Whistley Dene provides accommodation and personal care for up to five people with a learning disability. At the time of our inspection five people were living in the home. The service is one of many, run by the White Horse Care Trust, within Wiltshire and Swindon. The inspection took place on 3 October 2017 and was unannounced. At the last inspection in August 2015, the service was rated as ‘Good’ overall. We rated Responsive as requires improvement, as some information in care plans needed clarifying. At this inspection we found the provider did not satisfy all of the legal requirements in the areas that we looked at.
A registered manager was employed by the service but was not present during our inspection. Our inspection was supported by two area care managers who have responsibility for overseeing the services within the Trust. 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.
Assessments were undertaken to identify risks to people’s safety. However, assessments had not been completed for all areas where risks had been identified in their care plan. There was not always guidance in place to support staff to keep people safe.
Staff undertook training in how to safeguard people from potential abuse and harm. Staff were aware of their responsibilities to report any concerns they had. Appropriate actions were taken when safeguarding concerns were raised.
The planning of staffing was flexible to support such things as outings or appointments. However, there were some concerns raised by staff about the lack of consistent staffing. Staff vacancies were currently being covered by bank staff and agency staff. The area care managers were reviewing staffing arrangements.
The CQC is required by law to monitor the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Mental Capacity Act 2005 sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this.
Where people’s capacity to consent had been assessed, assessments had not been reviewed since the last inspection in August 2015. DoLS that had been applied for had also not been reviewed to ensure they remained the least restrictive practice. Staff were able to explain how they promoted people’s day to day living choices.
People were supported to eat and drink sufficient amounts. We observed people accessing food and drink throughout our inspection. Where people had fluid monitoring charts in place these were not reviewed to ensure people were receiving sufficient fluids.
Staff spoke about how they maintained people’s privacy and dignity. However, interactions we observed did not always uphold people’s dignity. The culture of the home was not consistently enabling and promoting people’s independence.
During our last inspection we found the service was responsive to people’s needs and wishes. However some information in care plans needed clarifying. During this inspection we found the care plans had not been updated and some care plans had information missing.
People had access to some structured activities throughout the week but on the days when nothing was planned staff told us they felt access to opportunities could be improved.
People looked comfortable in the presence of staff and didn’t hesitate to seek support when required. We observed individual staff were kind and caring towards people when offering support.
Medicines were stored safely and securely. All medicines in the home were given by staff who had received training and had their competencies observed. Records showed that people had access to healthcare services to maintain good health.
Quality audits and monitoring had not been completed to ensure improvements to the service were identified and acted upon. The service worked in partnership with other appropriate health and social care professionals to ensure people’s care needs were met.
Staff spoke positively about the support they received management.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.