Archived: East Wheal Rose

East Wheal Rose is a residential care home that provides care and accommodation for up to three autistic people. It is part of the Spectrum group who have several similar services in Cornwall. They are providers of care for autistic people and/or people with learning disabilities. At the time of the inspection two people were living at the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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

People’s needs were not always met because the service was short staffed. Although there was a core staff team who had worked at the service for several years the service was short staffed. An agency staff worker had been allocated to the service who routinely worked long hours. They had left the service without notice and this had resulted in the service running on ‘emergency minimum’ staff numbers in the week running up to the inspection.

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. For example, one person did not have access to a kitchen. This decision had not been regularly reviewed. Due to the breakdown of one of the two vehicles people were not always able to go out when they wanted to. The provider had not taken action to resolve the problem in a timely manner.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The service did not support people to have maximum choice, control and independence.

The service did not always support people in a safe, clean, well equipped, well-furnished and well-maintained environment that met people’s sensory and physical needs. Part of the premises, which were originally set up to enable one person to access it safely, were no longer arranged to meet their needs. This meant people were not able to work towards identified goals.

Staff shortages impacted on people’s opportunities to go on planned trips out and take part in pastimes and activities in the service.

When they were able to go out, people were supported by staff to take part in activities in their local area.

People had exclusive possession of their own bedrooms and living spaces.

Right care:

Safeguarding concerns were investigated. Staff knew how to recognise and report abuse.

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. For example, people were supported to have access to films and music which were relevant to their culture.

Where appropriate, staff encouraged and enabled people to take positive risks. Staff were enthusiastic and motivated in encouraging and supporting people to take part in hobbies and experiences that interested them.

Right culture:

People’s dignity was not consistently respected. Action to improve people’s experiences were not taken in a timely manner.

The core staff team had worked at the service for a long time, knew people well and had a good understanding of their needs.

Staff communicated with families regularly. People had access to independent advocates to help represent their wishes.

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 17 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks. We also undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for East Wheal Rose on our website at www.cqc.org.uk.

Enforcement

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 staffing levels, upkeep of the premises, supporting people with dignity and oversight of the service. Following the inspection managers told us about actions they had taken to mitigate risk. We have made a recommendation about ensuring consent to care is in line with best practice.

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.

What life is like for people using this service:

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. There was a stable staff team who were all knowledgeable about the people living at the service and had built trusting and meaningful relationships with them.

¿ Staff were recruited safely and there were sufficient numbers to ensure people’s care and social needs were met. Staff knew how to keep people safe from harm.

¿ There was time for people to have social interaction and activity with staff. Staff actively encouraged people to maintain links with the local community, their friends and family.

¿ People's care was individualised and focused on promoting their independence as well as their physical and mental well-being. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible.

¿ The environment had been adapted to meet people’s individual needs and keep them safe from harm. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

¿ People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. People were involved in meal planning and preparation. Staff encouraged people to eat a well-balanced diet and make healthy eating choices.

¿ Where restrictions had been put in place to keep people safe this had been done in line with the

requirements of the legislation as laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Any restrictive practices were clearly recorded and regularly reviewed to check they were still necessary and proportionate.

¿ There was a clearly defined management structure and regular oversight and input

from senior management. Staff were positive about the management of the service and told us the registered and deputy managers were supportive and approachable. Any concerns or worries were listened and responded to and used as opportunities to make continuous improvements to the service.

Rating at last inspection: Overall Good (Safe rated Requires Improvement). The report was published on 1 November 2016.

Why we inspected: This inspection was a scheduled comprehensive inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received we may inspect sooner.

The full details can be found on our website at www.cqc.org.uk

East Wheal Rose provides care and accommodation for up to three people who have autistic spectrum disorders. It is part of the Spectrum group who have several similar services in Cornwall. They are providers of specialist care for people with autistic spectrum disorders and learning disabilities. At the time of the inspection two people were living at the service.

The service is required to have a registered manager. 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. Since our last inspection the registered manager had left and there was no registered manager in post at the time of the inspection. The acting manager had been in post since August 2016 and was in the process of making an application for the position.

Staff told us staffing levels had improved since the last inspection. They worked to cover any gaps in the rotas which arose because of sickness or planned leave. The manager told us the staff team were flexible in their approach and committed to helping ensure people were able to take part in activities.

