Wrekin Cottage - Telford (West Midlands)

Wrekin Cottage - Telford (West Midlands) is a residential care home that accommodates up to 16 people living with learning disabilities or autistic spectrum disorder. At the time of our inspection there were 16 people living at the home.

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

People were safe as the infection, prevention and control procedures had been revised by the provider and effectively implemented.

The provider had reviewed their systems to identify environmental issues to ensure repairs were completed in a timely way. This minimised the risk of harm to people.

The provider had implemented effective systems to identify and drive good and safe care provision. The service did not have a registered manager in post at the time of the inspection. However, the provider was actively recruiting for this position.

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.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

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

Wrekin Cottage - Telford (West Midlands) was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The care service had not been developed or designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was because Wrekin Cottage - Telford (West Midlands) provided accommodation for up to 16 people, some of whom were expected to use shared facilities including bathrooms and communal areas.

Wrekin Cottage - Telford (West Midlands) was located within a 'campus' style location which contained other care homes with day centre facilities also on site. We were told the management team were looking to change the type of accommodation offered to people living there to be in line with right support, right care, right culture guidance. However, no dates or plans for the proposed changes could be provided by the management team we spoke with.

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 Requires Improvement (published 18 May 2021).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wrekin Cottage - Telford (West Midlands) is a residential care home that accommodates up to 16 people living with learning disabilities or autistic spectrum disorder. At the time of our inspection there were 16 people living at the home.

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

People were not always safe as the infection prevention and control procedures were not effectively implemented.

The provider did not have effective systems in place to identify environmental issues which could put people at the risk of harm.

The provider did not have effective systems in place to identify and drive good or safe care provision. The management team failed to address all concerns, previously raised with them regarding the quality of service provided for people. The service did not have a registered manager in post at the time of the inspection.

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.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

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

Wrekin Cottage - Telford (West Midlands) was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The care service had not been developed or designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was because Wrekin Cottage - Telford (West Midlands) provided accommodation for up to 16 people, some of whom were expected to use shared facilities including bathrooms and communal areas.

Wrekin Cottage was located within a 'campus' style location which contained other care homes with day centre facilities also on site. We were told the management team were looking to change the type of accommodation offered to people living there to be in line with right support, right care, right culture guidance. However, no dates or plans for the proposed changes could be provided by the management team we spoke with.

People received their medicines as prescribed. Staff understood how to protect people from the risk of abuse and knew what to do if they suspected something was wrong. The provider followed safe recruitment practices.

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 Requires Improvement (published 29 May 2019).

At the last inspection we found improvements were needed to keep people safe and to effectively monitor the quality of service provided. In addition, we found breaches in safety and quality monitoring. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the same breaches. Not enough improvement had been made/ sustained and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has now been rated requires improvement for two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the management of the location. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained the same. This is based on the findings at this inspection.

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 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.

Following our inspection site visit the provider took action to mitigate the immediate risks to people.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wrekin Cottage - Telford (West Midlands) 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 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 keeping people safe and the provider’s monitoring of the provision of care at this inspection.

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

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wrekin Cottage is a residential care home that accommodates up to 16 people living with learning disabilities or autistic spectrum disorder. At the time of our inspection there were 15 people living at the home.

The care service had not been developed or designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was because Wrekin Cottage provided accommodation for up to 16 people, some of whom were expected to use shared facilities including bathrooms and communal areas. Wrekin Cottage was located within a ‘campus’ style location which contained other care homes with day centre facilities also on site.

People’s experience of using this service:

The provider had not assessed and mitigated risks effectively to minimise the potential of harm to people using services.

Infection prevention and control processes were not effective in reducing the risk of communicable illnesses.

People were not always treated with dignity or respect as they were expected to use defective facilities.

The provider did not have effective quality monitoring processes in place to identify and drive ‘good’ care.

People received safe support with their medicines by competent staff members. The provider had systems in place to respond to any medicine errors should they occur. The provider completed regular checks to ensure people received the right medicine at the right time.

People were protected from the risks of abuse and ill-treatment as the staff team had been trained to recognise potential signs of abuse and understood what to do to safely support people.

People had individual personal evacuation plans and staff members were aware of the necessary action they should take in the event of an emergency.

The provider, and management team, had good links with the local communities within which people lived. The provider had systems in place to ensure the Care Quality Commission was notified of significant events in a timely manner and in accordance with their registration.

The provider supported staff in providing effective care for people through relevant training and one-to-one supervision and support.

Staff members were knowledgeable about the relevant legislations that informed their practice and supported the rights of those receiving services from Wrekin Cottage.

People were referred for additional healthcare services when required. People were supported to maintain a healthy diet by a staff team which knew their individual preferences.

People received help and support from a kind and compassionate staff team with whom they had positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability. People were supported to develop their independence.

People were provided with information in a way they could understand. The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them.

More information in Detailed Findings below.

Rating at last inspection:

At the last inspection Wrekin Cottage was rated ‘Good’ (Published 14 October 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’

Enforcement:

Please see the ‘action we have told provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

A registered manager was in post. They were on annual leave during our inspection, and therefore the inspection was supported by the registered provider’s regional manager. 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.

All five people we spoke with told us they felt safe. We observed people looking relaxed and comfortable with each other and the staff who were on duty. Relatives we spoke with had complete confidence that their relative was safe. Staff understood their roles and responsibilities to protect people from the risk of potential harm. Staff were aware of the provider’s processes for reporting any concerns. There had been a recent turnover of staff and recruitment was on-going to ensure there would always be enough staff to support people. Recruitment checks were in place to help ensure that the staff employed were safe to work with people.

People were supported to manage their prescribed medicines. Where possible people were encouraged to participate in their medicines management. Staff had received training and ongoing checks to ensure they could undertake this part of their role safely.

Staff had been trained to support people effectively. This included learning about the specific needs and conditions people lived with. Staff told us that they received regular supervision and felt supported.

People were encouraged to make suggestions for food and meals they would like to have included on the menu. People were supported when necessary to access a range of health care professionals.

Staff did not fully understand their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions. The registered manager has informed us she will address this with a number of workshops. We observed staff working consistently in line with good practice, which included seeking people’s consent before providing any support.

We observed people and staff enjoying each other’s company. Relatives and health professionals we spoke with were complimentary about the staff team. People had been encouraged to develop skills to help them be more independent. We observed staff ensuring people’s privacy and dignity was maintained.

People told us about the range of activities they could undertake. Some people had recently enjoyed holidays, or had these planned for later in the year. We identified that more opportunities needed to be provided for people to do interesting things when they were spending time at home.

People and their relatives knew how to raise complaints, and described open and accessible communication with the registered manager. People and their relatives had confidence that their concerns would be taken seriously and acted upon.

There was a registered manager in post who was aware of her responsibilities, and who had the skills and experiences required to enable her to effectively lead this service. A range of checks and audits had been developed by the registered manager and registered provider to ensure they could ensure the safety and quality of this service.