Archived: Winchester House

Winchester House provides accommodation and personal care for up to 12 people aged between 18 and 65 years, who have a learning disability and autism. At the time of our inspection, 11 people were using the service. Winchester House is one of several small homes owned by Aitch Care Homes (London) Limited.

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 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.

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

At our last inspection, there was inadequate staffing level in the service, which meant people’s needs were not being consistently met. During this inspection, we found that the provider had made improvements. There were enough staff deployed to meet people’s needs and staff morale had significantly improved.

People were safe at Winchester House. Staff knew their responsibilities in relation to keeping people safe from the risk of abuse.

Risks were appropriately assessed and mitigated to ensure people were safe. Medicines were managed so people received their medicines as prescribed.

The provider continued to operate robust recruitment and selection procedures to make sure staff were suitable and safe to work with people. Staff received training, support and supervision to enable them to carry out their roles safely.

People's care plans clearly detailed their care and support needs. People and their relatives were fully involved with the care planning process. The service had developed care plans which clearly detailed people’s likes, dislikes and preferences. Care had been delivered in line with people’s choices.

People received the support they needed to stay healthy and to access healthcare services. Each person had an up to date support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

We observed people’s rights, their dignity and privacy were respected.

Staff supported people to maintain a balanced diet and monitor their nutritional health.

People knew how to complain and felt confident any concerns would be listened and responded to by the provider.

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.

There was a positive leadership in the service. The service was well led by a management team who led by example and had embedded an open and honest culture.

Effective governance systems to monitor performance had been fully embedded into the service.

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 17 December 2018) and there was a breach of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

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.

Winchester House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Winchester House is one of several small homes owned by Aitch Care Homes (London) Limited. The service provides care for up to 12 people with a learning disability. Winchester House is located in a quiet residential area, with access to local shops, public transport and facilities nearby. All bedrooms have en suite facilities. At the time of our visit, 12 people lived in the service. People who lived in the service had moderate to severe learning disabilities, autism, epilepsy and different levels of communication difficulties.

Winchester House was designed, built and registered before registering the right support. Therefore, the service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance.

Although the service had not been originally set up and designed under the Registering the Right Support guidance, they were continuing to develop their practice to meet this guidance and used other best practice to support people. They have applied the values under Registering the Right Support. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last Care Quality Commission (CQC) inspection on 17 October 2017, the service was rated as Good. At this inspection, we found the service Requires Improvement.

There was a registered manager at the service. The registered manager was on annual leave when we inspected. 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 and associated Regulations about how the service is run.

The staffing levels were not always appropriate to support people and meet their needs. Both members of staff and relatives confirmed this.

People were not actively engaged in activities and pursue their interests due to insufficient staffing levels in the service. Both relatives and staff confirmed this.

The registered manager had a quality audit in place. However, this was not comprehensive enough. Areas of concerns we identified had not been picked up and resolved.

Medicines practice was safe. Medicines were recorded accurately and we found no gaps on the MAR chart.

Staff received regular training. Appropriate support and supervision were provided as is necessary to enable staff to carry out their duties.

People were protected from the risk of abuse at Winchester House. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. People received the support they needed to access healthcare services.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

People were supported to eat and drink enough to meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Relatives and visitors were welcomed at the service at any reasonable time. People were supported to maintain their relationships with people who mattered to them.

Staff showed they were caring and they treated people with dignity and respect. Staff ensured people's privacy was maintained particularly when being supported with their personal care needs.

The registered manager ensured the complaints procedure was made available in an accessible format if people wished to make a complaint.

The registered manager provided leadership. They checked staff were focused on people experiencing quality care and support.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

Winchester House is one of several small homes owned by Aitch Care Homes (London) Limited. The home provides care for up to 12 people with a learning disability. Winchester House is located in a quiet residential area, with access to local shops, public transport and facilities nearby. All bedrooms have en suite facilities. At the time of our visit, 12 people lived in the home. People who lived in the home had autism, epilepsy, PICA ( Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and plastic) and different levels of communication difficulties.

At the last inspection, on 17 November 2015, the service had an overall rating of Good but Required Improvement in Effective domain because the provider had failed to adequately train staff to provide care and support to meet peoples assessed care needs. This was a breach of Regulation 18 (2) (a).

The provider sent us an action plan on 01 February 2016 which, showed they planned to make the changes and meet regulations by 02 March 2016.

At this inspection, we found the service had remained Good.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

There was a manager at the home. The manager took up this position about four weeks prior to our visit and was undergoing registration with the commission when we visited 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.

Effective recruitment processes were in place and followed by the manager. Staff had the opportunity to discuss their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

People were protected against the risk of abuse. We observed that people felt safe in the home. Staff recognised the signs of abuse or neglect and what to look out for. Both the manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place. This was to identify and reduce risks that may be involved when meeting people’s needs such as inability to verbally communicate, which could lead to behaviour that challenges and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People had good access to health and social care professionals when required.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

People were supported to eat nutritious foods and staff had worked hard to give support with weight gain or reduction when required.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The manager understood the requirements of their on-going registration with the Commission.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People experienced care, treatment and support that met their needs and protected their rights.

People were not protected from the risk of infection because appropriate guidance had not been followed.

Appropriate arrangements were in place for obtaining medicine and medicines were prescribed and given to people appropriately. Medicines were administered and kept safely.

People who used the service, their representatives and staff were asked for their views about care and treatment and they were acted on.

People told us that they enjoyed the inclusive environment, and they were involved in choosing daily activities. One person we talked to told us about taking part in activities they enjoyed, and said, 'I like cooking, going swimming, and going to the cinema on Fridays. Going to the pub is my favourite'.

Another person said, 'It's nice here, it's okay'.

People said they liked living at Winchester House. They said they had been involved in discussions about the help they needed and their preferred day to day routines. People said there were different activities to do and that they could go out for activities they liked such as attending art classes, shopping and visiting the local pub if they wanted to. They said they were happy with the support they received, that the staff supported them well and asked them what they wanted to do each day. People said that the home was always kept clean and smelled fresh. People said they knew who to speak to should they have any concerns, but said they had no complaints.