Records showed there were several occasions in the three weeks preceding the inspection when staffing levels that had been commissioned had not been met. Staff told us this had not impacted on people’s opportunities to take part in activities. Daily records confirmed people were going out regularly. We were satisfied that, although commissioned hours were not always met, people were supported by sufficient staff to enable them to take part in meaningful activities. Although the service was now compliant with the requirements of this regulation we have recommended that the provider takes action to ensure people consistently receive the levels of staff support they require and in line with the hours commissioned by Local Authorities.

Staff were not receiving regular face to face supervisions or appraisals to help them think about their professional development or identify training needs. We have made a recommendation about this in the report.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse. Risks were clearly identified and appropriate action taken to minimise risks and protect people from avoidable harm. People sometimes became anxious and distressed and this could lead them to behave in a way which put themselves and others at risk. In these circumstances there were clear guidelines for staff to follow which protected people. Staff told us they were confident supporting people at all times.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). Where people were deprived of their liberty in order to keep them safe the correct processes had been followed. Staff demonstrated a good understanding of the underlying principles of the Mental Capacity Act (MCA).

Staff used a range of techniques and tools to communicate effectively with people. They were skilled and knowledgeable in this aspect of care and were able to describe to us when it would be appropriate to use certain approaches. Information was available for people in pictorial formats to aid understanding. The acting manager had plans to develop this further.

Care plans were well organised and up to date. They had been developed with the support of relatives who told us they were kept informed of any changes. The plans contained information about what was important to people as well as information regarding their health needs. Personal histories were recorded to help staff get a picture of the events and circumstances which may have impacted on who people are today. Family relationships were valued by staff and they supported people to maintain these either in person or using the telephone and/or video conferencing technology.

Roles and responsibilities were well-defined and understood by the staff team. The acting manager was supported by an acting deputy manager and development support worker. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for East Wheal Rose on our website at www.cqc.org.uk

East Wheal Rose provides care and accommodation for up to two people who have autistic spectrum disorders. At the time of the inspection two people were living at the service.

The service is required to have a registered manager. 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. There was a registered manager in post at the time of the inspection. However, a few days before the inspection visit, CQC had received a notification to change the registered manager at the service. The registered manager was no longer working at the service and arrangements for their replacement had not been finalised. The service was being managed on a day to day basis by the deputy manager with the support of the divisional manager.

Commissioned staffing levels were not consistently adhered to. During the three weeks preceding the inspection staffing levels had not been met on seven occasions during the day and five occasions during the night.

People were supported to take part in activities outside of the service. Staff told us they made sure people were supported to go out most days. There was one vacancy for a support worker. During the inspection the divisional manger was informed this vacancy had been filled.

There was a stable and consistent staff team in place. Staff told us they worked well together and were a "close knit" team. New staff were required to complete an induction and period of shadowing more experienced staff before starting to work independently.

Since our last inspection, improvements to the premises had been made. These helped ensure facilities were appropriate for people's needs. The property was an old house and regular maintenance audits were carried out to quickly identify any defects. A programme of improvements for the coming year was in place. Any defects or breakages requiring immediate attention were dealt with in a timely fashion.

Staff told us they felt well supported by the deputy manager and divisional manager. The divisional manager had clear oversight, and a good understanding of the day to day running of the service. The deputy manager had been in post since November 2015 and was carrying out regular supervisions and audits. Staff told us Spectrum communicated well with them and kept them informed of any changes which might affect them.

We identified a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The actions we have asked the provider to take are detailed at the back of the full version of the report.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We examined people's care files and found the records were up to date and reviewed as the person's needs/wishes changed.

People were protected from the risks of inadequate nutrition and dehydration.

People were safeguarded from the risk of abuse because the provider had taken steps to identify the possibility of abuse and prevent it from happening.

Premises were adequate although one bathroom required updating.

We looked around the home and found that it was clean and hygienic. We examined the person's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that the person was involved in making day to day decisions and participated in tasks at home, such as cleaning and preparing meals. The records showed that the person went out frequently. The person saw healthcare professionals on a regular basis or when they needed them.

Staff were friendly and respected the person's right to privacy, dignity, and independence. Staff said they had received sufficient training to enable them to carry out their roles competently.

There were effective systems for safeguarding people from abuse. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights. We found that the staff used physical intervention techniques with the person but there were no recorded agreements from health or social care professionals. However we were told by the registered manager that meetings were being set up to ensure that such management techniques were properly agreed.