Archived: Whitehatch

Whitehatch is an adapted residential care home providing personal care and support for up to 11 people with complex physical and learning disabilities. At the time of inspection there were nine people living at the home.

The service applied the principles and values of Registering the Right Support and other best practice guidance for people with learning difficulties and autism in a consistent way. Each person lived as full a life as possible and achieved the best possible outcomes that include control, choice and independence.

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

People living at Whitehatch were exceptionally safe. People were supported in innovative ways to learn about the risk of abuse. They were encouraged to speak up for themselves and others about anything that concerned them. People were empowered to take control of situations, and be actively involved in managing their own risks, tackle safety issues and to live as full a life as possible. Where individual risks were identified, actions were taken unobtrusively to enable people to be and feel safe but not held back. There was a good team of skilled staff to safely meet all of people’s needs.

People enjoyed a very good quality of life. Feedback we received from people’s relatives was very positive, confirming how safe, happy and contented people were. A healthcare professional also said, “Whitehatch is a happy home to live and work in.” Everyone received personalised, planned, and co-ordinated support that was appropriate and inclusive.

People received high quality care and support that was carefully tailored to each individual. Visiting professionals and families praised the excellent results of the person centred care provided. The service developed community contacts and experiences for people to address issues and inequalities that might prevent them taking part. People were supported to develop new skills and staff were exploring opportunities for volunteer work for some people.

People’s communication needs were known and addressed by staff who were creative and persistent in bringing out the best in each person. Staff had developed their skills to enable each person to increase their communication and their choices.

The staff and managers had gone ‘over and above’ in the way they had supported two people who had died in the last year. There had been a personal and responsive approach to helping those who were bereaved to feel comforted.

People’s health and wellbeing was given priority. Staff were pro-active in ensuring specialist health advice was sought for people when needed. People ate well and were actively involved in choosing their meals and with food preparation where possible. People’s dietary needs were well understood and managed by staff. The home was well adapted to meet people’s needs and to promote and allow people to have their independence and freedom.

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.

Staff were consistently caring and kind. One relative said, “Staff have varied over time, but the warm atmosphere has been present throughout.” Staff were observed interacting positively with people, having fun and speaking with respect at all times. Families were kept informed about people’s lives and involved in decision making. People were enabled to express their wishes and feelings.

The service was very well led by an enthusiastic and experienced registered manager and deputy manager. Together, they provided consistent leadership that was strong, organised and able to deliver elements of outstanding practice within the service. There was an inclusive and person-centred approach where people and staff felt involved and valued. There were plans to continually improve the service and create even more opportunities for the people they supported.

Rating at last inspection

The last rating for this service was Good (published 5 December 2016)

Why we inspected

This was a planned inspection based on the previous rating.

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

The home had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out a previous inspection of this service on 5 November 2014 where we found improvements were required in relation to staffing numbers. At this inspection on 8 November 2016 we found action had been taken to respond to our concerns and improvements had been made.

This inspection took place on 8 November 2016 and was unannounced. At the time of our inspection there were 11 people living in Whitehatch. People had a range of needs, with some people living with complex epilepsy, autism and learning disabilities. Eight people required the use of a wheelchair.

In the months prior to our inspection a new manager had started at the home and had registered with the CQC. Since the registered manager had started in the service they had made a number of improvements relating to the culture at the home. The registered manager had put work into making the home more person led and flexible to meet the individual needs of people.

The registered manager was in the process of introducing new care plans for people which contained more detailed information about their histories, individual needs, routines, preferences and interests. People and staff who knew them well were involved in updating these .

People were protected from risks relating to their health, mobility, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

Staff knew how to recognise possible signs of abuse which also helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report concerns. Safeguarding information and contact numbers for the relevant bodies were accessible to staff and people who lived in Whitehatch in a format they could understand. People and staff told us they felt comfortable raising concerns. Recruitment procedures were in place to ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with vulnerable people.

Staffing numbers at the home were sufficient to meet people’s needs and provide them with one to one support and time in their chosen activities. During our inspection we saw positive and caring interactions between people and staff. We found staff had caring attitudes towards people and spoke highly of them, their personalities and qualities. Staff spent time with people individually and knew people’s needs, preferences, likes and dislikes.

