Background to this inspection
Updated
27 July 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
East Wheal Rose is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. Due to an administrative error the manager had cancelled their registration. They were reapplying for registration.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We met people living at East Wheal Rose and observed their interactions with staff. We spoke with three members of staff including the manager, deputy manager and a care worker. We reviewed a range of records. This included people’s care records and one person’s medicine records. We looked at rotas, incident reports and daily records. A variety of records relating to the management of the service were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at records we had requested from the service. We contacted two relatives of people using the service and one external professional. We spoke with three staff members.
Updated
27 July 2022
About the service
East Wheal Rose is a residential care home that provides care and accommodation for up to three autistic people. It is part of the Spectrum group who have several similar services in Cornwall. They are providers of care for autistic people and/or people with learning disabilities. At the time of the inspection two people were living at the service.
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.
People’s experience of using this service and what we found
People’s needs were not always met because the service was short staffed. Although there was a core staff team who had worked at the service for several years the service was short staffed. An agency staff worker had been allocated to the service who routinely worked long hours. They had left the service without notice and this had resulted in the service running on ‘emergency minimum’ staff numbers in the week running up to the inspection.
People were not consistently 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. For example, one person did not have access to a kitchen. This decision had not been regularly reviewed. Due to the breakdown of one of the two vehicles people were not always able to go out when they wanted to. The provider had not taken action to resolve the problem in a timely manner.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support:
The service did not support people to have maximum choice, control and independence.
The service did not always support people in a safe, clean, well equipped, well-furnished and well-maintained environment that met people’s sensory and physical needs. Part of the premises, which were originally set up to enable one person to access it safely, were no longer arranged to meet their needs. This meant people were not able to work towards identified goals.
Staff shortages impacted on people’s opportunities to go on planned trips out and take part in pastimes and activities in the service.
When they were able to go out, people were supported by staff to take part in activities in their local area.
People had exclusive possession of their own bedrooms and living spaces.
Right care:
Safeguarding concerns were investigated. Staff knew how to recognise and report abuse.
Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. For example, people were supported to have access to films and music which were relevant to their culture.
Where appropriate, staff encouraged and enabled people to take positive risks. Staff were enthusiastic and motivated in encouraging and supporting people to take part in hobbies and experiences that interested them.
Right culture:
People’s dignity was not consistently respected. Action to improve people’s experiences were not taken in a timely manner.
The core staff team had worked at the service for a long time, knew people well and had a good understanding of their needs.
Staff communicated with families regularly. People had access to independent advocates to help represent their wishes.
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 17 April 2019).
Why we inspected
The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks. We also undertook this inspection to assess that the service is applying the principles of Right support right care right culture.
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. This included checking the provider was meeting COVID-19 vaccination requirements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for East Wheal Rose 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 monitor the service and will take further action if needed.
We have identified breaches in relation to staffing levels, upkeep of the premises, supporting people with dignity and oversight of the service. Following the inspection managers told us about actions they had taken to mitigate risk. We have made a recommendation about ensuring consent to care is in line with best practice.
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.