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Inspection carried out on 16 July 2020

During an inspection looking at part of the service

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. Two people living in the supported living properties were receiving personal care.

Our inspection carried out in September and October 2019 found that the service did not always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

This targeted inspection found the principles and values of Registering the Right Support and other best practice guidance had started to be implemented to ensure people lived as full a life as possible.

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

During the inspection we spoke with two senior care staff. Following the inspection we spoke by telephone to six more. Overall staff said since the last inspection there had been some clear improvements. These included updated training on all key areas such as person centred planning, epilepsy, autism, infection control and safeguarding. Everyone we spoke with said this had been good and most could give an example of how this had impacted on their practice. For example, ensuring people could choose their own menus, choice of drinks, where they would like to go.

Staff said there had been improvements in the way they documented how they were working with people. Several staff said they had always worked in an inclusive and person centred way but they had not been good at documenting this.

At our last inspection there was a lack of adequate staff to meet peoples' needs placed people at risk. This targeted inspection found improvements had been made with staffing reflective of individual needs.

Staff said the management approach was moving towards being a listening and supportive approach. One staff member said, "The managers are respectful of staff, it seems to me they have worked very hard and when issues have been raised they have tried to address them."

Our observations of people showed staff interacting in a kind and respectful way. People appeared comfortable in their surroundings and several of them happily showed us their rooms and their homes which they were very proud of. During this inspection we spent a short time speaking with people who use the service and observing how staff interacted with them. It was clear people were comfortable in their surroundings. Staff appeared to have good relationships with people and interactions were kind and responsive.

Plans were starting to be more person centred but this was still work in progress. Some of the information within plans was repetitive and long winded. Information at the start of one plan began with their negative behaviours. This is not in keeping with best practice for person centred care plans.

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.

At our last inspection there were widespread and systemic failings identified; there were ten breaches of regulations. The shortfalls related to all the key aspects of the management of the service and included: safeguarding; safe care and treatment; person centred care; privacy and dignity; staffing; staff recruitment; complaints; statutory notifications, and good governance. This targeted inspection found improvements had started to be made. The service had b

Inspection carried out on 25 September 2019

During a routine inspection

About the service

Otterhayes is a 'care home' providing personal care and accommodation for up to six people living with learning disabilities, Down’s syndrome and/or autism. 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. At the time of this inspection five people were living in the residential home known as Hayes House within a rural, private community with gates to prevent vehicles entering the grounds at speed.

Otterhayes also provides support under a supported living scheme for an additional 15 people with learning disabilities, Down’s syndrome and/or autism living in their own homes as tenants. These were seven properties within the private community, all with links to the provider. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection the provider and registered managers did not understand what the regulated activity of personal care meant. We looked at the care provider to the 15 people living within the supported living scheme and found there were two people receiving personal care.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The providers and registered managers had managed the service for many years supporting people living with learning disabilities, Down’s syndrome and/or autism. However, neither the providers or the registered managers had heard of Registering the Right Support at the time of our inspection. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Following Registering the Right Support new services should not be developed as part of a campus style development such as Otterhayes as this does not follow best practice guidance. The negative impact on people was not mitigated by factors such as adequate staffing skills, effectiveness of management, and promotion of the principles of independence, choice and control.

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

Otterhayes is owned and managed by The Otterhayes Trust, a registered charity. Members of the same family have roles within Otterhayes. This includes the Trust chair, registered managers and support workers who also live on site. People, families and staff felt unsupported and unable to make complaints and be assured these were managed independently of the family. Other family members also worked as maintenance and support workers. Although management had tried to support staff with personal issues, professional boundaries with staff were blurred because robust processes were not in place. This had led to poor management of staff and low staff morale. Recruitment processes were not robust to ensure vulnerable people were safe and there was a lack of supervision and training to ensure people’s needs were understood and met.

Although there were some care plans, these were not always up to date, and staff did not use them as working documents to inform care delivery. Risks were poorly managed, and accidents/incidents were not always understood or recorded as such which put people and staff at risk.

There was a lack of person-centred care. Staffing levels were not reflective of people’s needs, there was no dependency tool to relate staffing levels to need. Staffing levels were set and not reviewed. People generally followed t

Inspection carried out on 17 April 2018

During a routine inspection

This comprehensive inspection site visit took place on 17 and 18 April 2018. The first day was unannounced and the second day was announced.

