Reach Wendover Road

We found the following examples of good practice.

Visitors were not currently visiting the service, except for health professionals. Visitors to the service were required to wear a mask and had their temperature taken and asked to use hand sanitiser. Visitors other than health professionals, such as maintenance staff, were required to complete a lateral flow test and would not access the service until the result of the test had been obtained. During the current lockdown the service had facilitated video calls to family members and the registered manager provided family members with email updates on their family member.

The service encouraged and promoted social distancing within the service. Some people spent time in their bedrooms and had their meals there, whilst a maximum of three people sat in the dining room for meals to promote social distancing. People were provided with posters and videos to promote their understanding of why staff had to wear masks, social distancing and handwashing. The registered manager had considered how isolation, cohorting and zoning would be implemented in the event of an outbreak of COVID-19.

The service was responsive to changes in people’s well-being and had liaised with health professionals to enable further support to be provided. In house activities took place. Family members were encouraged to join in remotely to benefit people’s well-being.

The service had no new admissions to the service during the pandemic. However, systems were in place to ensure people were admitted safely. The registered manager confirmed potential new admissions would be tested for COVID-19 prior to admission and isolated on their arrival at the service for 10 days to mitigate the risk of cross infection.

The service had a good supply of personal protective equipment (PPE). This was kept stocked and replenished throughout the shift. Pictorial guidance was provided on donning and doffing of PPE and systems were in place for safe disposal of used PPE.

The service had an identified infection control lead and the registered manager had attended training on donning and doffing PPE. Staff were trained in infection control practices which included assessment of staff on donning and doffing PPE and handwashing.

The service was registered to regularly test staff and people using the service for COVID-19 infection. The registered manager was clear of their responsibly in the event of any positive cases to mitigate the risk of transmission. Systems were to place to consult with people about COVID-19 testing. For some people who lacked mental capacity to make a decision on being tested, a decision had been made that it was in their best interests not to be tested, due to the risks the procedure posed to them. This decision was not recorded as a best interests decision. These were completed after the inspection and evidence provided. All of the people living at the service had received their first vaccination against COVID-19. Mental capacity assessments and best interests decisions were completed for people who lacked mental capacity to make the decision on being vaccinated.

The home was clean and hygienic. High touch areas such as door handles and light switches were cleaned two hourly. Alongside this, there was a detailed and specific cleaning schedule in place for staff on each shift to complete and sign. These were all signed off and completed.

The organisation had an infection prevention and control policy in place. This was updated to reflect the COVID-19 pandemic and the extra measures required to infection control practices to mitigate transmission. There was a coronavirus contingency plan in place which was regularly updated in response to changes in guidance and the provider’s own learning from an outbreak in another service.

Systems were in place to audit and monitor infection control practices. The provider had completed an infection control audit in September 2020, a health and safety audit in December 2020 and the manager completed monthly in-house infection control audits to enable them to ensure infection control practices were in line with the provider and government guidance.

Reach Wendover Road is a care home (without nursing) which is registered to provide a service for up to ten people with learning disabilities. There were nine people living in the home on the day of the inspection. Some people had other associated difficulties such as being on the autistic spectrum.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Reach Wendover Road accommodates people in a large adapted building which had an added extension. Six people live in the older part of the building and share three bathrooms whilst up to four people live in the extension and have en-suite facilities. One of the bedrooms in the extension part of the building was unoccupied on the day of the inspection visit. The service was run in line with the values that underpin the ‘’registering the right support’’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism can lead as ordinary a life as any citizen.

At the last inspection, on 03 and 04 July 2017, the service was rated as requires improvement in three domains and good in two domains. This meant that the service was rated as overall requires improvement.

There was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to make improvements to the areas we identified as requiring attention. It was intended that any improvements made should be to at least a good rating.

We received a provider action plan on 02 August 2017 to tell us how they would meet the relevant legal requirements. That is, to demonstrate how they were working to the principles of the Mental Capacity Act 2005.

They told us they would complete these actions by of 30 September 2017. We found that these actions had been completed.

