Whitwood Hall

Whitwood Hall can accommodate up to 16 people across three separate houses, each of which have separate adapted facilities. These houses are known as Saxon, Moore and Lodge. The home supports people with autism, learning disabilities, complex needs and behaviours which may challenge others. On the day we inspected, 11 people were living in the home.

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

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.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people

using services lead confident, inclusive and empowered lives

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture. People were not being supported to access the local community in line with their assessed needs. We found there was confusion about whether agency workers were allowed to support people away from the home. This meant people were not empowered to have full control over the day-to-day routines. The provider has taken action since our inspection.

People were not supported to have maximum choice and control of their lives and staff were not enabled to support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There had been a lack of robust oversight at this home in the lead up to our inspection. At the beginning of July 2021, a home manager from a ‘sister’ service had been asked to take day-to-day control of Whitwood Hall. They were being supported by two area managers who were providing intensive support.

Training completion levels were found to be low in some areas. The provider was addressing this following our inspection. Staff received formal support through supervision.

Soap dispenser units in some people’s bathrooms did not have soap in them and a cover. This was addressed on the day of inspection. Staff largely wore their PPE correctly.

The premises were not in a good state of repair. The provider had identified this prior to our inspection and was taking action. However, it was evident that a regular programme of maintaining the three houses had not been suitably managed.

There were sufficient numbers of staff to meet people’s needs. However, we had concerns regarding the suitable deployment of staff to ensure there was an appropriate skills mix. Staff had been safely recruited with relevant background checks.

Relatives knew how to complain if they were dissatisfied. There was no record concerning the only complaint we became aware of and how it was dealt with, although we are aware this was resolved.

People and relatives felt the service was safe and that people were protected from harm. Staff received safeguarding training to ensure they knew how to recognise and report abuse. People received sufficient amounts to eat and drink. Healthcare support was provided for people when they needed this.

People and relatives were mostly positive about the care their loved ones received. We witnessed caring interactions between staff and people living in the home. Staff were familiar with people’s care needs and people’s privacy and dignity was being maintained.

Medicines were mostly well managed, with staff receiving training and a competency check for this. Medication audits were being completed.

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 outstanding (published 19 March 2019).

Why we inspected

The inspection was prompted due to concerns received about staffing levels, the state of the premises, staff not receiving training, people’s safety, leadership and an over reliance on take away foods. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider was taking action to address these areas at the time of inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the suitable deployment and training of staff as well as a lack of oversight of the home.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Whitwood Hall accommodates 16 people across three separate units, each of which have separate adapted facilities. The home supports people with autism, learning disabilities, complex needs and behaviours which may challenge. On the day we inspected 13 people were living at Whitwood Hall.

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.

There was a registered manager at the service. 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.

The registered manager drove the service with a strong vision to enable people to live fulfilled lives as independently as possible. There was a transparent culture and staff were confident in discussing issues or incidents in an open culture which promoted improvement. Excellent teamwork and communication was embedded across the home, with all staff having a clear understanding of each person’s role.

People were supported to take positive risks and be as independent as possible. People were enabled through encouragement and incentives to be as independent as possible and undertake as much as possible for themselves. All risk assessments were detailed and ensured people faced the minimal level of restriction. We found numerous examples where people had been supported out of their usual routines and encouraged to try new experiences.

People were enabled to participate in their preferred daily living activities at the times they wanted due to the exceptional staffing levels, which gave ample capacity to ensure people could go out whenever they wished. The service had actively sought to obtain mobility vehicles to ensure people who enjoyed car rides could do so at their preferred time rather than having to wait for the company vehicle.

Staff’s skills ensured hospital admissions due to people’s complex behavioural needs had been minimised. The service provided effective advocacy to support people receiving access to treatment.

The number of success stories shared with us showed people were at the heart of the service and celebrated achievements. Care documentation reflected people’s needs thoroughly and were constantly reviewed to reflect changes to people’s needs.

Staff were highly empathetic and knew people really well. Staff were extremely attentive, kind and compassionate. They also demonstrated how much they liked working with people in the service and had a strong focus on providing an atmosphere like any family home. Staff were calm and unobtrusive, allowing the person to be the focus of attention and promoting their equality. Staff were extremely knowledgeable and confident in ensuring better outcomes for people.

We found staff promoted privacy and respected dignity as this was embedded practice. The registered manager took an innovative approach to training in this area.

The quality assurance systems in place encouraged continual reflection and review of support provision, all with the ultimate goal of improving people’s lives. Holistic assessments of people ensured all aspects of support were in the best interests of the person and staff knew how to provide support effectively.

Medication was managed safely and people’s needs regularly reviewed. PRN, or ‘as required’, medication was always used as last resort as staff supported people with diversion and distraction activities which usually worked. The home was clean and we observed staff follow infection control procedures as needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service had not received any complaints but there was a well-publicised procedure.

Whitwood Hall is a residential care home for adults who have a learning disability and behaviour that challenges. It consists of three units, each one providing care and support for individuals with different levels of need.

The service is required to have a registered 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. The service did not have a registered manager. The manager had applied to register with CQC, but at the time of the inspection the application had not been finalised.

People who used the service told us they felt safe at Whitwood Hall. Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Effective recruitment and selection processes were in place and medicines were managed in a safe way for people.

There were enough staff to provide a good level of interaction. Staff had received an induction, supervision, appraisal and role specific training. This ensured they had the knowledge and skills to support the people who used the service.

People’s capacity was always considered when decisions needed to be made. This helped ensure people’s rights were protected in line with legislation and guidance.

People were supported to eat a balanced diet and meals were planned on an individual basis.

Staff were caring and supported people in a way that maintained their dignity and privacy.

People were supported to be as independent as possible throughout their daily lives.

The service was led by each individual’s goals and aspirations. Individual needs were assessed and met through the development of detailed personalised care plans and risk assessments.

People and their representatives were involved in care planning and reviews. People’s needs were reviewed as soon as their situation changed.

People engaged in social activities which were person centred. Care plans illustrated consideration of people’s social life which included measures to protect them from social isolation.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.

The culture of the organisation was open and transparent. The manager was visible in the service and knew the needs of the people who used the service.

People who used the service, their representatives and staff were asked for their views about the service and they were acted on.

The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of the people were met and that the service provided was to a high standard.

We saw that a range of care needs assessments had been carried out, and both appropriate and up to date care plans were in place. We saw care assessments which considered a broad and holistic range of needs. Each of the three staff members we spoke with would recommend Whitwood Hall to family and friends.

We were told all staff members had received safeguarding training. The three staff members we spoke with confirmed this and each could explain to us different types of abuse, and what they would do if they had concerns about a person's safety and welfare. All three staff were confident that if any safeguarding concerns were brought to the attention of managers they would be taken seriously.

We found evidence that Whitwood Hall worked with a range of other services and professionals to ensure the needs of its residents were being met.

We saw that an appropriate staff recruitment process was in place to ensure only persons fit and appropriate were employed.

We saw that Whitwood Hall had a range of up to date records, not only relating to the care needs of residents, but to the overall management and safety of the home.