White Cliffs Lodge

White Cliffs Lodge is a care home providing accommodation and personal care to up to maximum 15 people. The service provides support to people who need support with their mental health and or people with a learning disability and autistic people. At the time of our inspection there were 13 people using the service.

The service was separated into two houses, White Cliffs Lodge and White Cliffs Court. White Cliffs Lodge supported 6 people. White Cliffs Court supported 7 people in their own self-contained flats.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Staff did not always support people to achieve their aspirations and goals. Staff were not always able to support people to take part in activities and pursue their interests in their local area due to the availability of drivers. People were not supported to have maximum choice and control of their lives and staff did not always 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. For example, best interest meetings had not always been carried out. However, following inspection the provider carried out best interest meetings with family members where a need was identified.

Right Care

Staff had not always protected people’s privacy and dignity. Not all people had curtains or blinds at their windows. Staff had not consistently applied their safeguarding training as incidents were not always recorded or reported in line with guidance, not all staff had completed their safeguarding training. People were not always supported in line with their care and support plans, for example, some people were at risk of choking and staff had not always followed guidance, resulting in choking episodes. We observed kind and caring interactions between people and staff during inspection

Right Culture

The culture of the service did not always enable staff to continuously learn and improve. For example, lessons learned from incidents were not always analysed and shared with staff. The service had recently introduced the use of advocates to support people. The service was aware of some of the concerns we identified on inspection and had already started to implement a service development plan to address the issues.

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 24 January 2019).

Why we inspected

We received concerns in relation to the management of people’s specific health risks and their safety. As a result, we undertook a comprehensive 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.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to people’s safety, how the service manages and mitigates risks to people and the overall governance and running of the service, person centred care and the skills and competencies of staff.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

White Cliffs Lodge 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. White Cliffs Lodge is privately owned service providing care for up to 15 people. The accommodation comprises of two adjacent buildings. In one of the buildings there are six purpose built self-contained flats and in the other building there is accommodation for six people. At the time of the inspection there were 13 people living at White Cliffs Lodge.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. The service continues to be rated Good.

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. The service ethos is to enable people with learning disabilities and autism to live as ordinary a life as any citizen.

People and relatives praised the staff and management of White Cliffs Lodge and staff felt supported and valued by the registered and deputy managers. 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 and associated Regulations about how the service is run.

The atmosphere at White Cliffs Lodge was warm and friendly. People and staff interacted with kindness and respect and people living at White Cliffs Lodge were supported to live full and enriching lives as much as possible. There was an inclusive, supportive and homely culture that reflected the providers visions and values. It was clear that staff knew people well and had the appropriate knowledge and training to keep people safe. Positive risk taking was encouraged to ensure people could maintain skills and experience new things. We saw people engaged and enthused taking part in activities of their choosing at White Cliffs Lodge.

There continued to be enough staff to support people. Staff continued to have the training and support to provide people with high quality care that responded and adapted to people's changing needs. Staff had a good working relationship with associated professionals, so people received care and support from professionals as and when they required it. Relatives told us that they were kept informed of changes in people's physical and emotional health.

Medicines continued to be managed safely and daily checks ensured that any shortfalls were quickly identified and resolved. The clean and well-maintained premises continued to meet the needs of people. Peoples accommodation promoted their independence and were decorated in a way that reflected their individual personalities. Staff knew how to protect people against the spread of infection.

Care continued to be guided by developments in best practise. The provider attended a variety of forums and developments were passed down to management and discussed in team meetings and through training sessions. Care plans were person centred and thorough and were written with people, in a way that was meaningful to people. Peoples communication needs were assessed and staff used different methods to enable people to communicate their views and choices in their own way, through communication aids, signs and through discussions and reviews.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff worked with people and their relatives to ensure that care plans and support reflected their care needs. The management were in the process of finding out peoples end of life preferences.

The registered manager sought feedback from people using the service, staff, relatives and health professionals and an accessible complaints procedure was available. Complaints, compliments, accidents and incidents were recorded, and these were collected and analysed by both the registered manager and the provider to identify patterns and if lessons could be learnt.

People's information was kept securely in the office and staff were respected people's privacy, dignity and confidentiality. The previous CQC rating of 'Good' was displayed on the provider's website and in the hallway for people to see.

Further information is in the detailed findings below.

White Cliffs Lodge is a privately owned service providing care for up to 15 people with learning disabilities. There were 13 people living at the service at the time of the inspection. The care and support needs of the people varied greatly. The accommodation comprises of two adjacent buildings. In one of the buildings there are six purpose built self-contained flats (known as 'The Court'). There were six people living in this part of the service and they were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted. They were encouraged and supported to be as independent as possible. Some of them were able to go out independently.

In the other building there was single occupancy accommodation for seven people (known as 'The Lodge'). The people in this part of the service needed more assistance and support with their daily activities. Some of them were not able to communicate using speech but used sign language or body language to express themselves.

Rating at last inspection

At the last inspection, the service was rated good and requires improvement in the ‘safe’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 July 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for White Cliffs Lodge on our website at www.cqc.org.uk

At this inspection we found the service remained good and is now rated good in the ‘safe’ domain.

Why the service is rated Good

The service had improved since the last inspection. Potential risks to people were now identified and there was guidance on how to safely manage the risks. People received the interventions they needed to keep them as safe as possible. Risk assessments were designed to keep risks to minimum without restricting people’s activities or their life styles and promoting their independence, privacy and dignity.

