Whitegates & The Cottage

Whitegates and the Cottage comprises three adjoined houses and a separate cottage providing accommodation and support for up to 21 people who have a learning disability, some of whom also have a physical disability. Whitegates and the Cottage is in the village of Liss in Hampshire

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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The culture in the home was not risk adverse. People were supported to take positive risks and the service was passionate about promoting people’s independence.

The provider's vision and values focused on person-centeredness, being passionate about making a difference to people's lives and ensuring positive outcomes for people. Care was person-centred and promoted people’s choice, independence, dignity and privacy. We observed that staff understood and cared for people in a manner that was in keeping with these principles of right support, right care and right culture.

There were appropriate policies and systems in place to protect people from abuse and there were robust processes in place for investigating any safeguarding incidents that had occurred. Staff consistently told us they were confident that concerns would be responded to appropriately. We observed staff were appropriately deployed during the inspection and relatives and staff confirmed there was sufficient staffing in place. Medicines were administered safely by staff who knew people well. Systems were in place to ensure people's medicines were managed safely.

We were assured that the provider was preventing visitors from catching and spreading infections and we were assured that the provider was making sure infection outbreaks can be effectively prevented or managed. The provider had utilised different communication methods to support people to maintain contact with their relatives and friends throughout the pandemic.

Relatives and staff were positive about the service and the management team. Staff had access to policies and procedures which encouraged an open and transparent approach. The COVID-19 pandemic had placed additional pressures on the service, and we saw, and were told, about how the service had adapted to support people to be safe. People’s emotional wellbeing had been a priority for the provider and people had been supported in a person-centred way to manage the impact of the pandemic. The provider had quality assurance procedures to help drive ongoing improvements within the service and had developed close links with external agencies to ensure best outcomes for people.

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 17 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding. We made a decision A to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whitegates and the Cottage 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. If we receive any concerning information we may inspect sooner.

Whitegates and the Cottage comprises three adjoined houses and a separate cottage providing accommodation and support for 20 people who have a learning disability, some of whom also have a physical disability. Each of the houses and the cottage accommodates five people. Whitegates and the Cottage is in the village of Liss in Hampshire.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection the service achieved an overall rating of Good with a Requires Improvement rating in well led. This was due to the registered manager not sending the appropriate notifications to us for injuries to people in the service, or for applications made to deprive people of their liberty.

The failure to notify us of these incidents were breaches of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations 2009.

At this inspection we found the registered manager was submitting notifications appropriately for injuries and for applications to deprive people of their liberty. This meant that sufficient improvements had been made so the provider was no longer in breach of this regulation.

The service had a registered manager. A registered manager is a person who has registered with the 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.

Robust systems were in place to protect people from harm and abuse. Staff had received the necessary safeguarding training which was regularly updated. The registered manager ensured that sufficient staff were deployed to keep people safe and meet their needs. There were safe recruitment processes in place to make sure the provider only employed staff who were suitable to work in a care setting.

People were protected from risks to their safety and wellbeing. Risks to people were assessed, recorded and managed safely. Care plans contained sufficiently detailed information for staff about how to manage these risks. People's medicines were stored, recorded and administered safely by trained staff who had their competency regularly assessed. People received care from appropriately skilled, knowledgeable and trained staff who received regular supervision to help develop their knowledge and skills.

People were protected from the risk of acquiring an infection. Suitable personal protective equipment was available and was used appropriately by staff. The registered manager recorded accidents and incidents and supported staff to reflect on these to prevent reoccurrences.

Staff were aware of the legal protections in place to protect people who lacked mental capacity to make decisions about their care and support and implemented them in their practice. People were supported to maintain a balanced diet. Staff encouraged people to make healthy meal choices whilst respecting their preferences. People were supported to participate in cooking.

People had access to care from relevant health and social care professionals. Staff had developed caring relationships with the people they supported. Staff encouraged people to express themselves and promoted their independence, privacy and dignity. Care plans were written in partnership with people and their families, were regularly reviewed and accurately reflected the care and support people needed.

The provider had processes in place for investigating and responding to complaints and concerns. A complaints policy was available to people in an easy read format. People who lived in the home were not receiving end of life care, however, staff had held sensitive discussions with people about what they would like to happen as they approached the end of their lives and after they passed away where it was appropriate to do so.

Robust systems were in place for monitoring the quality within the service to drive improvements. The registered manager maintained a detailed, up to date service improvement plan and completed regular audits. Staff worked effectively in partnership with health and social care professionals to meet people's needs.

Whitegates and the Cottage had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service is required by a condition of its registration to have a registered manager.

