Wurel House

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Wurel House is a small four bedroom supported living service and domiciliary care service providing support to people living in their own houses and flats. At the time of our inspection, 5 people received domiciliary care in the community and no one was living within the supported living service. All 5 people received a domiciliary care package providing support with personal care. This is help with tasks related to personal hygiene and eating. We also considered any wider social care provided.

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

Right Support:

Staff supported people to complete personal care tasks and activities. Staff enabled people to access specialist equipment and health and social care support in the community. However, processes were not in place to ensure equipment used in people’s homes, such as lifting hoists and pressure relieving equipment, were safe to use or maintained. We did not identify that any equipment was not functioning correctly. We were unable to form a judgement about whether staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. This was because, other than the application of skin creams, the provider was not supporting anyone with management or administration of medicines. However, staff had received medicines training and had been competency checked.

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:

Enough staff were deployed; they were recruited safely and adequately checked to ensure they were suitable to work with people. However, individual risks were not always assessed and managed to keep people safe. Some care plans required further development to provide step by step guidance for staff to reflect specific considerations of some risk assessments. We found no evidence that people had been harmed, however, systems were not robust enough to demonstrate assessments of risk and care planning were always effectively managed.

Right Culture:

People and those important to them, were involved in care planning. Staff were able to communicate well with them. The provider had developed core values and behaviours for staff, which promoted a caring and enabling culture. People spoke positively about the service and the staff who supported them. However, the systems in place to audit the quality of the service were not always effective to alert the provider to the concerns and issues; audits had not picked up areas which were identified during this inspection.

People using the service told us the staff and manager were approachable and friendly; people felt safe when staff supported them and when they were in their home. Staff were introduced to people before they started to support them. People told us staff stayed for the full duration of the planned visit.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 29 June 2022) and there were breaches of regulation. These related to risk management, medicines management, infection control, recruitment staff deployment, safeguarding people from abuse, capacity and consent, staff training, assessment of care, records, complaints, reporting of notifiable events and effective systems to monitor and improve the service. We served the provider warning notices and asked them to meet the breached regulations by 31 May 2022.

We carried out a targeted inspection (published 24 November 2022) to check that action had been taken. We found that they had not been met and we took further enforcement action against the provider.

At this inspection we found areas of improvement but the provider remained in breach of some regulations.

This service has been in Special Measures since 29 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Enforcement

We have identified breaches in relation to risk management, care planning and quality assurance process at this inspection. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well Led sections of this full report.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Wurel House is a small four bedroom supported living service providing personal care to people with a learning disability. The service also provides domiciliary care to older people living in their own houses and flats in the Swale area of Kent. At the time of our inspection there was one person living at the supported living service and 14 people receiving domiciliary care in the community. All 14 receiving a domiciliary care package received support with personal care. This is help with tasks related to personal hygiene and eating. We also considered any wider social care provided.

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

This was a targeted inspection that considered medicines, risk management, infection control, staff training and recruitment, assessment of care needs and management oversight of the service.

Right Support

Staff did not support people with their medicines in a way that promoted their independence and achieved the best possible health outcome. People could not be sure their prescribed medicines were always managed in a safe way. Staff had not received medicines training and had not been competency checked.

Right Care

Individual risks were not always assessed and managed to keep people safe. Care plans and risk assessments were inconsistent and did not always detail the relevant information staff would need to meet people's assessed care and health needs. People could not be assured new staff were adequately checked to ensure they were suitable to work with people to keep them safe. We found no evidence that people had been harmed however, systems were either not robust enough to demonstrate staff recruitment was effectively managed.

Right Culture

Within Wurel House supported living service, people and those important to them, were involved in planning their care. Staff were able to communicate well with the person living at Wurel house supported living service, despite staff not receiving Makaton training to help them communicate. The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection.

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

Relatives expressed frustration and concerns in relation to the frequency, length and duration of community care visits. However, most relatives gave us positive feedback about their loved one's care and support from the care staff. They told us, “The carers have been wonderful, they are really caring and they do a good job”; “They are very good”; “They are very friendly” and “The girls are very helpful.”

