Archived: Avenues South East - 4 Westhall Park

About the service

Avenues South East – 4 Westhall Park (referred to as ‘Westhall Park’ in this report) is a residential care home providing accommodation and personal care for up to six people with autism and/or a learning disability. At the time of the inspection five people were living at the service which is a converted house in a rural area with its own garden.

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

Right Support:

There was the potential that people could come to harm as staff did not always have access to training to support them in caring for people with specific needs. We have issued a recommendation to the registered provider in relation to this. There was little evidence to show that staff were supporting people to learn new life skills or giving people the opportunity to increase their independence.

People were cared for by a sufficient number of staff whilst indoors, but there were not enough staff on a regular basis to enable people to go out into the community or participate in new activities.

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’s care was not always person-centred; care that focused on the person and their individuality. Some staff did not always demonstrate a respectful approach, communicate or provide information to people in a way they understood. Although we saw some nice occasions when staff engaged with people in a kindly way.

People lived in an environment that required redecoration and refurbishment, although their individual rooms were personalised.

People received the medicines they required and relatives said they felt their family members were safe living at Westhall Park. Staff understood what constituted potential abuse and knew how to report this.

Right Culture:

There had been a lack of registered manager at the service, although the operations project manager had made some improvements to the service since they had been on site.

There were occasions when staff were seen not wearing their masks correctly and we spoke with management about this.

Staff told us they felt supported by their managers and they had the opportunity to meet with them on a one to one basis for supervision.

The registered provider, prior to our inspection, had recognised the shortfalls in the service and had already made the decision to close the service within the next two months. They were working closely with the local authority to find alternative homes for people to move to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 2 March 2018)

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

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 found no evidence during this inspection that people were at immediate risk of harm. Although, we identified that not all staff were given appropriate information about people prior to caring for them.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, respect and good governance. We have also made a recommendation to the registered provider around supporting people’s independence and additional training for staff.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At out last inspection in January 2017, the service was rated as Requires Improvement. During that inspection we did not have any concerns about the service that was being provided, however as the service had previously been rated Inadequate overall we were unable to award them a Good rating until we checked that the improvements had been sustained.

There was not a registered manager in post, although the manager had been managing the service for a year. 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 manager had submitted their application to registered with CQC and as such had their fit person interview with a CQC registration assessor in February 2018 and was awaiting the outcome. The manager assisted us with our inspection.

People received support from staff who knew them well and we saw relationships had developed between people and staff. Staff treated people with kindness and attention and demonstrated a good understanding of people’s communication styles. Staff helped to ensure people received care that focused on their health and wellbeing. People received the medicines prescribed to them and staff sought advice from health and social care professionals to help ensure people received the most appropriate, effective and responsive care.

People were supported by staff who were aware of their responsibilities in safeguarding people from abuse and robust recruitment processes were in place to ensure only suitable staff were employed. People were supported by a sufficient number of deployed staff to meet their needs Risks to people had been identified and as such staff took appropriate steps to help mitigate any risk of harm of injury to people.

Staff received on-going training, induction and supervision to support them in their roles. We observed staff acting in a competent manner and they were able to provide us with all the information we required on the day of the inspection. Staff were knowledgeable in relation to infection control and what to do in the event of a fire.

People were encouraged to make their own decisions about their care and supported to be independent as much as they could. This included helping around the home and carrying out routine day to day tasks, such as the laundry. Where there were restrictions in place staff had followed legislation in order to help ensure these were in people’s best interests.

People had access to nutritious food of their choosing. People’s care records were person centred and completed in detail. Staff received up to date information about a person during daily handovers and where accidents or incidents had happened these were discussed at staff meetings as lessons learned. People had access to a range of individual activities in line with their interests. Staff actively encouraged people to access the community but also respected people’s wishes to stay indoors or not participate in a particular activity.

People lived in an environment that was suitable for their needs, although some further personalisation to the communal areas was needed following recent refurbishment to make the house seem more homely. The manager was aware of this and work had already started. The home was clean and hygienic and people had access to communal areas, a garden and their own bedrooms which were individualised.

Systems were in place to monitor the quality of the service provided and ensure continuous improvements took place. People and staff were involved in the running of the home and relatives played an active role. People and their relatives had the opportunity to raise concerns if they needed to. Staff felt supported by the manager as well as the deputy manager. The manager worked with external agencies to ensure staff worked to best practice and followed published guidance and policies.

On the day of our inspection there was no registered manager in post but there was a new manager who was in the process of applying to become registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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. The manager assisted us with our inspection on the day.