The Otterhayes Trust is a group of houses for adults with learning difficulties where up to 21 people they can be supported.

Otterhayes is the main house which is a ‘care home’ which accommodates six people in an adapted building.. 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 12 people living in four separate houses within the four acre grounds and to a couple living nearby in the local community, so they can live as independently as possible. Those people’s care and housing are provided under separate contractual agreements. CQC does not regulate the premises used for supported living; this inspection only looked at those people’s personal care and support.

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.

The service had two registered managers in post, who shared the role. 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.

People felt safe and had their care needs met by staff they knew and trusted. The risk of abuse was minimised because staff demonstrated a good understanding of what constituted abuse and knew how to report concerns within the service and to external agencies. People had a range of ways through which they could raise concerns. People’s concerns were listened and responded to. Safe recruitment practices were followed before new staff were employed to work with people.

Some aspects of safety needed to be improved relating to managing challenging behaviour, personal emergency evacuation procedures and environmental risks in the grounds for people living in Otterhayes. We have made two recommendations about this aspect.

People were encouraged to be creative and express themselves through a variety of inspiring and innovative ways. For example, through art, drama, music, dance and film. People received personalised care that responded to their changing needs. They were supported to live as independently as possible and were supported do their own cooking, shopping, laundry and housework, according to their ability. People had a wide range of hobbies and interest and were part of their local community.

People receive effective care from staff with the relevant qualifications and training and skills to meet their individual needs. For example, several people had limited verbal communication skills, but understood what staff were saying to them, as they used simple language and short sentences. Information was provided in format suitable for their individual communication needs, such as in picture and symbol easy read formats.

People were supported by staff who provided person centred, caring and compassionate care. People were partners in their care and were fully involved in decisions about their care and treatment. Staff treated people with dignity and respect.

New staff received induction and all staff had regular supervision and opportunities for further training and professional development. People were supported to see appropriate health and social care professionals regularly to meet their healthcare needs. People ate a well-balanced diet and received staff supported

Inspection carried out on 29 and 30 September 2015

During a routine inspection

This unannounced inspection took place on 29 September 2015. We returned on 30 September 2015 as arranged with the registered managers.

Otterhayes provides residential accommodation for up to six people who require personal care. They are not registered to provide nursing care. They are also registered to provide personal care to people who live in supported housing. The Otterhayes Trust is a registered charity. At the time of our inspection there were 20 people receiving a service from Otterhayes. This included six people living within the residential accommodation.

There were joint registered managers in post. 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.

People felt safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. 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. Medicines were safely managed.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. 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 strong, caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate.

There were effective staff recruitment and selection processes in place. Staffing arrangements were flexible in order to meet people’s individual needs. Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately. Staff spoke positively about communication and how the registered managers worked well with them, encouraged team working and an open culture.

A number of effective methods were used to assess the quality and safety of the service people received.

Inspection carried out on 6 November 2013

During a routine inspection

This inspection was carried out to review actions taken by the provider since the last inspection in June 2013 to achieve compliance. At this last inspection improvements were needed with outcome 4 Care and welfare of people who use services and outcome 14 Supporting workers. This inspection focussed on the residential accommodation only.

We found the service had taken a range of actions to achieve compliance, including reviewing and improving the care plans and risk assessments. A new office had been created which meant staff had good access to the care plans and relevant documents and guidance at all times. De-briefing sessions had taken place after incidents, and meetings had also been held where staff shared ideas and suggestions to improve the service. Guidance was provided to staff was easy to read and detailed.

Good staff support systems were in place including regular supervision sessions, handovers between shifts and a range of training. Staff were experienced and knowledgeable. We spoke with three staff on duty at the time of our visit. They told us they were well supported and had received a good range of training. They confirmed recent changes in care planning systems and management support were working well.

At the time of our inspection people living at Otterhayes were cheerful and relaxed. They were engaged in a range of activities including cooking, menu planning and games.

