Westhope Mews

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found 2 breaches of the legal regulations in relation to safe care and treatment and staffing. Staff did not always assess risks to people's health and safety or mitigate them where identified. Risk assessments were sometimes incomplete and did not always include risks we identified during our assessment. Staff did not always have the knowledge to recognise how to support people to live full lives. Medicines were generally safely managed however some medicine protocols had incomplete guidance for staff to follow to provide consistent care.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always supported by staff who fully understood what constituted an incident, which meant there were inconsistencies in practice. For example, some incidents of anxiety were recorded, and some were not. This also meant that lessons could not be effectively learnt from because not all incidents were recorded. People and their relatives spoke positively about the current staff and management team. They told us they were approachable, and worries could be raised. They had confidence action would be taken. Some people had positive behaviour support plans (PBS) These are plans designed to support a person to manage when they become upset. These plans should contain detailed information to guide staff how to support the person and provide the person with opportunities to develop skills to help themselves in the longer term. The template used by the provider did not contain a functional behaviour assessment or skills building sections which support staff to understand why a person may be finding things difficult and how to support them to develop skills to reduce the causes of their anxiety. This was discussed with the interim manager, who demonstrated a good understanding of PBS and told us they were working on further referrals and development of the plans.

Systems were not always effective in highlighting shortfalls in incident recording. Staff were not clear with how to report and record incidents. A staff member told us, “We talk a lot if something happens, so it doesn’t happen again, but not always recorded.” Another said, “Everything had become normal, no reviews were done.” The interim manager had started to record incidents more effectively on the provider’s internal reporting system and was able to demonstrate a number of incidents where appropriate actions had been taken.

Providers processes failed to identify shortfalls in staff practice and a number of concerns were raised during our assessment visit. These included poor or no recording of some incidents where people put themselves at risk on a daily basis, that had become normalised and was not recognised as a behaviour of concern. Following our visit, we sought assurances from the provider of the actions they were taking to ensure people’s immediate safety and well-being.

People told us they did not like or were not happy living with the other people in the house. One person told us they didn’t like to go into the shared areas of the house and didn’t want to mix with other people. Another person told us they liked the staff but didn’t get on with the people they shared the house with. During our visit we observed one person in the shared area with staff and others in their own rooms. On the second day we found 2 people in the shared areas.

Staff received contradictory information about a person who moved into Westhope Mews. Some risk assessments and support plans had been developed but some needed improvement. For example, a person’s hearing loss was noted in the assessment carried out by the provider but was not transferred to the person’s communication support plan where it would have been relevant in supporting staff to understand a person’s communication needs.

The feedback we received from health professions was generally positive, commenting on staff and management engagement and how this had improved recently. However, there were some concerns around health referrals not being followed up after hospital discharge. The interim manager was aware of these issues and had started to take action.

There were systems and processes in place to support safe care, however these relied on local staff and managers knowing people well, there was a lack of detailed recording particularly in daily records and handover documents to support effective analysis of trends. The acting regional manager told us, a new system of recording was planned to help support oversight.

People generally told us they felt safe at the service. One person said, “I feel happy with the staff”. Another person told us, “This is a good place, staff are very good, they help as much as possible” “if I was feeling worried, I would talk to staff”, “I know they would help me.” Another person said, “its bloody awful here.” But did not give any further information.

Staff demonstrated knowledge about how to generally assess and manage safeguarding risks. Staff told us they now had confidence in all managers that concerns would be addressed if raised and felt the culture was better and things were discussed openly. Staff comments included, “Safeguard to our best capacity to make sure they are not abused and report anything that may be abuse, could be shouting, being physical." Staff were less clear about identifying different ways people might self-injure as abuse.

We observed a mealtime where a person was coughing while drinking, staff did not recognise this may be of concern in relation to the persons SaLT assessment and could indicate aspiration. This was raised by inspectors with the managers, and they took action to contact the SaLT team to seek immediate advice. However, we also observed staff and people sharing friendly and relaxed conversation. Including respectful banter.

Deprivation of Liberty Safeguards (DoLS) processes had not been effectively monitored. A number of people were subject to Deprivation of Liberty Safeguards (DoLs). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. One person had a DoLs in place. There was a lack of understanding of when a capacity assessment should be carried out. Staff appeared confused about the difference between a person with capacity making an unwise decision and a person without capacity making an un safe decision. This was discussed with the interim and the acting regional manager and they arranged an assessment of capacity to start on the same day.

Risks were not always managed in a way to ensure people were safe. For example, Some people were being supported to eat their meals in bed, contrary to Speech and language guidance (SaLT) with no assessment or professional advice sought to mitigate risk. A visiting social care professional told us, they were concerned the person being in bed increased the risk of chocking.

The manager told us they were working on developing risk assessments further, however at the time of our visit there were several missing or incomplete risk assessments in place. These included risk assessment of health conditions, eating and drinking, and mobility. The manager took steps to address these during and shortly following out visit. However, the practice of identifying and mitigating risks had not always been effective.

We observed staff supporting people individually in shared parts of the house. People observed being supported with meals and drinks generally in line with guidance. However, we noted one of the people being supported to eat their meal in bed was not in line with guidance which meant that the person was at risk of choking.

The registered manager was responsive to areas of shortfall identified during the assessment and made changes. However, there had not enough effective oversight into how risk assessments were developed and monitored. Risks to people were not always identified or managed appropriately in the least restrictive way to promote good outcomes for people. For example, some people had health risks which had not been assessed, for others the risks from being inactive had not been considered. There was a failure to ensure staff were provided with appropriate training and guidance to ensure risk assessments were monitored in a consistent and safe way.