We carried out an inspection to this home in May 2016 where we identified seven breaches of the HSCA (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. These breaches related to staffing levels, a lack of staff support and training, a failure to comply with the legal requirements in relation to consent, a failure to show people respect and dignity, person-centred care and safe care, a lack of good quality assurance and a lack of notifying CQC of important events. Following that inspection the provider issued us with an action plan to tell us how they planned to address our concerns. We undertook this fully comprehensive inspection to check that the provider had taken appropriate action to address the concerns we had identified.

Individualised activities for people had improved within the home and the manager told us the next step was to start working towards getting people out more to participate in external activities that were meaningful to them. Care records in relation to people were detailed and generally up to date. The manager explained that the care plans were a work in progress and were continually being reviewed to help ensure they were accurate. Information about how to complain was made available to people.

There were enough staff on duty to meet people’s needs. Staffing levels had increased since our last inspection and we observed that people received the support they required when they needed it. We saw that people were enabled to go out with staff, but with a sufficient number of staff left in the home to attend to people who remained indoors.

Accidents and incidents were recorded although the manager told us there had been no incidents since our last inspection. We found where potential safeguarding issues had been identified, appropriate notifications had been submitted to CQC.

Where there was a risk to people this had been identified and staff were knowledgeable about these risks. Staff were aware of their responsibility to safeguard people and knew what steps they should take if they suspected abuse. There was an effective recruitment process carried out by the provider’s head office which helped ensure that only suitable staff were employed to work in the home.

People’s care would continue in the event of an emergency, such as a fire or the home having to close as the provider had a contingency plan in place. Staff carried out fire drills and an external fire assessment had recently been carried out.

Staff were provided with regular training to assist them with carrying out their role. The new manager had started to meet regularly with staff to check they were following best practice, or to discuss any aspect of their work.

Staff had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Where restrictions were in place decision specific mental capacity assessments had been undertaken and appropriate applications made to the local authority.

People were cared for by staff who treated them with respect. They were caring and attentive towards people and clearly knew them well. People’s bedrooms were individualised and it was easy to see people’s interests from how their rooms were decorated.

Quality monitoring was carried out in different aspects of the service and any actions identified addressed. Relatives and other stakeholders were asked their views on the service provided and people were involved in the running of the home as the manager had introduced ‘house’ meetings.

Staff were involved in aspects of the home as staff meetings were held. staff told us they felt valued and supported by the new manager who had made a positive difference since commencing at Westhall Park.

People were given freedom around nutrition and meal times. People were able to choose the foods they ate and they could eat at a time that suited them.

Good medicine management procedures were followed by staff and if people were unwell staff ensured they had access to external healthcare professionals.

The provider had been very proactive in response to our last inspection. They had taken action immediately to address many of the concerns we had found. We received regular updates and a senior management team had been placed in the home to oversee improvements. With the recruitment of the new manager improvements had continued as we found he had a good management oversight of the service and had provided a positive approach towards making changes and supporting staff. It should be noted however that at our last inspection the service was rated as ‘Inadequate’ in Safe and Well-Led. Until we can be satisfied that the improvements made by the registered provider are sustained, we cannot award Westhall Park a ‘Good’ rating in these domains.

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 it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

There were not enough staff on duty to meet people’s needs, particularly during the night. Staffing levels were such that during the night only one member of staff was present to support six people, some of whom suffered from epilepsy and one of whom was meant to have one to one support 24 hours a day. This meant there was a potential that if an incident occurred there would be no staff to support people. People were not always enabled to go out because of the staffing levels.

Accidents and incidents were recorded and monitored by staff to help ensure they could mitigate against further incidents happening. However, records were sparse and notifications of serious events had not been reported to CQC.

Where there was a risk to people this had been identified but staff did not always act in order to reduce people’s risks. If an accident occurred there may not be enough staff to support people. Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse. There was an effective recruitment process that was followed which helped ensure that only suitable staff were employed to work in the home.

The provider had plans in place to ensure people would continue to receive care and support in the event of an emergency, however their fire risk assessment had not been updated in line with the provider’s policy.

Staff were not provided with regular training to assist them with carrying out their role. Staff did not have the opportunity to meet regularly with their line manager regularly to check they were following best practice, or to discuss any aspect of their work.

Staff did not have a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, which meant people had restrictions in place without the proper procedures being followed.

People were not always shown respect by staff and staff did not always engage in a meaningful way with people. People lived in an environment that was not homely or cared for by staff or the provider.

