This was an announced inspection which took place on the 21 and 27 October 2016. This was the services first inspection since re-registration in April 2013. Westgate Court is a domiciliary care provider who provide support for around 150 people; the service supports people across England in their own tenancies or in shared houses. The service specialises in brain injury care post rehabilitation, as well as people with a learning disability, physical/sensory disability and people on the autistic spectrum.
The service had a registered manager who had been registered since May 2016. 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 was absent from work at the time of inspection. We were assisted by other senior staff including the former registered manager.
Where the service had identified issues relating to the consistency of supervision they had taken steps to ensure this issue was addressed. However records demonstrated and staff told us that supervisions and appraisals were still not happening as frequently as the providers policy stated. The service had not responded quickly to this issue.
The services process to respond to incidents, using a root cause analysis form, was being used inconsistently and not in line with best practice. This meant that evidence around learning and actions taken was not being recorded consistently to be used to improve the service.
We found that people’s care was delivered safely and in a manner of their choosing, or in their best interests. People told us they were supported in a way that reflected their wishes and supported them to remain as independent as possible or develop further independence.
Staff told us and records showed they were trained and inducted well into their new roles, or when they were to work with a new person. They felt they had been supported and mentored effectively and people and staff were supported by the services psychology team to assist in delivering a personalised service.
The service supported people to make important decisions about how their care was delivered, working with people to develop their capacity to make decisions. Where people lacked capacity to consent, their care was developed and delivered in line with the Mental Capacity Act and in their best interests.
People’s medicines were managed well. Staff watched for potential side effects and sought medical advice as needed or when people’s conditions changed. People were supported to self-manage their own medicines if they wished.
Staff felt they were well trained and encouraged to look for ways to improve on their work. Staff felt valued and this was reflected in the way they talked about the service, senior staff and the people they worked with.
People who used the service were matched up with suitable staff to support their needs, and if people requested changes these were facilitated quickly. Relatives and external professionals were complimentary of the service, and were usually included and involved by the staff. They felt the service provided met peoples sometimes complex needs.
There were high levels of contact between senior staff and people, seeking feedback and offering support as people’s needs changed quickly. People and their relatives felt able to raise any questions or concerns and felt these would be acted upon.
When people’s needs changed staff took action, seeking internal and external professional help and incorporating any changes into care plans and their working practices. Staff worked to support people’s long term relationships. People thought that staff were open and transparent with them about issues and sought their advice and input regularly.
The registered manager and area managers were seen as good leaders, by both staff and relatives of people using the service. They were trusted and had created a strong sense of commitment to meeting people’s diverse needs and supporting staff. External professionals felt that people’s needs were supported effectively by a person centred service. They told us that when they had contact with senior staff or area managers of the service this was always positive and prompt.
We found a breach of regulations in relation to good governance. You can see what actions we have asked the provider to take at the end of the full report.