Westhope Mews

Westhope Mews is a residential care home providing accommodation and personal care support for up to eight adults with learning disabilities. The service specialises in the care of people who have a learning disability and complex needs including autism, communication, physical health and behaviours that challenge others. At the time of the inspection the service was supporting eight people. People had their own rooms with en-suite wet rooms and access to communal spaces such as, an activity room, lounge, kitchen and courtyard garden.

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

Quality assurance processes were not robust to ensure effective provider oversight of monitoring systems. Audits undertaken by the provider had not identified some of the issues found during the inspection.

People’s health risks were appropriately assessed, and care plans were written to guide staff on how to meet people’s needs. This included providing safe support with swallowing difficulties and catheter care.

People were cared for by staff who knew them well and were trained to meet their needs. Staff understood their responsibilities to recognise and report safeguarding concerns. People received their medicines in a person centred and timely way, staff were trained and assessed as competent before administering people’s medicines. One person told us, “I get confused by the medication, but staff tell me what they are.”

People were empowered to make decisions and were asked for their opinions on the service. House meetings and discussions were held for people to express their views. One relative told us, "They've created a culture which is a like a home environment. From what I see they do a very good job with all the service users despite their individual requirements.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service did not have a manager and the nominated individual was providing operational oversight of the service. People told us they would feel able to approach the nominated individual if they had concerns. One person told us, “If I'm worried about anything, I can go to [nominated individual].”

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence. People’s communication needs were met to maximise their choices. People had personalised bedrooms and were asked their opinions on the environment.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. Planned care was person-centred and holistic to meet people’s needs.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. People were supported to give their views and were listened to.

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 good (published 24 September 2019).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westhope Mews on our website at www.cqc.org.uk.

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.

We have identified a breach in relation to good governance at this inspection.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Westhope Mews is a residential care home providing accommodation and personal care to eight people living with a learning disability and/or Autism at the time of the inspection. The home is registered for up to eight people living on one floor of an adapted building. People had their own rooms with en-suite bathrooms.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were safe, and staff understood how to manage and reduce risks to people. One person told us, “I feel safe because I know the staff care.” Peoples medicines were administered safely. People lived in a clean and hygienic environment. There were enough staff to meet people’s needs.

People were supported to access health professionals when needed and were supported to live healthy lives. Staff were well trained and understood people’s needs. People were offered choices in their day to day lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were kind, caring and knew people well. One person told us, “The staff are nice, I can joke with them.” Staff supported people to live as independently as possible and promoted them to develop new skills. People were supported to express their views and make decisions about their care. People’s privacy and dignity were respected.

People received person centred care tailored to their individual needs. People were supported to be active members of their local community and took part in activities that met their interests. People were supported to maintain relationships that were important to them.

The home was well-led. People, their relatives and staff were positive about the management of the home and spoke highly of the manager. A relative told us, “They home is well managed. (Manager) is a breath of fresh air. He gets stuck in and knows people really well.” There were quality assurance processes in place to continually drive improvements to the service. Staff worked well with other professionals to meet people’s needs.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 13 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. Improvements had been made and the overall rating for Westhope Mews has been revised to good.

Westhope Mews is registered to accommodate up to eight people. It specialises in providing support for people who have a learning or physical disability. At the time of our inspection there were seven people living in the service.

There was a manager in post, however they had not yet applied to become the registered manager of the service, and at the time of our inspection, they were not registered with the CQC. 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 staff we spoke with were aware of their role in safeguarding people from abuse and neglect and had received appropriate training. We saw risk assessments had been devised to help minimise and monitor risk, while encouraging people to be as independent as possible. Staff were very aware of the particular risks associated with each person’s individual needs and behaviour.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The service asked people and other stakeholders to fill in surveys about the quality of the service and people’s feedback was included in plans for future improvements. There were effective systems in place for monitoring the quality and safety of the service. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “Yes I feel safe and I am happy here”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

People’s needs had been identified, and from our observations, people’s needs were met by staff. Staff used touch as well as words and tone to communicate with people in a positive way. There was positive interaction between people and the staff supporting them. Staff spoke to people with understanding, warmth and respect and gave people lots of opportunities to make choices. The staff we spoke with knew each person’s needs and preferences in detail, and used this knowledge to provide tailored support to people.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good knowledge of this.

People were supported to eat and drink sufficient to maintain a balanced diet. One person told us, “I like the food, it’s nice. We get what we want and have meetings about menu plans”. People were supported to maintain good health, to have access to healthcare services. We looked at people’s records and found they had received support from healthcare professionals when required.

People’s individual care plans included information about who was important to them, such as their family and friends and we saw that people took part in lots of activities in the service and in the community.

There was a complaints procedure, and evidence that people were consulted about the service provided. We saw that ‘house’ meetings took place for people to comment on their experience of the service.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

The staff members we spoke with said they liked working in the service and that it was a good team to work in. They told us staff meetings took place and they were confident to discuss ideas and raise issues with managers at any time.

We spoke with three relatives. They were all complimentary about the home and staff. One said, 'The staff are really friendly and very helpful' and, 'They're learning to read X (their relative) really well'. Another told us, 'I'm really pleased, X is happy as Larry'.

We also gathered evidence of people's experiences of the service by observing how people were supported by staff, looking at records and talking with members of staff and the manager. We found that people's care needs were being managed safely by the service and that staff had a good understanding of their roles and responsibilities in this area.

We found that the support people received was individualised to their needs. People's rights with regard to consent were being promoted by the service and that staff understood how people's capacity should be considered. People told us that they could approach the staff and manager if they were unhappy or had ideas to discuss.

We spoke to people about the things they liked to do at the home. One of them said, " I love going to college". Another told us that he liked to go in to the town. We saw that each person had an individual weekly activity programme that enabled them to plan the things they liked to do, including going to the pub, cooking and going to the cinema.

We looked at people's care plans and saw that they were based on their individual strengths and needs and their likes and dislikes. They were regularly discussed with people and updated.

We spoke to staff and they all felt well supported in their roles. Some of the staff we spoke to said they had received supervision but that this had not been done as regularly recently. Not all of them had received an annual appraisal.

The home had effective arrangements in place for safeguarding people from abuse and there was a complaints system in place.