Otterbourne House

Otterbourne House is a care home which caters for up to nine people who may be living with autism, a learning disability, a personality disorder, bipolar or schizophrenia.

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

People were treated with dignity and respect by staff who understood the principles of the Mental Capacity Act and safeguarded them from the possibility of abuse.

Safe arrangements were in place for the management of medicines.

Effective procedures were in place to reduce the possibility of infections

People’s care needs were appropriately risk assessed and staff were trained to keep people safe during times when behaviours became challenging.

Staff and relatives were complimentary about the leadership within the home and told us they were provided with opportunities to provide feedback.

The provider had effective governance systems in place to drive improvement.

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.

Right support:

• We were assured the model of care and setting maximised people’s choice, control and

Independence.

Right care:

• We were assured care was person-centred and promoted people’s dignity, privacy and human rights.

Right culture:

• We were assured the ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

We previously carried out an Infection prevention and control inspection on 18 December 2020 and were assured their procedures were safe.

Why we inspected

We received concerns that people were being placed at risk due to inappropriate behaviour by staff. We were advised people were being discriminated against because of their individual characteristics. We found no evidence to suggest the allegations made to us were accurate and could not substantiate the claims. Following the last inspection the provider submitting an action plan and that we found improvements had been made and the provider was no longer in breach of the regulations.

The last rating for this service was requires improvement (published 24 October 2018). The service has now progressed to a good rating.

Otterbourne House is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection. At the time of our inspection there were nine people living in the service.

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.

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

People’s experience of using this service:

People’s relatives told us that their family members received inconsistent care.

There had been a large turnover of care staff which had resulted in the provider using agency staff, who did not always have the training or knowledge about people to provide effective care.

Relatives told us improvements were needed in the support people received around their nutrition to ensure they followed a healthy and balanced diet.

There had been a large turnover of management staff which had a negative effect on communication and working partnership between the provider and families.

The provider’s quality assurance systems were not always effective in identifying shortfalls in the quality of care.

The manager had recently joined the service and had made some initial improvements to the quality and safety of the service.

The positive changes at the service were not fully imbedded and the manager required more time to demonstrate that the improvements were sustained.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to good governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection:

At our last inspection, we rated the service good (13 December 2016).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

Otterbourne House, to be referred to as the home throughout this report, is a care home which provides residential care for up to nine younger and older adults with learning disabilities. People receiving the service also live with complex emotional and behavioural needs including autism. Some people living at the service also had additional health conditions such as epilepsy and cerebral palsy.

The care home comprises of single floor accommodation consisting of seven en-suite bedrooms in the main home which also had a main lounge and a smaller quieter lounge, dining area, laundry room and social area which had facilities including a juke box and pool table. The home was situated with its own communally accessed secure rear garden. Each person living in the main home also had patio doors which led from their bedrooms to a small fenced patio area allowing each individual their own outdoor space. Two annexes were situated in the grounds of the home, both of which comprised of a living room, bathroom, kitchen and a bedroom area. The home was situated on the outskirts of the village of Otterbourne. At the time of the inspection nine people were using the service.

The home has a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Most relatives of those using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

People were kept safe as the provider ensured sufficient numbers of staff were deployed in order to meet people’s needs in a timely fashion. In the event of unplanned staff sickness the provider sought to use existing staff including the registered manager to deliver people’s care or used regular agency staff to ensure familiarity for people living in the home.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as large scale staff sickness or accommodation loss due to fire or floods.

People were protected from the unsafe administration of medicines. Staff responsible for administering people’s medicines had received additional training to ensure medicines were administered, stored and disposed of correctly. Staff skills in medicines management were regularly reviewed by other staff including managerial staff to ensure staff remained competent to administer people’s medicines safely.

The provider used robust recruitment processes to ensure people were protected from the employment of unsuitable staff.

New staff induction training was followed by a period of time when they worked with experienced colleagues to ensure they had the skills and confidence required to support people safely.

People were supported by staff who had up the most relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The home promoted the use of advocates where people were unable to make key decisions in their life. This is a legal right for people who lack mental capacity and who do not have an appropriate family member or friend to represent their views about health issues and where people wish to live.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed an understanding of what constituted a deprivation of person’s liberty. Appropriate authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted. Conditions which had been attached to any authorisations had been met appropriately.

People were supported to eat and drink enough to maintain their nutrition and hydration needs. People were involved in developing the home’s menus and were able to choose their meal preferences. We saw that people enjoyed what was provided. People were supported to participate in meal times and where it had been identified people were at risk of choking guidance provided by health care professionals was followed. People’s food and drink preferences and eating support required were understood and appropriately provided by staff.

People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

Staff had taken time to develop close relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These skills were practically demonstrated both by the registered manager and staff during their interactions with people.

People received personalised and respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised care plans. Care plans contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. People were encouraged and supported by staff to make choices about their care including how they spent their day within the home or in the community.

Most relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. Relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager. Information was made available in alternative formats to allow people receiving the service to provide their feedback or complaints, thereby enabling them to feel valued.

People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. A range of activities were available to people to enrich their daily lives which included attending school to progress their academic potential. Staff were motivated to ensure that people were able to participate in a wide range of external activities and encouraged them to participate in external day trips they knew people would enjoy.

The registered manager fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events happened. This allowed the CQC to monitor that appropriate action was taken to keep people safe.

Most relatives told us and we saw that the home had a confident registered manager and staff told us they felt supported by the registered manager. The registered manager provided strong positive leadership and promoted the providers values which included providing person-centred care to people within a homely environment whilst promoting their independence with the aim to allow people to live semi independently. These values were known by staff and evidenced in their working practice.

Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided. People were assisted by staff that encouraged them to raise concerns with them and the registered manager. The provider routinely and regularly monitored the quality of the service being provided in order to drive continuous improvement.