The inspection took place on 11 and 14 July 2016 and was unannounced. The last inspection was carried out on 24 and 25 July 2014. At that inspection the overall rating for the service was ‘good’ although we found the service was not fully responsive because documentation was not in place to support people if they had an unplanned admission to hospital. At this inspection we found this had been addressed by ensuring each person had a document known as a ‘hospital passport’ providing essential information for medical professionals in the case of emergency admission to hospital.

Covenant Care – The Wheelhouse provides accommodation with personal care for up to 9 people with learning disabilities, autistic spectrum disorders or mental health difficulties. At the time of this inspection the service was in the process of seeking approval for one additional named person for the duration of their stay at The Wheelhouse.

The service also provides a supported living service to people living in their own homes in the local community. At the time of this inspection the service provided support to 10 people who were tenants in shared houses in the Wellington and Taunton areas (although many of these did not require support with personal care needs).

In the last year the management of the service has changed. The service now has two registered managers, one of whom manages the residential service provided at The Wheelhouse, and the other manages the supported living service to people living in the Wellington and Taunton areas. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were many elements of good quality assurance systems, although there were also areas where improvements could be made. The registered managers carried out checks on many aspects of the service to ensure people received a good quality of service. People were involved and consulted through questionnaires and house meetings. Care plans had been reviewed, but some monthly review dates had been missed and this had not been picked up by the provider through the quality monitoring process. The reviews did not always involve the person or their relatives or representatives.

People who used the service, relatives, staff and professionals spoke positively about the new managers. We heard about many improvements to the service since they had taken over their management roles. While our overall findings showed that people received a safe, effective, caring and responsive service, there were some aspects of the recording and quality monitoring systems that could be improved. Staff told us they had received a wide range of training, but this could not be fully evidenced by the training records we were shown. Training was also confirmed by people who used the service, for example, one person said “They are always going on courses. They are constantly expanding, learning new things as often as they can.”

The service supported people to receive a varied and balanced diet. People were involved and consulted as far as they were able in every part of the meal planning and preparation process. Staff understood each person’s likes, dislikes and dietary needs and offered people a choice of foods to suit their preferences. Those people who used the supported living service were supported to budget and plan their weekly menus and to shop, prepare and cook meals of their individual choices.

There were safe systems in place to make sure people received their medicines as prescribed. Medicines were stored safely. Records of administration had been accurately maintained. Those people who wanted to hold and administer their own medicines were supported by staff to do so safely.

Staff demonstrat

When we visited the home there were nine people living there. We observed that people were not always able to communicate verbally with staff. We saw that people were well known to staff and we observed close and trusting relationships between people and staff.

We observed that people were offered choices throughout the day about how they wanted to spend their time and what they wanted to eat and drink.

We reviewed the care plans of nine people living at the home. We noted that each care plan had a detailed medical history of each persons mental health needs, a personal profile and information about each person's personal preferences. This ensured that people's care needs were identified and their care plan was developed in line with each persons individual care and support needs.

We observed that staff had attended up to date infection control training and were aware of the infection control policies and procedures at the home.

We observed during the day that staff were skilled at handling the challenging behaviours that were exhibited by people at the home. We saw that staff were able to engage with people in a kind and sensitive manner which ensured that people were able to participate as fully as possible in daily activities at the home.

We saw that a request had been expressed by two people at the home to go on 'big rides'. The home arranged a trip to a large amusement park and the people really enjoyed the experience.

People living at the home are unable to fully express their views on the infection control practices within the home. During our brief visit we observed that the home was reasonably clean and fresh, providing a comfortable environment for people living there.

Many people using The Wheel House services are unable to express themselves verbally or fully express their views on the services they receive.

We spent time observing care practices and noted that the atmosphere was relaxed and people appeared comfortable with the staff who supported them. Staff interpret behaviours, use pictures and signage to communicate with people.

Care is person centred and during our visit many people took part in activities which they appeared to enjoy.

People living at the residential home moved freely around the communal areas and some people were supported to go outside when they requested to do so.

People appeared well nourished and hydrated and the main meal of the day was enjoyed by everyone observed.

Throughout the day there was constant interaction between people living and working at The Wheel House providing ongoing social stimulation.

We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Covenant Care – The Wheelhouse provides care home accommodation for up to 10 people. It also provides a supported living service to people living in a shared house in the community where each person had their own personal room and shared communal areas of the house with other people using the scheme. People using the supported living scheme had a contract outlining the personal care and other support provided by Covenant Care – The Wheelhouse. Some staff working for the service provided care to people living in the care home and the supported living scheme others work exclusively in the care home. Both parts of the service specialise in the care of people who have a learning disability, autistic spectrum disorder or mental health difficulties.

At our last inspection of this service in October 2013 we raised concerns about the reviewing of care and care plans at the care home. We found the service was not always involving professionals from outside the home in the review of people’s individual care. We also found people who used the service were not always fully involved in the creation and review of care plans. Care records we read during the last inspection did not always give details about how people had consented to their care. At this inspection we found action had been taken to address the shortfalls identified.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

Throughout our inspection we observed people in both parts of the service were very comfortable and relaxed with the staff who supported them. We saw people living in the care home were free to move around the house and garden, and had unrestricted access to their bedrooms. People who were using the supported living service told us they were able to come and go as they pleased.

There were adequate numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities.

People in both parts of the service had access to health care professionals to make sure they received appropriate care and treatment to meet their individual needs. Staff followed advice given by professionals to make sure people received the treatment they needed.  Records showed people had access to appropriate health care professionals to manage ongoing healthcare needs. One person using the supported living service told us: “You get good advice and they would help you make appointments if you needed to.” However the care records that we read for people who lived in the care home did not contain easy to read information about people’s care needs and preferences that could be shared with other providers or healthcare professionals. This meant there was no document in place to assist any other staff, such as hospital staff, to appropriately support the person if they had an unplanned admission to hospital or another service.

Many people who lived in the care home were unable to fully express their views verbally. The staff used pictures, signs and objects to assist people to make choices and express their views. Each month staff used a pictorial questionnaire to ask each individual for their views. There were questions about food, individual rooms, activities and how happy people were with the other people they lived with. This enabled people to spend time with a member of staff and express their views.

There were regular reviews of care for each person who used the service which enabled individual care to be monitored. We saw that recent reviews for people who lived at the care home had been carried out with health and social care professionals, family members and independent advocates.  

The service responded to people’s changing needs and arranged care and activities in line with people’s up to date needs. We saw that the service had consulted with healthcare professionals about changes in behaviour and medication. We also heard how the home had changed some activities when people showed an interest in other things.

Staff said that communication in the home was good and they always felt able to make suggestions. There was a monthly meeting for staff. Minutes of these meetings showed this was an opportunity to share ideas and make suggestions as well as a forum to give information.