Whitmore Vale House

Whitmore Vale House is a care home which provides accommodation and personal care for up to 20 people with a learning disability and autistic people. The service is divided into three separate living quarters, each with their own kitchen and communal areas. At the time of our inspection 16 people were living at the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

People were cared for by staff who supported them to learn new life skills and retain their independence. People could choose how they liked their care and how they wished to spend their time. One person said, “I go out for dinner and we go to the cinema.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported in taking positive risks in order to promote their independence. Staff had written up risk assessments where guidance was recorded for staff to help reduce people’s risks.

People could express their views through meetings and staff took an interest in people and worked with them to achieve their goals and aspirations.

Right Care:

People were treated with respect by staff. People and staff had good relationships and staff spent time with people to enable them to do the things they wanted, like going to see their girlfriend or taking the bus into town.

People were cared for by a sufficient number of staff who had been trained appropriately. People received the medicines they were prescribed and were supported to access health care professional input when needed. This helped to ensure they retained a good level of health. People were able to choose what they ate and participated in the preparation of meals and drinks.

People lived in an environment which was suitable for them. People said they liked living at Whitmore Vale House and that they felt they were well cared for and safe.

Right Culture:

The registered manager had made improvements to the service since our last inspection. Relative’s gave positive feedback on management telling us, “The new manager is a good person” and, “The new manager is approachable.”

Staff and managers were clear about their roles and responsibilities and staff worked well together as a team. People received person-centred, individualised care as a result from staff who knew people and their needs well.

The registered manager and other senior staff were always looking for ways to improve the service by working with other external agencies, obtaining feedback from people, staff and relatives and through their governance processes and auditing systems.

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 30 January 2021).

At our last inspection we recommended the registered provider arrange for refresher training for staff to enable them to carry out their role with confidence. We also recommended they carry out decision specific capacity assessments for people where restrictive practices were being considered. At this inspection we found the registered provider had responded to our recommendations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Whitmore Vale House is a care home which provides accommodation and personal care for up to 20 people with a learning disability. The service is divided into three separate living quarters, each with their own kitchen and lounge areas. The service also has a day centre on site in which people can meet. At the time of our inspection 13 people were living at the service.

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

People said they felt safe living at Whitmore Vale House and staff were kind to them. Staff had a good knowledge of the different types of abuse that could take place and were confident in their understanding of how to report any concerns.

People’s individual risks had been identified and staff demonstrated they knew people well and how to respond to any particular concerns. Risk assessments for people had been reviewed and updated and where people had accidents these were recorded, discussed and action taken.

People were provided with the medicines they needed by competent staff. Medicines records were comprehensive and audits were carried out regularly. People said staff were always available to support them and we observed this on the day. Staffing levels meant people received the care they needed when they needed it, by staff who had been recruited through robust processes.

The provider had ensured people lived in a clean environment and staff did all they could to adhere to Government guidelines around COVID-19 and the risk of transfer of infection. There was an up to date infection control policy, plenty of personal protective equipment, regular cleaning and easy-read information for people to help them understand how they could stay safe.

Staff felt positive changes had been made in the service which resulted in better communication and more cohesive working. Audits were robust and any actions identified were addressed. Senior management used an overarching improvement plan to review and improve the service and care provided to people.

People were asked for their views on the care they received and staff were asked for opinions and input. Staff told us they felt supported and received the training they required. We did spot some gaps in training and will check at our next inspection that this has been addressed.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

As this was a focused inspection, we did not look at all aspects of Right Support, Right Care, Right Culture. However, we would expect the service to be able to demonstrate how they were meeting the underpinning principles of the guidance. This was because they would be able to show the model of care and setting maximises people’s choice, control and independence, the care is person-centred and promotes people’s dignity, privacy and human rights and the ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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

Rating at last inspection

The last rating for this service was Requires Improvement (report published 2 April 2020).

Why we inspected

This focused inspection was prompted as a result of the shortfalls we found at our last inspection. We visited the service to check action had been taken in response to our inspection and as such improvements had been made. We found nothing of concern at this inspection and the service had improved.

At this inspection we reviewed the Key Lines of Enquiry in the key questions of Safe and Well-Led only and this report covers our findings in relation to those.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whitmore Vale House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme when we will carry out a fully comprehensive inspection looking at all key questions. If we receive any concerning information we may inspect sooner.

Whitmore Vale is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Whitmore Vale provides residential care for people with a learning disability. The service accommodates up to 20 people across three separate units. At the time of our inspection, the service was supporting 16 people.

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. However, as reported, records did not always reflect this.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 20 people. 16 people were using the service. This 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 and the other large domestic homes of a similar size. 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

Staff had not received adequate training in areas that were pertinent to the people they were caring for, such as training in caring for people with autism. This had caused an impact on the quality of care people had received on occasions. For example, accident and incident records highlighted an issue in staff’s perception of people’s behaviours, rather than looking at the root cause of them. These records also did not include information around actions taken to prevent reoccurrence. We identified documentation where inappropriate or disrespectful terminology about people and their behaviours had been used. The senior management team were aware of this and were already taking action to ensure staff were re-educated in dignity and respect and were completing ongoing close monitoring of the service.

