We carried out an unannounced inspection of Whitegates and the Cottage on 20 and 22 September 2016. Whitegates and the Cottage consists of three adjoined houses and a separate cottage providing accommodation and support for 20 people with learning disabilities, some of whom also have physical disabilities. Each of the houses and the cottage accommodates five people. Whitegates and the Cottage is set in the village of Liss in Hampshire. Whitegates and the Cottage had a registered manager in place. 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 a 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 is required by a condition of its registration to have a registered manager.
People can be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA) 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). During this inspection we found where people lacked the capacity to agree to the restrictions placed on them to keep them safe, the provider made sure people would have the protection of a legal authorisation and had made the appropriate DoLS applications to the local authority.
Where the provision of people’s care required restrictions upon their movements, the provider was able to demonstrate following the inspection that legal requirements had been met.
We found that the registered manager had not consistently followed the requirements of their registration to notify CQC of specific incidents relating to the service. We had not been notified of all injuries to people so that we could check that the provider had taken appropriate action to keep them safe. We also had not been notified of the outcomes of the service's applications to deprive people of their liberty so that we could monitor whether the service met the DoLS requirements.
There were sufficient staff to meet people’s care needs at Whitegates and the Cottage. When there were absences, for example due to sickness, the provider managed these internally by deploying staff flexibly across the houses. They also used regular agency staff in order to ensure staffing levels were maintained to keep people safe. Recruitment procedures were in place to ensure that people were protected from the risk of employment of unsuitable staff.
Staff understood their role in relation to keeping people safe from the risk of abuse. A safeguarding policy was in place and staff knew how to identify concerns and what action they would need to take to report any suspicions or allegations of abuse.
Staff received an appropriate induction and continued to receive regular supervision and relevant training in their role. People were cared for by staff who had received appropriate training and support.
Risks to people had been assessed and measures were in place to manage them. Staff understood the risks to each person and ensured these were managed appropriately. There were systems and processes in place to ensure people’s medicines were managed safely and that their administration was documented. Staff had undertaken training to enable them to administer people’s daily medicines safely and their competence was regularly checked by registered manager or her deputy.
There were processes were in place to monitor the quality of the service and identify the risks to health and safety of people. Where systems had been effective in identifying any shortfalls or issues of concern, actions had been taken to ensure that recommendations were acted on to improve the quality of service provided and keep people safe.
People were supported to eat and drink enough to maintain a healthy balanced diet. They had access to freshly cooked food which looked and smelt appetising. People enjoyed their meals and had the freedom to choose when they wanted to eat meals and snacks.
People’s records demonstrated they were supported by staff to see a range of health care professionals. Referrals were made to enable people to access healthcare services when they needed to.
Staff were kind and warm in the ways that they supported people to help ensure that people had a positive and personalised experience of care. They communicated with people in a way which made them feel included and that they mattered. Staff were knowledgeable about people and had the skills, understanding and motivation to deliver good quality care. Relatives spoke positively and enthusiastically about the quality of care provided to people by staff at Whitegates and the Cottage.
People were supported by staff to be involved in decisions about what they ate, what they wore and what they wanted to do each day. Staff had access to guidance about how to communicate with people, which they followed. Staff and relatives were able to describe to us how people’s privacy was maintained when their care was provided. Staff treated people with respect when they were delivering care and support to them and encouraged them to be independent where they were able.
Staff had a good knowledge of each person’s care needs, interests and characteristics and care plans were person centred. Staff supported people to attend activities which enabled them to lead stimulated and fulfilled lives wherever possible.
The service was responsive to feedback and put in place improvements where these were identified. Relatives told us they had little cause to complain, but would feel comfortable in approaching the staff who looked after their loved ones or the registered manager if they had any concerns.
The registered manager was supportive of staff and ran a well-managed supervision and appraisal system. Policies and procedures were in place and available to staff. Staff applied the provider’s values in their work with people, which included ensuring that people were treated as equals and had choice in their lives. The culture of the service was person centred, and it was clear that people’s experience of care was a priority for staff.
We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.