At this inspection we found all the domains had improved to good. This meant that the overall rating had improved to good.

People were protected from abuse. Staff training in safeguarding people was refreshed regularly and staff continued to understand their responsibilities and what action to take if they identified any concerns. The service identified health and safety, safe working practices and individual risks to people. All aspects of safety were considered and actions were taken to assist people to remain as safe as possible.

People were supported by staffing ratios which enabled staff to meet people’s specific needs, including any relating to diversity and/or special needs, safely. Recruitment systems made sure, that as far as possible, staff recruited were safe and suitable to work with people. People were supported to take their medicines, at the right times and in the right amounts by staff who were trained and competent to do so.

People were offered effective care by an appropriately trained staff team. They met people’s diverse needs including their current and changing health and emotional well-being needs. The service worked with health and other professionals to ensure they offered individuals the best care they could.

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.

The staff team continued to be caring and were committed to meeting people’s needs with kindness and respect. They ensured they promoted people’s privacy and dignity and communicated with them effectively.

The service was person centred and remained responsive to people’s diverse, individualised needs and aspirations. Activity programmes were designed to meet people’s needs, preferences and choices. Care planning was individualised and regularly reviewed which ensured people’s current needs were met and their equality and diversity was respected.

The service did not have a registered manager. However, a manager who had applied to be registered was in post. They had been leading the team since 2017. The management team did not tolerate any form of discrimination relating to staff or people who live in the service. The quality of care the service provided was assessed, reviewed and improved, as necessary.

We previously inspected the service on 29 and 30 November 2016. The service was not meeting the requirements of the regulations at that time and was rated as requires improvement with an inadequate rating in caring. Requirements were set to address the breaches in regulation. This inspection was a comprehensive inspection to review the rating and progress made.

Wendover Road is a care home which provides accommodation and personal care for up to ten people with learning and/or physical disabilities. At the time of our inspection there were eight people living in the home.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. Therefore the home did not have a registered manager. The provider had advertised for a new manager and interviews were taking place. A registered manager from another location was managing the home until that position was filled.

At this inspection we found progress had been made in addressing the requirements made at the previous inspection. Staff were caring and responsive to people. Improvements were made to the safety, effectiveness and management of the service. Some further improvements were still necessary in those areas to benefit people. Relatives were generally happy with the care provided. They recognised the improvements made to the service although some relatives felt the lack of consistent management created anxiety for them.

Appropriate Deprivation of Liberty Safeguards (DoLS) applications were made to the local supervisory body for people who had restrictions imposed on them. However staff did not work to the principles of the Mental Capacity Act 2005 (MCA). This meant decisions on their care and treatment was not made in a best interest meeting in accordance with the act.

Systems were in place to keep people safe and safeguarded from potential abuse. Most relatives felt the home provided safe care.

Risks to people were identified. Staff were aware of risks people presented with. Some aspects of practice such as leaving the laundry room unlocked, used gloves in an open bin and propping open fire doors still had the potential to put people at risk of injury.

Systems were in place to ensure people were assessed prior to coming to live at the home. People had care plans in place. They were detailed, up to date and reflective of people’s care needs. People’s health and nutritional needs were identified and met although follow up health appointments were not always recorded as taking place. Some relatives felt their family member's health and nutritional needs were met. One relative felt person centred care was not promoted and their family member's health had deteriorated due to the their diet not being monitored and regular exercise not encouraged.

Systems were in place to manage people’s medicine. Improvements were needed to the way medicines for home leave and thickeners in people’s drinks were managed. This was addressed at the time of the inspection.

Improvements were made to the way staff supported people. Staff were kind, caring and responsive to people. They promoted people’s privacy, dignity and independence. They supported people to be involved in the service by giving them choices and using their preferred means of communication to communicate with them. Staff supported people to attend college, work placements and leisure activities.

Staffing levels were flexible to take account of how many people were at home. Improvements were made to the way shifts were managed to provide a more timely response in meeting people’s needs.

