Archived: Whiteoak

Whiteoak provides a respite service for people with learning disabilities. It can accommodate up to 21 people at any one time. Accommodation consists of a predominantly single storey building, split into three separate suites. One of the suites is over two floors. There is also a self-contained bungalow. At the time of the inspection, approximately 144 people were regularly using the respite service. On the days of the inspection 17 people were staying at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 21 people. However. the size of the service having a negative impact on people was mitigated by the building being separated into individual suites. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The registered manager and staff understood their responsibilities in keeping peoples safe from the risk of harm. However, we found regular checks on the premises and equipment had not always been completed and not all staff had attended a recent fire drill. Where an incident had occurred, people’s risk assessments had not been updated. The recruitment of staff and the management of people’s medicines was safe. Although the home was clean, not all staff followed good practice guidance regarding the infection prevention and control.

There was a programme of induction in place to support new staff. Staff told us they felt supported however, at the time of the inspection not all staff had received supervision in line with the registered providers policy. Staff received training but not all refresher training was up to date. People were supported with eating and drinking. People were enabled to access other health care professionals as required.

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 have made a recommendation about meeting the requirements of the Mental Capacity Act 2005. The service applied 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.

Staff were caring and kind. People were supported to make choices and to retain their independence. People were treated with dignity and respect. People’s right to privacy was respected. Peoples care records were person centred and detailed. Although they had not all been reviewed recently we were assured people were still receiving appropriate care and support. People attended activities and day services during their stay at Whiteoak. None of the relatives we spoke with raised any concerns regarding the care and support their family member received during their stay at the home.

The registered manager had only been in post since February 2019. Both the registered manager and staff understood their roles and responsibilities. Although the registered manager had not always sent notifications to CQC in line with their regulatory requirements. The registered manager had held a guest’s forum and a relatives meeting since they had begun to work at the service. Audits were completed but they had failed to identify the issues we have highlighted regarding risks to people’s safety.

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 7 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to safe care and treatment at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A long established registered manager was in place. 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.

At the last inspection in August 2014 we found the service delivered high quality care and rated the service as ‘Good.’ This inspection took place between 30 January 2017 and 1 February 2017 and was unannounced and we found the quality of the service had been maintained.

Due to people’s complex needs we were unable to ask them in detail about their care experiences. We spent time observing care and support and spoke with relatives of people who used the service. Relatives told us the service provided good quality care and that their relatives were happy to use the service.

We found people were safe from abuse. Staff understood safeguarding and we saw safeguarding procedures had been followed to help keep people safe. Risks to people’s health and safety were assessed and clear, person centred plans of care put in place which were well understood by staff.

Medicines were managed safely, with people’s medicines checked carefully by staff before support was provided. The decision to administration medicines in a covert or hidden way was done as part of a best interest process including a multidisciplinary team, however theses processes had not always been subject to regular review. We have made a recommendation about the management of covert medicines.

There were enough staff deployed to ensure people were safe, appropriately supervised and provided with social opportunities. Staff were carefully recruited to ensure they were of suitable character to work with people with learning disabilities.

The premises was safely managed. Whilst the service was undergoing extensive building work, this was being managed in a careful way with admissions restricted to ensure people were supported in a safe way with minimal distress.

Staff received training relevant to their role working with people with learning disabilities. This included training in autism, epilepsy and positive behaviour support. Training was largely up-to-date and staff demonstrated a good knowledge of the people and topics we asked them about.

The service was compliant with the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were involved in decisions about their care and support and best interest processes were followed where people lacked capacity.

The service assessed people’s healthcare needs and put in place appropriate plans of care. The service was good at liaising with external health professionals to access specialist knowledge.

People were treated fairly, with dignity and respect by the service. Staff were warm and kind with people. Staff knew people well and their individual likes and preferences.

Care and support was person centred, with adjustments made to the service to meet people’s individual needs taking into consideration their varied cultural and religious backgrounds.

People’s care needs were assessed and appropriate plans of care put in place, although some of these required updating, this had been recognised by the service and was being addressed. Documentation we reviewed, comments from relatives and health professionals and discussions with staff led us to conclude people’s care needs were met by the service.

People had access to a range of activities which were based on their own individual needs and preferences. This included internal activities and trips out.

Relatives told us they were satisfied with the service but felt able to raise any issues or problems with the management team. They said that when minor issues had been raised they had been dealt with effectively by the registered manager or deputy.

We found a positive and inclusive atmosphere within the home. Relatives and staff both praised the registered manager and staff said morale was good in the service.

Audits and checks were undertaken and along with people’s feedback were used to further improve the quality of the service.

All three relatives said they had no concerns and thought their relatives received good quality care. One person told us 'It is a good service, they really understand his needs.' Another person told us 'the care is excellent.'

We found the provider had systems in place to ensure valid consent was sought from people who used the service. Where this was not possible, processes were in place which ensured decisions were made in people's best interests.

We found staff displayed a caring attitude towards people in the home and people's care and welfare needs were properly assessed.

We found the home maintained a clean and hygienic environment and had suitable systems in place to reduce the risk of infection.

We saw evidence staff were well supported by the management structure in the carrying out of their duties and were provided with appropriate training and supervision.

We found the provider had an appropriate complaints system in place which ensured all complaints were recorded and fully investigated.