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Inspection carried out on 29 April 2019

During a routine inspection

About the service: Whitstone House provides residential care for up to nine people with a learning disability and diagnosis of autism. At the time of the inspection there were eight people using the service.

People’s experience of using this service: The service provided spacious, generous accommodation which was unrestricted, and people could move around freely and access the garden and out buildings. The property was partly owned by Autism Anglia and partly by a housing association. We had some concerns about the safety and cleanliness of the building because audits were not sufficiently robust and had not identified potential hazards to people’s safety. We were however confident about the response of the provider to immediately address our concerns to ensure people were as safe as possible.

The management and oversight of the service had improved upon the appointment of a new registered manager who had started to identify and improve the service with the support of their manager. There had been no registered manager in post for a while after the previous manager left. Some of the governance processes had not been sufficient to identify gaps in the service provision. The service had been using high numbers of agency staff to help ensure they met their contractual arrangements for one to one staffing levels for some people. Since the new manager came into post agency usage had been significantly reduced and staff recruitment robust. This meant people had greater continuity of support by staff they had established a rapport with and were familiar with their needs.

Staff were being well supported with training being brought up to date and in line with their job roles and job description. Records supported a robust staff recruitment process and staff support and development.

Record keeping in general required improvement particularly regarding people’s care plans which were large documents and did not clearly and specifically show what people wanted to achieve and how the service supported them to do it.

People using the service had opportunities to go out and pursue a range of different activities appropriate to their needs. The staffing levels at the service made it possible to provide individualised support and people were supervised to help reduce any risks they might otherwise encounter.

People were supported to maintain good health and the service was proactive in monitoring and helping to manage people’s health care needs.

Staff were clear about how to support people who might lack mental capacity or unable to make decisions about their care, health and welfare. There was clear documentation in place where people could not consent particularly around access to health care.

People were supported to take the medicines they had been prescribed and there was clear guidance in place to ensure staff understood the benefits and side effects of medicines.

Rating at last inspection: Good: Report published 26 September 2016

Why we inspected: This was a planned inspection to check that the service remained Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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

Inspection carried out on 26 September 2016

During a routine inspection

This was an announced inspection that took place on 26 September 2016.

Whitstone House is registered to provide accommodation with personal care for adults with learning disabilities or autistic spectrum disorder. The home can accommodate up to ten people. The home has a communal lounge, conservatory and dining room. People each have their own bedroom and bathroom. At the time of our visit eight people were living at the home.

The provider has another home, Walnut House, which is also situated on the same site as Whitstone House and is managed by the same manager. The two homes have some staff who work across both homes and some of the provider’s records also relate to both locations. The two homes share communal gardens, swimming pool and garden rooms.

The homes registered manager had recently left, and the newly appointed manager was in the process of registering to become the 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff told us they worked as part of a team, and that the manager and deputy manager were supportive, encouraging and led by example. There was a strong caring culture in the care and support team.

Staff received the training they needed to deliver a high standard of care. Specialist professionals employed by the provider, such as a speech and language therapist, worked closely with and supported staff to deliver high quality care. People received individualised care in relation to their needs.

There were effective systems in place to manage risks, safeguarding and medicines, and this helped to keep people safe. Where people displayed behaviour that some people may view as challenging there was training and guidance given to staff. This helped them to manage situations in a consistent and positive way, and protected people's dignity and rights. The manager and staff ensured that people’s consent was obtained where they had the capacity to do so before providing support. There was a process in place to ensure that where people did not have the capacity to make decisions themselves, then this was done in their best interests on their behalf. People were able to contribute to the planning of their care.

People received care and support that was responsive to their needs. Care plans provided detailed information about people so staff knew exactly how they wished to be supported. People were at the forefront of the service provision and encouraged to develop and maintain their independence. People participated in a wide and varied range of activities. Regular outings were organised and people were encouraged to pursue their interests and hobbies.

