Archived: Otterhayes

The Otterhayes Trust provides accommodation and personal care for a maximum of six people living with learning disabilities and/or autism in a property known as Hayes House. At the time of the inspection there were five people living in Hayes House. This service also provides a domiciliary care agency service and provides support to a further 15 people living in seven supported living properties, with the aim that they can live as independently as possible. One person living in the supported living properties was receiving personal care

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

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.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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

Right support: Model of care and setting maximises people’s choice, control and Independence. For example, people being encouraged to set goals for things they want to achieve.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights. For example, ensuring people are receiving person-centred care and support in line with individual care plans.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. For example, adopting ‘active support’ which is a method of enabling people with learning disabilities to engage more in their daily lives.

Although the service is larger than recommended, the introduction of positive support plans with health and social care professionals’ involvement; people’s preferences, hobbies and interests were now being considered. Individualised activities meant people were enabled to follow their interests' hobbies and passions as far as possible. However, this had been curtailed by the pandemic and lockdown restrictions.

People’s equality, diversity and human rights were respected. The service had adopted an ‘active support’ approach, which is accredited with the British Institute of Learning Disabilities (BILD). Active support is a method of enabling people with learning disabilities to engage more in their daily lives.

The service provided safe care to people. During our inspection we spent a short time speaking with people who used the service and observed how staff interacted with them. People were comfortable in their surroundings and with the staff group who supported them. Positive feedback was received from relatives. Relatives comments regards to safeguarding concerns included: “Absolutely none at all, if I did (relative) wouldn’t be there at all.”

Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. Medicines were safely managed on people’s behalf. Infection control measures were in place and taken seriously to protect people.

Care files were increasingly becoming more personalised to reflect people’s personal preferences. People had individual planners and communication boards in place to aid routines and communication. Goal setting for people continued to be implemented to ensure they lived the lives they want to. People were encouraged to maintain relationships with their friends and family.

People were supported to maintain a balanced diet of their choosing. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff provided care that was kind and compassionate. People’s privacy and dignity were respected. People were increasingly being encouraged to be as independent as possible. Staff adopted a positive approach in the way they involved people and respected their independence.

There were now effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent. Staff continue to receive regular supervision in order for them to feel supported in their roles and to identify any future professional development opportunities.

There were now opportunities for people to raise issues, concerns and compliments. A system was now in place to record complaints. Complaints were acknowledged and responded to in an appropriate time frame and other professionals informed and involved where appropriate.

Relatives confirmed that improvements were evident to the management of the service, but recognised further improvements were needed in order for them to feel confident that people's care and support needs were being appropriately met. We received mixed comments from relatives; “The quality of life and care are positively influenced by them (registered managers), I have the highest regard for their intentions.” Another relative thought the registered managers were ‘good with them and their relative’, but “Management skills are not what they might be.”

The principles of good quality assurance as a tool to drive improvement had been gradually implemented in stages and continued to do so. The provider's service improvement plan was continuing to attend to the deficits found at our last inspections and those identified through the local authority whole home safeguarding process.

Various audits had been implemented to oversee the running of the service. For example, audits covered ensuring care plans and risk assessments were up to date and accurate, infection control practices, incidents and accidents, staff personnel and training and activities.

The culture of the service continued to improve to ensure it was individually person-centred for people. Feedback from professionals acknowledged the enormous strides made to the service to improve the care and support people received and the active dialogue from the registered managers with health and social care professionals to improve outcomes for people.

We continue to receive statutory notifications in relation to safeguarding events and serious injuries in a timely manner.

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

Rating at last inspection

The last rating for this service was inadequate (published January 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service continues to provide us with a monthly report in line with conditions that were imposed following the previous inspection. At this inspection enough improvement has been made, and the provider was no longer in breach of regulations.

This service has been in Special Measures since January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook a targeted inspection on 16 July 2020 to check whether the service had addressed some of the concerns raised at our last inspection in September and October 2019 where breaches of legal requirements were found. The provider completed an action plan after that inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 coronavirus and other infection outbreaks effectively.

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

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.

The Otterhayes Trust provides accommodation and personal care for a maximum of six people living with learning disabilities and/or autism in a property known as Hayes House. At the time of the inspection there were five people living in Hayes House. This service also provides a domiciliary care agency service and provides support to a further 15 people living in seven supported living properties, with the aim that they can live as independently as possible. Two people living in the supported living properties were receiving personal care.

Our inspection carried out in September and October 2019 found that the service did not always apply 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.

This targeted inspection found the principles and values of Registering the Right Support and other best practice guidance had started to be implemented to ensure people lived as full a life as possible.

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

During the inspection we spoke with two senior care staff. Following the inspection we spoke by telephone to six more. Overall staff said since the last inspection there had been some clear improvements. These included updated training on all key areas such as person centred planning, epilepsy, autism, infection control and safeguarding. Everyone we spoke with said this had been good and most could give an example of how this had impacted on their practice. For example, ensuring people could choose their own menus, choice of drinks, where they would like to go.

Staff said there had been improvements in the way they documented how they were working with people. Several staff said they had always worked in an inclusive and person centred way but they had not been good at documenting this.