People can be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA) 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). During this inspection we found where people lacked the capacity to agree to the restrictions placed on them to keep them safe, the provider made sure people would have the protection of a legal authorisation and had made the appropriate DoLS applications to the local authority.

Where the provision of people’s care required restrictions upon their movements, the provider was able to demonstrate following the inspection that legal requirements had been met.

We found that the registered manager had not consistently followed the requirements of their registration to notify CQC of specific incidents relating to the service. We had not been notified of all injuries to people so that we could check that the provider had taken appropriate action to keep them safe. We also had not been notified of the outcomes of the service's applications to deprive people of their liberty so that we could monitor whether the service met the DoLS requirements.

There were sufficient staff to meet people’s care needs at Whitegates and the Cottage. When there were absences, for example due to sickness, the provider managed these internally by deploying staff flexibly across the houses. They also used regular agency staff in order to ensure staffing levels were maintained to keep people safe. Recruitment procedures were in place to ensure that people were protected from the risk of employment of unsuitable staff.

Staff understood their role in relation to keeping people safe from the risk of abuse. A safeguarding policy was in place and staff knew how to identify concerns and what action they would need to take to report any suspicions or allegations of abuse.

Staff received an appropriate induction and continued to receive regular supervision and relevant training in their role. People were cared for by staff who had received appropriate training and support.

Risks to people had been assessed and measures were in place to manage them. Staff understood the risks to each person and ensured these were managed appropriately. There were systems and processes in place to ensure people’s medicines were managed safely and that their administration was documented. Staff had undertaken training to enable them to administer people’s daily medicines safely and their competence was regularly checked by registered manager or her deputy.

There were processes were in place to monitor the quality of the service and identify the risks to health and safety of people. Where systems had been effective in identifying any shortfalls or issues of concern, actions had been taken to ensure that recommendations were acted on to improve the quality of service provided and keep people safe.

People were supported to eat and drink enough to maintain a healthy balanced diet. They had access to freshly cooked food which looked and smelt appetising. People enjoyed their meals and had the freedom to choose when they wanted to eat meals and snacks.

People’s records demonstrated they were supported by staff to see a range of health care professionals. Referrals were made to enable people to access healthcare services when they needed to.

Staff were kind and warm in the ways that they supported people to help ensure that people had a positive and personalised experience of care. They communicated with people in a way which made them feel included and that they mattered. Staff were knowledgeable about people and had the skills, understanding and motivation to deliver good quality care. Relatives spoke positively and enthusiastically about the quality of care provided to people by staff at Whitegates and the Cottage.

People were supported by staff to be involved in decisions about what they ate, what they wore and what they wanted to do each day. Staff had access to guidance about how to communicate with people, which they followed. Staff and relatives were able to describe to us how people’s privacy was maintained when their care was provided. Staff treated people with respect when they were delivering care and support to them and encouraged them to be independent where they were able.

Staff had a good knowledge of each person’s care needs, interests and characteristics and care plans were person centred. Staff supported people to attend activities which enabled them to lead stimulated and fulfilled lives wherever possible.

The service was responsive to feedback and put in place improvements where these were identified. Relatives told us they had little cause to complain, but would feel comfortable in approaching the staff who looked after their loved ones or the registered manager if they had any concerns.

The registered manager was supportive of staff and ran a well-managed supervision and appraisal system. Policies and procedures were in place and available to staff. Staff applied the provider’s values in their work with people, which included ensuring that people were treated as equals and had choice in their lives. The culture of the service was person centred, and it was clear that people’s experience of care was a priority for staff.

We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People we spoke to told us they were happy with the care being provided by the home. One person told us "Staff nice". Another person told us "If I need anything I don't have to hesitate to ask".

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke to told us that they felt safe in the home and that they would speak to a member of staff if they had any worries.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We spoke to three members of staff who told us that they felt supported and enjoyed their work.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. We asked to see the log of complaints and were told that there had not been any in the last year

We spoke with two people who used the service. We made observations of interactions between the people who used the service and staff. People told us about the community activities they were involved in and how they could make their own decisions about what to do and when. One person said, "staff help me I like going to discos.' People said they were happy living at Whitegates and The Cottage and didn't have any complaints. A sample of people's comments about their lives at the home included, 'it's good I like my bedroom.' and " I have friends and I am happy. '

People knew about their care plans, or had been involved in discussions with staff about their care and support. People said they liked the meals and were able to choose what they had to eat. People told us they like their rooms, the home was well maintained and always clean and tidy.

People told us they thought there were sufficient staff on duty and this was confirmed from records viewed.

The quality monitoring systems were effective and ensured the service was monitored and good standards maintained for people.