The staff recruited had the right values and skills to work with people who lived at the home. Staffing levels remained at the levels required to make sure every person's needs were met and helped to keep people safe. The manager planned staffing resources flexibly and responsively so that people were able to enjoy a varied but well-structured day.

Systems were in place which continuously assessed and monitored the quality of the service provided at the home, including obtaining feedback from people and their relatives. Systems for recording and managing complaints, safeguarding concerns, incidents and accidents were managed well. The management took steps to learn from such events and put measures in place. This meant that lessons were learnt and similar incidents were less likely to happen again.

Inspection carried out on 12 August 2014

During a routine inspection

One adult social care inspector inspected Whitstone House. At the time of the inspection there were 10 people using the service.

We spoke with three people who used the service, one person’s relative, the assistant manager and three support workers. The registered manager was not available to speak with us. We reviewed the care records for three people. We also reviewed a selection of other records. These included staffing rotas, minutes from meetings and audit results.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

At the time of our inspection no person was subject to a DoLS authorisation. The assistant manager told us that they and the registered manager were currently applying for DoLS authorisations for all of the people who used the service. This was in relation to preventing people from leaving the service unaccompanied. The assistant manager told us that they had assessed people as lacking mental capacity and that the safeguard would help to protect people’s safety and welfare.

We saw evidence that there were enough suitably skilled, qualified and experienced staff on duty at all times. This included staff to provide one to one and two to one care for people.

There was a safeguarding policy and procedure in place and this was in date. All of the staff, including the bank and agency staff used, had received training in relation to safeguarding vulnerable adults. The provider undertook the necessary checks to ensure that employees were of good character before employing them.

We saw evidence that the provider’s audit schedule was effective. This included regular auditing of the quality of the service, as well as accidents and incidents and environmental risks.

Is the service effective?

The care and support that people received met their needs. All of the staff demonstrated a good understanding of the needs of people living with autism. We saw evidence that staff had received specialist training in relation to their roles and responsibilities.

Plans of care and risk assessments were regularly updated in order to reflect any changes in people’s needs. We saw evidence that staff helped people to achieve their goals and aspirations. Effective communication techniques were used and all information was presented in an easy read format to help people understand what had been written.

The provider had effective working arrangements with other health and social care professionals. This included psychologists and speech and language therapists. This helped to ensure that people’s care needs were being met.

Is the service caring?

All of the people told us that they were happy with the care and support that they received. One person said, “I am happy. I have been playing table tennis and the staff are nice.” Another person said, “I have been to the day centre and enjoyed myself. My key worker is good.”

We spoke with a relative of one person and they said, “The staff are very good with my (relative). They look after their priorities and needs. I cannot think of a better place for my (relative) to be in. They are so happy here. The service is wonderful and all of my (relative’s) needs are met.”

People received person-centred care. This meant that their care was individualised to their specific needs. It was evident that staff thoroughly understood the needs of the people that they were caring for, and treated people with compassion and respect. We observed staff interacting with people in a positive way. Different communication techniques were used to help ensure that the person understood what the staff member was saying. At all times, staff were courteous and caring towards the people they supported.

Is the service responsive?

The environment at Whitstone House was arranged to help meet the needs of the people who used the service. This included different areas where people could choose to spend their time. We noted that there were secure gardens, a swimming pool and numerous communal areas. One of the communal areas had been adapted for a person who wished to spend time alone.

It was evident that the care and support people received met their individual needs. People’s care plans included all aspects of the person’s daily living and there were support plans in place for staff to follow to help ensure that they responded to people’s needs in an effective way. People’s likes, dislikes and preferences were taken into consideration on all accounts. We noted that the activities people undertook reflected their hobbies and interests.

Each person who used the service had stated what their goals were. We found that their care and support was structured in a way that facilitated people to achieve their goals. The staff promoted people’s independence whilst ensuring that their safety and welfare was maintained.

The provider had a complaints policy and procedure and we saw evidence that they took account of complaints and comments to improve the service.

Is the service well-led?

