Wallace Mews

Wallace Mews is a residential care home providing accommodation and personal care to up to 15 people. The service provides support to people living with a learning and / or physical disability. At the time of our inspection there were 15 people using the service.

People’s experience of the 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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were supported in a way that respected them as individuals and their personal and cultural choices. Staff had a good understanding of people’s needs and care records contained good detail to support staff in appropriately helping people. There was a friendly and homely atmosphere at the service and people and staff enjoyed each other’s company. One relative told us, “It’s all lovely. I wouldn’t have them anywhere else. It's perfect.”

Right Care

People received high quality care from staff who had completed a range of training and were well supported by management. Care records contained information about risks related to support and how staff should deal with or mitigate these risks. Doors in some areas were left unlocked posing a potential hazard. The registered manager addressed this issue. People looked happy and relaxed in the company of staff and had a good relationship with them. Staff looked to ensure people lived the best life they could.

Right Culture

There was a strong culture of delivering high quality care. All staff were committed to ensuring people had the same opportunities and access to services as the wider public. There was strong and effective leadership at the home, which proactively advocated for people. Family members and professionals all praised the service and said people’s lives had been enhanced from living at the home.

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.

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 30 July 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Wallace Mews on our website at www.cqc.org.uk.

Follow Up

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

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There were regular checks of the premises, equipment and utilities which were documented to ensure the safety for people living at the service, visitors and staff. People’s care plans reflected their individual needs and personal risks were assessed. We found there were policies and procedures in place to help keep people safe. Staff were safely recruited and they were provided with all the necessary induction training required for their role. 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.

There was a transition program at the service to encourage people to become fully independent and move from the service to their own home. We saw this stepping stone process being used with a person using the service and the documented outcomes of each stage. During the inspection we observed one person being supported to do their own laundry as part of this process, to promote their independence.

The service had a comprehensive complaints and compliments policy in place. Any complaints received were logged, responded to within the stated time frames and analysed. Action plans were created and lessons learned were documented.

During the inspection we observed people carrying out activities with staff and attending sessions in the local community. We saw records of activities undertaken by people and they were supported to carry out their own choices for activities. There was training provided for staff in delivering end of life care and we saw this training being used to support people receiving palliative care.

Staff treated people with dignity and respect. We saw kind, warm and caring attitudes between people living at the service and staff. We observed people enjoying positive relationships with staff and it was apparent they knew each other well. Staff understood each person, how to support them and knew what they liked and disliked.

There was a robust governance framework in place to continually monitor and improve the service. We saw evidence of involvement from the provider’s senior management team and documented audits carried out during their visits to the service. There was a registered manager in post. The registered manager was aware of their responsibilities and had a clear strategy and vision for the service in partnership with the provider’s organisational vision. The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service were supported to live as ordinary a life as any citizen.

Further information is in the detailed findings below.

Wallace Mews is a purpose built care home that provided care for up to 15 people with learning disabilities and people with a physical disability. The home is formed from two converted houses and operates over three floors.

The registered manager has been in post since 2013. 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.

At the time of the inspection 14 people lived at the home and we met nine of the people who used the service. They told us that they were very happy with the service and found it met their needs.

We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle. Staff readily identified triggers that would lead people to become distressed or that their mental health was deteriorating. We found this had a very positive impact on people and led to a marked reduction the number of occasions people were admitted to hospital.

Staff were aware of how to respect people’s privacy and dignity. We saw that staff supported people to make choices and decisions.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

We saw that people were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities. Staff had also received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The staff we spoke with fully understood the requirements of this Act and were ensuring that where appropriate this legislation was used.

Staff shared with us a range of information about how they as a team worked very closely with people to make sure the service enabled each person to reach their potential.

People and the staff we spoke with told us that there were enough staff on duty. We found there were sufficient staff on duty to meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the registered manager had an effective system in place for dealing with people’s concerns and complaints. We found that people felt confident that staff would respond and take action to support them.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety, relevant infection control procedures were followed by the staff at the home. We found that action was taken to minimise known risks.

The registered manager had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Where staff had identified a potential risk, either during the initial assessment or after admission, we found that a risk assessment had been completed to ensure people were safe. We saw that the risk assessment clearly identified the potential hazards and the control measures in place to manage the risk. The provider had developed policies and procedures in relation to safeguarding adults. We viewed these policies and saw that they contained information for staff to refer to about safeguarding, such as what constituted abuse, key responsibilities and how to report concerns. The provider had a system for

logging and investigating safeguarding concerns.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that DoLS had been submitted appropriately and relevant staff had been trained to understand when an application should be made.

Is the service effective?

Each person had individual support plans which set out their specific care needs and people had been involved in the assessment and planning of their care. Relatives we spoke with told us they were also involved in the planning of care. We saw that support plans and risk assessments were up to date and reflected people's individual needs and we observed staff supporting people in a caring and sensitive way. A family member told us, "They let me know what is happening on a regular basis."

There was an advocacy service available if people needed it, this meant that when required people could access additional support. We found that care records had been written using a person-centred approach. This meant that they described the person's abilities and how they preferred their care needs to be met. Staff we spoke with told us the managers were approachable and accessible at all times. The provider had systems in place to ensure that staff training was kept up to date.

Is the service caring?

People were supported by calm, kind and attentive staff. We saw that care workers showed patience and gave encouragement when assisting people. We saw people were supported to enjoy their meals at their own pace. Staff spent time chatting with people about their interests in a warm and engaging manner. We saw staff were skilled at understanding people's individual communication methods. They guided people in a way that supported them to retain their dignity. Staff told us they knew what interested people by reading what was written in the persons care plan and also spending time with them. Staff gave us examples of preferences of people watching DVD films and one person enjoyed bingo. Our observations of the care provided and discussions with people showed us that individual wishes for care and support were taken into account.

Is the service responsive?

People were given the chance to make decisions for themselves. Records showed that people's preferences, interests and needs had been taken into account and care and support had been provided in accordance with people's wishes.

We saw that where necessary people had been referred to other professionals. For example, we saw one person had been referred to the Speech and Language Therapy Team. Family members we spoke with were aware of how to make a complaint but they did not raise any complaints or concerns with us about their relative's care. A family member told us, "I know how to make a complaint. I have not needed to raise one though."

Is the service well led?

The provider had a system to assure the quality of the service they provided. The way the service was operated had been regularly reviewed. A range of checks were carried out including care records, medication and the environment for people who lived there. The area manager carried out at least monthly visits to audit the systems and procedures at the home.

The manager held regular team meetings with staff. Regular checks of the premises took place to ensure it was safe and suitable for the people who lived there. Staff were properly supported by the manager and received training relevant to their role.

We found people were cared for by staff who were supported to deliver care and treatment safely.

The provider had an effective complaints system available

People were protected from the risks of unsafe or inappropriate care because accurate and appropriate records were maintained.

We found people experienced care, treatment and support that met their needs and protected their rights.

During our visit, all interactions we observed between the staff and the people living at the home were open, respectful and courteous.

We saw that staff provided whatever was wanted in a way that demonstrated a good knowledge of each individual person. Where appropriate, we saw staff providing support and encouragement to the people to do things as independently as possible.

We saw that staff included people living at Wallace Mews in the day to day running of the home and that, whenever possible, it was the people living at the home that made decisions on what happened through the day and when. We saw that people's needs were met in a calm and unhurried way.

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people for their care needs.

Comments from relatives included, "I come here most days, the manager keeps me informed of any changes to my ...", "I do not have any complaints about Wallace Mews. It is a great place" and "The staff are always friendly and let me know about any little matter."