Archived: WhiteHorse Care - Brownhills

Whitehorse Care is a residential care home providing personal care to seven people at the time of inspection in one adapted building.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to eight people, seven people were currently residing at the home which is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

The provider’s governance and auditing systems was inadequate and further improvement was needed to ensure that they were consistently effective in ensuring people consistently received safe care and treatment. The provider had failed to send notifications into CQC as required by law.

Whilst staff understood the importance of recording any accidents or incidents, the provider’s systems to safeguard people from the risk of harm or abuse were not robust and therefore we could not be assured people were consistently safe. The provider’s systems for monitoring the safe administration of medication was not effective. There were sufficient numbers of staff to meet people's needs and the provider had a system in place to recruit staff safely.

At our last inspection, we found people were subject to restrictions on their liberty without the legal safeguards in place. At this inspection, we found improvements had been made and people's mental capacity had been assessed, however, this was not done in line with the Mental Capacity Act.

People were not consistently supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Whilst people received support from kind and caring staff, systems in place did not always support the service to be caring. Staff received specialised training to give them the knowledge to support people’s individual needs. People were supported by regular staff who knew them well. People’s religious and cultural beliefs were respected.

Whilst care plans and risk assessments had improved since the last inspection, further improvement was required to make them easy to follow. People knew who to speak to if they had any concerns. People who wished, had an end of life care plan in place.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 04 January 2019) and we found multiple breaches of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At the last inspection the provider was in breach of Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good Governance and Regulation 18 (Registration) (Notification of other incidents). We imposed conditions upon the provider’s registration to drive forward improvements. The provider completed an action plan following the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvements had been made and the provider was still in breach of the same regulations identified at the last inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Whitehorse Care is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Whitehorse Care accommodates up to eight people with learning disabilities in one adapted building. There were seven people living at the home at the time of our inspection visit.

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.

We found the provider did not have robust systems in place to safeguard people from the risk of harm or abuse and therefore we could not be assured people were consistently safe. Whilst staff understood the importance of recording any accidents or incidents there was no oversight by the provideron patterns and trends and how to reduce the risk of these incidents from happening in the future. There were sufficient numbers of staff to meet people’s needs and the provider had a system in place to recruit staff safely. People’s medicines were managed safely. People were protected from the risk of infection and cross contamination because staff members were provided with sufficient personal protective equipment.

We found people did not always have their rights upheld in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards People were supported by staff who had undergone induction training and who knew them well. People were supported to access healthcare services in the community. People received care from staff that had the knowledge about their individual nutritional needs. People’s nutritional needs had been assessed and people had food that they enjoyed.

People were supported by staff who were often caring but this was not consistent and embedded into the service. People’s dignity was not always respected. People were encouraged to maintain their independence and received regular visits from family and friends.

People and their families were not always involved in care reviews. People’s cultural and religious beliefs were respected. The service had looked at ways to make sure people had access to the information they needed in a way they could understand it, to comply with the Accessible Information Standard (AIS). People were encouraged and enabled to take part in activities and hobbies that interested them.

The provider had failed to send in statutory notifications as required by law. There were no robust systems and processes in place to effectively assess, monitor and improve the quality of the service provided. Staff felt supported by the Registered Manager. The provider worked with other agencies to support the well-being of the people living at Whitehorse Care.

During this inspection we identified three breaches of the Health and Social Care Act 2008 and You can see what action we told the provider to take at the back of the full version of the report.

From our previous inspection some action had been taken to improve the service to people. There are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were eight people living at the home on the day of the inspection but most people were out at the local day centre. During our inspection we met three people who used the service, but due to their complex health needs they were unable to speak with us so we observed how they were supported to help us understand their experiences of care. We spoke to one person at the end of our inspection who arrived back from the day centre and was willing and able to speak with us. We spoke with three members of staff who supported people, the manager and the provider who was supporting the inspection process and three relatives by phone after the inspection. We looked at three people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that there were systems in place to support learning from events like accidents, incidents and complaints. All the relatives we spoke with knew who to complain to, but told us they have never had to complain. Records showed there was a process in place that was displayed and available to people in other formats so that the information was accessible to them. This meant that people or relatives knew how to share any concerns they had.

One person we spoke with said, "I do feel safe here". Our observations of people were that staff interaction was good and people responded to staff in a relaxed and confident way. Staff were able to explain how they would keep people safe, and what action they would take where they had concerns around people's safety. This meant that staff had the knowledge and skills to keep people safe.

