Archived: Otterhayes

Updated 19 February 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector on 24 November and 4 December 2020 and two inspectors on 17 December 2020. An assistant inspector contacted staff to seek their views on 3, 4 and 7 December 2020. An Expert by Experience contacted relatives on 9 December 2020 to seek their views. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Otterhayes Trust provides accommodation and personal care for a maximum of six people living with learning disabilities and/or autism in a property known as Hayes House. At the time of the inspection there were five people living in Hayes House. 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.

This service also provides care and support to people living in seven supported living' settings, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

The service had two managers registered with the CQC. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection on 24 November and 4 December 2020. This was because the service is small, and people are often out, and we wanted to be sure there would be people at home to speak with us. The third day of our inspection on 17 December 2020 was unannounced to follow up on specific areas of concern raised by staff and relatives.

What we did before the inspection

Prior to the inspection we reviewed the information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law. We also reviewed the information the provider sends us every month about the progress they are making in meeting the on-going breaches of regulation identified at our last two inspection.

We spoke with various health and social care professionals as part of the whole home safeguarding process, which was closed on 29 September 2020.

During the inspection

We spoke with two members of staff, the registered managers and interim operations director. We spoke generally with people living at Otterhayes and observed interactions between them and staff. After the inspection we spoke with/emailed an additional eight members of staff and spoke to six relatives.

We also requested documents to be sent to us, including care plans and risk assessments, the training matrix, supervision records and various documents with regard to the running of the service. For example, audits, policies and procedures, meeting minutes, incident and accident records and health and safety checks.

After the inspection

Following the inspection, we spoke by telephone to the independent consultant. We also spoke with 12 health and social care professionals as part of the quality assurance and improvement process.

Updated 19 February 2021

About the service

The Otterhayes Trust provides accommodation and personal care for a maximum of six people living with learning disabilities and/or autism in a property known as Hayes House. At the time of the inspection there were five people living in Hayes House. This service also provides a domiciliary care agency service and provides support to a further 15 people living in seven supported living properties, with the aim that they can live as independently as possible. One person living in the supported living properties was receiving personal care

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

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.

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.

The service was able to demonstrate how they are working towards meeting the underpinning principles of right support, right care, right culture.

Right support: Model of care and setting maximises people’s choice, control and Independence. For example, people being encouraged to set goals for things they want to achieve.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights. For example, ensuring people are receiving person-centred care and support in line with individual care plans.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. For example, adopting ‘active support’ which is a method of enabling people with learning disabilities to engage more in their daily lives.

Although the service is larger than recommended, the introduction of positive support plans with health and social care professionals’ involvement; people’s preferences, hobbies and interests were now being considered. Individualised activities meant people were enabled to follow their interests' hobbies and passions as far as possible. However, this had been curtailed by the pandemic and lockdown restrictions.

People’s equality, diversity and human rights were respected. The service had adopted an ‘active support’ approach, which is accredited with the British Institute of Learning Disabilities (BILD). Active support is a method of enabling people with learning disabilities to engage more in their daily lives.

The service provided safe care to people. During our inspection we spent a short time speaking with people who used the service and observed how staff interacted with them. People were comfortable in their surroundings and with the staff group who supported them. Positive feedback was received from relatives. Relatives comments regards to safeguarding concerns included: “Absolutely none at all, if I did (relative) wouldn’t be there at all.”

Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. Medicines were safely managed on people’s behalf. Infection control measures were in place and taken seriously to protect people.

Care files were increasingly becoming more personalised to reflect people’s personal preferences. People had individual planners and communication boards in place to aid routines and communication. Goal setting for people continued to be implemented to ensure they lived the lives they want to. People were encouraged to maintain relationships with their friends and family.

People were supported to maintain a balanced diet of their choosing. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff provided care that was kind and compassionate. People’s privacy and dignity were respected. People were increasingly being encouraged to be as independent as possible. Staff adopted a positive approach in the way they involved people and respected their independence.

There were now effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent. Staff continue to receive regular supervision in order for them to feel supported in their roles and to identify any future professional development opportunities.

There were now opportunities for people to raise issues, concerns and compliments. A system was now in place to record complaints. Complaints were acknowledged and responded to in an appropriate time frame and other professionals informed and involved where appropriate.

Relatives confirmed that improvements were evident to the management of the service, but recognised further improvements were needed in order for them to feel confident that people's care and support needs were being appropriately met. We received mixed comments from relatives; “The quality of life and care are positively influenced by them (registered managers), I have the highest regard for their intentions.” Another relative thought the registered managers were ‘good with them and their relative’, but “Management skills are not what they might be.”

The principles of good quality assurance as a tool to drive improvement had been gradually implemented in stages and continued to do so. The provider's service improvement plan was continuing to attend to the deficits found at our last inspections and those identified through the local authority whole home safeguarding process.

Various audits had been implemented to oversee the running of the service. For example, audits covered ensuring care plans and risk assessments were up to date and accurate, infection control practices, incidents and accidents, staff personnel and training and activities.

The culture of the service continued to improve to ensure it was individually person-centred for people. Feedback from professionals acknowledged the enormous strides made to the service to improve the care and support people received and the active dialogue from the registered managers with health and social care professionals to improve outcomes for people.

We continue to receive statutory notifications in relation to safeguarding events and serious injuries in a timely manner.

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 inadequate (published January 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service continues to provide us with a monthly report in line with conditions that were imposed following the previous inspection. At this inspection enough improvement has been made, and the provider was no longer in breach of regulations.

This service has been in Special Measures since January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook a targeted inspection on 16 July 2020 to check whether the service had addressed some of the concerns raised at our last inspection in September and October 2019 where breaches of legal requirements were found. The provider completed an action plan after that inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Otterhayes 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.