14 September 2023
During an inspection looking at part of the service
Welham House is a residential care home providing personal care to up to 14 people. The home provides support to people with a learning disability or autism. At the time of our inspection there were 13 people living at the home.
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 service did not support people to have the maximum possible choice, control and independence and control over their own lives. There were no assessments in place about what decisions they could make for themselves.
Staff failed to focus on people’s strengths and did not promote what they could do. People spent time sitting around with nothing to do. They were not supported to take part in household chores such as cooking or washing and care plans lacked information on how to increase people’s independence. The provider had not supported people to take part in activities and pursue their interests in their local area.
Staff expected people to become distressed and lacked information on de-escalation techniques for each person. This led to people being restrained. The provider did not monitor the level of restraint in the home and staff did not learn from incidents.
The service gave people care and support in a clean, well-furnished environment that met their physical needs. People had a choice about their living environment and were able to personalise their rooms.
Staff enabled people to access specialist health and social care support in the community. However, information provided by staff to healthcare professionals was not supported by documented evidence.
Medicines were not safely managed, and staff did not support people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
Right Care:
Staff did not understand how to protect people from poor care and abuse. The service failed to work well with other agencies to do so. Staff had training on how to recognise and report abuse but lacked the skills to put their training into practice.
Staff had received training, but this had not been of a suitable quality to ensure staff had the skills needed to meet people’s needs and keep them safe. Staff did not understand how to provide care in line with national guidelines and to reduce restrictions on people.
Risks to people were not properly identified and assessed. Therefore, care was unable to be planned to keep people safe from repeated incidents.
People were not offered activities or the opportunity to pursue interests that were tailored to them.
Right Culture:
There was a closed culture in the home, with a lack of transparency to external organisations. Staff did not raise concerns as they were worried about their jobs. Staff did not understand best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. Therefore, people received more restraint both physical and chemical than they may have needed.
Staff manipulated the homes routines to make their roles easier and failed to place people’s wishes, needs and rights at the heart of everything they did. There was no reflection on the quality of care provided and how it impacted on the people living at the home.
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 5 April 2019).
Why we inspected
The inspection was prompted in part due to concerns received about allegations of abuse within the home. A decision was made for us to inspect and examine those risks.
You can see what action we have asked the provider to take at the end of this full report.
The provider has been responsive to concerns raised and has taken immediate action to mitigate risks in the home.
Enforcement and Recommendations
We have identified breaches in relation to the use of restraint in the home, the management of risks to keep people safe, the management of medicines, the number of staff on duty and their training, keeping people safe from abuse, assessing people’s capacity to consent, quality of information in the care plans, the level of activities offered to people and the governance of quality and safety of care at this inspection.
Please see the action we have told the provider to take at the end of this report.
We have imposed conditions on this location to help keep people safe. The conditions require the provider to get external expertise in relation to medicines management and positive behavioral support as well as reducing risks to people when they go out of the home. We require the provider to submit monthly information to us so that we can monitor the quality of care they are providing.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.
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.