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

Rating at last inspection and update

The last rating for this service was inadequate (published 29 June 2022) and there were breaches of regulation. The provider was issued with Warning Notices for breaches of four regulations and requirement actions for breaches of five regulations. The provider completed an action plan after the last inspection to show what they would do to meet the requirement actions and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 continued breaches in relation to medicines management, risk management, infection control, staff deployment, staff training and support, governance arrangements to monitor and improve the service at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

About the service

Wurel House is a small four bedroom supported living service providing personal care to people with a learning disability. The service also provides domiciliary care to older people living in their own houses and flats in the Swale area of Kent. At the time of our inspection there was one person living at the supported living service and nine people receiving domiciliary care in the community. All nine receiving a domiciliary care package received support with personal care. This is help with tasks related to personal hygiene and eating. We also considered any wider social care provided.

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

Relatives expressed frustration and concerns in relation to the frequency, length and duration of community care visits. Comments relating to this included, “Time wise they should be there for one hour for morning, same at night. 30 minutes at lunch and dinner times. A total of three hours a day. They roughly stay for 15 to 20 minutes each time, I’m pretty sure they don’t stay that long.” And “On Monday [staff member] suggested not to come in for the lunchtime as she came late morning.” They went on to explain this left their elderly parent to carry out care. They said, “They can’t plan for anything and feel anxious waiting as the [person] wants to get up out of bed. [Spouse] had to help him get on the commode yesterday.”

Most relatives gave us positive feedback about their loved one’s care and support from the care staff. They told us, “She is so comfortable after they have been, they talk to her as a person and not a patient. They do everything for her.” “We are 100% pleased with the girls, they are angels.” “She really likes them, they proper get her cheerful, jolly and make her laugh.” And “[Loved one] seems very happy. Staff are good with her. They have conquered communication with her.”

The management team were not aware of Right support, right care and right culture. Based on our review of safe, effective and well-led, 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

Staff did not support people with their medicines in a way that promoted their independence and achieved the best possible health outcome. People could not be sure their prescribed medicines were always managed in a safe way. Staff supported people to complete personal care tasks and activities. However, these assessed needs were not set out in the care plans for people with learning disabilities and other people receiving support in the community. Care plans for people with a learning disability and or autism were not structured to support people to achieve their goals and aspirations. Staff enabled people living at Wurel House to access specialist health and social care support in the community.

Right Care

The provider did not have effective safeguarding systems in place to protect people from the risk of abuse. Staff had not received training on how to recognise and report abuse. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. People’s care, treatment and support plans did not reflect their range of needs to promote their wellbeing and enjoyment of life. Individual risks were not always assessed and managed to keep people safe. Care plans and risk assessments were inconsistent and did not always detail the relevant information staff would need to meet people's assessed care and health needs. People could not be assured new staff were adequately checked to ensure they were suitable to work with people to keep them safe. We found no evidence that people had been harmed however, systems were either not robust enough to demonstrate staff recruitment was effectively managed.

Right culture

Within Wurel House supported living service, people and those important to them, were involved in planning their care. Staff were able to communicate well with the person living at Wurel house supported living service, despite staff not receiving Makaton training to help them communicate. The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection. Registered persons had failed to notify CQC of incidents and events such as abuse and serious injuries.

Wurel House supported living service was not clean, people were at risk from the spread of infection. Government COVID-19 guidance in relation to testing people and staff and the use of PPE (personal protective equipment) had not always been followed. The provider’s infection control policy was not up to date or robust.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

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 13 December 2019)

Why we inspected

The inspection was prompted in part due to concerns received about person centred care, staffing levels, medicines management and recruitment of staff. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wurel House 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 risk management, medicines management, infection control, recruitment and deployment of staff, safeguarding people from abuse, capacity and consent, staff training, assessment of care, records, complaints, reporting of notifiable events and effective systems to monitor and improve the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Wurel House is a domiciliary care service that provides care and support services to four people with a learning disability living in their own home. The office where the provider runs the service is located in the garden of Wurel House. There were staff at the service 24 hours a day, including a member of staff who slept at the service. The provider owned the property, people could choose to be supported in their home by another agency and this would not impact their tenancy.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The provider was supporting each person at Wurel House with the regulated activity of personal care.

