One adult social care inspector undertook the inspection of Wensum Way. At the time of the inspection there were seven people using the service.We spoke and communicated with four people who used the service, the registered manager and four care staff, of which two were regular agency staff. We reviewed four people's care records and four staff files. We also reviewed a selection of other records that included staff rotas, audit results and policies and procedures.
We used the evidence we collected during our inspection to answer five questions.
Is the service safe?
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty. At the time of this inspection no person was subject to a DoLS authorisation. The registered manager told us that some people did not have mental capacity. There were no mental capacity assessments in place or best interest decision records. Some people had restraints in use. These were wheelchair lap belts and bed rails. People had not consented to these restraints. This meant that their liberties were unlawfully deprived. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the MCA and DoLS.
There were inadequate processes in place to ensure that people's health needs were met. The care staff had treated one person without the advice of health care professionals. The service is not regulated for nursing care. People had not been referred to healthcare professionals when they should have been. We were concerned that the staff had not reported a safeguarding concern to the registered manager. We were concerned that the registered manager was not aware of a situation that required a safeguarding referral. The inspection team submitted a safeguarding referral to the local authority in relation to this. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to people's care and welfare.
There were inadequate numbers of staff on duty to meet the needs of people. People with complex needs were left, at times, without a care worker because of the staffing arrangements. People's social needs were not always met because of the number of staff on duty. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to staffing.
We did not see evidence that the service had an effective system in place to audit accidents and incidents. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.
Is the service effective?
During our inspection we saw that people's needs had been assessed. However, care and support was not delivered in line with people's individual care plans. There were numerous gaps in people's records as to whether their nutritional, personal hygiene and social needs had been met. People who should have been referred to a healthcare professional had not been. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the care and welfare of people who use the service.
Staff had received their mandatory training and had obtained further training.
Is the service caring?
We spoke with four people who used the service. Our communication with them was limited due to their complex needs. One person said, 'I'm happy here. Everything is alright. I like to watch television. I am going to the day centre tomorrow.' Another person said, ' I like to sit and watch television. I do this most days. I go shopping outside. The staff are alright. The food is alright. I am okay here.' Another person said, 'I am okay.' A fourth person signed, 'Okay' and laughed.
People's plan of care and support were not always focussed on them as individuals. Although people's interests had been documented it was not evident that people were enabled to undertake these.
We observed the interaction between the staff and people who used the service. Staff were seen to be kind and respectful to people most of the time. Some of the staff used sign language to communicate with one person. It was evident that staff did not spend time with people on a one to one basis or ensured people were undertaking meaningful activities. The staff told us that this was because there were not enough staff on duty to do this.
Is the service responsive?
People's needs had been assessed and their care and support had been planned to meet their needs. However, the delivery of people's care and support did not always respond to their needs. There was a lack of social stimulation when people were in the home. People's interests and hobbies were not encouraged within the home. We saw that some people had requested more outings and to do more activities. These requests had not been met.
Staff had not responded to the deterioration in two people's health. Referrals to healthcare professionals had not been made.
The service had a complaints procedure but the registered manager told us that no complaints had been made. There was limited evidence to show how people who could not verbalise their thoughts were assisted to raise any concerns.
Is the service well-led?
The service was not well-led. The staff we spoke with said that they felt supported and that they felt confident to raise any concerns or issues. However, there was little evidence that these had been acted upon. The staff told us that they had raised their concerns about staffing arrangements with the registered manager but there had been no action from this. Staff told us that they were concerned that people were not receiving any social stimulation and that they had raised their concerns with the manager but there had been no action taken.
There was lack of evidence that quality assurance processes were in place. The registered manager told us that the service was monitored by a staff member from the provider's headquarters. They showed us an action plan from a previous audit but none of the shortfalls had been actioned. The registered manager told us that accidents and incidents were audited by the provider's headquarters but the provider has failed to send us this information. The registered manager was not sure how the views from people's relatives were sought.
Staff had regular supervisions but the registered manager failed to identify the poor practice of some of the staff. This related to the poor management of people with health problems. The registered manager was not aware of these problems. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.