Westhope Care Limited - 11 Kings Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Managers and staff did not always have the knowledge to recognise how to support people to live full lives. For example, considering people’s mental capacity when accessing risk and supporting people to make decisions. People’s rights were not being upheld in relation to tenancy arrangements and consent to care. Medicines were generally safely managed. However, some medicines were ordered, stored and administered in a manner which was not in line with expected person-centred practice for people in supported living settings. We found a breach of regulations relating to the need for consent and staffing.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always supported by staff who fully understood what constituted an incident, which meant there were inconsistencies in practice. We found 2 incidents had been recorded on the system and reviewed by a manager in the past 6 months. However, incidents which happened daily were not being recorded to allow for analysis. Staff told us it was just ordinary for the person. This also meant that lessons could not be effectively learnt from because not all incidents were recorded. Some people who may benefit from positive behavior support plans (PBS) did not have them. These are plans designed to support a person to manage when they become upset. Plans should contain detailed information to guide staff how to support the person and provide the person with opportunities to develop skills to help themselves in the longer term. The template used by the provider did not contain a functional behavior assessment or skills building sections which support staff to understand why a person may be finding things difficult and how to support them to develop skills to reduce the causes of their anxiety. This was discussed with the interim manager, who told us they would make referrals. People and their relatives spoke positively about the current staff and management team. They told us they were approachable, and worries could be raised. They had confidence action would be taken.

Systems were not always effective in highlighting shortfalls in incident recording. Staff were clear they needed to report to a manager or team leader, but less clear about recording incidents or what exactly constituted an incident which should be recorded.

Whilst the provider had processes in place to record and monitor incidents, there was a lack of knowledge around what should be recorded, particularly in relation to behaviors of concern. The providers systems for monitoring services had failed to identify this issue.

People’s rights were not safeguarded as they were subject to tenancy agreements which the provider confirmed did not pass the real tenancy test and where there the landlord and care provider were in effect the same. Therefore, not giving people the right to stay in their own home if they wanted to change their care provider. However, people generally told us they felt safe at the service. One person said, “good “and gave a thumbs up when asked if they felt safe. Relatives spoken with told us they felt their relatives were safe and were confidant they could raise concerns if they needed to.

Staff demonstrated knowledge about how to generally assess and manage safeguarding risks. However, they were not able to demonstrate an understanding of how people’s rights were safeguarded. Staff told us they had confidence in managers that concerns would be addressed if raised.

Deprivation of Liberty Safeguards (DoLS) processes had not been effectively monitored or assessed. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. No person had a DoLs in place nor had any assessments been made or considered. Staff told us people were not able to go out of the building without staff support as they would be unsafe because they did not understand how to keep themselves safe. This should have led to consideration of capacity assessment and potentially a DoLs referral. This meant people were subject to restrictions without the appropriate safeguards the legal framework provides.

Risks identified around behaviours or actions people might present, were not fully considered. For example, where a person did the same thing repeatedly every day, no consideration had been given to looking at the function of the behaviour for the person or what could be done to help the person gain the same function but in a lower risk way. However, risks were generally managed in a way to ensure people were safe. For example, People had risk assessments to guide staff around health conditions such as diabetes.

Staff were aware of risk assessments for people who had a history of epilepsy, and their prescribed medicines, however they were not aware of increased risks to people who might have a seizure whilst in a bath or swimming pool. These risks were not assessed, or guidance given to staff. This was raised with managers, who acted to address the shortfall in information to staff.

There had not been enough effective oversight into how risk assessments were developed and monitored. Risks to people were not always identified or managed appropriately in the least restrictive way to promote good outcomes for people. For example, There was a failure to ensure staff were provided with appropriate training and guidance to ensure risk assessments were monitored in a consistent and safe way.

The provider did not always effectively manage equipment. Areas of the building did not support the culture of supported living, for example, People were unable to freely use (with support) their kitchen to cook meals. Staff told us the kitchen was too small. There was a large industrial sanitizer machine in the kitchen, in place of a dishwasher. The care provider told us they would remove this equipment and replace it with a dishwasher. People had en suite rooms, however there was a shared bathroom with an accessible bath, which staff told us 2 people use. This room was full of staff lockers, mobility and incontinence equipment. It was clearly being used as storage by staff and was not in keeping with a supported living culture of people’s own home.

This shared house was owned and maintained by Westhope properties under the brand of Accomplish. Staff and the maintenance team were responsible for carrying out checks to safety equipment such as fire and people moving equipment. Staff had received fire awareness training and understood the actions they should take should a fire occur. Staff were clear about the regular safety checks to be carried out. Staff told us they participated in regular training around all aspects of environmental safety. Records confirmed staff training and regular safety checks on equipment.

Systems were in place to identify and manage foreseeable environment risks within the building. However, security was not always maintained. A visiting professional told us they were able to enter the building and spend time with a person without any staff being aware they were in the building at all. They felt this had put people at risk if anyone could enter the building. Managers assured us they will review the security arrangements of the building.

People were not always receiving support from staff who understood how to protect people’s rights because they had limited knowledge about their role under the mental capacity act. Staff were not clear about the type of service they were providing to people. For example, a staff member produced a visitors’ book for the inspector to sign in to the building and was unaware people did not sign in when visiting a person in their own home rather than a care home. The language some staff used when referring to people did not always demonstrate respect for the person. People and relatives told us they liked the staff and felt they knew people well.

Staff told us they had received training and records confirmed this; however, staff practice did not reflect some of the training to specifically support the needs of the people. For example, some staff had active support training. Active Support is a method of enabling people with learning disabilities to engage more in their daily lives. Active Support changes the style of support from ‘caring for’ to ‘working with’, it promotes independence and supports people to take an active part in their own lives. The support given to the person is also active. Active Support enables people with learning disabilities to live ordinary lives. Active support was not always practiced. Staff told us they had asked for training around communication tools, such as sign to help them communicate with people who used and understood sign, they had not received this particular training. Staff told us they felt supported by the interim area manager and they had supervision and appraisal meetings.

Staff training includes some practice competency assessments carried out by the manager in the topic area of medicine administration. Competency assessments covering person centred care, active support, PBS and MCA were not in place. These were the areas of staff knowledge which required improvement. Staff were safely recruited and received an induction and training in a number of topic areas. All staff were working on or had completed the care certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that should form part of a robust induction programme.

People were supported to manage potential risks of infection. Meals were prepared by staff who had received food safety training. People told us staff kept their rooms clean.

Staff were clear about their role in managing the risk of infection. Staff told us they had training and told us they would use personal protective equipment such as gloves were needed.

We observed staff working in line with infection control guidance and policy. The shared areas of the building were generally clean.

People were observed to have a generally positive experience of receiving support with medicines. Staff talked to people about their medicine and knew how each person wanted to receive it. Staff showed kindness and patience.

Whilst our assessment identified some shortfalls with medicines practices, staff demonstrated clear understanding of the medicines people took and why they had them. Managers and staff told us the systems and practices had improved following recent restructuring of the management arrangements.

Systems for the requesting and storage systems were not person centred; medicines were in some cases being stored in a hospital style medicine trolly. This did not fit with a culture of supported living in a shared house. Managers responded to issues found during our assessment. Evidence of detailed medicine audits carried out by managers were not available to inspectors. Evidence was presented showing, staff received training, and competency checks before giving medicines.