The inspection took place on 25 November 2014 and it was unannounced, which meant that the provider did not know that we were coming.
Welcome House - Leeza Court is registered to provide accommodation and personal care for up to 16 people with mental health needs who do not require nursing care. Accommodation is provided in a detached property in Rainham, close to the town centre.
There was a registered manager at the home. 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.
While some people said that the food was good, others told us the food was not nutritious. Staff did not adequately support people in preparation of their meals. For example, one person’s food was kept in the oven for too long by staff and was clearly overcooked. At no point was the person actively involved in making their own lunch or in choosing what they ate or how it was prepared.
We have made a recommendation that the provider seeks and follows guidance on how to provide nutritious meals and on including people in choosing and preparing their own food as part of developing their daily living skills.
People did not have copies of their own care plans and did not understand what their plans were for. The care plans were kept in the registered manager’s office. However, we noted that people were able to access the office to see their care plan if they so wished.
Some people told us they felt they were not involved in managing their health care needs. One person said, “They arrange all things for hospital appointments for me”. People told us they were able to see a doctor whenever they wanted to but they were not involved.
We have made a recommendation about involving people in decisions about their care.
People were not always provided with a range of suitable individual and group activities they could choose from. Our observation showed that people were not encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished. For example, people sat down watching TV, or doing nothing in the home throughout our visit. People told us that they were not able to choose when they wanted to get up and when they wanted to go to bed.
The examples above show that people did not have their individual needs met and proper steps had not been taken to ensure their welfare. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
The provider had a clear set of vision and values, which staff had not followed. The management and staff team had not demonstrated their commitment to implementing these by putting people at the centre when planning, delivering, maintaining and improving the service they provided.
The home had a system to assure the quality of service they provided and the way the home was run had been regularly reviewed. Prompt action had not always been taken to improve the home and put right any shortfalls they had found. However, the same recent internal home audit failed to identify people not being involved in their care plan, people not being able to go to bed at a time that suits them and the non-provision of nutritious food.
There were systems in place to protect people from abuse or harm and make sure that safeguarding alerts were raised with other agencies, such as the local authority safeguarding team. People told us they felt safe in the home and indicated that if they had any concerns they were confident these would be quickly addressed by the registered manager.
The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. There were risk assessments related to people’s mental health and details of how the risks could be reduced. These risk assessments were last reviewed in October 2014. They contained relapse indicators such as violence, self-harm and neglect. These records were reviewed monthly to look for trends. This enabled the staff to take immediate action to minimise or prevent harm to people. These audits were part of the quality assurance system.
There were sufficient staff to meet people’s needs. The registered manager and staff told us there were enough staff to care for people and keep them safe. The registered manager told us staffing levels were regularly assessed depending on people’s needs and occupancy levels, and adjusted accordingly. The weekly roster confirmed this. The provider operated safe recruitment procedures which included carrying out legally required checks. This was to make sure staff were suitable to work with the people who lived at this home. Staff told us there was a good atmosphere and they worked as a team.
Medicines were safely stored and administered correctly. People showed that they had been given information about their medicines by being able to describe the names and purpose of the medicines they took. Medication administration record (MAR) sheets showed that people received their medicines as prescribed. Clear and accurate records were maintained.
People said, “Staff were well trained and knew what they were doing”. Staff knew each person well and had a good knowledge of the needs of people. Staff had completed training in a range of areas that reflected their job role. Staff told us that they had received one to one supervision and yearly appraisals, which enabled them to develop their skills further.
Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. For example, one person who did not agree with the use of a disability term in their care records was listened to and a best interest meeting took place where a decision was reached by everyone that it was in their best interest to have the word in their care records.
People told us that staff supported them with health care appointments and visits from health care professionals such as mental health professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.
People told us that they received the care and support they needed. They said they liked living in the home. One person said, “I like living here. The staff are much better than my old place”
People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person concerned and their relatives and care plans had been updated as people’s needs changed.
Staff demonstrated respect for people’s dignity during our visit, as they were discreet in their conversations with one another and with people who were in communal areas of the home. People knew how to make a complaint if they were unhappy. One person said, “I have no complaint and if they did, they will speak with staff”.
People spoke positively about the way the home was run. Members of staff told us that the registered manager was very approachable and understanding. They said they were encouraged to raise issues or make suggestions and felt they were listened to.
A quality audit was carried out by NHS West Kent Clinical Commissioning Group (CCG), named ‘Quality and Safety Site Visit’ to the home in October 2014. The CCG shared the results with us and these were mainly positive. They did ask the registered manager to make information about the MCA and DoLS, advocacy services and safeguarding available to people.