Wesley Place

Wesley Place is a care home providing personal care to seven people at the time of the inspection. The service specialises in providing support for up to seven older or younger adults. They may have a number of needs, such as a learning disability and/or autism or mental health needs.

People had their own flats within one purpose-built building, each flat had been adapted to meet people’s environmental and sensory needs. The offices were located on site with two separate areas for management and staff to oversee the running of the service.

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

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 guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The provider had not always consulted people’s representatives to maximise people’s choice, control and independence when significant decisions had been made that affected them. Staff did not always treat people with dignity and respect and/or protect their human rights. This demonstrated a lack of person-centred support. We evidenced some aspects of a poor culture within the service, management of complaints and staff reporting concerns to CQC instead of using the providers whistle blowing process.

People were not always supported to have maximum choice and control of their lives and although the service had considered the least restrictive practices and reducing incidents, the intensity had increased for some people and staff injuries were of concern. The policies and systems in the service did not always support in practice the best interests of people.

Improvements were required to monitor, analyse and effectively manage risks to people and staff. There was a lack of clinical oversight and in-depth knowledge to support staff to develop in their role. This was evident in the number of incidents where risks had not been managed effectively.

Care records detailed people's support needs, preferences and sensory needs. Positive behaviour support plans were in place, which detailed least restrictive options for staff to consider and how to interact, using certain responses, to prevent the escalation of behaviours that may challenge. However, we had some concerns about the leadership and skills of some staff to manage people’s behavioural needs.

Sensory profile's had been completed. The provider needed further time to ensure the recommendations were fully implemented for each person and to ensure their sensory needs were met. We identified some areas where staff had not fully considered people’s sensory and communication needs.

Whilst the environment was observed to be clean during the site visit, we were provided with evidence following the site visit of one bedroom which was unclean and unhygienic.

The provider and staff advised staffing levels had improved since the service first opened. However, staff still raised concerns regarding the deployment of skilled staff that were able to confidently meet people’s needs.

Staff being kind and respectful towards people. Staff overall wanted the best outcomes for people and were passionate in their approach. However, some records and feedback demonstrated there were aspects of a poor culture within the service.

Medicines records were managed effectively. We had concerns that 'as and when required medicines' were not always given at appropriate times to prevent behaviours from escalating. Following the inspection, the provider informed us they were seeking additional training in this area.

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

Rating at last inspection

This service was registered with us on 28 February 2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on the registration date. We returned to the service on 25 August 2021 due to concerns about people's living conditions and the support they were receiving.

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.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risks, safeguarding people from harm and abuse and overall governance at this inspection.

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

We recognised as part of this inspection that the provider had failed to notify CQC of some safeguarding incidents. The provider submitted notification retrospectively and we have not taken any enforcement action in relation to this matter.

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 return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.