Inspection carried out on 28 June 2013

During a routine inspection

Otterhayes provides residential and supported accommodation for people with learning disabilities. We brought our planned inspection forward because we received information from the local authority safeguarding team about two incidents between two people living in the residential home. A safeguarding meeting took place a few days before this inspection to consider the safety of people living in the home and any actions that may be necessary to reduce the risk of recurrence. The people involved in the incident did not appear to have suffered any lasting harm.

On the day of this inspection the registered manager was away on holiday. Two acting managers were managing the home in their absence. A further incident had occurred just before we arrived. A member of staff had diffused the incident without the need to use physical intervention. We looked at the actions taken by the home to reduce the risk of further incidents. We found that two care plans did not provide sufficient information or instructions to staff about the things that may cause people to become upset or angry, how to prevent this happening or what to do if it occurred. Therefore behaviour that could be challenging for staff and distressing for people living at the home was not well managed and adequate steps were not taken to minimise challenging behaviour?

We looked at the support and training given to the staff team specifically around conflict management, restraint and safeguarding people from abuse. Some staff had worked in the home for many years and had received training in the past. For newer staff the level of training in these topics was low. The acting managers told us they were planning to provide further training in the near future. Records showed that formal supervision sessions for staff had recently been introduced. Staff told us there were informal support systems in the home. We did not see records of staff handover sessions during our inspection. The provider told us after the inspection these records were kept on the home's computer system.

The provider had failed to notify the Commission without delay about two incidents that occurred in the home. Since the safeguarding meeting the home has notified the Commission promptly when further incidents have occurred. This showed they are now aware of their legal duty to notify the Commission about matters affecting the service.

Inspection carried out on 31 January 2013

During a routine inspection

On the day of this inspection there were five people with learning disabilities living in the residential home known as Otterhayes. In addition the service provided a personal care service to 15 people who lived in supported accommodation situated either in the grounds of Otterhayes, or in the town nearby. During our visit we spoke with four people who lived in Otterhayes and three people who received a personal care service. We also spoke with four members of the management team, and three members of staff.

People told us the care and support they received met their needs and protected their rights. One person told us �They help us with what we have to do every day. They explain things. They always listen to us.�

People received a healthy and varied diet. They were supported to plan and prepare their own choice of meals and drinks. Comments included �The food is fab!�

People told us they felt safe. They were encouraged and knew how to speak out and raise any concerns or complaints. Staff knew how to protect people from the risk of abuse. Medicines were stored and administered safely.

People who lived in Otterhayes lived in comfortable, safe and well maintained premises. A person who showed us their bedroom told us �It�s perfect!�

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. They told us �The staff are nice!� and �The staff are fun � they are all friendly.�

Inspection carried out on 7 February 2012

During a routine inspection

This inspection took place on 7 February 2012. There were 5 people living in the main house known as Otterhayes at the time of our visit. They also provided support to 15 people who lived in the four houses situated in the grounds of Otterhayes, and one house in the centre of Ottery St Mary.

During our visit we talked to three of the people living in the main house, two people who lived in supported accommodation, and three members of staff. We also talked to the husband and wife team who set up Otterhayes Trust in 1984 and have managed the service since then and two members of their family who have assisted them in the management of the service.

People told us they were happy living there. When we arrived a group of people were going on a swimming trip and we heard about a range of activities people regularly enjoyed. Comments included �I like it here � I like making new friends.�

We looked at some of the records maintained by the home including care plans, risk assessments, staff recruitment and training records, and quality assurance procedures. We also looked at the way the home supported people to manage their money. We found that all records were well maintained and regularly updated.

There was a stable staff team, many of whom had worked at the home for a number of years. All of the staff team held a relevant qualification. They had also received a range of training on topics relevant to the needs of the people who received a care service. However, some staff had not received training or regular updates on important topics including safeguarding of vulnerable adults.

Following our visit we contacted five relatives to find out if they were satisfied with the care and services provided by Otterhayes. At the time of writing this report we had received four responses. They told us they were entirely satisfied with all aspects of Otterhayes. Comments included; �.. we are confident that X is well cared for at Otterhayes� , �I have nothing but praise for the quality of care that Y receives" and "With so many members of one family on the staff for so many years there is a wealth of experience and knowledge plus a close affinity with the residents. There is a deep sense of commitment to the welfare of the residents."

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