At our last inspection there was a lack of adequate staff to meet peoples' needs placed people at risk. This targeted inspection found improvements had been made with staffing reflective of individual needs.

Staff said the management approach was moving towards being a listening and supportive approach. One staff member said, "The managers are respectful of staff, it seems to me they have worked very hard and when issues have been raised they have tried to address them."

Our observations of people showed staff interacting in a kind and respectful way. People appeared comfortable in their surroundings and several of them happily showed us their rooms and their homes which they were very proud of. During this inspection we spent a short time speaking with people who use the service and observing how staff interacted with them. It was clear people were comfortable in their surroundings. Staff appeared to have good relationships with people and interactions were kind and responsive.

Plans were starting to be more person centred but this was still work in progress. Some of the information within plans was repetitive and long winded. Information at the start of one plan began with their negative behaviours. This is not in keeping with best practice for person centred care plans.

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.

At our last inspection there were widespread and systemic failings identified; there were ten breaches of regulations. The shortfalls related to all the key aspects of the management of the service and included: safeguarding; safe care and treatment; person centred care; privacy and dignity; staffing; staff recruitment; complaints; statutory notifications, and good governance. This targeted inspection found improvements had started to be made. The service had brought in an interim operations director and an independent consultant to oversee operational and strategic practices. This has led to the service making improvements as cited in this report. Relatives confirmed that improvements were evident but recognised further improvements were needed.

The principles of good quality assurance as a tool to drive improvement had been gradually implemented in stages. The provider’s service improvement plan was gradually attending to the deficits found at our last inspection and those identified through the whole home safeguarding process. Various audits had been implemented to oversee the running of the service. For example, audits covered ensuring care plans and risk assessments were up to date and accurate, infection control practices, incidents and accidents, staff personnel and training and activities.

At our last inspection records did not always contain the information required to protect people from the risk of unsafe care. There was also a failure to identify recording errors and omissions in people's care records to analyse to look for trends or patterns, such as behavioural charts or incidents. This targeted inspection found improvements had been made to how information is recorded. The registered managers had learnt that they needed to record everything and ensure they were robust in order to provide safe care and support. Further work was needed to how information is recorded as highlighted at the most recent whole home safeguarding meeting held on 23 July 2020. The provider acknowledged this and recognised systems were not entirely embedded in the service at the moment.

At our last inspection staff and relatives consistently told us that if they had any concerns or needed to raise a complaint either with the registered managers or the provider, they would not feel comfortable to do so due to the number of management and support roles held by family members. The targeted inspection found improvements had been made. The service has introduced an outside independent person for staff and family members to be able to talk to along with having external management present Monday to Friday as a point of call.

At our last inspection we had not received statutory notifications in relation to safeguarding events and serious injuries since October 2018. This targeted inspection found improvements had been made and we are now receiving notification appropriately in a timely manner.

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

Rating at last inspection

The last rating for this service was inadequate (published date February 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service continues to provide us with a monthly report in line with conditions that were imposed following the previous inspection.

At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the service had addressed some of the concerns raised at our last inspection. .

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. Therefore, the overall rating for this service has to remain inadequate as not enough areas were inspected in order to change the rating. We plan to return in the near future to carry out a further inspection which can potentially change the rating of the service.

Enforcement.

At the previous inspection there were ten breaches of regulation. These were in relation to breaches of regulation 9 (Person-centred care), regulation 10 (Dignity and Respect), regulation 11 (Need for consent), regulation 12 (Safe care and treatment), regulation 13 (Safeguarding service users from abuse and improper treatment), regulation 16 (Receiving and acting on complaints), regulation 17 (Good governance), regulation 18 (Staffing), regulation 18 (Notifications of other incidents) and regulation 19 (Fit and proper persons employed. At this targeted inspection we judged regulations 9, 12, 13, 18, 18 (registration), 11 and 16 no longer to be in breach. We identified continued breaches in relation to regulations 10, 17 and 19. We did not look at regulation 10 and 19.

We are mindful of the impact of 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. Therefore, we decided that we will continue to regularly monitor the service, and have requested an action plan be submitted, to keep people safe.

Follow up

We will request a further action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to work alongside the provider and the local authority to monitor progress. We have also been having regular meetings with the provider and there is an external consultant overseeing the service. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Otterhayes is a 'care home' providing personal care and accommodation for up to six people living with learning disabilities, Down’s syndrome and/or autism. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of this inspection five people were living in the residential home known as Hayes House within a rural, private community with gates to prevent vehicles entering the grounds at speed.

Otterhayes also provides support under a supported living scheme for an additional 15 people with learning disabilities, Down’s syndrome and/or autism living in their own homes as tenants. These were seven properties within the private community, all with links to the provider. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection the provider and registered managers did not understand what the regulated activity of personal care meant. We looked at the care provider to the 15 people living within the supported living scheme and found there were two people receiving personal care.

