Weir End House

Updated 28 December 2019

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 Care Act 2014.

Inspection team

The inspection was completed by one inspector.

Service and service type

Weir End House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The first day of our inspection visit was unannounced. We informed the provider of the date on which we would be returning to complete our inspection visit.

What we did before the inspection

Before the inspection visit, we reviewed information we had received about the service since the last inspection. This included information about incidents the provider must notify us of, such as any allegations of abuse. We sought feedback on the service from the local authority.

During the inspection

We spoke with four people who used the service about their experience of the care provided. We also spoke with the registered manager, operations director, quality improvement lead, three senior care staff and six care staff.

We reviewed a range of records. These included three people’s care records, medicines records, complaints records and three staff recruitment records. We also reviewed incident records, selected policies and records relating to the safety of the premises and management of the service.

After the inspection

We spoke with three relatives and two community health and social care professionals about their experiences of the care provided. We also reviewed additional information sent to us by the provider.

Updated 28 December 2019

About the service

Weir End House is a residential care home providing personal care and accommodation for younger and older people with learning disabilities, autism and mental health needs.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. Ten people were using the service at the time of the inspection visit. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Incidents involving people who used the service and unexplained injuries were not always appropriately reviewed and investigated by the registered manager and provider, as part of protecting people from potential abuse. The provider’s procedures for assessing and managing the risks to people were not sufficiently robust. People’s risk assessment and care plans were not always reviewed and updated in light of incidents and episodes of challenging behaviour. The provider had failed to inform us of three potential safeguarding incidents involving people living at the home.

Staff expressed mixed views on the management of the service. Some staff lacked confidence bringing concerns about people’s care to the attention of the registered manager. The provider’s quality assurance systems and processes were not as effective as they needed to be, and had not enabled the provider to address the shortfalls in quality we identified during our inspection. The provider and registered manager did not fully seek to engage positively with people and staff and involve them in the service.

Staff had received training in, and understood, how to identify and report abuse. Checks were completed on the premises and equipment in use to protect people’s health and safety. People told us there were enough staff on duty to provide them with prompt support when they needed this. Prospective staff underwent pre-employment checks before they started work at the home. People were supported to take and manage their medicines safely. The provider took steps to protect people, visitors and staff from the risk of infections.

People’s care plans were individualised and promoted a person-centred approach. People’s individual communication needs were assessed, reviewed and plans put in place to address these. People had support to spend time in way they found interesting and enjoyable, and to participate in their local community. People had been provided with accessible information on the provider’s complaints procedure, and they told us they would speak to staff and management about any concerns. People’s wishes regarding their end-of-life care were assessed, in order to address these at the relevant time.

People described the positive relationship they had with the registered manager and felt the home was well-managed. Staff and management sought to work collaboratively with community health and social care professionals to ensure people’s care needs were monitored and met.

Rating at last inspection

The last rating for this service was Good (report published 14 February 2019).

Why we inspected

This was a focussed inspection to assure ourselves the service was protecting people from abuse and avoidable harm and meeting people’s needs through effective leadership and management.

We reviewed the key questions of safe, responsive and well led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions, therefore we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated to Requires improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches at this inspection. These relate to the provider’s failure to implemented robust procedures and processes to protect people from abuse and to inform us of any safeguarding incidents involving people. In addition the provider’s quality assurance systems and processes were not sufficiently effective.

You can see what action we have asked the provider to take at the end of this full 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.