Individualised activities were not available for people and activities that took place within the home were limited. Care records in relation to people were comprehensive, however some information was contradictory or missing. Complaint information was not made readily available to people.

Quality assurance monitoring was not always completed and actions from provider and internal audits had not always been addressed by the registered manager or the provider. The provider had not taken action in relation to the welfare of staff.

Staff were not always involved in all aspects of the home and did not regularly attend staff meetings. Staff told us they did not always feel supported by the registered manager or provider and their morale was low. Relatives were asked for their feedback in relation to Westhall Park and they said they were made to feel welcome when they visited.

The registered manager was not complying with their legal requirements in relation to registration as they had not submitted notifications when they should.

People were able to choose the foods they ate, however people’s dietary requirements were not always known by staff.

Medicine management procedures were followed by staff, although staff did not take the time to describe people’s medicines to them. People had access to external healthcare professionals when required.

Relative’s we spoke with said their family members appeared happy within the home and felt safe with staff. Relative’s told us they were made to feel welcome and one relative said things had improved for their family member since the new registered manager had started. Relatives said staff were caring to their family member and knew their needs well. Although, relatives had a positive view of the care provided we found evidence that not everyone was living in a home where they were encouraged to live independent and fulfilling lives.

During the inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed 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.

As part of our inspection we spoke with three staff, the registered manager and the area manager. We also spoke with two relatives of people who lived in the house and reviewed four care plans. We were unable to speak with any of the people who used the service because of their complex needs, so we used observation to inform our judgements.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found during our inspection that people were cared for in an environment that was safe, clean and hygienic. We found the building was generally well maintained and we were told that redecoration was due to take place.

We noted that the provider has ensured that where people lacked capacity to give their consent a mental capacity assessment had been carried out. We also noted that 'best interest' meetings were held in relation to some of the restraints that had been put in place.

We spoke with relatives who told us that they felt their family member was safe at Westhall Park. One relative told us they had, 'No concerns.'

Is the service effective?

It was evident from our observations and from speaking to staff that they had a clear understanding of people's needs. The relatives we spoke with told us that they felt staff knew their family member well. One relative told us, 'My relative's well-being is looked after.'

Is the service caring?

We saw that people were supported by kind and attentive staff. We saw that people were supported to do things, such as take off their coat and shoes after they had been out, or to eat their lunch. One relative told us, 'Everything is brilliant. I am very happy with Avenues.'

Is the service responsive?

People who used the service had a keyworker who regularly reviewed the needs of the person. The relatives that we spoke with told us they were involved in these reviews. They also told us that if there was any medical problems with their relative, staff called the doctor.

Is the service well-led?

Staff that we spoke with told us that they were asked for their comments and suggestions on how to improve the service. We heard from relatives that they felt the management of the service was good. One relative told us, 'There's nothing they're not doing.' We saw that the provider carried out a stakeholder's satisfaction survey in order to gain the views from people with regards to the quality of the care and support the service provided.

The PCP's provided comprehensive information and guidance for staff to follow to deliver people's care. Staff sign to indicate that they have read them and are aware of people's needs.

People's PCP's contained information about how their personal care needs were to be supported.

We saw that the service had the local authority safeguarding procedure in place. We spoke to staff who were aware of safeguarding procedures, and confirmed that they had received refresher training in this area. Staff were also aware of other connected policies, such as their responsibility for reporting abuse and whistle blowing, and deprivation of liberty

safeguards, when it is in the best interest of the person who uses the service.

The service had undertaken a period of maintenance to ensure that the people who lived there live in an environment which meets their needs.

The service had completed some quality auditing (QA) which indicated a high level of satisfaction with the services provided at 4 Westhall Park. The provider however must ensure that the QA process is open to the people who used the service, their representatives and professional bodies that have regular contact with them.

People spoke about being able to choose what they wanted to do, and activities they had been involved in.

People told us that the staff were nice and they liked the food, the home and their rooms, although one person said they wished they could buy the house across the road.

People's relatives told us that they thought the building was suitable. They said they thought there were enough staff, their relative was looked after well and the staff kept them involved and informed.

They also told us they felt their relative was safe there. They had not needed to raise any formal complaints, but if they needed to raise anything, they felt listened to and action would be taken.

One person's relative also told us that they had never had a negative experience with the home.

There were no arrangements in place to plan for and deal with foreseeable emergencies. This meant that if an emergency situation did occur there would be no procedures known to staff to mitigate the risks that may arise.

We found that people who use the service were not always protected against the risks of unsafe or unsuitable premises because the provider had not taken steps to provide care in a home that was suitably designed and adequately maintained.