Archived: Westbrook House

Westbrook House is a residential care home providing personal care to people with a learning disability and/or autistic people. The service can support up to seven people. At the time of the inspection there were five people living in the home. Westbrook House is a terraced house set over four floors.

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

People living in the service had been exposed to risk of harm. Risks relating to numerous areas including the environment had been poorly assessed and responded to. Safeguarding systems were ineffective and exposed people to risk of abuse. Incidents were not always reported and when incidents occurred staff did not take effective actions to mitigate risks. People were exposed to an increased risk of infection, this included in relation to COVID-19. Staffing was poorly managed, and this impacted on the ability of staff, including managers, to carry out their roles. Medicines were not being safely managed.

People were not being supported by staff who had the correct skills and training. Best practice guidance and legislation was not being applied. The environment had been poorly maintained and was dirty. People were living in dirty bedrooms with mould and damp. Staff were not supporting people in the service to eat healthily and in some cases people’s individual needs around their diet were not met. Staff were not proactive in managing or responding to people’s healthcare needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The dirty poorly maintained environment was not respectful and did not promote their dignity. People were not supported by staff who paid attention to their needs and ensured these were met. Staff did not always treat people with respect. People’s rights were not fully protected and as a result their property and finances were not always treated respectfully. Staff were not effectively utilising the systems in place to ensure people were fully involved in their care.

The support provided had not adequately met people’s needs or been provided in a timely manner. A lack of person-centred planning meant people’s needs were not considered and met, this was across a wide range of areas including social contact and recreational activities. Staff were not utilising communication systems to ensure people’s communication needs were met.

There was a lack of leadership and management in the service. There had been no registered manager in post since April 2020. Staff spoke about poor communication and support which hampered their ability to meet people’s needs. Governance systems were ineffective and where issues had been identified action to drive improvement had not taken place. The incident reporting and monitoring system was ineffective, and incidents had not been reported where required including to CQC.

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 not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care being followed did not maximise people’s choice, control and independence. The care was not person-centred and did not promote people’s dignity and human rights. There was a lack of person-centred culture and values within the service. These concerns had contributed to people’s individual needs not being met and being placed at risk of harm. The issues identified during the inspection were discussed with the provider. The provider told us they had recognised and identified widespread failings in the service and the poorly maintained environment prior to our inspection. They told us given the extent and nature of the concerns they had identified that the best course of action would be to close the service. At the time of our inspection the provider was working with the local authority to identify alternative placements for people so the service could be closed as soon as reasonably possible.

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 07 March 2019)

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service, governance and oversight, safe care and improper treatment of service users, and environmental concerns. A decision was made for us to carry out a comprehensive 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, effective, caring, responsive, and well-led sections 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 person-centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, premises and equipment, staffing, good governance, notification of incidents, and there being no registered manager.

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

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.

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

People’s experience of using this service:

¿ People and their relatives made positive comments about the care provided at Westbrook House. Comments included, “I am happy here and I have a big bedroom,” and, “I have always been pleased with the service, it is first class.”

¿ Measures were in place to ensure people and the environment they lived in was safe.

¿ People's health was well managed and there were links with other services to ensure that individual health needs were met.

¿ People received their medicines when they needed them.

¿ Staff were recruited safely and staffing levels were sufficient to meet people’s needs.

¿ Staff were knowledgeable and were kind, caring and patient.

¿ People were treated with dignity and respect.

¿ Staff knew people well and had developed meaningful relationships with them. Support was provided in a person-centred way based on people’s preferences.

¿ The outcomes for people using the service reflected the principles and values of ‘Registering the Right Support’. People were supported to be as independent as possible and given opportunities to participate actively within their local community.

¿ People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way.

¿ People could take part in a range of activities which promoted their wellbeing.

¿ The service was well managed and staff felt supported.

Rating at last inspection: Good (report published 29 March 2016)

Why we inspected: This was a planned inspection based on the previous rating.

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

Westbrook House provides accommodation, care and support for up to six people with a learning disability. At the time of our inspection there were six people living in the home.

The service had a registered manager in post. 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.’

This inspection found that mental capacity assessments had not been carried out when necessary for people who were unable to make their own decisions. This meant that the service had not acted in accordance with the Mental Capacity Act 2005.

People were safe living in the service and were supported by staff that were knowledgeable about safeguarding matters. There were enough staff available to meet people’s needs and to provide caring and personalised support. Recruitment procedures were robust and people’s medicines were safely managed.

Staff received effective and comprehensive training which was specifically tailored to meet people’s individual needs when this was necessary. People enjoyed the food in the home and were able to participate in choosing what meals they wished to have. Where people had specific nutritional needs these were planned for and met. Prompt referrals were made to health professionals when necessary and people benefitted from a wide range of health professionals involved in their support.

People received care from staff that were patient and friendly. Positive relationships had been developed between people and staff. Staff used a variety of methods to communicate with people in order to support them to express their views. People’s privacy and dignity was supported.

The service was responsive to people’s needs and staff had a thorough understanding of people’s likes and dislikes. They were supported to maintain as much independence as was possible. People we spoke with told us they would be happy to raise any concerns if they had any and felt that staff would take any concerns seriously.

The service was well managed which helped ensure people’s welfare. Staff were supportive of the management team and an open culture had been fostered which ensured that staff felt comfortable to raise any queries or make suggestions for the benefit of people living in the home. There were systems in place to ensure people’s views were frequently obtained and to ascertain and improve the quality of the service people received.

We experienced a friendly and positive environment and all rooms were appropriately furnished. All bedrooms were personalised and had individual items and objects of interest in them. A number of rooms also contained musical instruments.

We saw evidence that everyone who used the service was engaged in a wide range of meaningful activities throughout the whole week.

We spoke formally with two members of staff. Both staff said they were happy working in the home and that they were supported well in their work. One staff member said, 'My days are well planned and I get on well with all the staff". We saw evidence that staff were well trained and received regular supervision and appraisals.

We observed that medicines were administered correctly and in a safe manner. We saw evidence that people who used the service were offered a healthy and balanced diet and that staff understood and supported their specific nutritional needs.