We found that risk assessments were in place and where people had specific health conditions, staff had the knowledge and skills to meet people's needs. For example where people were at risk of choking we saw that the appropriate training was available. This meant that people could be confident that staff were able to support them safely.

The home had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager had a good understanding of MCA and DoLS and confirmed that there had been no DoLS applications submitted to the local authority. All the staff we spoke with told us they had not been trained in the MCA or DoLS. Records we saw confirmed that not all staff had received training and staff were unable to explain what was meant by both terms and the implication for people who lacked capacity. Staff were able to explain how people were safeguarded and the actions they would take were people were at risk of harm.

We found from our previous inspection that medication was not secure. We found that improvements had been made to ensure medicines were now more secure. This meant that where people were being administered medicines, they were now being stored securely.

Is the service effective?

Records showed that the appropriate assessments and support plans were in place to highlight to staff how people's support needs should be met. Where people had health conditions like epilepsy, management plans were in place so staff had the right information to support them. Our observations were that people's needs were being met how they wanted. Where people attended a day centre so they were able to take part in social interaction and stimulation, this was identified in their support plan. Their development plan which was reviewed yearly highlighted why they attended a day centre and the benefits to them. One relative we spoke with said, "I am more than happy with how X is being cared for". This meant that people were receiving the support they wanted as highlighted in their support plan.

We found that where people needed support from health professionals this was available. Records however did not show how often people had appointment with health care professionals. For example, there was no optician or dentist visits. One relative we spoke with said, "The manager always let me know when X has a health visit". This meant that where people was seen by their health care professional this was not being recorded.

Where people had their meals supplemented or needed a special diet we saw this information displayed in the kitchen. This meant that staff who supported people to prepare meals or prepared people's meals could access the information as needed to support people's nutritional needs.

Is the service caring?

All staff we spoke with had a good understanding of people's needs and knew how to support them. We saw that people interacted with staff in a friendly manner having a laugh and a joke amongst themselves. Our observations of people were that they were relaxed and able to wonder around the home how and when they wanted. At meal times people were supported to eat their meals with staff encouragement and support where needed. One person who had a swallowing difficulty, we saw staff reminding them in a compassionate way to slow down and not rush what they were eating.

All staff were able to explain how they would support someone they found on the floor. Staff told us they had received training in first aid and where they were unsure as to a person's medical condition they would contact the emergency services and the person would not be moved. One person said, "The staff are all alright here". This meant that staff were caring in ensuring people's needs were met.

Is the service responsive?

We found that since our previous inspection records were now kept secure. The provider had a filing cabinet in place so records could be locked away and the office door was also locked. This meant all records were now meeting the providers confidentiality procedures.

All relatives told us they were able to be kept up to date on a regular basis about people's support needs. One person we were able to speak with told us that any concerns they had would be discussed with the manager. This meant the provider had a good communication process in place to ensure people's and relatives were kept up to date with information.

Is the service well-led?

The service was led by a registered manager, who was supported by the provider. We met both of them who were both present at the time of our inspection and assisted us with any information we needed.

We found that the quality assurance process used to gather people's views needed to be improved. We found that the questions used needed updating and all the relatives we spoke with told us they did not remember ever being sent a questionnaire to complete. This would enable the provider to improve their services based on the feedback from people.

Where people did not have capacity, a suitable assessment had not been carried out. Important decisions were made for people and the registered manager could not demonstrate they had been made in people's best interest.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the d'cor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We checked to ensure medication was stored and administered in a safe way. We found medication management was suitable.

We saw there were sufficient staff to meet the needs of the people using the service.

We saw records relating to people using the service were not stored securely.

We looked at five outcomes to assess whether people were involved and participated in the service they received; whether care was provided appropriately; whether the home could adequately ensure people's safety; whether staffing requirements were appropriately carried out and whether there was a system for ensuring ongoing quality assurance within the home.

One person living at the service told us, 'It's nice here. I like the staff'.

A relative told us, "It is a very good and very homely service. The staff are very friendly'.

Four people living at the service were not available to talk to us as they were doing activities and working in the community on the day of our inspection.

Staff we spoke with told us they had completed safeguarding training and understood how to identify abuse and what to do if an incident occurred.

We found that there were effective systems in place to manage risks to the health, safety and welfare of people living at the home.

We found that the home was compliant in all five outcome areas.