Staff had the competencies and information they required in order to meet people’s needs. There was a schedule in place to ensure staff had supervision and appraisal regularly. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

People had been involved in decorating their bedrooms as well as the dining room and living room which had recently been redecorated.

People were supported to have enough to eat and drink in ways that met their needs and preferences. People were supported to make choices about what they wanted to eat and encouraged to help prepare meals where they were able. Where people required specific foods or food textures, these were provided by staff who understood people’s needs.

There was open and effective management at Whitehatch. The registered manager led by example to ensure best practice was followed. People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were effective systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

During our inspection we spoke with four staff, four people who used the service, the registered manager and the regional operations manager. We carried out observations on how quickly people were being attended to by staff and looked at staffing rotas and associated paperwork to reach a judgement.

Staff we spoke with told us there were not enough staff on duty and we heard from some people they would like more staff in order to go out more often to meet their social need's.

We found the provider was not meeting all of the regulations set out in the Health and Social Care Act in relation to staffing.

Below is a summary of what we found based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

We spoke with three people who used the service. We looked at three people's care records. We spoke with three staff and looked at three staff records. At the time of the inspection the service was providing care and support to 11 people.

Is the service safe?

Safeguarding procedures were robust and staff understood how to safeguard people they supported. The Care Quality Commission monitors the operation of Deprivation of Liberty Safeguards which is applied to care homes. Proper policies and procedures were found to be in place for submitted applications.

Risk management plans and care records were detailed and promoted people's rights and dignity. One person said: 'I can say what I want' when we asked if they were offered choices. We observed care staff signed each person's care record to state they had read and understood them.

Systems were in place to make sure managers and staff learnt from events such as accidents/incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The provider took people's care needs and preferences into account when making decisions about the numbers, skills and experience required when allocating staff. One person told us: 'Sometimes there is loads of staff...if they are short of staff I can't go out.'

The manager informed us there had been occasions when staffing levels were below what they had planned. They used agency staff and were recruiting new staff to ensure people's needs were met.

Recruitment practice was safe and thorough in respect of the provider obtaining Disclosure and Barring Service checks and at least two references. However we noted there were some gaps on staff application forms in respect of previous employment. The manager said they would ensure this was addressed.

We observed the environment was suitably designed and adequately maintained and regular maintenance was carried out.

Is the service effective?

Care plans reflected people's current needs, choice and preferences and were reviewed regularly. We invited the manager to tell us why reviews were not always completed with the person. The manager told us they were ensuring further staff training in person centred planning to facilitate this. We observed people using the service communicating their wishes with staff and the staff were responsive and effective.

People's nutritional needs were met and staff ensured people's individual dietary and preferences were met. People chose where to eat and staff were competent in supporting and monitoring a person's diet and fluid intake. We invited the manager to comment on why records were not always completed. The manager told us they were ensuring staff were aware of the importance of accurate and detailed record keeping.

Is the service caring?

Feedback from people was positive, for example one person told us: 'I'm happy with the service.' Another person told us: 'I like it here and I like the staff.' When speaking with staff it was clear they genuinely cared for the people they supported.

People's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided in accordance with people's wishes.

Is the service responsive?

People were offered support to make a complaint if they were unhappy. People could be assured complaints were investigated and action taken as necessary.

The service worked with other agencies and services to make sure people received care in a consistent way. People had access to health care professionals such as the GP, dentist, optician and attended hospital appointments which meant people were supported to keep healthy and well.

We observed people were comfortable in interacting with staff and staff were polite, responsive and knowledgeable about people's individual needs and preferences. One person us: 'If I want anything, I can ask staff'my keyworker is very nice and asks how things are.'

Is the service well-led?

The service had a quality assurance system, and records showed concerns were addressed promptly. People who used the service were enabled to have their views heard and acted upon. This helped in ensuring people received a good quality service.

We found the provider had in place business contingency plans for management of foreseen emergencies such as lighting or heating failure and staff were aware of the policies and procedures to follow.