All of the staff we spoke with spoke positively about the management team at Whitstone House. Staff told us that they felt well supported and were able to access specialist training. Each person told us that they were encouraged to raise any concerns or comments that they had. They told us that the management team always listened to what they had to say and responded to their comments appropriately.

Staff told us that the staff meetings held by the manager were meaningful and productive. All of the staff we spoke with felt valued and part of the team.

We noted that there was a positive culture within the service. The staff told us that the management team regularly worked alongside them while they carried out their duties in order to support them.

The service had effective quality assurance systems in place to assess and monitor the quality of the service that people received. This included monthly audits of all aspects of the service as well as regular meetings with the people who used the service. Included in these were appropriate action plans to address any shortfalls in the quality of the service provision.

Inspection carried out on 3 July 2013

During a routine inspection

People spoken with told us that they were happy in the service and that they were involved in their care. For example one person told us, “The staff always have time for me.” This and the other evidence seen showed us that this service respected people’s privacy, dignity and independence.

The individual care records reviewed demonstrated that people's care and therapeutic needs were recorded in detail and that they were being met in line with their assessed need. This meant that people experienced care, treatment and support that met their needs and protected their rights.

We saw that people were enjoying their lunch and could choose what they would like to eat and drink. This and the other evidence assessed demonstrated to us that people were protected from the risks of inadequate nutrition and dehydration.

Staff reported that they felt well supported by senior managers and by the provider and that there were good opportunities for training and career development. This showed us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The service was being audited monthly by the regional service manager with the assistance of the registered manager. We noted that any actions arising had been addressed. This demonstrated to us that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

Inspection carried out on 21 November 2012

During an inspection to make sure that the improvements required had been made

At our inspection on 26 July 2012 we found concerns in relation to the consent and recording processes in place at Whitstone House.

The purpose of this inspection, carried out on 21 November 2012, was to ensure that improvements had been made. We found that they had.

We found that the manager of the home had put in place processes which would ensure people were able to consent to their care and treatment and that should a person’s mental capacity need to be assessed in relation to a specific decision, records were in place to show how specific decisions had been reached.

We also saw records which demonstrated significant improvements in the way in which safeguarding referrals are recorded and monitored by the service.

Inspection carried out on 26 July 2012

During an inspection in response to concerns

We spent some time observing the care and support provided to the people living at Whitstone House. We observed that staff were kind, friendly and respectful.

We saw that people were enabled to do what they liked and staff supported them with this. For example, some people wished to go for a walk during the afternoon and staff accompanied them to do this. We also saw that people who wished to go outside in the garden were supported to do so.

Staff spoke with people in a respectful manner. They encouraged people to sit down where they kept wandering and involved them in conversation that was taking place in the home.

Inspection carried out on 20 April 2012

During an inspection to make sure that the improvements required had been made

Although the majority of people were unable to communicate their views verbally, we were able to observe people's non verbal communication cue's to inform us that people were relaxed and at ease with the staff who were supporting them. However one person we spoke to was able to tell us that they liked the staff and that they "Were kind to them and took them on holidays."

Inspection carried out on 8 November 2011

During a routine inspection

Although the majority of people living in Whitstone house could not communicate tehri views verbally, they showed many signs of well being. They interacted confidently with staff and were able to make their needs known by using a simple sign language.

People living in Walnut house were able to communicate their views and stated that they "liked the staff and that they are taken on nice holidays and out for lunch." Another person we spoke to said that they "Liked the staff and that people take me out to my daycentre." One person was also happy to show the inspector around the home showing that they were proud of where they lived and showed many signs of well being.

One person spoken to said that they "Liked the staff and that they were kind." Three people spoken to in Walnut house all felt that staff "were kind," caring and that they felt safe".

One person said that if they had a problem they would "Go to the staff and report it."

People living in Walnut house were able to confirm that they have regular service user meetings with one person stating that they "like meetings with their friends and the staff."

Reports under our old system of regulation (including those from before CQC was created)