Wensum Way is a care home providing support for up to eight people with a learning disability. The service is also registered to provide domiciliary care for people living in three supported living settings in the locality. At the time of our inspection on 9 May 2018, seven people lived at the residential care home, and nine people received domiciliary support.

At our last inspection on 9 July 2015, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. 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.

People received support to take their medicines safely. Staff knew how to keep people safe from the risk of harm. Actions had been taken to reduce risks to people’s safety. There was enough staff to keep people safe and meet their needs.

Peoples care and support needs had been assessed which was reflected in support plans. The care provided by staff was in line with this.

Staff were competent to carry out their roles effectively and had received training that supported them to do so. People were supported to eat freshly prepared meals, and their individual dietary needs were met. People were able to access and receive healthcare, with support, if needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were kind and compassionate in the way they delivered support to people. People were treated with dignity and respect and were able to lead their lives with high levels of independence. Staff ensured that people were able to have visitors, and enabled people to maintain relationships with relatives and friends who did not live nearby.

People and their relatives were confident that they could raise concerns if they needed to and that these would be addressed. People were able to access a range of activities of their choosing which they enjoyed.

The registered manager ensured that the service was well run. Staff were committed to the welfare of people living there. Staff were motivated and worked together with strong teamwork and high morale.

Further information is in the detailed findings below

This unannounced inspection was carried out on 09 July 2015. The last inspection took place on 29 September 2014 we found the provider was not meeting all the regulations that we looked at. We found concerns in relation to care and treatment, care and support, staffing and quality assurance. The provider informed us of the actions they would take to meet the regulations by 28 February 2015. During this inspection we found that improvements had been made.

At our comprehensive inspection on 09 July 2015 we found that they had followed their plan and confirmed that they now met the legal requirements.

Wensum Way is registered to provide accommodation for persons who require nursing or personal care for up to eight people who have physical and learning disabilities. Nursing care was not provided. There were seven people living in the home when we visited.

At the time of our inspection a registered manager was in place. 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 and associated Regulations about how the service is run. However, the registered manager had been seconded to manage another of the organisations services. Another registered manager (acting manager) from the organisation was providing suitable management cover at the home

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that people’s rights were being protected as DoLS applications were in progress where required and had been submitted to the relevant local authorities.

People who lived in the home were assisted by staff in a way that supported their safety and they were treated with respect and dignity. People had health care and support plans in place to ensure their needs were being met.

Risks to people who lived in the home were identified and plans were put into place to enable people to live as safely and independently as possible. Medicine was safely audited, stored and administered to people.

There were sufficient numbers of staff available to meet people’s care and support needs.

Staff cared for people in a warm and sensitive way. Staff assisted people with personal care, eating and drinking and going on trips out in the local community throughout our inspection to the home.

Staff received training and support so that they could provide safe, effective care and support which met people’s individual needs and wishes that were living at the home.

Arrangements were in place to regularly monitor health and safety and the quality of the care and support provided for people living at the home.

One adult social care inspector undertook the inspection of Wensum Way. At the time of the inspection there were seven people using the service.

We spoke and communicated with four people who used the service, the registered manager and four care staff, of which two were regular agency staff. We reviewed four people’s care records and four staff files. We also reviewed a selection of other records that included staff rotas, audit results and policies and procedures.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty. At the time of this inspection no person was subject to a DoLS authorisation. The registered manager told us that some people did not have mental capacity. There were no mental capacity assessments in place or best interest decision records. Some people had restraints in use. These were wheelchair lap belts and bed rails. People had not consented to these restraints. This meant that their liberties were unlawfully deprived. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the MCA and DoLS.

There were inadequate processes in place to ensure that people’s health needs were met. The care staff had treated one person without the advice of health care professionals. The service is not regulated for nursing care. People had not been referred to healthcare professionals when they should have been. We were concerned that the staff had not reported a safeguarding concern to the registered manager. We were concerned that the registered manager was not aware of a situation that required a safeguarding referral. The inspection team submitted a safeguarding referral to the local authority in relation to this. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to people’s care and welfare.

There were inadequate numbers of staff on duty to meet the needs of people. People with complex needs were left, at times, without a care worker because of the staffing arrangements. People’s social needs were not always met because of the number of staff on duty. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to staffing.

We did not see evidence that the service had an effective system in place to audit accidents and incidents. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.

Is the service effective?

During our inspection we saw that people’s needs had been assessed. However, care and support was not delivered in line with people’s individual care plans. There were numerous gaps in people’s records as to whether their nutritional, personal hygiene and social needs had been met. People who should have been referred to a healthcare professional had not been. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the care and welfare of people who use the service.