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.

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

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. There were enough staff available to meet people’s needs promptly. People received their medicines safely. Incidents and accidents were investigated, and actions taken to prevent a reoccurrence. Infection control procedures were followed by staff.

People's needs were assessed, and care was planned and delivered to meet legislation. People were supported to plan their own menu and make healthy choices. 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. People were supported by staff who received regular training to meet their needs.

People received kind and compassionate care. People’s independence was promoted by staff. People were treated with respect and dignity and supported to make decisions about their care.

People received personalised care that was tailored to meet their individual needs, preferences and choices. Care plans were detailed and guided staff about people's needs and how to meet them. People’s concerns and complaints were listened to and used to improve the service they received.

The registered provider was well regarded and had a clear vision for the service which was understood by the staff and embedded within their practice. There were effective quality assurance systems in place that were used to drive service improvements.

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 25 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 5 May 2017 and was announced.

Wurel house provides domiciliary care and support services to people with a learning disability living in their own home. The service has an office in the garden of the house where the people they support live. The service currently provides support to three people in Sittingbourne who share a house. There were staff at the service 24 hours a day, including a member of staff who slept at the service. The provider owned the property, people could chose to be supported in their home by another agency and this would not impact their tenancy.

The provider manages the service on a day to day basis. As a registered provider, 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.

Risks to people were assessed and people were supported to take risks and try new things. People were encouraged to understand and manage risks themselves. Staff had clear guidance about what could make people anxious and the best way to support them to calm down. Staff could recognise the different types of abuse and knew who to report any concerns to, both within the organisation and externally.

Staff had an understanding of the Mental Capacity Act (MCA) and followed the principles on a day to day basis. People were assumed to have capacity, but formal capacity assessments had not always been completed for people. There was a risk people did not fully understand decisions they were making, we made a recommendation about this. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). For people who live in their own homes this is managed by the Court of Protection (COP). No applications had been made for people as none were needed.

Most staff were recruited safely although some people only had one reference. The provider resolved this after our inspection. Staff had induction training and were introduced to people by established staff before supporting them. Some staff completed basic training but some staff had not. The provider had booked this to be delivered in shortly after this inspection. Staff were in regular contact with the provider, who often worked alongside them and had regular one to one meetings. There were enough staff to meet people’s needs and people told us they felt supported.

Medicines were managed safely and people were encouraged to be as involved as possible with their medicines. Staff worked closely with local health and social care professionals to manage people’s health and develop new opportunities for them. Not all visits to health professionals were recorded, the provider told us he would address this with staff. When people’s needs changed advice was sought and followed to make sure the staff could still meet people’s needs safely.

People had good relationships with the staff who supported them. Staff knew people well and treated them with dignity and respect. People had opportunities to express themselves and have a say about their care on a day to day basis. People were involved in planning their support and writing their care plan, but people’s care plans were not always in an accessible format. People’s care plans needed more detail about what people could do for themselves.

People were supported to be part of their local community and follow their interests or hobbies. People were supported to maintain relationships with people who mattered to them. However, there were no personal goals recorded for people or plans to help people reach their goals. We made a recommendation about this.

People had support to eat healthily and planned their own menus. Some people had planners with pictures to help them plan their day. People took ownership of their home and shared the household chores between them. Some people attended local colleges to completed courses. Staff worked with people to develop skills both in the house and when out and about such as using public transport independently.

No complaints had been received, the service had an accessible complaints procedure and people knew who to speak to if they had a complaint. People’s confidentiality was respected and records were stored securely.

There was an open culture, people and staff could contact or visit the provider whenever they wanted to. The provider spent time with people regularly to check if they were happy with the service and they were accessible to people, professionals and staff. The provider maintained contacts with service commissioners and provider’s forums in order to maintain their knowledge and keep up to date with good practice.

Views were sought from people, relatives and professionals and were acted on. Audits were completed and actions taken to address any issues.

The CQC had not always been informed of any important events that occurred at the service, in line with current legislation. The provider stated they were unaware that they needed to inform us of certain issues but would do so in the future.