About the service:

Walberton (South Coast) is a residential care service. The service consisted of four houses Russett, Melrose, Pippin and Fortune. Russet and Melrose were bigger than most domestic style properties. It is registered to provide support for up to 33 people living with complex needs, a learning disability or autism. 31 people, both young and older adults, were living at the service, at the time of the inspection. This is larger than current best practice. However, the size of the service having a negative impact on people was lessened by people living across four houses and the building design fitting into the residential area. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People's support focussed on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service:

¿Quality assurance processes had improved since the last inspection. However, they failed to identify issues in relation to MCA and DoLS.

¿The registered managers and staff did not always have a good understanding of the Mental Capacity Act (2005) (MCA) or Deprivation of Liberty Safeguards (DoLS). Conditions on two people’s DoLS were not known or understood by the registered managers or staff. The registered managers had not fully implemented the providers policies and systems to effectively support this practice. ¿ ¿Capacity assessments and best interest decisions did not consistently take place and outcomes were not always documented.

¿People were supported to have maximum choice and control of their lives however it was unclear if staff supported them in the least restrictive way possible, as best interest decision meetings did not always occur. The policies and systems in the service did not always support this practice.

¿The registered managers were not fully aware of their regulatory responsibilities in relation to their registration with the Care Quality Commission (CQC).

¿People were safe from the risk of abuse. ¿There were sufficient numbers of staff to meet people's need. A relative told us, “He is safe at Walberton, the staff are there for him. I know he feels safe as he is happy living there.”

¿Staff had the skills and knowledge to deliver effective care and support. ¿People were supported to maintain a balanced diet and had access to healthcare services as and when needed.

¿People were treated with kindness and respect. ¿People's independence was promoted and their differences respected. People were supported to develop and maintain friendships.

¿Care was personalised to meet people's care, social and wellbeing needs. ¿People had access to a range of activities that met their interests.

¿People, their relatives and staff were complimentary of the management of the service

We carried out a comprehensive inspection of Walberton on 27 and 30 November 2017. The inspection was unannounced.

Walberton is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Walberton is registered to provide accommodation and personal care for up to 33 people with a learning disability across four properties. All of the properties were situated on the same site. The properties names were Melrose, Russett, Pippin and Fortune. At the time of the inspection there were 13 people living at Melrose, two in Fortune, 1 in Pippin and 10 in Russett. People living at the properties were all adults and there was a mix of younger and older adults across the service.

The provider ran a wood workshop and small apple juice production facility on the same site as the residential properties, along with a designated centre providing support with activities, which people could attend if they wished; these are not registered with the CQC as they do not provide any regulated activities under the Health and Social Care Act 2008 (regulated Activities) Regulations 2014 and were not inspected.

Walberton has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We found Walberton conformed to this guidance and values in their approach to supporting people using their service.

There were two managers in post who were both currently in the process of applying to be registered managers for the service. An operations manager was supporting the service and undertaking some registered manager responsibilities until the managers had been registered. A registered manager is a person who has registered with the CQC 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.

We last inspected the service on 19 May 2015. At the previous inspection, we asked the provider to take action to make improvements as we found areas of the environment in all three properties were poorly maintained and not always clean which was compromising people’s dignity and quality and life. At this inspection we checked to see if the provider had taken actions to address these issues and found this still required improvement.

Two of the three properties were not clean on the first day of our inspection. All three properties were in need of maintenance works. The provider was aware of the outstanding maintenance work and a schedule of necessary repairs and improvements had been approved prior to our inspection and scheduled to take place.

The provider was not adequately assessing, detecting or controlling risks to people from infection and cross infection. Correct procedures for preparation and storage of food was were not being followed in two of the properties. Kitchens and the equipment in them was unclean. Hazardous waste was not always being disposed of correctly. Bathrooms and the equipment in them were not always clean.

Management of risks to the safety of communal and personal spaces and the living environment required improvement. Restricted cleaning chemicals were not stored securely. Health and Safety and fire checks and audits for communal and personal spaces at the service were in place, but were not being consistently completed at all three properties. Where checks and audits had been completed and issues had been identified as possible risks to people, no action had been taken to rectify problems.

The inspection took place on 19 May 2015 and was unannounced.

The home provides care and accommodation for up to 33 people with a learning disability. These were aged from 31 to 67 years of age and had medium to high needs. The service was provided in three properties on a site which has landscaped grounds. The properties were as follows: Melrose houses up to 13 people and there were 10 people living there at the time of the inspection, Russett accommodates up to 18 and had 11 people living there and Fortune accommodates two people and had two people there at the time of the visit. Twenty three people were accommodated in total at the time of the inspection. Each of the properties had communal lounges and dining rooms. All bedrooms were single and seven had an en suite bathroom with a kitchen so people could be more independent. The provider ran a workshop and small apple juice production facility nearby which people could attend if they wished; this is not registered with the Commission and was not inspected. The home had a staff team of 22 care staff and a team of staff who worked occasional shifts as part of a bank staff team.

The home had a registered manager. 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 a number of areas of the home where redecoration was needed and where cleanliness needed to be improved. This included floor coverings in bathrooms and toilets as well as carpets. There was an odour of urine in two toilets which had spread to adjoining corridors. Paintwork on windows was in particular need of attention.

Staff were aware of safeguarding adults procedures and their responsibilities to report any concerns they had. People said they felt safe at the home and relatives also said people were safe at the home. Health and social care professionals said staff reported any concerns to them and that staff were safety conscious.

Care records included assessments of any risks to people and corresponding action staff should take to reduce these risks. These included details about people’s behaviour which presented a risk and for supporting people who were at risk when going out in the community.

There were sufficient numbers of staff on duty, although one of the cottages should have had two staff on duty but only had one at the time of the inspection. Pre-employment checks were made on newly appointed staff so that only people who were suitable to provide care were employed.

People’s medicines were safely managed. Staff were trained and assessed as being competent to handle and administer medicines.

People told us they were supported by staff who were well trained and competent. Staff had access to a range of relevant training courses and said they were supported in their work.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). There were policies and procedures regarding the assessment of people who may not have capacity to consent to their care and the registered manager knew when these procedures needed to be used.

People were supported to eat and drink and to have a balanced diet. There was a choice of food and people said they liked the food. Special dietary needs were catered for and nutritional assessments carried out when this was needed so people received appropriate support.

People’s health care needs were assessed and recorded. Care records showed people’s physical health care needs were monitored and that people had regular health care checks.

Staff treated people with kindness and had positive working relationships with people. People were consulted about their care and said they were listened to. Staff acknowledged people’s right to privacy and people were supported to develop independent living skills.

Care needs were reassessed and updated on a regular basis. Care plans were completed for each person and reflected how people liked to receive care. The support people received was based on each individual’s needs and was tailored to reflect people’s preferences. People were supported to attend a range of activities including work schemes, day care and leisure pursuits.

The complaints procedure was available in the home and was in a format that could be easily understood by people. A record was made of any complaints along with details of how the issue was looked into and resolved.

Staff were committed to a set of values which included compassion and promoting equality and respect for people. The registered manager and staff empowered people to be involved in decision making in the home and in their daily lives.

A number of audit tools were used to check on the effectiveness of care plans, medicines procedures, and, the environment.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.