Whitworth Lodge

Whitworth Lodge is a residential care home providing personal or nursing care to up to six adults. The service provides support to adults living with mild to moderate learning disability needs. At the time of our inspection there were 6 people living at the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support

People were supported to have maximum choice and control over 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 were kept safe. Staff knew how to raise safeguarding concerns and how to report them appropriately. Risks to people were identified as part of the assessment and care planning procedure. Risk management strategies were in place to assist staff to manage these risks and to identify triggers for behaviours that display distress, for people they were supporting.

There were sufficient numbers of staff to meet people's needs.

We saw that medicines were managed in a safe way.

Right care

Staff received a wide range of training to ensure they had the skills and knowledge to support people safely. Staff told us they also received good support in their supervision with the manager.

People's dietary needs were being met, and they had access to healthcare services where needed.

People were supported by staff in a kind and caring way. People were supported and encouraged to maximise their full potential where-ever possible. Staff knew the people well and care records which were well maintained and easy to access, detailed people's preferences, likes and dislikes. People had access to social activities that met their interests and needs.

A complaints procedure was available and displayed to enable people to access it if they or their relatives had a need.

Right culture

People received personalised care and support to meet their needs and wishes.

People using the service, relatives and staff were given the opportunity to provide feedback on the service. Audits took place to ensure the quality of the service was maintained.

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

Rating at the last inspection and update

The last rating for the service was requires improvement [published September 2022] and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care and right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for this service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information we may inspect sooner.

About the service

Whitworth Lodge is a care home for up to six people. The service provides support to people with a learning disability and/or autistic people. There were six people living at the service at the time of our inspection.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

The service did not always provide people with safe care and support. Systems to monitor people at risk of malnutrition or weight gain could be improved. The provider lacked oversight of the service and audits in place had not identified the concerns we found, nor that the registered manager lacked knowledge in key areas.

The service was hygienic and well-maintained. The registered manager sought feedback from people, relatives and staff as part of monitoring and improving the service.

Right Care:

Staff received the support, supervision and training they needed to understand people’s needs in a person-centred way. Staff received training in safeguarding and staff and the registered manager understood their responsibilities in relation to this. There were sufficient staff to care for people safely.

People’s healthcare needs were met. People received choice of nutritious food in line with their needs, preferences and cultural backgrounds.

Right Culture:

The registered manager and provider lacked sufficient oversight of the service which meant they may not be able to prevent people coming to harm. The registered manager lacked understanding of the necessary health and safety checks required and poor recording systems meant they could not be sure the checks had been carried out. Infection control systems had not sufficiently improved since our last inspection.

An infection control audit was not in place and the provider had not identified risk assessments for people at higher risk due to COVID-19 had not been carried out by the registered manager, despite this being identified at our last inspection.

Medicines management was not always safe because the registered manager lacked oversight of stocks of ‘as required’ medicines. This meant they could not be sure people received their medicines required. The registered manager lacked systems to ensure medicines would always be stored at a safe temperature.

The registered manager lacked understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards and had not ensured people were supported to make decisions following best practice in decision-making. People were not always supported to have maximum choice and control of their lives and staff did always not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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

Rating at last inspection and update

The last rating for the service was requires improvement, published on 18 February 2022 and there was a breach of the regulation relating to infection control. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found that the improvements required had not all been made and other concerns meant the provider remained in breach of this regulation and also regulations relating to consent, good governance and notifications.

Why we inspected

We undertook this focused inspection due to anonymous concerns raised with us regarding poor care and to check they had followed their action plan and were now meeting legal requirements. We also assessed whether the service was applying the principles of right support, right care, right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service is requires improvement. This is based on the findings at this inspection. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

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

Enforcement

The service has been rated requires improvement and we have identified breaches in relation to people's safety, consent, good governance and notifications. We took enforcement action in relation to our concerns regarding people’s safety and good governance by serving warning notices against the provider and the registered manager. You can see the action we told the provider to take for the other breaches at the back of the full length report.

