An assessment has been undertaken of a specialist service that is registered for use by autistic people or people with a learning disability. At the time of the inspection, the service was not used by anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. At the time of the inspection the service was providing personal care to older people and people living with dementia. Date of assessment: 5 February to 13 February 2025. We found 1 breach of the regulations in good governance. However, the service was no longer in breach of the regulations relating to safe care and treatment. Improvements were still needed to the quality assurance processes to ensure information provided to staff was sufficiently detailed and staff were keeping appropriate records. However, the care staff provided was safe and staff knew people well. Staff had undertaken the training they needed to support people and were safely recruited. Staff knew how to report incidents and safeguarding concerns and were confident action would be taken if concerns arose. People and their relatives felt listened to and involved in their care. Staff understood the principles of the Mental Capacity Act 2005 and people were supported to make choices. Staff protected people’s privacy and dignity and promoted people’s independence. Staff were motivated in their role and were positive about the support they received from the provider. Staff told us they felt valued and respected in their role and were listened to if they raised concerns. The provider and staff worked in partnership with other health and social care services to improve outcomes for people and people were referred to other services as needed. We have asked the provider for an action plan in response to the concerns found at this assessment.
PDF cached but not yet analysed by Claude; set ANTHROPIC_API_KEY and re-run npm run etl:reports -- --location 1-2194228851.
Wurel House improved from Inadequate to Requires Improvement overall, exiting Special Measures, with continued regulatory breaches under Regulation 12 (risk and care planning) and Regulation 17 (governance and record-keeping). Caring practices were rated Good, reflecting positive feedback from people and relatives, but audit processes and care plan detail remained insufficient to ensure consistent safe support.
Concerns (5)
criticalCare planning: “a person's care plan did not make any mention of how they transferred out of bed or the equipment required to do this safely. There was no risk assessment or guidance for staff”
criticalGovernance: “audits of the quality of the service remained insufficient to alert the provider of care planning and risk assessment inconsistencies”
moderateRecord keeping: “catheter care records did not always detail when weekly use catheter bags had been replaced. Records of repositioning people...did not detail if people had been positioned on their left side, right side or their back”
moderateStaff competency: “this did not amount to a competency check to ensure specific training was embedded safely into working practice, for example, when using a lifting hoist”
minorConsent / capacity: “where people had a lasting power of attorney appointed for health and welfare decisions, the provider had not always retained a copy of the order”
Strengths
· Staffing levels were sufficient and recruitment processes were safe, with no missed calls evidenced by electronic monitoring systems.
· Safeguarding training was in place and staff could identify and report concerns; incidents were investigated and reported to the local authority.
· Infection prevention and control practices were improved, with PPE used appropriately during personal care.
· Staff supported people to access healthcare services effectively and maintained hospital/care passports.
· People and relatives gave positive feedback about staff being caring, patient, calm and friendly.
Quality-Statement breakdown (17)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyInsufficient evidence to rate
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
well-led: Continuous learning and improving care; quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Working in partnership with othersGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
This targeted KLOE inspection of Wurel House (August–September 2022) found continued breaches of Regulations 12, 17, 18, and 19, with serious failures in medicines management, staffing levels, missed and shortened care visits, staff training, infection control, and governance. The overall rating remains Inadequate and the service continues in Special Measures, as insufficient improvements had been made since the previous inspection in March 2022.
Concerns (14)
criticalMedication management: “Staff had been administering medicines to people without training and without being assessed as competent to do so. Training records evidenced that no staff had received any medicines administration training.”
criticalMedication management: “One person was prescribed a medicine which needed to be administered 20 minutes before meals. We observed staff administer the medicines 13 minutes after the person had eaten their meal.”
criticalMissed or late visits: “Several relatives reported that their loved ones had experienced delays in receiving support...people were having 16 hours between care visits.”
criticalMissed or late visits: “One person's daily care records for 30 July 2022 evidenced that their morning care visit was carried out in 10 minutes...The person had been assessed as requiring 45 minutes for care in the morning.”
criticalStaffing levels: “A staff member told us, 'It is impossible with the real rotas to fit in all the care calls...There are 17 hours of care visits which they fit in to a 12 hour shift.'”
criticalCare planning: “Risk assessments contained unclear guidance for staff...There was no guidance or risk assessment in place to detail safe ways of working with them to minimise anxiety and protect staff.”
