Archived: West Heath House

West Heath House is a residential care home providing rehabilitation and personal care to seven people who have sustained a brain injury. The service can support up to 24 people. Within the home, there were flats for people to use as and when they developed more independent skills and were getting ready to move on from the service

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

The leadership and the culture they created drove high-quality, person-centred care. The vision and values of the home were person centred, empowering, inclusive and imaginative. There were consistently high levels of constructive engagement with people and staff to enable people to achieve their goals.

Mental capacity assessments had been undertaken and deprivation of liberty safeguards had been applied where needed. People’s needs were assessed prior to receiving rehabilitation at the home. The home was fully accessible for people who used wheelchairs.

Medicines were managed safely. Recruitment was undertaken safely. We were assured of good infection prevention control practices regarding COVID-19. People and their relatives told us they felt safe. Care plans and risk assessments identified people’s individual support needs and ways to help people stay safe.

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 and update

The last rating for this service was requires improvement (published 29 November 2019).

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.

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.

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.

We found the following examples of good practice.

¿ On arrival all visitors were required to complete a Covid-19 questionnaire. This was to ensure their visit took place safely in line with current guidance.

¿ Social activities had been adapted during the pandemic to support people’s rehabilitation. For example, activities including Tai Chi took place on a one – one basis with staff instead of in a group.

¿ People were supported to maintain contact with people who were important to them in a variety of ways. In times of fewer restrictions risk assessments of local coffee shops had been completed in an attempt to identify ‘safe places’ for people to socialise with their loved ones.

¿ People who lived at the home had opportunities to attend meetings to gain information and updates about Covid-19. Information was available in a variety of formats and languages.

¿ Furniture in the dining room had been rearranged to encourage people to social distance safely at mealtimes.

¿ Cleaning schedules had been increased to monitor cleanliness of the environment. A specialist cleaning company were due to complete a deep clean of the environment.

West Heath House is a residential rehabilitation home for people with an acquired brain injury which provided personal care to 11 people at the time of the inspection. The service can support up to 24 people.

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

Staff had received training in safeguarding and knew how to keep people safe. Staff had been recruited safely and were trained and supported to provide the best possible care for people. Medication was administered safely.

People were supported by staff who had the skills and knowledge to do so effectively and staff sought guidance from health professionals in order to support people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not always 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.

People were supported by kind and caring staff who respected their privacy and dignity and supported their independence.

People's support needs were assessed regularly and planned to ensure they received the support they needed, however, people were not always involved in the review of their care. People had daily activity plans in line with their hobbies and interests. The provider had a complaints process to share any concerns.

The provider carried out regular audits of the service, however, further improvements were required in order to make them more robust. The manager was implementing changes to the service to make it more inclusive. There was no registered manager in post as required by law.

Rating at last inspection

The last rating for this service was good (published 11/05/2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to regulation 11 (need for consent) at this inspection.

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

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.

There was a registered manager at the service. 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 told us they felt safe living at the service. Staff had a good understanding of the potential signs of abuse and knew the appropriate action to take should they have concerns.

People had the risks associated with their care well managed. Where any incidents had occurred there were systems in place to analyse these and plans had been put in place to reduce the risk of similar incidents reoccurring.

People received safe support with their medicines from staff who had received training and who had been assessed as safe to support people. There were systems in place to ensure people received their medicines safely.

There were sufficient staff available to support people and staff had been safely recruited. Staff had been provided with training to equip them with the skills and knowledge they needed to support people.

People benefitted from the support from a team of healthcare professionals who worked at the service. These healthcare professionals worked together to aid people’s rehabilitation. Staff understood how promoting independence was a key part of aiding rehabilitation and we were provided with many positive examples of progress people had made with their independence at the service.

Staff understood how to support people in line with the Mental Capacity Act (2005).Where restrictions on people’s care had been identified appropriate action had been taken to safeguard people’s liberty.

People and their relatives told us that staff were kind and caring in their approach. Staff had a good knowledge of the people they supported and could describe people’s interests and preferences for care.

