Whitwood House

Whitwood House is a residential care home which was providing accommodation for 12 people on each of the three days of our inspection. The service can support up to 16 people.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

• Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

• Staff supported people to achieve their aspirations and goals.

• The service worked with people to plan for when they experienced periods of distress so their freedoms were restricted only if there was no alternative.

• Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents. The use of restraint had significantly reduced due to the way people were supported.

• People had a choice about their living environment and were able to personalise their rooms.

• Staff enabled people to access specialist health and social care support in the community.

• Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

• Staff supported people to play an active role in maintaining their own health and wellbeing.

Staff shortages and a lack of drivers had impact on support for people to access the community.

The provider had not taken sufficient action following our last inspection to ensure the living environment had been maintained to a suitable standard.

Right care

• Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.

• People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

• Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

• Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

• People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

People were protected from abuse and poor care. The service had appropriately skilled staff the provider employed to keep people safe. People’s risks were assessed regularly and managed safely. People’s care, treatment and support plans, reflected their needs.

Records showed that medicines were well managed and people received their medicines as prescribed.

The service provided care, support and treatment from trained staff and access to specialists able to meet people’s individual needs.

Right culture

• People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.

• Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

• People and those important to them, including advocates, were involved in planning their care.

• Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

• The service enabled people and those important to them to work with staff to develop the service.

• Staff ensured risks of a closed culture were minimised so people received support based on transparency, respect and inclusivity.

Leadership from the registered manager was positive, and governance processes helped the service to keep people safe, protect their human rights and provide good care, support and treatment.

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

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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.

This service has been in Special Measures since 7 July 2021. During this inspection, the registered manager 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.

Enforcement

We have identified breaches of regulation in relation to insufficient action being taken in response to the last inspection findings and insufficient staffing levels.

Follow up

We will meet with the provider and request an action plan to understand what they will do to improve the standards of quality and safety. We will work with the 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 House is a residential care home providing personal care and accommodation for up to 16 people. These people may live with a range of complex conditions, including profound and multiple learning disabilities, autism, sensory and communication impairments, acquired brain injuries and complex behavioural needs. There were 13 people living at Whitwood House at the time of our inspection.

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

We found systems and processes used to ensure the service was running safely were not effective. We observed a lack of leadership, direction and oversight.

Risks associated with people’s behaviours were not managed safely. Risks had not always been assessed and there was a lack of guidance about how to manage some people’s behaviours. Incidents and accidents were not effectively reviewed to ensure lessons were learnt to drive improvements. We were not fully assured people were protected by the risk and spread of infection.

People were not supported to have maximum choice and control of their lives and staff did not 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.

Staff were not always deployed effectively to ensure people’s needs were met. Staff did not receive effective competency checks on their performance and abilities to ensure they carried out their roles and responsibilities safely. Systems in place to safeguard people from abuse were not effectively implemented. Following the inspection, we referred four safeguarding concerns to the local authority,

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 not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

People were subject to restrictive interventions that did not respect their rights. People had their own bedrooms but could not always access the shared lounges and kitchens.

Right care:

Care and support plans were not always reviewed or updated to reflect people’s changing needs. Staff did not always have the skill or guidance to respond appropriately in risky situations.

Right culture:

We identified a closed culture; people did not have their human rights upheld.

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 19 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the care people were receiving. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection. We have found evidence the provider needs to make improvements. Please see the safe, effective, and well-led domains of this report. Whilst we did not identify any impact on people, there was the potential for people to come to harm, as risks were not adequately assessed and there was an absence of key documentation.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whitwood House 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 monitor the service 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 safe care and treatment, premises, staffing and good governance at this inspection.

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We found the following examples of good practice.

Robust checks were in place for visitors to the home. Risk assessments were completed before visits were undertaken. Visitors wore appropriate personal protective equipment (PPE). Alternative forms of social contact, such as video and telephone calls, were in place. One person’s family had recorded voicemails to provide reassurance to that person when they weren’t available in person.

Staff encouraged people to maintain a social distance. Social distancing measures were in place for staff, for example, during breaks. Staff supported the same group of people each shift.

Good stocks of PPE were readily available. Staff wore PPE at all times. There were designated areas for staff to change into and out of their work clothes at the start and end of each shift. Staff had received additional training about PPE usage. People had been supported to understand the need for staff to wear PPE where this had caused anxiety.

Government guidelines were followed to support regular testing for people and staff. Clear processes were in place should someone test positive.