Follow up

We will request an action plan for the provider to understand what they will do to improve in relation to the breaches. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice

The service encouraged visitors to reduce the risk of isolation for people. The registered manager was booking visits to space them out and avoid potential infection transmission with other visitors. Visitors were also provided with a mask and hand sanitiser. All staff had been trained in infection prevention and control in relation to COVID-19 infections. The provider tested all staff and residents for COVID-19 infections in accordance with government guidance and all staff had been vaccinated against this infection. Staff received the support they needed to meet people's needs through training and regular supervision. The provider had resolved previous health and safety concerns such as a damp wall and uneven flooring. This meant the premises were safe for the people who lived there.

We found the following examples of practice which could be improved

We found the service required improvement in relation to infection prevention and control. The registered manager had not established a suitable system to check visitors were safe to enter the care home and any checks were not always recorded, in line with government guidance. The registered manager told us they would improve immediately. Staff did not always use personal protective equipment (PPE) safely and the registered manager told us they would monitor this more carefully ongoing. The provider’s infection prevention and control policy required updating to ensure it was in line with government guidance. The registered manager told us they would update it as soon as possible. The provider had not assessed infection risks to people and staff at higher risk of COVID-19 due to having learning disabilities. The registered manager told us they would carry out these assessments as soon as possible. The registered manager’s knowledge of infection prevention and control required improvement as did their oversight of the service as they did not carry out infection control audits which would have identified the concerns we found. We found a breach in relation to regulation 12, safe care and treatment. You can see the action we told the provider to take at the back of the full length version of this report.

The provider carried out the expected recruitment checks on staff to be sure they were safe to work with vulnerable people. However, the provider did not always get a full employment history for staff as required. The registered manager told us they would improve going forwards.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

The service has been rated requires improvement and we have identified a breach in relation to people's safety. You see the action we told the provider to take at the back of the full length report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of safe care. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Whitworth Lodge accommodates up to six people with a learning disability in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. At the time of this inspection there were six people using the service.

This inspection took place on 2 October 2018. At our last comprehensive inspection of the service in August 2017 we gave the service an overall rating of ‘requires improvement’. This was because the provider did not always make records relating to people's capacity to consent to or agree to the care provided. The provider had not always notified CQC or other external organisations, as required, of significant events or incidents involving people and staff. And, systems were not in place to record accidents and incidents consistently. As a result, we identified that arrangements to monitor the service were not always robust as they had not identified the issues we found during that inspection.

At this inspection we found the provider had used the learning from the previous inspection to make improvements at the service. People’s capacity to make decisions about their care had been documented in their records. People’s relatives and relevant healthcare professionals had been involved in making decisions in people's best interests, where people lacked capacity to do so, and these decisions were also documented. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

The service continued to have a registered manager in post who was fully aware of their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service. Our records showed these had been submitted when required and in a timely way.

The provider had introduced a standardised reporting system for accidents and incidents to ensure clear and consist records were maintained as well as support the service to improve from any lessons learnt. When things went wrong the provider acted to make improvements. We saw improvements had been made following an incident involving a person to help reduce the risk of a similar incident reoccurring.

The provider had enhanced their arrangements for monitoring and assessing the safety and quality of the service. Senior manager’s audits were now recorded which gave a clear picture of any improvements that were needed. The registered manager undertook regular checks of key aspects of the service and acted to make improvements when required. Records relating to people, staff and to the management of the service were accurate, up to date and well maintained

Staff knew how to safeguard people from the risk of abuse and how to report any concerns about people to the appropriate person and agencies. Staff understood the risks posed to people and followed current guidance about how these should be minimised to keep people safe from injury or harm.

Risks posed by the premises were appropriately managed. The provider maintained a servicing programme of the premises and the equipment to ensure areas covered by these checks did not pose unnecessary risks to people. Since our last inspection they had improved arrangements relating to checks of water hygiene to prevent legionella accumulating in the water system. The premises were clean. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing and storing food.

Medicines were stored safely and securely, and people received them as prescribed. The provider had made improvements to the way they checked that staff remained competent to administer medicines. This helped ensure all staff were working in a consistent and safe way when administering medicines.