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

Risks to people were not always appropriately recorded or managed. Quality audits had not identified the issues we found during our inspection, or the concerns that led to our inspection. Healthcare professionals were involved in people’s care where necessary, but relatives were not always kept updated with changes to their loved one’s health or care needs.

Apart from one occasion, people and their relatives felt that staff treated them with respect and kindness. The senior management team were monitoring the service closely following safeguarding concerns that had been raised and were asking staff to self-reflect of their own practices.

Staff encouraged people to be independent where safely possible and respected their independence and privacy. People were involved in making decisions around their day to day care, including what they wanted to eat and wear. Relatives and staff felt the senior manager was approachable. Feedback had been sought from people, their relatives and healthcare professionals on a regular basis.

There were a suitable number of safely recruited staff to meet people’s needs. Following a recommendation at our last inspection, staff deployment had improved to allow people to take part in activities and outings that were meaningful to them. Staff received regular supervision and competency checks to ensure they were effective in their role. However, these had not identified the shortfalls we found on the day, nor the concerns that led to our inspection.

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 as many opportunities as possible for them to gain new skills and become more independent. However, records did not always reflect this principle.

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

Rating at last inspection

The last rating for this service was Good (published 5 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the culture of the service and people not being treated with dignity and respect. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the provider’s processes and systems not identifying shortfalls in the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

There was a registered manager in post and present on the day of the inspection. 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.

There were times where staff were not deployed in a way that suited people’s needs. This was because of additional duties that staff undertook for example cleaning and cooking. We have made a recommendation around this. There were activities in the service that people could participate in on a daily basis. Work was being undertaken to improve the external activities.

People said that they felt safe. Staff ensured that people were protected against the risk of abuse and told us that they would not hesitate in reporting any concerns. Robust recruitment of staff took place before they started work. There were appropriate numbers of staff available.

Detailed risk assessments took place in relation to people’s individual needs. The environment was checked in relation to potential risks to people. In the event of an emergency there were plans in place to protect people.

Accidents and incidents were acted upon and steps taken to reduce the risks. These were analysed by the registered manager regularly and any learning discussed with staff.

People’s medicines were managed safely and appropriately by staff. People had access to pain relief when they needed. People’s nutritional and hydration were managed to ensure they received the most appropriate care.

People told us that they enjoyed the food at the service. People were supported and encouraged to eat healthily and had access to nutritious food. Health care professionals were involved with the care of people and people were supported to attend health care appointments.

Training and supervision were provided to staff that ensured that the most appropriate care was being provided to people. We saw through observations that staff were knowledgeable and effective in the care that they provided.

The Mental Capacity Act 2005 (MCA) is a legal framework about how decisions should be taken where people may lack capacity to do so for themselves. Staff had received training around the Mental Capacity Act (MCA) 2005 and how they needed to put it into practice and staff were knowledgeable in this. People at the service had the capacity to make decisions about their care. There were no people at the service that were being restricted in any way.

Staff showed care and empathy towards people. It was clear that staff had good relationships with people and understood what was important to them. Staff showed patience, dignity and respect and people responded well to staff. Families and visitors were welcomed to the service.

People received individualised care and were able to make choices around how they wanted their room to look and how they wanted their care to be delivered. People were supported to be independent and to make their own choices.

Care plans were detailed and specific to each person. There was guidance for staff on how best to provide the support. Staff were aware of what care needed to be provided. People were set goals to achieve and work was undertaken to ensure that these goals were met.

People were supported to make a complaint if they needed to. Complaints were investigated and improvements made where needed.

People and staff were complimentary of the management and the support they received.

Staff worked well as a team and felt that there had been improvements in the service since the registered manager had started at the service.

Steps were taken to review the care and the delivery with actions to make improvements. Methods they used included surveys, audits, staff meetings and spot checks.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had informed the CQC of significant events. Records were accurate and kept securely.

The service was last inspected on the 6 October 2015 where no concerns were identified.

We found that people had been involved in planning their care and that they had given their consent to the care they received. There were processes in place if people lacked the capacity to make a specific decision and staff had received relevant training.

People's care plans, risk assessments and other records had been reviewed with people to ensure that they contained up to date information. People had received care that met their individual needs.

There were processes in place to ensure that people were safeguarded against the risk of abuse.

Staff had received an induction and appropriate training was provided for them.

There was a complaints system that had been brought to people's attention.

People told us 'it's lovely living here' and 'staff are nice and friendly'. They told us staff understood the help they needed and they had the freedom to go out when they wanted.

People had not been asked to give their written consent to the care provided. The staff we spoke with demonstrated they understood when verbal and written consent was required. We found although best interest decisions had been recorded the provider's documentation had not been used. This documentation would have provided clear evidence of how decisions had been reached.

Staff understood people's care needs and ensured information was shared between staff. We found staff promoted people's independence. People told us 'staff let me get on with everything I can'.

We saw the care plans had been written some time ago and they had not all been reviewed regularly to ensure they provided up to date information with regard to people's care needs. The registered manager was aware of this issue and had taken measures to start to review people's care plans.

We found there were processes in place to ensure medicines were administered safely.

Staff had undergone appropriate checks prior to them starting work.

There were systems in place to monitor the quality of the service provided.