Whitley Farm

We found the following examples of good practice.

Visitors were protected from the risk of infection; visits were not limited, and appropriate screening was implemented with Personal Protective Equipment (PPE) provided.

Virtual visits had been promoted throughout the COVID-19 outbreak and alternative meeting areas could be arranged in isolated areas and outdoor spaces to help maintain meaningful family relationships.

The registered manager had systems and records in place to meet the current COVID-19 visitor vaccination requirements.

Risk assessments had been developed for people and staff belonging to higher risk groups and actions had been taken to reduce risk.

Social distancing and isolation were not always possible due to peoples individual needs however, appropriate measures had been taken to help manage risk.

The registered manager knew how to admit people to the home safely and contacted the correct authorities for additional support and guidance.

Appropriate COVID-19 testing was in place for staff and people living at the service.

The home was clean and tidy with enhanced cleaning in place which included all high touch areas. Audits had been developed to monitor the environment with an action log to implement change.

An up to date infection prevention and control policy was in place.

Heathcotes (Whitley) is a residential care home for people with autism, learning disabilities, mental health needs, physical disability or sensory impairment.

The premises are in a rural location on the outskirts of the village of Whitley. The main building has eight bedrooms on the ground and upper floor, each with en-suite facilities. A one bedroomed self-contained flat is separate to the main house. The premises have communal areas and secure outside space people to use.

Services for people with learning disabilities and or autism are supported

The service was registered to provide support to up to nine people and there were nine people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because the environment had been made as homely as possible, there were communal spaces such as two separate lounges and two outdoor areas so people could access space when needed. Staff empowered people to live their lives as they had chosen and achieve their aspirations, such as to travel independently on public transport. The provider was continually looking to improve people’s life skills, choice, control and involvement in the community, including through work opportunities.

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

The provider encouraged a person-centred approach to explore people’s specific needs and best to support them. The staff team communicated well with each other to plan and deliver the best outcomes for people. People were supported to build independent living skills and work in the community. Activities and events considered each person’s needs and supported social inclusion and choice.

Staff described a family atmosphere within the home. People were encouraged to maintain relationships with friends and relatives, people used digital means of communication when relatives were unable to visit.

People trusted staff that knew and understood them. Staff were aware of risks to people and how to respond to them. Staff supported people to express themselves through a variety of different communication methods including sign language.

The area manager was in charge of the day to day running of this service to ensure it was well-led. The new manager had completed their induction programme. They were in the process of awaiting documentation before submitting an application to register with CQC. Staff morale was good at the time of this inspection, considering the management changes in progress. Staff were keen to build positive relations with their new manager and support them to settle into the service. This showed they supported the visions and values of the service to provide a consistent and positive approach to provide the best quality of service for people.

The service demonstrated positive outcomes for people which reflected the principles and values of Registering the Right Support. This included supporting people to make their own decisions and choices to maintain independence and control of their lives. People's life experiences were improved by staff accessing the right support at the right time, to maintain positive outcomes for people's health conditions. The service ensured people's rights were upheld and advocated on their behalf when necessary. This meant people received timely care and support from health professionals and other agencies, which had a positive impact on their lives.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People and their relatives or representatives were fully involved in all aspects of their care. People's aspirations were considered, and goals set to achieve them. Staff were committed to improving people’s experiences, explore their capabilities and help them to build new life skills. Staff knew the importance of asking for people's consent before delivering care and support to them.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this service was good (Published 9 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Heathcotes (Whitley) is a residential home for people with autism, learning disabilities, mental health needs, physical disability or sensory impairment. The service can accommodate up to nine people, but at the time we inspected there were seven people using the service. The building is a converted farmhouse in a rural location on the outskirts of the village of Whitley. Bedrooms are on the ground and upper floor, each with en-suite facilities. The service has communal areas and a secure garden for people to use. At the front of the service there is a courtyard, which people access and which is secured by a locked gate. A driveway, also secured by a locked gate, runs from the courtyard to the main road. Up to four cars can be parked on this driveway.

At the last inspection on 23 and 24 May 2016 the provider did not meet all of the regulations we assessed. This was with regard to safe care and treatment, staffing numbers, person-centred care and good governance. The provider had not ensured that people’s risk assessments were followed, sufficient support workers were on duty to meet people’s needs for one-to-one care, support was delivered in line with support plans and record keeping was accurately maintained. At that inspection the service was rated ‘Requires Improvement’.

At this inspection we also found the overall rating for the service to be ‘Good’. The rating is based on an aggregation of the ratings awarded for all five key questions. Improvements were made in the provision of safe care and treatment, as risks were managed, reduced and followed on an individual and group basis so that people avoided injury or harm wherever possible. Improvements in staffing numbers meant there were sufficient support workers to meet people’s needs and we saw that rosters accurately cross referenced with the support workers that were on duty. People’s support plans were followed more closely and so they were provided with person-centred care. However, although support workers maintained certain records more accurately than at the last inspection, some were still not detailed enough. This meant that while the requirements made against breaches in regulations at the last inspection, were now met, there were still some recommendations made with regard to best interest and physical intervention records.

