitable to work with vulnerable people.

We saw that people had choice and that staff responded to them expressing choice in a positive and supportive manner.

The service was compliant with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to have enough to eat and drink and to maintain a balanced diet. Staff monitored people's health and well-being and ensured people had access to healthcare professionals when required.

People experienced caring relationships with the staff that provided good interaction by taking the time to listen and understand what people needed. People's care was planned in a personalised way and delivered by staff that knew them well. Their support needs were monitored and reviewed to ensure that care was provided in the way that they needed.

Staff treated people with dignity and respect. People’s views were actively sought and they were involved in making decisions about their care and support. Information was provided in ways that were easy to understand. People were supported to maintain relationships with family and friends.

The provider was introducing systems to check on the quality of service people and these needed to be embedded to demonstrate that the improvements could be sustained. The provider had acted and had taken action to improve the environment. We have made a recommendation about this.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

31 Whitwell Road is registered with the Care Quality Commission to provide the regulated activity: Accommodation for persons who require nursing or personal care. The service is a care home without nursing and supports people with a learning disability. The service can provide accommodation for a maximum of nine people.

The service was last inspected in July 2014 and was not fully compliant with the outcome areas that were inspected against. Medicines were not managed in a safe or proper way.

The service had a registered manager but they were not present at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Staff knew how to recognise and respond to abuse. They understood their responsibilities and who to report concerns to. However we found safeguarding issues had not always been reported to the local authority safeguarding team or notified to the Care Quality Commission.

Staff were supported to carry out their roles. There was a plan in place to ensure all staff had a one to one meeting with the registered manager. However staff had not always completed the training they needed to carry out their roles.

Medicines were not stored appropriately. We observed people received their medicines when they needed it and were encouraged to be as independent as possible when taking their medicines. Records for medicines were not always present.

People were involved in developing and shaping the service. People were involved in daily life within the home such as in the cooking and cleaning.

The provider had quality audit tools in place. However these had not identified the risks to people’s health and wellbeing.

People and their relatives spoke positively about the support they received. They said staff were kind and caring. Staff treated people with respect and dignity. However the environment did not always support people’s privacy and dignity. We have made a recommendation about this.

Regular fire drills were undertaken and people and staff knew what to do in the event of an emergency.

There was enough staff to meet people's needs. People were able to do the activities they wanted and attend all of their appointments. Before staff started working at the service all the necessary checks were carried out to ensure staff were suitable to work with people.

All staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had looked for the least restrictive options when depriving someone of their liberty.

People were supported to prepare and eat balanced and nutritious food. People attended a variety of healthcare appointments and staff supported people to be as independent as possible.

People decorated their rooms in the way they wanted and their loved ones could visit whenever they wanted.

People were involved in writing their care plans and risk assessments. They received the care they needed, in line with their wishes. People were actively involved in the local community and various local clubs.

There had been two complaints in 2016 which had been dealt with appropriately. People and their relatives told us they were in regular contact with staff and felt they could raise any issues if they arose.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. CQC is currently considering the right regulatory response to the problems and issues we found at the inspection on 3 November 2016.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Is the service safe?

People had individual risk assessments. Where a risk or need had been identified, there was a written plan to inform staff as to how to reduce the risk. We saw people had access to medical support as necessary. People who used the service would be better protected by improved medication practices, as records were not always completed accurately. The service was clean and hygienic. Safeguards were in place to manage infection control.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found staff had been trained to understand when an application should be made, and how to submit one. There were proper policies and procedures in place and these had been followed.

Is the service effective?

We observed people were happy with the care they received and they told us they were happy. It was clear from what we saw and from speaking with staff they understood people's care and support needs and they knew them well. People assessed as not having capacity to make decisions were supported to ensure decisions were made their best interest.

Is the service caring?

We observed that staff had a good understanding of people's support needs. They were supportive and were available when people needed them.

Is the service responsive?

Records showed people's preferences, interests had been recorded and care and support had been provided to meet their wishes. People were supported to maintain and increase their independence.

Is the service well-led?

People were asked their views and these were listened to. There were systems to record, monitor, evaluate and improve the service, care and support that people received.

We saw that where people did not have capacity to consent their relatives were engaged and involved in their care planning. Whilst we saw that the home actively encouraged people to be involved and make choices and decisions, there were no records to demonstrate that the home formally assessed capacity and made best interest decisions for people.

People's needs were assessed and recorded. Care plans were recorded on how people's care and behaviour needs should be met. Staff told us people were looked after well and had a fulfilled lifestyle. Relatives also told us the home looked after people well.

The provider had systems in place for staff to be able to recognise abuse and prevent this.

We found areas of the home were not clean and the home did not maintain any records of cleaning or infection control audits.

The home had sufficient numbers of staff to meet the needs of people and where additional staffing was needed this could be accessed.

The home had a complaints procedure and this was also in a pictorial diagram format for easier understanding by people. Relatives said they knew what to do if they had any concerns about the home.

Comments from people were positive. One person told us 'I am happy here the staff are good to me'. Another person said 'The staff are kind and help me to do things'. People told us that the staff were kind and that they got on well with all the staff.

All of the people we spoke with said they felt safe at the home and expressed satisfaction with the staff that supported them.

Not all people were fully aware of the homes complaints procedure. However people said that if they were unhappy or had any concerns they would speak to a member of staff.

We also spoke to four family members and they told us that their relatives were supported by the staff to receive the care they needed. They told us that their relatives were treated well by the staff and that they had no concerns about the safety of their relatives. We were also told that staff were patient, kind and caring. One person told us 'The staff are wonderful; they do over and above to make sure everyone is safe, happy and well looked after'.

Relatives told us that if they had any concerns they would raise them with the manager. People were confident that any concerns would be quickly sorted out.