The home was clean. Team leaders directed staff to undertake cleaning and schedules were adhered to. Additional cleaning of communal areas took place. Cleaning schedules were in place and checks undertaken.

Whitwood House is a residential care home, providing personal care and accommodation for 16 people who may have a learning disability and or complex/physical health needs.

Whitwood House has three separate houses – Gatehouse, Coach House and Hanwell House. Another person lives in their own separate accommodation on the site.

People’s experience of using this service:

The 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 a learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service met the characteristics of good in all areas.

People and their relatives were positive about the support provided by the Whitwood House. There was a positive culture within the service where people, staff and relatives felt listened to. The manager felt supported by the provider and this flowed through the service.

Quality assurance systems were in place which ensured high standards were maintained. The manager was in the process of becoming the registered manager of Whitwood House. The previous registered manager left the service in December 2018.

People received safe care. There were enough staff to support people. Recruitment checks were completed to ensure staff were suitable to work with people in this environment. People were protected from harm and staff administered their medicines safely.

Staff understood the risks posed to people and had management plans in place. Lessons were learnt when mistakes happened. Staff followed infection control practices to protect people.

People were supported by staff to make their own decisions and choices. Staff were knowledgeable and understood the principles of The Mental Capacity Act.

The care that people received was effective. 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.

Staff received training and support to provide care effectively. People were provided with meals and plentiful drinks to maintain their wellbeing. People were supported by health care professionals to sustain their health.

Rating at last inspection:

Good: report published on October 2016.

Why we inspected:

This was a scheduled inspection based on previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Whitwood House provides accommodation for up to 16 people in three separate houses – Gatehouse, Coach House and Mansell House. Another person lives in their own separate accommodation on the site.

Our last inspection of this service took place in December 2013. At that time we found the service to be compliant with the regulations.

The service had in place 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.

We found the service provided a safe environment for people. Appropriate checks were in place to ensure the building and the grounds were maintained.

Staff were trained to give people their medicines and their competency to do this had been assessed. We found people’s medicine administration records were up to date and matched the stock held by the service. There were regular audits in place to ensure people’s medicines had been safely administered.

Staff were aware of how to report safeguarding concerns, or raise any other concerns they had about the service. Staff told us they would raise concerns with the management team.

The home met the requirements of the Mental Capacity Act and had made appropriate applications to deprive people of their liberty and keep them safe.

We found staff working in the service had been given an induction to the service, training and supervision so they could actively work in the service. Staff were clear with us and without having the appropriate training and skills to work with individual people they would not be allowed to support them.

People’s needs had been extensively assessed and continued to be assessed to ensure the environment and staff providing the service were up to date and knew how to meet each individual person’s needs.

Without exception people’s care plans were carefully constructed to give staff very specific guidance on how people should be cared for in the home. Changes to people’s plans on review were discussed with people and staff were encouraged to carry out plans consistently to avoid any distress to people who used the service. Staff were informed of any changes through daily communication and staff meetings.

Staff were caring and understood their role in ensuring people lived in a low stimulus environment. We saw staff treated people with kindness and respect. Relatives told us they were happy with the care provided as people talked about, “Going home” when they were due to return to the service.

Communication scripts were given to staff to ensure all staff spoke the same language and give the same messages to people which in turn promoted people's stability and their well-being.

People were able to identify the staff who were supported them as staff wore homemade badges with people’s photographs on them. This meant people were aware who were tasked to provide their care that day and could focus on them.

We found there was clear partnership working between the home and other professionals. The home sought advice and listened to the advice given in order to better meet people’s needs.

The service supported people to access the local community to meet their needs. People used the local bowling centre or local walks as well as do their shopping to meet their personal needs.

The management team acted as the drivers for improvement for the service. They carried out audits to measure the quality of the service and led staff meetings to discuss improvements to people’s care planning.

We looked at medication charts and reviewed records for the receipt, administration and disposal of medicines and conducted a sample audit of medicines to account for them. We found that records were complete and that people had received the medication they had been prescribed.

The provider had taken steps to provide care in an environment that was suitable and adequately maintained.

The service employed a team of care staff who carried out various roles. The service did not employ a cook nor domestic staff as these duties were seen as part of the therapeutic package to assist and encourage service users to be independent.

Staff members completed induction training when they first started to work in the home that prepared them to work with people with a learning disability. We spoke with three members of staff who told us that they liked working at Whitwood House, felt completely supported by their manager and felt confident in raising concerns should they need to. We were told by staff that they were supported with formal regular supervision and an appraisal system and that staff meetings took place for peer support.