Withins (Breightmet) Limited

Withins (Breightmet) Limited is a residential care home providing personal care for up to 65 people in one purpose-built building over three floors, including autistic people and people with a learning disability. There are 22 bedrooms on the lower ground floor, 32 bedrooms on the ground floor, and 11 bedrooms on the first floor. All bedrooms have ensuite facilities with communal lounges, bathrooms, and dining rooms. During the inspection there were 64 people using the service. There is access to secure outside terraces or gardens on all floors.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The provider was not always ensuring risks were assessed and mitigated effectively and medicines were not always managed safely. Documents with regard to medicines were not always complete and accurate. Audits in place were not always robust enough to identify and address the issues found during the inspection with the safe management of medicines. We have made a recommendation about medicines audits.

Staffing levels were sufficient to meet people's needs and managers recruited staff safely. Staff followed an induction programme, and training was on-going throughout employment. Staff thoroughly assessed people's needs prior to a service starting. Care plans included information about support required in areas such as nutrition, mobility, and personal care to help inform care provision. Staff made appropriate referrals to other agencies and professionals when required.

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. People were supported by staff to pursue their interests and staff supported them to achieve their aspirations and goals. People had a choice about their living environment and were able to personalise their rooms.

Right Care:

Care was person-centred and promoted people’s dignity, privacy, and human rights. Staff promoted equality and diversity in their support for people and understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity and understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The provider worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People’s care plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life. People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. People told us they were well treated, and their equality and diversity were respected. People felt staff respected their privacy and dignity and took into account their views when agreeing on the support required. Staff identified people's communication needs and addressed these with appropriate actions.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. The ethos, values, attitudes and behaviours of leaders and care staff ensured people led confident, inclusive, and empowered lives.

Staff placed people’s wishes, needs, and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families, and other professionals as appropriate

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity.

Managers responded to complaints appropriately and used these to inform improvement to care provision. The provider was open and honest, in dealing with concerns raised. The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service. These governance systems and processes ensured the service provided to people was safe, however medicines monitoring systems needed improving.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 June 2022) and there were breaches 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 the provider remained in breach of regulations. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 17 May 2023 and 23 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We found the provider remained in breach of regulations.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Withins (Breightmet) Limited on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to safe care and treatment. Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Withins (Breightmet) Limited accommodates up to 65 people in one purpose-built building over three floors. The home is located in a residential area in Breightmet, about two miles from the centre of Bolton. During the inspection there were 60 people using the service.

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

People were not always safe. The provider was not always ensuring risks were assessed and mitigated effectively. Medicines were not always managed safely.

Documents with regard to medicines, risk management and care planning were not always complete and accurate. There was a lack of audits and those in place were not always robust enough to identify and address the issues found during the inspection.

All required health and safety measures were in place. There were systems to help ensure people were safeguarded from the risk of abuse. The premises were clean and hygienic and measures were in place to help prevent and control the spread of infection.

Staffing levels were sufficient to meet people’s needs and staff were recruited safely. There was a thorough staff training programme and more specialised training had been commenced to help ensure improvements could be made in record keeping, recognition and escalation of concerns.

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.

People we spoke with felt they were well cared for and supported. Communication between the provider and people who used the service and their relatives was good. Complaints were responded to in an appropriate and timely way. The service worked well in partnership with other agencies and professionals.

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 10 May 2018).

Why we inspected

We received concerns in relation to systems, record keeping, escalation of incidents and governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Spaces, such as outdoor areas, were used creatively to help with infection prevention and control. Designated entrances were used for visitors to mitigate the risks of people spreading infection. Visits were limited to people from one household to minimize risks and visiting for people who were nearing the end of life complied with current guidance.

People were supplied with personal protective equipment (PPE) to wear on visits and had no contact with people using the service other than the person they were visiting.

The service ensured people were tested prior to admission to the home and were isolated for 14 days as per guidance. Whole home testing for staff and people using the service was in evidence at the service.

All staff worked in only one care setting to help reduce the spread of infection. Staff members wore appropriate PPE within the home. Arrangements were in place for staff to socially distance on breaks.

The home had implemented outbreak cleaning schedules from the start of the COVID-19 pandemic, including regular cleaning of high touch areas. The schedules were followed effectively and there was evidence of communication with cleaning staff around guidance and requirements.

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

Withins (Breightmet) Limited accommodates up to 65 people in one purpose built building over three floors The home is located in a residential area in Breightmet, about two miles from the centre of Bolton.

There was a registered manager in place. 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.

People felt safe at the home. Staff had received training in safeguarding and were confident the registered manager would take concerns seriously.

There were individual and general risk assessments in place and health and safety records were complete and up to date. Staffing levels were good and recruitment was robust.

There was a suitable medicines policy and procedure in place and systems were safe. Infection prevention and control measures were in place, the building was clean and clutter free and there were no malodours in any area.

There was a thorough induction programme and further training was on-going. Care plans were person-centred and included relevant personal, health and support information. The files included care plans around death and dying. These outlined people’s wishes for when they were nearing the end of their lives.

People were involved in their care planning and regular reviews of care. Care records were held securely to help ensure the confidentiality of people’s personal information.

People’s nutritional and hydration needs were addressed appropriately. Attention had been paid to making the environment suitable for people living with dementia.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff interacted respectfully with people who used the service, showing compassion and empathy. People’s dignity and privacy was respected. There was a service user guide which included details of the service and facilities.

People we spoke with felt the service was very responsive. There were a range of activities on offer and people were also taken out into the community to other activities.

The complaints procedure was appropriate and up to date and complaints were responded to appropriately and in a timely manner. We saw a number of compliments received by the service.

The registered manager and deputy manager had an ‘open door’ policy. Staff turnover was low and staff said that were very happy with their jobs.

Formal supervision sessions were not up to date. Following the inspection the registered manager implemented a programme of supervision sessions and commenced these immediately.

All the policies and procedures were appropriate, reviewed regularly and up to date. There were a number of audits in place at the home, followed by appropriate actions.

Care plans evidenced good partnership working with other professionals and agencies. The management attended the regular local care home meetings to share good practice and access current guidance. The service had enrolled with Bolton Council's ‘Care Home Excellence programme’ where all care homes are in partnership with the Council and the Clinical Commissioning Group (CCG) to help improve the quality of their care.

We looked at five care plans, which included information about health, care needs, background, likes and dislikes. There were appropriate risk assessments and monitoring charts which were reviewed and updated on a monthly basis.

We spoke with four people who used the service. One person said 'They look after us here. The food is lovely.' Another said 'They do their best for you', whilst another told us 'The girls are all nice, I'm happy here.'

We spoke with six visitors who were all very positive about their relatives' care. One visitor said 'I feel very involved." Another visitor told us that when their relative had been admitted to the home the staff had been exceptionally supportive 'It was like somebody putting an arm around me, like being wrapped in a warm blanket.'

The home had safeguarding procedures which were followed appropriately. Staff were aware of safeguarding issues and were confident that they could recognise, report and record concerns.

We spoke with three staff members who felt they were well supported in their employment, learning and development.

There was evidence of quality assurance and consultation with people who used the service and their relatives to ensure the continued quality of the service delivery.