The Wilberforce Trust provided good care overall for 31 people with visual impairments across nine supported living services, with strong safeguarding, staffing and person-centred practice. However, the service was rated Requires Improvement for well-led due to a breach of Regulation 17, with insufficiently robust quality assurance processes, inconsistent accident and incident recording, and limited evidence of audits driving improvement.
Concerns (6)
critical
Governance
: “quality assurance processes were not sufficiently robust to assess, monitor and improve the quality of the services provided — breach of Regulation 17 (2)(a)(b)”
moderateIncident learning: “an example of an incident recorded in the hard copy accidents and incidents file that had not been added to the electronic log, so the manager of the service involved was not aware”
moderateRecord keeping: “two different versions of the electronic log in use, and some managers had been logging required updates on the wrong version in error”
minorSupervision / appraisal: “Not all staff had received supervision from their line manager in the last three months, but plans were in place to address this”
minorConsent / capacity: “not all staff had received training in relation to the mental capacity act… records in relation to this could be clearer in some cases”
minorMedication management: “the registered provider did not routinely have protocols in place for other types of medication that may be prescribed for use on an 'as required' basis, such as creams”
Strengths
· Staff demonstrated warm, caring relationships with people using the service, with positive feedback from people, relatives and visitors.
· Robust safeguarding procedures in place with staff demonstrating good understanding of how to identify and respond to abuse.
· Safe recruitment processes including DBS checks and references ensured suitability of workers.
· Medication was managed and administered safely with competency checks completed before independent administration.
· Comprehensive induction and ongoing training programme including specialist areas such as epilepsy, PEG feeding and end of life care.
Quality-Statement breakdown (17)
safe: Safeguarding systems and whistleblowing policyGood
safe: Risk assessments and managementGood
safe: Staffing levels and recruitmentGood
safe: Medication managementGood
effective: Staff training, induction and competencyGood
effective: Mental Capacity Act compliance and consentRequires improvement
effective: Nutrition, hydration and healthcare accessGood
effective: Staff supervision and team meetingsGood
caring: Caring relationships and dignityGood
caring: Choice, control and independenceGood
caring: Communication with people and familiesGood
responsive: Person-centred support planningGood
responsive: Complaints and compliments handlingGood
responsive: Activities and community accessGood
well-led: Quality assurance and audit systemsRequires improvement
well-led: Accident and incident recording and oversightRequires improvement
well-led: Leadership culture and staff supportGood
The Wilberforce Trust was rated Good across all five key questions at this August 2018 inspection, demonstrating sustained improvement following a previous Regulation 17 breach around governance which had since been fully remedied. Minor gaps were noted in the absence of end-of-life care arrangements and partial compliance with the Accessible Information Standard.
Concerns (2)
minorEnd-of-life care: “We did not see evidence of end of life arrangements in place for people within the service. Discussion held with house leaders identified this was an area to be improved upon.”
minorRecord keeping: “Not all people's care plans were in this format. This did not impact on people's care and support as staff were fully aware of individual needs.”
Strengths
· People felt safe and reported their lives had significantly improved due to the support received from well-trained, caring staff.
· Robust safeguarding processes in place; staff clearly understood how to raise concerns and referrals were made in a timely manner.
· Detailed, person-centred care plans developed with people and their families, regularly reviewed and updated.
· Staff received regular supervision, competency checks, appraisals and a wide range of training including the Care Certificate for new staff.
· Provider had resolved the previous Regulation 17 breach by implementing new audit and quality assurance systems.