White Leaf Support provides care and accommodation at 8 and 10 Priory Avenue for up to 13 people with either learning disabilities or autistic spectrum disorders. At the time of our inspection 13 people used the service. One house accommodated people who were more independent and the other house supported people with more complex support needs.There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.
The registered manager was not available during our inspection. A deputy manager managed the service while the registered manager was unavailable. We meet with the director of the service on the third day of our inspection.
Relatives provided us with feedback about the service. We received mixed views about the service. Comments included, “It’s hard to keep a tab on what’s going on. I am happy at the moment; I am keeping an eye on how things go.” Other comments were, “I am 50% happy and hope things improve.”
Relatives felt their family members were safe from harm and abuse. One family member told us, “[Our family member] is safe because it is a secure place.” Staff were trained and knew their responsibilities in relation to safeguarding. Staff told us they would not hesitate to report any concerns they had. The service had sufficient staff to meet people’s care needs and keep people safe. Supervisions were undertaken on a six to eight week basis. Staff told us they felt supported in their role.
Staff told us “It’s good here. The more I’m here the easier it gets” and, “It’s been busy; it’s like jumping in at the deep end.” All staff we spoke with told us they felt supported.
Safe recruitment processes were used when appointing new staff which included checks of criminal history of new staff using the Disclosure and Barring Service (DBS).Staff were trained and understood their responsibilities in relation to safeguarding.
Relatives told us there was a high turnover of staff and staff did not always understand the specific needs of the people living at the service. Comments included, “I am unimpressed. We were promised additional speech therapy for [name] but, we are still waiting. One comment we received was, “I met a member of staff by chance who used to work at White Leaf. They said the reason they left was because they felt ‘out of their depth’ in terms of looking after people.” However, other families told us staff were well trained and knew their relative well.
We found the service acted in accordance with the Mental Capacity Act 2005. Consent was sought from people or their members who had legal authority to give it. People were supported at meal times. However, care records did not always contain information about each person’s dietary needs.
Relatives did not always feel the support was individualised. Comments we heard were, “They have stalled in terms of moving him forward. There is not enough focus on moving on to the next stage”.
Care plans did not always capture preferences, interests and aspirations. One care plan we reviewed was not completed in ‘goals and hopes for the future’. Care plans and risk assessments were not regularly reviewed and kept up to date. One care plan we saw had a review due date of December 2016. However, this had not been completed at the time of our inspection.
Risk assessments did not always give staff clear advice and guidelines to follow.
Medicines were not always managed in accordance with best practice guidelines. For example, medication administration records (MAR) did not always show what medicines were given. We looked at MAR charts and found a total of 41 missing signatures over a period of time. Daily stock checks of medicines were undertaken. However, audits of medicines were not carried out to show discrepancies in medicine administration. We spoke with the deputy manager and they told us this was not something the service carried out.
When people had accidents and incidents these were not recorded correctly to identify the cause of the incident. For example, we saw on four occasions people had sustained bruising to their body with no explanation of the cause of the bruising. Other incidents such as episodes of challenging behaviour did not have details of follow up response to prevent reoccurrence.
There was no evidence of systems being used with people to aid their communication. Some parents told us communication was poor at the service. In light of this, one parent asked staff to write down events of the day in a specific diary to show what their family member had done throughout the day. However, they told us not all staff completed this.
People were supported to take part in a range of social activities to provide stimulation, and social contact. On both days of our inspection people were supported to attend community activities and social events. Staff promoted people’s independence and supported them to exercise choice.
We did not see that care plans were reviewed on a regular basis or as needs changed. We saw several examples of care plans that did not reflect the current care being carried out.
Relatives felt the service was not always well-managed. Comments we received were, “The management are not open to parents” and, “We are not always listened to. It needs careful monitoring.” However, the services commitment to improve was clearly evident during our inspection.
Audits undertaken did not highlight shortfalls. For example, care plan reviews had not identified that reviews had not taken place.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.