We inspected Wansbeck House on 25 July 2017 and spoke with relatives on 27 July and 2 August 2017. This was an unannounced inspection.

Wansbeck House is part of the Percy Hedley Foundation. On the college campus there is residential accommodation for a maximum number of 10 people who have a learning disability and complex physical care needs. People who used the service also accessed the college facilities during the week. At the time of our inspection there were five people using the service.

The service did not currently have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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. The previous registered manager was still working for the provider and a new manager had been in post for four weeks and was applying to be registered with CQC.

At our last inspection on 16 December 2016, we rated the service as Requires Improvement. There was a breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On this visit we found all regulations had been met and the service was rated as Good.

On our last visit we found there was not a robust quality assurance system in place. On this visit we saw staff did stock checks on medicines and counted to make sure medicines tallied through an audit process. We also saw a monthly management audit that checked staffing, care plans, health and safety and the environment.

The provider had undertaken quality surveys with people who used the service, their families and staff members as part of the quality improvement programme. We saw people were actively involved in choosing activities and menus.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met and nutritional screening was now in place.

People were supported to maintain good health and had access to healthcare professionals and services. People had hospital passports now in place and staff we spoke with were knowledgeable about people’s health needs and how to seek medical assistance if needed. Hospital passports provide an easy reference guide to record people's health and communication needs that can go with them in case of emergency.

Staff demonstrated a good understanding of safeguarding and the provider’s whistle blowing procedure. This included knowing how to report concerns.

Health and safety checks were completed regularly to help keep the building safe. Up to date procedures were in place to ensure people continued to be supported in emergency situations.

Staff told us they were well supported and trained appropriately.

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.

People’s needs had been assessed and personalised care plans developed. These were reviewed to accurately reflect people’s current needs.

There was a clear complaints process in place.

We received positive feedback about the manager and staff said they were approachable. We also saw lots of positive feedback about the service from family members.

Staff were able to provide feedback about the service and people’s care. For example, through attending staff meetings and one to one supervisions.

We inspected Percy Hedley College on 13 January 2016. This was an announced inspection. We informed the registered provider at short notice that we would be visiting to inspect. We did this because we wanted the registered manager to be present to assist us with our inspection.

Percy Hedley College is part of the Percy Hedley Foundation. On the college campus there is residential accommodation for a maximum number of 10 people who have a learning disability and complex physical care needs. People who used the service also accessed the college facilities during the week.

The home had a registered manager 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 2008 and associated Regulations about how the service is run.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. We saw that the registered provider completed an annual health and safety audit in November 2015, however no other formal health and safety audits took place at other times. Infection control audits were not completed. Care record audits were not completed. This meant that the service did not have the appropriate audit documentation in place to effectively monitor quality.

Staff did stock checks on medicines and counted to make sure medicines tallied, however no other formal auditing in respect of medicines was completed. The registered provider failed to identify that medicines had not been written up from a current prescription, that PRN [as required] protocols were not in place and that the temperature of the room in which medicines were stored was not taken and recorded to ensure that medicines were stored at safe temperatures.

The registered manager had not sought the views of people who used the service and relatives in the way of an annual survey since June 2014.

Parents we spoke with during the inspection told us they felt listened to but thought there should be a forum in which parents meet with the registered manager to share their views and ideas. At the time of the inspection there were not any formal relatives meetings.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Head of Adult Residential Services visited the service on a regular basis and from November 2015 introduced a quarterly audit to monitor the quality of the service provided. This audit links to the registered provider’s organisation wide Quality Framework, which is updated monthly.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. At the time of the inspection people had not been weighed on a regular basis and staff had not undertaken nutritional screening of people.

People were supported to maintain good health and had access to healthcare professionals and services. People did not have hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital. The registered manager contacted us after the inspection and told us they had commenced work on hospital passports.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable peo

During the inspection we were able to observe the experiences of the nine people who used the service. Most of the people at Percy Hedley College had learning disabilities or other complex disabilities which limited their ability to communicate and so some of the people could not tell us their views. We did, however, spend time observing their experiences and speaking with staff and their relatives. One relative told us “The service is absolutely wonderful. The staff are fantastic, you only have to ask. My son is so happy here”.

We saw that staff provided what was required by the people who used the service in a way that demonstrated their knowledge of each individual's needs. We spoke with the four staff on duty and the manager. All the interactions we observed between the staff and the people who used the service were open, respectful and courteous.

Staff supported people to make choices about their food and supported them to get ready as they went to classes.

Each person had their own bedroom which was personalised. We saw the provider had made suitable adaptations to meet people’s physical needs. We observed that staff respected people’s privacy and knocked before they entered their rooms. We saw that the people who used the service related well with the staff. We saw that the staff communicated well and appropriately with people in a way that was easily understood.

The manager had carried out a survey of the relatives of people who used the service. In the survey everyone said that the care at the home was very good and one person commented, “My daughter has loved being a resident at Percy Hedley College. She has had fun, laughter and has learned to live away from home”.

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Other people we spoke to told us they were very happy at Percy Hedley College and that they felt well supported by the staff.

“I like it here, I also like activities outside.”

“It’s alright here.”

We found that people who used the service had their care and welfare needs met.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that people’s views were important and listened to by the staff. We found that there was an effective complaints system in place.

We used a number of different methods to help us understand the experiences of people using the service, because most of the people using the service had complex needs which meant they were not able to tell us their experiences.

Other people we spoke with said they were happy staying at the service and the staff were kind.

Comments included:

"There's plenty to eat."

"The staff are helpful."

"It's fine."

"I like it here."

"I go out to the shops."