The provider was required to have a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. On the day of the inspection there was no registered manager in post as they had left their position unexpectedly three days before we inspected. The provider was required to inform us of this via a formal notification. The acting area manager explained how the service was being managed in the interim period between having no registered manager and recruiting a new manager. They told us who would be managing the service from 7 August 2017 and that a new registered manager application would be made as quickly as possible. However, a service that does not have a registered manager in place cannot receive a higher rating than 'Requires Improvement' in the well-led domain as the registered provider is in breach of the conditions of their registration.

People were protected from the risk of harm because the provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Recruitment policies, procedures and practices were carefully followed to ensure support workers were suitable to carry out their roles and responsibilities with vulnerable people. We found that the management of medicines was safely carried out, but support worker knowledge regarding effects of some specialist medicines was lacking.

People were supported by qualified and competent support workers who were regularly supervised and had their personal performance annually appraised. Communication with people was effectively managed. People’s mental capacity was appropriately assessed and their rights were protected. Support workers had knowledge and understanding of their roles and responsibilities with regard to the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The management team explained how they worked with other health and social care professionals and family members to ensure decisions were made in people’s best interests where they lacked capacity, but this was not always fully recorded.

People’s nutrition and hydration needs were met. The premises were suitable for providing support to people with a learning disability and the environment was comfortable.

We found that support workers were kind and considerate and knew about people’s needs and preferences. People were involved in all aspects of their care and support and were always asked for their consent before any support tasks were carried out.

People’s wellbeing, privacy, dignity and independence were monitored and respected. This ensured people felt satisfied and were enabled to take control of their lives.

There was ample opportunity for people to engage in occupation, pastimes and activities if they wished to and these often related to helping people learn about or maintain daily living skills and acquire social skills. People had good family connections and support networks.

We found that the complaint procedure in place was effective and people had their complaints and concerns investigated without bias. People that used the service, relatives and friends were encouraged to maintain relationships through frequent visits and telephone conversations.

While there had been recent disruptions in the management of the service an acting area manager was supporting another registered manager to ensure the service was well-led. This registered manager was posted at a sister service close by, but they were on holiday at the time of our inspection. The culture and the management style of the service were positive. There was an effective system in place for checking the quality of care delivery using audits, satisfaction surveys and meetings. However, this had failed to identify that some records were lacking detail. A recommendation has been made for this. People had opportunities to make their views known using these methods. People were assured that recording systems used in the service protected their privacy and confidentiality. Records were held securely on the premises.

The service is a residential home for people with autism and learning disabilities. The service can accommodate up to nine people. The building is a converted farmhouse in a rural location on the outskirts of the village of Whitley. Bedrooms are on the ground floor or upstairs, and each bedroom has ensuite facilities. The service has communal areas and a secure garden for people to use. At the front of the service there is a courtyard which people access, it had a locked gate then a driveway with another locked gate.

At the last inspection in August 2015 the service was rated good overall and was found to be meeting the regulations.

The service had a registered manager however, they had applied to deregister. Another manager within the organisation, who had been registered at another service, had applied to register at Heathcotes (Whitley). They had been working at the service for the last four weeks. 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 always have sufficient staff to meet people’s needs. There were times when people who required specific support were not provided with this due to staff shortages. As the service did not employ ancillary staff this meant care staff were not always available to provide one to one care. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people who used the service were not always adequately managed. For example, one person who used the service had managed to run out of the service and onto a busy road. The service had implemented stricter security since the incidents. However, these should have been in place to prevent the incidents occurring. Environmental risks were identified during the inspection, for example, a broken trampoline and a chair at the top of a set of stairs which was a trip hazard. Not all areas of the service were clean. Some door handles were sticky and paintwork was dusty and stained. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s care did not always meet their needs. For example, one person’s care plan referred to a specialist communication method which should be used to enable them to express their needs and preferences. We did not see staff using this to communicate with the person. In addition another person was not supported to have a nutritious diet. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Record keeping was not adequate. There were gaps in key documents which meant we could not be certain people received the care they required. Gaps in the handover book meant, on some days, there was no record of staff on duty or who they were providing support to. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take in relation to these breaches of regulation at the back of the full version of the report.

Staff demonstrated a good understanding of how to safeguard people who used the service. They told us they would raise concerns with the manager and they were confident these would be investigated appropriately.

We saw evidence of detailed risk assessments and risk management plans. Where restraint or medicines were used to alleviate people’s distress, staff told us this was always a last resort and risk management plans contained detailed guidance to ensure staff used the least restrictive intervention to keep the person safe. Medicines were safely managed.

The service had safe systems in place to recruit staff and the required checks were carried out to ensure staff were suitable to support people who used the service.

Staff had access to regular support, training and supervision to enable them to effectively meet people’s needs.

The service adhered to the principles of the Mental Capacity Act (2005). Staff sought consent where possible and we saw records within people’s care plans of mental capacity assessments and best interest decisions were recorded when required.