Staff had received their mandatory training and had obtained further training.

Is the service caring?

We spoke with four people who used the service. Our communication with them was limited due to their complex needs. One person said, “I’m happy here. Everything is alright. I like to watch television. I am going to the day centre tomorrow.” Another person said, “ I like to sit and watch television. I do this most days. I go shopping outside. The staff are alright. The food is alright. I am okay here.” Another person said, “I am okay.” A fourth person signed, ‘Okay’ and laughed.

People’s plan of care and support were not always focussed on them as individuals. Although people’s interests had been documented it was not evident that people were enabled to undertake these.

We observed the interaction between the staff and people who used the service. Staff were seen to be kind and respectful to people most of the time. Some of the staff used sign language to communicate with one person. It was evident that staff did not spend time with people on a one to one basis or ensured people were undertaking meaningful activities. The staff told us that this was because there were not enough staff on duty to do this.

Is the service responsive?

People’s needs had been assessed and their care and support had been planned to meet their needs. However, the delivery of people’s care and support did not always respond to their needs. There was a lack of social stimulation when people were in the home. People’s interests and hobbies were not encouraged within the home. We saw that some people had requested more outings and to do more activities. These requests had not been met.

Staff had not responded to the deterioration in two people’s health. Referrals to healthcare professionals had not been made.

The service had a complaints procedure but the registered manager told us that no complaints had been made. There was limited evidence to show how people who could not verbalise their thoughts were assisted to raise any concerns.

Is the service well-led?

The service was not well-led. The staff we spoke with said that they felt supported and that they felt confident to raise any concerns or issues. However, there was little evidence that these had been acted upon. The staff told us that they had raised their concerns about staffing arrangements with the registered manager but there had been no action from this. Staff told us that they were concerned that people were not receiving any social stimulation and that they had raised their concerns with the manager but there had been no action taken.

There was lack of evidence that quality assurance processes were in place. The registered manager told us that the service was monitored by a staff member from the provider’s headquarters. They showed us an action plan from a previous audit but none of the shortfalls had been actioned. The registered manager told us that accidents and incidents were audited by the provider’s headquarters but the provider has failed to send us this information. The registered manager was not sure how the views from people’s relatives were sought.

Staff had regular supervisions but the registered manager failed to identify the poor practice of some of the staff. This related to the poor management of people with health problems. The registered manager was not aware of these problems. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.

We saw care plans and information that was personalised showing people living in the home were treated as individuals. One person we spoke with, who lives in this home told us they were involved in all their day to day needs. They said, "The staff are so kind, we do lots of things we want to do, go out when the weather is nice and can choose what we like."

The food and drink choices are made by using various methods to ensure all people have the opportunity to choose what they would like for their meals. One person said, "I like the food and we can choose what we want."

Medication is stored, recorded and administered safely.

There were enough staff on duty on the day of our inspection that met the needs of the people living in the home. Rota's for the previous week showed the same level of staff throughout. We were told by a person living at the home that, "The staff are all good. They know us well and because we have lived here a long time know what we like." They told us they felt 'safe' and were 'happy'.

All records belonging to the people who used the service and the staff who worked in the home were kept secure and safe within locked cupboards in the manager’s office.

On the day of this visit the majority of the people who live in this home were out at various day activities. We spoke with three people, two of whom could answer our questions. General conversations about their day to day lives gave us a clear picture of how involved people are within their home. We were told about the way they choose their meals, how they wish to spend their days and plans for the future. One person we spoke with told us how they take part in interviewing potential new staff when vacancies arise.

Although people were not spoken to directly about safeguarding, we were told that “I feel safe and happy here”.

Throughout the conversation with one person we were told how happy they were and that they would not want to leave this home

Three people we spoke with living at Wensum Way told us that staff were kind to them and treated them well. We noted a relaxed and friendly atmosphere in the home. People and staff were clearly comfortable in each other's company. We asked one person whether they could talk to staff about things that were important to them. They told us that they did this "....all the time." We found that people were involved in the way the service was run.

We reviewed the care records of three people, each of whom had lived at the home for several years. Each person’s record contained detailed information and guidance for staff to follow which showed how people needed to be supported. We found the service was responsive to people's needs on an individual basis.

Specific plans were in place to manage the home if there were an outbreak of a transmissible infection. This plan took people’s specific health requirements into account. We also noted the provider’s infection control policy. We found that there were effective systems in place to reduce the risk and spread of infection.

Appropriate steps had been taken to ensure that prospective employees had been vetted and were suitable for their role.

People were made aware of the complaints system. Information was available for people living in Wensum Way on noticeboards in an easy read format. This explained how people could make a complaint. People would be supported to make a complaint if necessary.