Archived: Welcome House - The Cedars

Welcome House – The Cedars is a residential care home providing personal care to nine people with mental health needs at the time of the inspection. The service can support up to 26 people.

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

People were not always safe at Welcome House – The Cedars. Individual risks had not been identified or clear guidance recorded to help to keep people safe. The premises and outside environment posed risks that had not been identified or action taken to keep people safe. The service was not clean and infection control procedures to mitigate against COVID-19 had not been managed within government guidance.

Accidents and incidents were not investigated and analysed to make sure lessons could be learnt and action taken to prevent further occurrences. People were not protected from harm or abuse as incidents were not always recorded or investigated. People’s prescribed medicines had not been managed well as clear guidance for staff was not available to keep people safe.

People did not receive the individual support needed as staffing levels did not allow time. Staff were completing all cleaning, cooking and gardening tasks as well as their care and support responsibilities as staff were not employed in these roles. Some staff were working long hours without a rest break which put people at risk of unsafe care.

People did not receive care and support that was individual and responsive to their needs.

The systems in place to audit the safety and quality of the service were not robust or sufficient to alert the provider to concerns and issues within the service. Timely action had not been taken to address issues that had been identified within audits. Monitoring systems had not picked up areas which were identified during the inspection. The provider had not acted to ensure they had sufficient oversight of the service, placing people at risk.

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 (report published 23 January 2020) and there were four 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns about the management of the service and concerns received from service users about their care. 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.

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.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Welcome House – The Cedars 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: the management of individual and environmental risk, learning lessons from accidents and incidents, medicines management, safeguarding people from abuse, management of infection control, safe staffing levels, providing person centred care, CQC were not always notified of significant events and having systems and processes to effectively assess, monitor and improve the quality and safety of the service at this inspection.

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.

Welcome House The Cedars is a residential care home providing personal 11 people with mental health needs. The service can support up to 26 people. Accommodation is provided in a detached house.

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

People were not consistently protected from the risks of abuse because staff did not always recognise the signs or report incidents correctly. People did not always receive their medicines safely. Staff completed training, however their understanding of mental capacity, deprivation of liberty and safeguarding varied. People were not supported by enough staff. This resulted in people not being supported with independent living skills, such as cooking. There was a lack of meaningful activities offered to keep people occupied. Audits were not consistently effective, and the registered manager had not told the Care Quality Commission about several incidents in line with guidance.

Risks to people’s health were assessed, monitored and reviewed and staff were knowledgeable about people’s health conditions. People’s communication needs and preferences were considered and staff used equipment, such as a white board, to support people. People were given the opportunity to discuss their end of life care.

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’s physical and mental health needs were assessed before they moved to the service to make sure staff could provide the right support. Staff worked with people’s health care professionals to help people stay as well as possible. People were encouraged to eat healthily, and menus were planned to take into account any cultural preferences.

People told us the staff were caring. Their privacy and dignity were maintained. People were encouraged to attend appointments, the local community and day centres independently. People were involved in the planning and reviewing of their support and told us they made decisions about their care.

People’s care plans contained detail about their life history and a detailed background of their mental health. Staff had guidance about signs which may indicate a decline in a person’s mental health, so they could provide the right support. People knew how to complain and told us they did not have any complaints about the service. Information, such as meeting minutes and the complaints process, were available in an easy to read format.

People spoke positively about the support they received from the registered manager. They felt confident they could speak with the registered manager or staff if they had any worries. People’s views on the day to day running of the service were valued. People told us they were happy and settled living at 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 and update

The last rating for this service was Good (report published 10 February 2017). At this inspection the rating has deteriorated to Requires Improvement and we found five breaches of Regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to insufficient staff, protecting people from the risks of abuse, medicines management and good governance.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

At the last Care Quality Commission (CQC) inspection on 05 August 2014, the service was rated Good in all domains and overall.

At this inspection we found the service remained Good.

People continued to be safe at Welcome House - The Cedars. 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. Medicines were managed safely and people received them as prescribed.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

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. Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

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.

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

The registered manager ensured the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

People were treated with respect and their privacy and dignity was upheld. People were involved in planning the kind of support they needed.

People received support that was well planned and sensitively delivered.

People received the medicines they needed, when they needed them.

Robust recruitment and selection procedures ensured that people were supported by suitable staff.

Effective quality assurance systems ensured that people were provided with a good service.

Overall we found that this service was safe, effective, caring, responsive and well-led and had achieved compliance.

The service made sure people were able to make their own decisions about their care and treatment. We found that the care and support that people received was well planned and sensitively delivered. People were supported to eat a balanced and healthy diet, they were given choice and had their preferences taken into account. The home was clean throughout. Staff were given appropriate professional development to enable them to understand people's needs and provide appropriate care and support.