Annual health checks took place and the service referred people to health care professionals when additional support was needed.

People had positive relationships with support staff. People told us about the progress their relatives had made since living at the service and how happy they were. Where appropriate, detailed care plans had been developed to ensure the service was aware about how people wanted their needs to be met at the end of their life. People were supported to maintain relationships with their families and relatives told us they could visit anytime. People had access to support from advocates to ensure their voices were heard.

Although we saw some good evidence of activity for people there were times when the service had a chaotic feel. This centred on people and support staff congregating in the main lounge waiting for planned activities to begin.

We saw some good evidence of care planning being based on what was important to the person who used the service. Care plans contained information about people’s like and dislikes. People had the opportunity to review their care and support with their key worker on a regular basis. The service had regular meetings where people could give their views and make suggestions about the service. Alongside this there was a clear complaints policy in place.

There had been a number of changes to managers at the service since we last inspected, this along with the turnover of support staff had resulted in a some challenges within the service. The registered provider had ensured additional support was available in order to address these. Although staff we spoke with told us morale was good we were concerned about staff approaching CQC directly to blow the whistle on what they alleged to be poor practice. The registered provider investigated these concerns and found them to be unfounded. We were concerned this demonstrated a culture of mistrust of managers within the service. Despite this we received consistently positive feedback from everyone we spoke with about the new manager and staff told us they were confident improvements would be made under their leadership.

The summary describes what people using the service told us or their relatives, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risks to people's health and wellbeing were known by the staff. These risks were kept under review to help to maintain people's safety.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Staff had been trained in this area to help to protect people's rights.

Systems were in place to make sure that the manager and staff learnt from accidents and incidents, complaints and concerns. This helped to reduce the risk to people and ensured that the service continually improved.

Staffing levels were monitored and adjusted to provide people with one to one or two to one support where this was needed. This helped to keep people safe and ensure that people were supported to live the life they chose.

Is the service effective?

People's health and care needs were assessed with them or with their chosen representative. People were encouraged to live their life and be as independent as possible, even if there were risks attached to this. Relatives we spoke with said 'The staff understand X's needs very well. They (the staff) get the doctor if X is not well.' and 'I look at X's care records. I am invited for reviews and asked about X's care.'

Help and advice was gained from relevant health care professionals. This helped to ensure that people received the help and support they needed to maintain their health and wellbeing.

People were provided with a choice of nutritious food. Snacks and drinks were available to people at any time. People's dietary likes and dislikes were known by the staff. Health care professionals were involved in monitoring people's dietary needs. This ensured people nutritional needs were met.

Is the service caring?

We asked people if they felt cared for, they nodded or said "Yes". We saw that people looked well cared for. People were supported by staff who appeared to be patient and kind. Staff appeared to understand people's need well. Staff offered assistance and support to people in a timely way.

We saw staff spent time with people. For example we saw two members of staff taking a person to the park, we observed them at the park. We saw that the staff were happy to spend as much time at the park as the person wished to, which allowed the person to enjoy this. People living at the home were supported by staff who told us that the resident's needs were their top priority.

People looked relaxed and comfortable in the presence of the manager and staff. A relative we spoke with said 'Staff have a positive attitude. They don't just say they are going to do things. When I came and looked round and met the manager I felt happy.'

Staff understood how people used sounds and body language to communicate their needs. We saw staff understood people's individual communication methods well.

People using the service and their relatives were asked on a two yearly basis to complete a satisfaction survey. Where shortfall or concerns were raised these were addressed.

Is the service responsive?

Enough staff were on duty to be able to support people in a timely way. The manager told us that the staffing rota was completed to make sure people had the support they needed at all times. Extra staff were provided for hospital appointments, outings and to take people on holiday. A relative we spoke with said 'There are plenty of staff, there are no problems.'

Information was provided to people and their relatives about how to make a complaint. Staff spent time observing people and asked people for their views. We saw that staff acted upon comments made. This helped people to remain happy with the service provided.

Is the service well led?

The manager and staff worked well with other health care professionals to ensure that people received the care they required.

Quality assurance systems were in place. The quality of the service provided was constantly being monitored by the manager and senior management team. Improvements were made where necessary to make sure that people living at the home received the help and support they required.

Staff we spoke with understood their roles and responsibilities. They told us they were happy working at the home. The ethos of the service was to make sure that people lived their life to the full. We saw that the manager provided staffing levels which promoted and encouraged people's independence. For example people were able to go on holiday, go shopping and go horse riding. A relative we spoke with said 'We met the manager and staff. We feel X is in safe hands."

People had support plans and risk assessments in place which helped staff to understand and meet people's needs. We observed staff helping people to maintain their independence and make choices for themselves.

The home had policies and procedures and systems in place which helped to protect people.

We observed good interactions between those living and working at the home. Staff received sufficient training to enable them to meet the needs of people living at the home and they told us that they received good support.

People's views were being sought about the quality of the service provided. We saw that the management team acted upon any issues to make sure that people remained happy with the service they received.