The Well House

Updated 23 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector on the first and third day and two inspectors on the second day. After the first day, we waited until the outbreak of COVID-19 had ended to return for the second day. We returned on a third day because we were unable to access documents we needed to see.

Service and service type

The Well House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The first and second day of this inspection was unannounced. The third day of the inspection was announced to ensure that the documents would be ready for us to look at.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. Due to technical problems, the provider was not able to complete a Provider Information Return (PIR). A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spent time with people living at the home. We spoke to three people about their views of the service and observed interactions between people and staff. We spoke with seven members of staff including the registered manager, deputy manager, senior support staff and support staff. We spoke to five people’s relatives over the phone. We reviewed a range of documents relating to people’s care such as support plans and medicines records. We looked at governance and assurance processes, records relating to the management of the service and staffing.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We reviewed records relating to people’s mental capacity and support needs. Where we had raised issues in recording, we received updated documents that showed our feedback had been acted on.

Updated 23 April 2022

About the service

The Well House is a residential care home providing support and personal care to up to 14 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were nine people using the service. The home was separated into three buildings, the main house where five people lived, the annex where three people lived and one building for one person.

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

Risks to people were not always effectively assessed and managed. Where people had specific health needs which may put the person at risk, guidance and risk assessments were not always present or clear. Government guidance around infection control was not always followed. There were enough staff to support people safely, however improvements were needed to the recruitment process to keep people safe. Medicines were not always managed safely.

Quality assurance and risk management processes required improvement. Audit processes were not effective in identifying improvements needed at the service. Actions needed to improve the service were not recorded or monitored. The culture of the staff team was person focused and staff were kind and caring towards people. Staff worked well with professionals to ensure people received appropriate support. People and staff were given regular opportunities to feedback on the home.

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.

Based on our review of safe 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: Model of care and setting maximises people’s choice, control and Independence.

Although we saw that people were offered choices throughout the day and supported to make their own decisions, the processes around mental capacity and decision making were inconsistent. Some people who had restrictions to keep them safe, had not had their mental capacity assessed to see whether they could have made this decision for themselves. We saw staff had supported people to be independent in aspects of their day to day lives. People’s bedrooms were unique to each person and we saw that people had been consulted about where they wanted to live. People told us they were able to do and choose how they spent their time, one person told us, “I like it here because I get to do what I want.”

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights

Staff treated people as individuals.

Staff supported people in a person-centred way. Staff knew people well and understood how to communicate effectively with each person. Staff spoke to people in a dignified and respectful way and enjoyed making people laugh. Information included in people’s care plans was individual and included what was important to the person. Relatives were positive about their loved ones’ experiences of the home. One told us, “[Person] isn't able to say if they're happy at the home, but when we ask, [their] face lights up and they shout yes.” People were supported by staff to have regular visitors and staff supported people’s relationships with their friends and family.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

Whilst improvements were needed at the service, the management team led with a caring and affectionate attitude. The ethos of the service was family orientated and we saw that people were comfortable and enjoyed where they lived. Relatives told us, “I can tell [person] is happy because of how they relate to me about the staff, they truly love them.” And “The staff are so friendly, you really feel it when you walk in there.”

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 10 December 2020).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns we had received about the service. The inspection was prompted due to concerns received about infection control measures and staffing. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with infection prevention and control so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 safe care and treatment relating to risk management and infection control and governance relating to quality assurance processes at this inspection.

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

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.