The Care Quality Commission (CQC) has downgraded the rating for Welham House in Spilsby, Lincolnshire, from good to inadequate, and placed it into special measures to protect people, following an inspection in September.
Welham House run by Boulevard Care Limited, is a residential care home that provides personal care for up to 14 people, including autistic people and people with a learning disability. At the time of this inspection there were 13 people living at the home, which mainly included people with a learning disability.
This inspection was prompted in part by concerns CQC received about allegations of abuse at the home.
In addition to dropping from good to inadequate overall, Welham House has also dropped from good to inadequate for how safe and well-led it is. It has declined from good to requires improvement for being effective, caring and responsive.
The home has now been placed in special measures, meaning it must make rapid and widespread improvements, and will be kept under close review by CQC and re-inspected to check on the progress of those improvements.
CQC has also taken further regulatory action to protect people, by placing urgent conditions upon the service to ensure the safe care and treatment of the people living at the home. This included people having thorough risk assessments before going out into the community, as well as the provider receiving external support regarding the safe management of medicines.
Rebecca Bauers, CQC’s director for people with a learning disability and autistic people, said:
“When we inspected Welham House we were concerned to find people who lived here being disproportionately physically restrained. Staff didn’t know how to respond to people in distress and there was no guidance for staff about how to use less restrictive approaches in the first instance. This is unacceptable and needs addressing immediately.
“We saw staff and leaders had created a closed culture which discouraged people who called Welham House home, or their loved ones, from raising concerns. There was a belief staff were always in the right, and there was a core group of staff who other staff were afraid to challenge.
“Also, one person told us how a member of staff would get angry and punish them, with the justification that it was to help them learn to control their behaviour. People didn’t know this was wrong as the home didn’t tell people what care they could expect to receive or how to raise concerns if something was wrong. This is an infringement on people’s human rights.
“CQC hadn’t been notified about incidents the provider was required to tell us about by law. This meant ongoing monitoring of the home wasn’t effective because senior staff didn’t understand the regulatory and legal requirements needed to run the service effectively.
“We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, and independence that most people take for granted and it’s unacceptable that the people they relied on to keep them safe and live meaningful lives were treating them this way.
“We are liaising with the provider, local authority safeguarding team, and police to ensure people are kept safe. We stand by our public commitment to ensure that reducing restrictive practices, and promoting positive cultures, is everyone’s business.
“We’ve told the provider exactly where improvements are needed and we will closely monitor the home to make sure people are being cared for safely during this time."
Inspectors also found:
- There has not been a registered manager in place since February 2022. While there had been a series of temporary managers, overseen by a location support manager this has not provided the support needed to provide safe care needed for the people living in the service
- Records of people's money and spending were generic and did not fully list what had been bought and receipts were not always available. This did not support the safe management of money to protect people from financial abuse
- There were no risk assessments for some people's health conditions including one person living with epilepsy. This meant staff did not have guidance on how to react when the person had a seizure or how to identify if the person's condition was deteriorating to ensure their wellbeing
- During the inspection there was no evidence staff had their competencies checked to ensure they administered medicines in line with the provider's policy. Despite reassurances from a senior carer, staff continued to administer the medicine in an unsafe manner. This meant there was an increased risk of medicine errors occurring that could cause people harm
- People's one to one needs had not been fully identified or provided, which meant people did not always receive the agreed level of care and support they were entitled to.
However:
- People's ability to eat and drink safely was monitored. If it was needed, advice from healthcare professionals was sought and meals were presented to people in a way they could eat safely
- People were supported to maintain contact with their family and friends. There were no visiting restrictions and staff welcomed visitors to the service at any time.
The report will publish on CQC’s website in the next few days.