Whiston House

Whiston House is a 'care home' and is registered to provide accommodation and personal care for a maximum of fifteen people. At the time of the inspection 11 people were living at the service, including one person who was in hospital. The service was divided into two areas. The top part of the service was called ‘The Willows’ which was more suitable for people who were more physically able; the bottom part of the service was called ‘The Oaks’ which was suitable for people with mobility issues.

Within both areas of the service people had access to a communal lounge, dining room, kitchen, shared bathrooms, and laundry room. Each person's bedroom had its own ensuite facilities. There was a large garden which people could access when they wished.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 15 people. Eleven people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design. The service was split into two separate smaller units and fitted into the residential area where there were other large domestic homes.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. Most people using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them. However, a few people needed to be involved in more meaningful activities to prevent the risk of social isolation and to support them to lead more fulfilling and active lives. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

People received care and support that was personalised to their individual needs. Most people participated in a range of activities that met their individual choices and preferences. This were recorded in their daily records and their goals and aspirations had been identified monthly. However, a few people’s records showed that they participated in very few meaningful activities. Goals and aspirations had not been identified for them. There was no information on what support and encouragement some people had received to lead a more fulfilling, meaningful and active life.

People indicated and said they felt safe living at Whiston House. Risks to people's health, safety and well-being were assessed, and action was taken to remove or reduce the risks. Some of the risk assessments were not individualised and contained generic information. This had been identified as a shortfall and the registered manager was taking action. Staff were clear and knowledgeable on how to keep risks to individual people to a minimum.

People were safe and protected from avoidable harm because staff knew how to identify and report any concerns relating to the risk of abuse. People received safe care and support as the staff team had been trained to recognise signs of abuse or risk and understood what to do to support people safely.

People received support with their medicines by staff who had received training and who had been assessed as competent. There were systems in place to respond to any medicine errors and regular checks were completed to ensure that people were receiving the right medicine at the right time.

Staff members followed effective infection prevention and control procedures. The service was clean and fresh. The provider had arrangements in place for the maintenance and upkeep of the building.

The provider took appropriate actions following any incidents and learning was shared with staff to prevent re-occurrence.

The provider followed safe recruitment practices when employing new staff members. Staff received the training they needed to undertake their roles effectively and safely. New staff completed an induction training programme. Staff received regular supervision and felt well supported by the registered manager and deputy manager.

People received help and support from a kind and compassionate staff team with whom they had developed positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age and gender and disability and these were respected.

People's needs were assessed prior to them using the service. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems supported this practice.

Staff knew people well and quickly identified when people’s needs changed. When people were unwell or needed extra support, they were referred to health care professionals and other external agencies. Staff supported people with their nutritional needs to help maintain their health and wellbeing.

People were supported to maintain a healthy diet and had choice regarding the food and drinks they consumed.

People were provided with information in a way they could understand. The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them.

The provider understood the requirements of their registration with the Care Quality Commission and was meeting the legal requirements. The provider had effective systems to monitor the quality of the service they provided and to drive improvements where needed. The registered manager had good links with the local community which people benefited from.

Staff knew their roles and were able to tell us about the values and the vision of the service. The registered manager and senior management team carried out regular audits to check the quality of the service. The registered manager provided leadership and considered the views of people, their relatives and staff about the quality of care provided. The registered manager and staff used the feedback to make improvements to the service.

Rating at last inspection:

At the last inspection the service was rated Good. (Published 31 January 2017)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whiston House on our website at www.cqc.org.uk.

Within both areas of the service people had access to a communal lounge, dining room, kitchen, shared bathrooms, and laundry room. Each person’s bedroom had its own ensuite facilities. There was a large garden which people could access when they wished.

The service is run by 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. The registered manager was present throughout both days of the visit.

There were enough staff with the right skills and knowledge to support people. Staffing was sufficient and flexible to meet people’s needs; staff had time to respond to people’s needs in an unrushed way. People were given the time to communicate at a pace that suited them. Staff had good support and supervision to fulfil their role effectively and felt confident in approaching the registered manager if they needed extra guidance. People were protected by the service using safe and robust recruitment processes.

Staff understood that although they had a duty of care to help keep people safe, people were also free to make their own choices even if this could increase the level of risk to that person. The risk of harm to people was reduced as robust risk assessments had been implemented. Staff were trained in safeguarding and understood the processes for reporting abuse or suspected abuse.

Incidents were recorded and audited to identify patterns and the registered manager used this as an opportunity to learn and improve outcomes for people. Staff had clear guidelines to follow to support people with behaviour which could challenge others, interventions focused on being preventative rather than reactive.

Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment.

There were safe processes for storing, administering and returning medicines. Medicines were administered by trained staff who were regularly competency checked by the registered manager and deputy manager.

The registered manager had a clear understanding of the principles of the Mental Capacity Act 2005 (MCA). People were offered advocacy services and the provider had taken the appropriate steps to meet the requirements of the legislation. Staff understood the importance of asking people for their consent when supporting them with their needs.

Staff had appropriate training and experience to support people with their individual needs and demonstrated a clear understanding of the people who lived there. Staff were supported to undertake further health and social care qualifications to improve their knowledge and skills.

The service was good at responding to people who needed help to manage their health needs. People were supported to access outside health professionals.

People were offered a variety of food and drink and were encouraged to make their own choices around this. Staff monitored people’s food and drink intake so further professional health input could be sought if necessary.

Staff demonstrated caring attitudes towards people. People felt confident and comfortable in their home and staff were easily approachable. Interactions between people and staff were positive and encouraged engagement. When people became distressed staff were quick to offer reassurance and care. Staff showed an interest in what people said and did, and spoke to people in a respectful manner promoting their dignity.

People were supported to follow their interests and take part in activities that were meaningful for them. Each person had a timetable of activities which took into consideration their abilities and preferences. Each person was assigned a key worker which maintained good oversight of people’s individual needs.

People’s care files were written in an easy read format which included pictures to help people understand its content. Documents gave a good level of detailed guidance to inform staff of how to deliver person specific care. People were encouraged to be involved in writing their care plans and agreeing its content. People were encouraged to remain as independent as possible to give them control over their lives.

Complaints were responded to appropriately and a robust system was in place. Each person had a copy of the easy read complaints policy in the care file which described who they could talk to if they were unhappy and what the stages of the complaint process were. People were helped to complain and staff supported people who were unable to use the easy read complaints policy by understanding what their body language meant if they were unhappy.

The registered manager had good oversight and direction of the service People were included and encouraged to be involved in the continuous improvement of the service. The provider had listened to people and acted on feedback. The provider strived to continually improve the service to improve the lives of the people living there. There were good systems in place for monitoring the quality of the service and when shortfalls were found action plans were agreed and worked towards so improvements could be made.

We saw that the provider had systems in place to obtain consent from people in relation to people's care and support.

People received care that met their needs and promoted their rights. Advice and guidance was sought from health and social care professionals to be able to meet people's needs effectively and promote their welfare and safety.

There were systems in place to manage people's medication effectively and safely.

Staff were supported to undertake their roles safely and effectively. They received relevant training, regular supervision and were encouraged to undertake further professional development. Staff told us that 'It is a good team' and the manager was approachable.

There was a system in place to manage compliments and complaints and we saw that complaints had been responded to promptly. One person told us that they could talk to any of the staff if they had any problems and they would resolve the matter for them.