Staff were inducted, trained, supported and supervised. They were clear of their roles and responsibilities and felt suitably skilled to do their job. Robust recruitment processes were followed

The provider had increased and improved their monitoring and auditing of the service to promote safe practices. Staff felt communication and team work had improved to provide a more inclusive way of working.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report

46 Wendover Road is a care home which provides accommodation and personal care for up to ten people with learning disabilities. At the time of our inspection there were nine people living in the home.

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 2008 and associated Regulations about how the service is run.

The home was previously inspected in May 2014. It was compliant with regulations in place at that time.

At this inspection we found systems in place to safeguard people were not followed. All risks to people were not identified and managed. Where risks were identified the right support was not provided to people to manage the risk. Staff failed to work in line with infection control guidance either to prevent the risk of cross infection.

Staff practice observed during the inspection demonstrated staff were not always kind, caring and did not promote people’s privacy, dignity and respect,

Staff were not suitably inducted and trained in roles and responsibilities which impacted on the care people received. The home had four care staff vacancies and used agency and bank staff to cover the vacancies. This led to inconsistent care for people. The shifts were not managed appropriately which meant people did not get the required care in a timely manner. A recommendation has been made to address this.

People were not routinely assessed prior to admission and care plans lacked detail as to the support people required. As a result staff were not always aware of how people were to be supported.

People’s records and records required for regulation were not suitably maintained and fit for purpose. The registered manager had not informed the Commission of an incident that they were required to. The provider was carrying out some aspects of auditing but effective quality auditing was not yet established to enable the provider to monitor the care being provided.

Medicines were given as prescribed but gaps in medicine administration were not picked up and acted on. A medication audit had been introduced which should promote safe medicine practices.

People’s health and nutritional needs were met. However meal times were disorganised and not conducive to promoting a positive, calm environment for people. People were supported to make choices and decisions on day to day care. Pictures and signing were sometimes used to promote communication. We have made a recommendation for staff to have the required skills and be encouraged to use the required aids, props and signing consistently to promote people’s involvement in their care.

Some people had access to activities, day centres and work placements. The registered manager was looking to improve access to more community activities for some people.

The communal areas of the home were generally clean. Some bedrooms had an odour, this was being addressed. The standard of cleanliness in some bedrooms was poor even after they had been cleaned. A recommendation has been made to address that. Maintenance issues were reported and repaired. A refurbishment plan was in place to keep the home updated.

Staff felt supported and received regular supervision. They felt the home was well managed. Relatives had confidence and trust in the registered manager and the deputy manager. However they felt the care provided when the registered manager was not on duty was not always in line with what was required.

The provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were protected against the risk of harm in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Where people were assessed as lacking capacity, appropriate procedures were followed to ensure arrangements were in people's best interests and in line with the correct legal framework.

Staff were knowledge around safeguarding issues and were able to tell us how they would raise their concerns. Where safeguarding incidents had occurred, the provider had taken appropriate steps to ensure the relevant authorities where contacted. We found risk assessments and care plans were thorough and concise. The home had a security system to ensure the safety of people who used the service.

Is the service effective?

We found regular audits where undertaken and highlighted areas of improvement. We saw evidence that these were acted upon accordingly and learning was implemented. Where issues where raised around people's needs, professional input was sought appropriately to ensure people's care and welfare was promoted. Care plans and risk assessments reflected people's current needs and gave an effective overview of the person's needs and how to meet them appropriately.

Is the service caring?

We saw positive interactions between staff and people who used the service. Staff supported people to access the community and during our visit they were asked if and where they would like to go for lunch. Staff promoted conversations with people who used the service and met their needs in a timely and professional manner.

Is the service responsive?

We saw staff had supported people where difficult behaviours where identified by seeking professional input. We saw staff actively engaged in key work sessions around behaviours and how people could protect themselves and improve their learning and understanding of situations. Each person within the home had their own personalised hospital passport in case of emergencies.

Is the service well-led?

Regular quality monitoring visits where undertaken by the provider which highlighted areas for improvement. People were involved in regular reviews of their care including professional input, family input and the person themselves. The manager undertook yearly audits of the service which included looking at principles of care such as dignity, privacy and respect.