The provider did not always effectively manage risks and provide maintenance in a timely way. For example, a large quantity of alcohol was freely accessible to a number of people with no risk assessment in place. This was in a room with no working lock and was known to managers. We found no harm however given the quantity it could have caused considerable harm. The interim and regional managers addressed the issues by the end of the visit by having a lock fitted and taking other appropriate actions including risk assessment. People told us they preferred to spend time in their rooms, which were personalised and comfortable. The shared areas of the house were bland and not homely, people told us they did not want to use them. People told us staff carried out regular safety checks needed to be carried out and told us about fire drills and wheelchair checks.

Managers and staff told us they were planning to remodel parts of the building to provide a new large accessible kitchen. We were shown plans and following our visit this work has been confirmed by another agency and in photographs. Staff had received fire awareness training and understood the actions they should take should a fire occur. Staff were clear about the regular safety checks to be carried out. Staff told us they participated in regular training around all aspects of environmental safety. Records confirmed staff training and regular safety checks on equipment.

Observations of the environment identified significant issues with security. The care home is situated on the ground floor of the building with a number of supported living flats on the first floor. We observed that one of the entrances gave full access to the care home from the supported living tenants or their visitors. We raised this with the regional manager who arranged for an appropriate security device to be fitted by the end of our assessment visit. There was a further issue with a room which formed part of the care home, but not in current use, which was located the other side of a security door to get into the rest of the care home. We raised this with the interim and regional managers who gave assurances the room would not be occupied until appropriate access arrangements could be made. These issues had not been identified by the providers internal auditing systems or by local managers. Records confirmed safety checks were being completed for example, fire safety, electrical and moving and handling equipment had been serviced in line with regulation.

Systems were in place to identify and manage foreseeable environment risks within the service. However, maintenance of the fabric of the building was not carried out within reasonable timescales. This meant people, visitors and staff were not effectively protected from the risk of harm. Equipment was monitored and maintained according to a schedule. In addition, gas, electricity, and electrical appliances were checked and serviced regularly. Fire safety risks had been assessed by a specialist and where necessary action taken to ensure the environment was safe.

People were not receiving support from staff who understood how to motivate and encourage people and to ensure they had opportunities to participate in their lives as much as they were able. People told us they wanted to go out more but there had not been a driver for the mini bus for 3 months. People told us they liked their staff.

Staff told us they had received training and records confirmed this, however staff practice did not reflect some of the training to specifically support the needs of the people living at Westhope Mews. For example, some staff had active support training. Active Support is a method of enabling people with learning disabilities to engage more in their daily lives. Active Support changes the style of support from ‘caring for’ to ‘working with’, it promotes independence and supports people to take an active part in their own lives. The support given to the person is also active. Active Support enables people with learning disabilities to live ordinary lives. Staff explain the concept of this approach but also told us they were not practising it. We raised this with the regional manager who said, “They need more training I will arrange that.” Staff told us they felt supported by the interim manager and they had supervision and appraisal meetings. Staff told us there were agency staff were being used and while they tried to have the staff agency staff for consistence this was not always possible. The interim manager told us recruitment was ongoing with the aim to remove the need for regular agency use.

We observed staff not always engaging with people, who were often in their rooms without support. Staff were providing care to meet basic needs and not providing activities to support enrichment or well-being. We raised this with the interim and regional managers who told us there was a culture which was task focused and they were starting to address this. On the second day of our assessment visit, we did see that people who had not been out for some time had been to the local shops and pub. They told us they had a good time.

Staff were safely recruited and received an induction and training in a number of topic areas. All staff were working on or had completed the care certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that should form part of a robust induction programme. Staff training includes some practice competency assessments carried out by the manager in the topic areas of medicine administration and moving people safely. Competency assessments covering person centred care, active support, PBS and MCA were not in place.

People were supported to manage potential risks of infection. Meals were prepared by staff who had received food safety training. People told us staff kept their rooms clean.

Staff were clear about their role in managing the risk of infection. Staff told us they had training and gave examples of where personal protective equipment such as gloves were needed.

We observed staff working in line with infection control and food safety guidance. The service was clean and tidy.

Infection Prevention Control Audits had been carried out and actions recorded and in progress. The service followed the principles of good practice guidance such as Safer Food Better Business (Food Standards Agency)

People were observed to have positive experience of receiving support with medicines. Staff talked to people about their medicine and knew how each person wanted to receive it. Staff showed kindness and patience. People could not be sure they would always receive PRN (medicine to be administered as needed) medicines safely or in line with good practice guidance. A review of people’s medication administration records (MAR) showed medicines for constipation did not have clear guidance to staff about when this should be given which could leave timescales open to different interpretation. This was not in accordance with National Institute for Clinical Excellence, (NICE) good practice guidance.

Whilst our assessment identified some shortfalls with medicines practices, staff demonstrated clear understanding of the medicines people took and why they had them. Some medicines received from the pharmacy were unexpected, so staff contacted the GP to get a clear understanding of the medicine change and then shared this with the other staff and the person.

There were some shortfalls with medicines processes where risks to people had not always been fully considered and this resulted in a potential risk of harm. Managers and staff told us the systems and practices had improved following recent restructuring of the management arrangements. Evidence was presented showing, staff received training and competency checks before giving medicines and audits had started to be carried out where some issues were identified and addressed. Managers responded quickly to issues found during our assessment and updated records to provide greater clarity to staff.