People had been involved in planning and reviewing their care. People took part in a range of activities based on their interests.

People and their relatives were happy with how the service was managed. Staff told us they felt supported in their role which in part was due to the effective teamwork that they experienced There were systems in place to monitor the quality and safety of the service and to seek feedback from the people who lived at the service.

We last inspected this service on 19 November 2013. At that time we found that people’s views and experiences were not always taken into account or acted upon. At this inspection we found that these issues had been addressed. West Heath House is primarily a rehabilitation unit for people with an acquired brain injury. People’s needs and support changes over time. We found that people’s views and experiences had been included at an individual level so that it was appropriate for each person.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There were procedures in place to safeguard people from abuse. The manager had a good understanding of issues around safeguarding and their role in protecting people. Staff understood how to safeguard people they supported. There were policies and procedures in place to make sure that unsafe practice would be identified and people would be protected. There were enough staff on duty to meet the needs of people who lived at the home.

Risk assessments and health and safety measures were in place and regularly reviewed. These kept people safe. A social worker told us, “I’ve always found them to be very well informed. They are brilliant. Their recording is meticulous.” We saw people were cared for in an environment that was safe and suitable for their needs.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a very good understanding of people’s care and support needs and that they knew them well. People told us that they were happy with the care that had been delivered.The service worked well with other agencies and services to make sure people received their care safely and effectively. We saw that people were treated with dignity and care. All the people we spoke with told us they were satisfied with the care and support they received. One person told us, “The staff are nice, I recently started to feel that I am getting my independence back.”

Is the service caring?

All staff were aware of peoples choices, preferences and support needs. One person told us, I like it here, the staff are lovely. They are kind to me.” We found the care and support was delivered with dignity and people’s decisions were respected. We saw the staff and manager were patient and gave encouragement when they supported people. A relative told us, “I think they are really friendly and they really help. They have been really good with X.”

Is the service responsive?

We saw clear and detailed records that ensured the manager could make timely and informed decisions about a person’s care and support. There were enough staff on duty to provide adequate care and support. We saw that the home had good access to other health professionals that meant it could respond quickly to a person’s changing needs. A relative told us, “We have no problems with the care X receives, no issues at all. We hear from them regularly. The managers are fine and keep us informed.”

Is the service well-led?

The systems in place to ensure the quality of the service were regularly assessed and monitored to ensure they were robust. The manager was aware of their responsibilities in meeting the essential standards of quality and safety.

Staff we spoke with told us they thought the manager was approachable and provided good support. One member of staff told us, “It’s a nice place to be. The new manager is brilliant. The managers are a good team and they are easy to approach.”

We found that the process of making sure supervisions and appraisals had taken place was not clear. Many supervisions and appraisals had not taken place.

There were 21 people living at the home. During the inspection we spoke with the manager, deputy manager, 10 people using the service, two relatives, two social workers and five members of staff.

People's views and experiences were not always taken into account in the way the service was provided and delivered in relation to their care.

Most people were able to tell us their views of the service, one person told us, 'It's very good here, all the staff are very good people and they have helped me to gain my independence.' A relative told us, "There is a constant group of staff that know [person's name] they know his needs, his moods and how to get the best out of him."

We found that people were protected and kept safe from abuse. The people living at West Heath House told us that they felt safe living there. They told us that they would have felt comfortable passing any concerns they had to staff and confident staff would support them with these.

Staff recruitment records showed that new staff had been checked to make sure they were suitable to work with vulnerable people.

We found that the provider had an effective system in place to deal with comments and complaints and this was monitored.

During our visit, we spoke with six members of staff, this included the registered manager. We spoke with seven of the 21 people who were living at the home.

We observed that staff spoke respectfully to people and spent time interacting with people on a social basis as well as meeting their care needs. They also took time to understand and respond to peoples' different communication styles. Most people were happy with the service provided. One person told us 'It's a pleasurable service.'

During our review, we discussed the quality of the service provided with local authority staff involved in monitoring them. They said they had not been made aware of any concerns about the service being provided.