About the service Waterside House is a supported living service providing personal care to people aged 18 and over with learning disabilities and/or autism provided by Trafford Metropolitan Borough Council. The supported living service provides supported accommodation to 22 people in seven supported living accommodation properties.
People's experience of using this service and what we found
Safeguarding processes were not effective, and people were put at potential risk of harm due to the poor management of safeguarding concerns. There had been some safeguarding events at the service which had prompted us to inspect. As a result of the number of safeguarding allegations the commissioners have placed Waterside House in a temporary suspension of new admissions to the service.
The provider's initial response to concerns raised has provided a level of assurance. We have been provided with an extensive action plan following our inspection, where the provider in some cases has taken immediate action.
The provider's incident management policies and procedures were not routinely followed. Opportunities to learn from incidents were missed, due to a lack of reporting systems in place. There was a closed culture where staff were reluctant to use the provider's whistle blowing procedure.
One of the supported living settings we visited we found two potential hazards to the environment. Risk assessments concerning these environmental risks had not been completed to minimise risks to people.
The providers approach to COVID-19 was inconsistent. The risk to staff and people using the service from COVID-19 had not been adequately assessed in a timely manner, with measures introduced to reduce the risk. The use of face masks to be worn by staff had only recently been introduced and key internal policies and procedures had not been devised in a timely manner to support to prevention of COVID-19 entering people’s homes. Shortly after the inspection safe systems were implemented.
The management of the service was not cohesive. The organisational structure was not followed, and reporting lines were unclear. Systems were disorganised and audits we requested had not been forthcoming in a timely manner due to this. The service was unable to demonstrate any analysis of themes and trends or how learning was shared with the staff team to ensure continuous improvement. The provider was looking to recruit a quality assurance manager that would support the service with the necessary improvements.
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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. There was a poor staff culture within a small number of the supported living settings which meant people were vulnerable to the risk of safeguarding incidents. Whilst the management team had completed some investigations into concerns about this culture, not all allegations were investigated appropriately or reported to the senior management team.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The rating at the last inspection was good, the report was published on 6 December 2019. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Waterside House on our website at www.cqc.org.uk.
Why we inspected
The provider contacted us to state they had raised several safeguarding concerns, some of which had not been reported in a timely manner. As a result, we undertook a focussed inspection to review the key questions of safe and well-led only.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to how the service is managed, how safe people are at this service, and staff knowledge and practice.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We requested an action plan from the provider, which was promptly provided and detailed 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.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.
This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as
inadequate for any of the five key questions, it will no longer be in special measures.