There were enough staff at the time of this inspection to meet people’s needs and keep them safe. The provider maintained a robust recruitment and selection process and carried out appropriate checks to verify staff's suitability to support people. Staff received training to help them meet people’s needs and had work objectives that were focussed on people experiencing dignity in care. Staff knew people well and understood people’s needs, preferences and choices. They were aware of people’s preferred communication methods and how people expressed their needs.

People and their representatives continued to be involved in planning their care so that they would receive personalised support. Staff followed current best practice, legislation and standards to support people to experience good outcomes in relation to their healthcare needs. People and their representatives were involved in reviews of their care which helped to ensure that the support provided continued to meet their needs.

People were supported to keep healthy and well, eat and drink enough to meet their needs and to access healthcare services when needed. The design and layout of the premises provided people with flexibility and choice in how they spent their time when at home. People participated in a wide range of activities and events at home and in the community to meet their social and physical needs. They were supported by staff to be as independent as they could be. Staff were kind, patient and considerate and treated people with dignity and respect. They ensured people's privacy was maintained when being supported with their care needs. People’s relatives were welcome to visit the service without any unnecessary restrictions.

People and relatives were satisfied with the quality of care and support provided. People, relatives and staff were asked for their views about the quality of care and support provided and how this could be improved. If people were unhappy and wished to make a complaint, the provider had arrangements in place to deal with their concerns appropriately. The provider worked in partnership with others to develop and improve the delivery of care to people.

Further information is in the detailed findings below.

Whitworth Lodge provides care and accommodation for up to six people with a learning disability, some of whom also have autism. Some people had behaviours which challenged the service in various ways. There were six people using the service at the time of our inspection.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider did not always enable bodies, including CQC, to carry out their regulatory duties in monitoring the service provided to people. This was because the provider did not always notify external bodies of significant events as required by law. The provider did not have systems in place to ensure all relevant information about accidents and incidents were consistently recorded as they had no template in place. The provider had systems in place to assess, monitor and improve the service, although these had not identified the issues we found during out inspection.

Staff understood their responsibilities to provide care to people in line with the Mental Capacity Act (MCA) 2005. However, the provider had not always recorded their assessments for significant decisions to evidence they followed the code of practice. In addition, the provider did not always formally record discussions held with family members and others involved in people’s care in relation to best interests decision making, in accordance with the MCA. The provider told us they would review their processes in relation to MCA as soon as possible. People were only deprived of their liberty when this was required as part of keeping them safe and authorisation was granted from the local authority.

Risks to people were mitigated because the provider identified and assessed risks and put suitable management plans in place for staff to follow in caring for people safely.

People were safeguarded from abuse and neglect by the provider as staff received relevant training and understood how to identify and respond to allegations appropriately.

People lived in a service which was maintained by the provider. Staff and external contractors carried out regular checks relating to the safety of the premises. The provider agreed to contract a specialist to carry out a risk assessment to further mitigate the risks of Legionella accumulating in the water system.

The provider recruited staff following robust procedures to check they were suitable to work with people. In addition there were enough staff deployed to meet people’s needs. Medicines management was safe and the provider carried out sufficient audits to check medicines safety.

People received care from staff who were supported with a suitable programme of training, support and supervision. People received the support they required in relation to eating and drinking and the provider supported people to access the healthcare services they needed.

People were treated with kindness, dignity and respect by staff. Staff understood the needs of the people they were caring for as well as their interests, preferences and the best ways to communicate with them. Staff supported people to maintain their independence. People were involved in decisions about their care and were supported to maintain relationships with people who were important to them.

People were cared for in a way that was responsive to their needs. In addition people were involved in planning and reviewing their care. People were supported to access activities they were interested in. The provider encouraged feedback from people and their relatives. Although people and relatives were confident any complaints would be dealt with well, the complaints policy required an amendment to clarify CQC do not investigate complaints which the registered manager told us they would make as soon as possible.

People, relatives and staff were confident in the leadership and management of the service. The registered manager had been in post for four months and had a good understanding of their role and responsibilities. The provider had open and inclusive ways of communicating with people, their relatives and staff.