Staff recruitment policies and procedures had been reviewed and a new system was in place. This made sure staff were fully checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively. Further details of how decisions were made to employ staff who may need to be monitored were in place.

People received their medicines safely and when they needed them. On the first day of the inspection not all medicines were stored at the correct temperature to make sure they worked effectively. The room temperatures where medicines were stored were not consistently recorded. Staff took immediate action to address this issue. On the second day of the inspection all medicines were stored safely and at the recommended temperatures.

Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

Safeguarding procedures were in place to keep people safe from harm. These procedures had been followed by the registered manager when necessary. Staff had been trained in safeguarding adults and they knew what action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the registered manager, or outside agencies.

There was enough staff on duty to keep people safe and give them the care and support that they needed.

White Cliffs Lodge is a privately owned service providing care for up to 15 people with learning disabilities. There were 13 people living at the service at the time of the inspection. The care and support needs of the people varied greatly. The accommodation comprises of two adjacent buildings. In one of the buildings there are six purpose built self-contained flats (known as ‘The Court’). There were six people living in this part of the service and they were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted. They were encouraged and supported to be as independent as possible. Some of them were able to go out independently. In the other building there was single occupancy accommodation for seven people (known as ‘The Lodge’). The people in this part of the service needed more assistance and support with their daily activities. Some of them were not able to communicate using speech but used sign language or body language to express themselves.

There was a registered manager working at the service and they were supported by a deputy 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.

We carried out an unannounced comprehensive inspection of this service on 19 March 2015. Three breaches of regulations were found. We issued requirement notices relating to consent, safeguarding service users from abuse and staffing. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that two of the breaches in the regulations had been met and one had been partially met. We found another breach in the regulations in relation to the safe care and treatment of people. Therefore, the provider had not fully met their legal requirements.

Some risks to people had been identified but guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. Some areas concerning risks to people needed developing and action was needed to make sure people were as safe as possible. The registered manager told us these would be addressed. On the whole there was guidance in place for staff on how to care for people effectively and safely and keep most risks to minimum without restricting people’s activities or their life styles and promoting their independence, privacy and dignity.

Although there had been improvements some staff continued not to have all the support they needed to make sure they could care safely and effectively for people at all times. Staff had not received regular one to one meetings with a senior member of staff and not all staff had received an annual appraisal.

On the whole staff were recruited safely. Checks were carried out before staff started to work at the service to make sure they were safe to work with people. Further details of how decisions were made to employ staff who may need to be monitored were not in place. This is an area for improvement.

Staff had completed induction training when they first started to work at the service and had gone on to complete other training provided by the company. There were regular staff meetings. Staff said they could go to the registered manager at any time and they would be listened to. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. People said there was enough staff to take them out and to do the things they wanted to.

Staff assumed people had capacity and respected the straightforward decisions they made on a day to day basis. When people needed help or could not make a particular decision on their own, staff supported them. Decisions were made in people's best interests. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. We received information from the service informing us that some people had applications granted to deprive them of their liberty to make sure they were kept as safe as possible. This was a shortfall at the last inspection but the breach in the regulation had now been met.

Safeguarding procedures were in place to keep people safe from harm. The provider had taken steps to make sure that people were safeguarded from abuse and protected from the risk of harm. People told us they felt safe at the service; and if they had any concerns, they were confident these would be addressed quickly by the registered manager or the deputy manager. The staff had been trained to understand their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures. This was a shortfall at the last inspection but the breach in the regulation hads now been met.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People knew who their key worker was. Staff were caring and respected people’s privacy and dignity. People were involved in activities which they enjoyed.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure they would be able to offer them the care that they needed. Each person had a care plan which was personal to them and that they or their representative had been involved in writing. Most of the care plans contained the information needed to make sure staff had guidance and information to care and support people in the way that suited them best. Plans were in place for behaviours that challenge and supported positive behaviour support techniques. People’s care and support was reviewed every year.

People received their medicines safely and when they needed them and they were monitored for any side effects. People received appropriate health care support. People’s health needs were monitored and referrals made to health care professionals if any concerns were identified.

People were offered and received a balanced and healthy diet. They could choose what they wanted to eat and when they wanted to eat it. People looked healthy and had a wide range of foods to cook and prepare. When people were not eating well the staff made sure they were seen by dieticians and their doctor. Extra food and snacks and supplement food and drinks were given to people so they maintained their weight and stayed healthy. People’s rooms were personalised and furnished with their own things. The rooms reflected people’s personalities and individual tastes.

The complaints procedure was on display in a format that was accessible to people.. Feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible. Staff told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within White Cliffs Lodge which allowed them to suggest new ideas which were often acted on. Checks on the quality of the service were regularly completed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with some people and also observed the interactions between the people and the staff. We saw how people responded and reacted with the staff.

People who used the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond in a caring and positive way.

Staff knew the people well and were able to communicate with them using a range of methods. If people were unhappy about something the staff were able to recognise the signs and take the appropriate action to resolve any issues. People told us that they felt safe and well looked after. Some people told us that they could talk to staff about any problems and they would listen.

Staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported. People received assistance to maintain a healthy, active lifestyle. They were supported to attend health care checks and community health professionals were involved to provide advice and intervention when needed.

There was enough staff on duty to meet support and meet people's needs.

The views of the people who use the service were listened to and acted on.