Wesley Place

Updated 17 December 2021

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 Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of four inspectors, an inspection manager and a medicines inspector. Three inspectors and one inspection manager attend the second site visit.

Wesley Place 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 had a manager registered with the CQC. 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.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure there would be people at home to speak with us. We returned to the service on 25 August 2021 unannounced.

What we did before the inspection

We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We spoke with two people who used the service with support from staff. We spoke with five members of staff including the registered manager, service manager, chief executive officer and the Nominated Individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and various other records including staff supervisions and meeting minutes. A variety of records relating to the management of the service, including policies and procedures were reviewed. We attended the service on the 25 August 2021 and visited three people in their flats and observed two people via CCTV monitoring to check their living conditions and welfare.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We reviewed further records and audits. We received feedback from three relatives, two advocates, and five other health and social care professionals. We also spoke with eleven members of staff by video link.

Updated 17 December 2021

About the service

Wesley Place is a care home providing personal care to seven people at the time of the inspection. The service specialises in providing support for up to seven older or younger adults. They may have a number of needs, such as a learning disability and/or autism or mental health needs.

People had their own flats within one purpose-built building, each flat had been adapted to meet people’s environmental and sensory needs. The offices were located on site with two separate areas for management and staff to oversee the running of the service.

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

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 guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The provider had not always consulted people’s representatives to maximise people’s choice, control and independence when significant decisions had been made that affected them. Staff did not always treat people with dignity and respect and/or protect their human rights. This demonstrated a lack of person-centred support. We evidenced some aspects of a poor culture within the service, management of complaints and staff reporting concerns to CQC instead of using the providers whistle blowing process.

People were not always supported to have maximum choice and control of their lives and although the service had considered the least restrictive practices and reducing incidents, the intensity had increased for some people and staff injuries were of concern. The policies and systems in the service did not always support in practice the best interests of people.

Improvements were required to monitor, analyse and effectively manage risks to people and staff. There was a lack of clinical oversight and in-depth knowledge to support staff to develop in their role. This was evident in the number of incidents where risks had not been managed effectively.

Care records detailed people's support needs, preferences and sensory needs. Positive behaviour support plans were in place, which detailed least restrictive options for staff to consider and how to interact, using certain responses, to prevent the escalation of behaviours that may challenge. However, we had some concerns about the leadership and skills of some staff to manage people’s behavioural needs.

Sensory profile's had been completed. The provider needed further time to ensure the recommendations were fully implemented for each person and to ensure their sensory needs were met. We identified some areas where staff had not fully considered people’s sensory and communication needs.

Whilst the environment was observed to be clean during the site visit, we were provided with evidence following the site visit of one bedroom which was unclean and unhygienic.

The provider and staff advised staffing levels had improved since the service first opened. However, staff still raised concerns regarding the deployment of skilled staff that were able to confidently meet people’s needs.

Staff being kind and respectful towards people. Staff overall wanted the best outcomes for people and were passionate in their approach. However, some records and feedback demonstrated there were aspects of a poor culture within the service.

Medicines records were managed effectively. We had concerns that 'as and when required medicines' were not always given at appropriate times to prevent behaviours from escalating. Following the inspection, the provider informed us they were seeking additional training in this area.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 28 February 2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on the registration date. We returned to the service on 25 August 2021 due to concerns about people's living conditions and the support they were receiving.

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.

You can see what action we have asked the provider to take at the end of this full report.

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 risks, safeguarding people from harm and abuse and overall governance at this inspection.

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

We recognised as part of this inspection that the provider had failed to notify CQC of some safeguarding incidents. The provider submitted notification retrospectively and we have not taken any enforcement action in relation to this matter.

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.