criticalStaff training: “Only two staff had completed learning disability and autism training. The staffing rota showed that four staff regularly worked with a person who had a learning disability.”
criticalStaff training: “One new member of staff employed since the last inspection had not received any induction and had not done any training prior to participating in care visits with people.”
criticalGovernance: “Audits and checks completed in May, June and July 2022 had not picked up on some of the issues identified in this inspection. For example, the medicines audits had not identified the issues with medicines.”
criticalGovernance: “The provider had failed to give us information when asked about care packages and then provided inaccurate information about care packages.”
criticalStaff competency: “The provider had not explored each staff members' full employment history. The provider could not be assured that all staff were suitable for their roles.”
moderateInfection control: “We observed staff not wearing masks on the first day of our inspection. Staff working in the community reported that they are not always wearing masks...not wearing aprons when providing personal care.”
moderateInfection control: “Staff had not completed food hygiene training and had not followed correct procedures for preparing and storing food...At this inspection, this had not changed.”
moderateRecord keeping: “Records in the service were of poor quality, were inconsistent and did not include a complete and accurate and contemporaneous record of care provided. The staff list the provider gave CQC was not complete.”
Strengths
· Window restrictors had been fitted and fire safety concerns had been addressed at the supported living premises.
· Assessments of people's needs had improved with care plans and risk assessments created; DNACPR status recorded.
· Support plans and goal setting had improved with actions to meet goals in progress.
· The provider had been following COVID-19 testing guidance for staff and completing the capacity tracker.
· The provider had sought support and guidance from Skills for Care.
Quality-Statement breakdown (7)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
well-led: Continuous learning and improving care; Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
Wurel House was rated Inadequate overall and placed in special measures following multiple breaches across safeguarding, medicines, recruitment, staffing, training, infection control, capacity, complaints, governance and CQC notifications. Warning notices were served for breaches of Regulations 9, 12, 17 and 18, with widespread shortfalls in care planning, late or missed domiciliary visits, and provider oversight.
Concerns (16)
criticalSafeguarding: “The provider did not have effective systems to protect people from the risk of abuse. Staff had not received safeguarding training”
criticalMedication management: “One person had been prescribed antibiotics; they had missed two doses of the medicine. Medicine administration records (MAR) showed other gaps in records.”
criticalMissed or late visits: “It's not unusual for them to come three times a day or twice a day when it should be four times”
criticalStaffing levels: “The provider had not ensured that sufficient numbers of suitable, experienced staff were deployed to meet people's assessed needs.”
criticalStaff training: “The only training we receive is a link to a video to watch through WhatsApp, no actual training, no assessment.”
criticalStaff competency: “Some staff employed to work in the community had not received any induction and had not shadowed experienced care staff”
criticalInfection control: “Some areas of the service were dirty and had not been cleaned effectively. Cleaning schedules were not completed”
criticalCare planning: “the care plans were not clear or robust and did not clearly detail what people's assessed needs were.”
criticalConsent / capacity: “There was no record that a capacity assessment or best interest discussion had taken place.”
criticalGovernance: “The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of concerns and issues within the service.”
criticalRecord keeping: “Records in the service were poor. The staff list the provider gave CQC was not complete.”
criticalComplaints handling: “These complaints had not been recorded and had not been dealt with appropriately, the issues and concerns were still occurring when we inspected.”
criticalIncident learning: “Incidents relating to people had not been managed safely to reduce the risk of harm.”
criticalLeadership: “The provider lacked oversight of the supported living service and the domiciliary care service.”
criticalPerson-centred care: “The provider had failed to provide care and treatment to meet people's assessed needs.”
criticalOther: “A robust approach to recruitment was not taken to ensure only suitable staff were employed to provide care.”
Strengths
· Most relatives gave positive feedback about kind, compassionate care from care staff
· Staff protected and respected people's privacy and dignity
· Staff enabled people at Wurel House to access specialist health and social care support
· Clear and regular communication between the service and social workers and commissioners
· Staff helped one person prepare for and attend a hospital appointment with reassurance
Quality-Statement breakdown (15)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and management; learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Staff support: induction, training, skills and experienceInadequate
effective: Supporting people to eat and drink enough to maintain a balanced diet