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. The providers and registered managers had managed the service for many years supporting people living with learning disabilities, Down’s syndrome and/or autism. However, neither the providers or the registered managers had heard of Registering the Right Support at the time of our inspection. 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. People using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Following Registering the Right Support new services should not be developed as part of a campus style development such as Otterhayes as this does not follow best practice guidance. The negative impact on people was not mitigated by factors such as adequate staffing skills, effectiveness of management, and promotion of the principles of independence, choice and control.

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

Otterhayes is owned and managed by The Otterhayes Trust, a registered charity. Members of the same family have roles within Otterhayes. This includes the Trust chair, registered managers and support workers who also live on site. People, families and staff felt unsupported and unable to make complaints and be assured these were managed independently of the family. Other family members also worked as maintenance and support workers. Although management had tried to support staff with personal issues, professional boundaries with staff were blurred because robust processes were not in place. This had led to poor management of staff and low staff morale. Recruitment processes were not robust to ensure vulnerable people were safe and there was a lack of supervision and training to ensure people’s needs were understood and met.

Although there were some care plans, these were not always up to date, and staff did not use them as working documents to inform care delivery. Risks were poorly managed, and accidents/incidents were not always understood or recorded as such which put people and staff at risk.

There was a lack of person-centred care. Staffing levels were not reflective of people’s needs, there was no dependency tool to relate staffing levels to need. Staffing levels were set and not reviewed. People generally followed the service routines and staff did not know people’s funded one to one staffing hours, ensure people were doing what they wanted to do or enable people to achieve any known goals.

Activities were mainly based on those available on site for additional payments, availability of staff and vehicles or accompanying staff with service tasks. The service location was rural and the nearby town was only accessible by car, which increased the risk of social isolation, independence and lack of consistent community links. Registering the Right Support states that services should be developed in locations that enable people to participate in their own local community.

People were not supported to have maximum choice and control of their lives and staff did 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.

The service rarely 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 did not fully reflect the principles and values of Registering the Right Support for the following reasons; there was a lack of choice and control, limited independence and limited inclusion. People did not always have choice in the food they ate or at what times meals were served. Menus were developed by staff with little meaningful input from people who lived at the service. Other rules and restrictive practices were in place without following best interest decision making and there was a culture of management and staff knowing what was best for people.

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

Rating at last inspection

The last rating for this service was Good. (report published 12 June 2018).

At this inspection we found the service had deteriorated to inadequate in all domains and there were ten breaches of regulation.

Why we inspected

The inspection was prompted due to concerns received from various sources about areas of concern such as communication with people and families, access to finances, biased management of complaints, unsafe staffing levels, lack of person-centred activities, lack of best interest decision making processes, poorly managed safeguarding and overall poor management and support for staff.

Enforcement

We have identified ten breaches in relation to safeguarding, safe care and treatment, medicines, staffing and recruitment, person centred care, consent, dignity and respect, complaints, governance and notifications during this inspection. We also asked the service to make a safeguarding alert in relation to an incident raised during the inspection relating to inappropriate comments made on social media by some staff, which they did.

CQC have taken enforcement action by imposing a condition on the provider's registration. This requires the provider to provide CQC with a monthly report outlining actions and progress in making the required improvements.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow up

Following the inspection, we continue to meet with the provider and partner agencies to ensure immediate risks were and continue to be managed appropriately.

The Otterhayes Trust is a group of houses for adults with learning difficulties where up to 21 people they can be supported.

Otterhayes is the main house which is a ‘care home’ which accommodates six people in an adapted building.. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service also provides care and support to 12 people living in four separate houses within the four acre grounds and to a couple living nearby in the local community, so they can live as independently as possible. Those people’s care and housing are provided under separate contractual agreements. CQC does not regulate the premises used for supported living; this inspection only looked at those people’s personal care and support.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had two registered managers in post, who shared the role. 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.

People felt safe and had their care needs met by staff they knew and trusted. The risk of abuse was minimised because staff demonstrated a good understanding of what constituted abuse and knew how to report concerns within the service and to external agencies. People had a range of ways through which they could raise concerns. People’s concerns were listened and responded to. Safe recruitment practices were followed before new staff were employed to work with people.

Some aspects of safety needed to be improved relating to managing challenging behaviour, personal emergency evacuation procedures and environmental risks in the grounds for people living in Otterhayes. We have made two recommendations about this aspect.

People were encouraged to be creative and express themselves through a variety of inspiring and innovative ways. For example, through art, drama, music, dance and film. People received personalised care that responded to their changing needs. They were supported to live as independently as possible and were supported do their own cooking, shopping, laundry and housework, according to their ability. People had a wide range of hobbies and interest and were part of their local community.

People receive effective care from staff with the relevant qualifications and training and skills to meet their individual needs. For example, several people had limited verbal communication skills, but understood what staff were saying to them, as they used simple language and short sentences. Information was provided in format suitable for their individual communication needs, such as in picture and symbol easy read formats.

People were supported by staff who provided person centred, caring and compassionate care. People were partners in their care and were fully involved in decisions about their care and treatment. Staff treated people with dignity and respect.

New staff received induction and all staff had regular supervision and opportunities for further training and professional development. People were supported to see appropriate health and social care professionals regularly to meet their healthcare needs. People ate a well-balanced diet and received staff supported them to plan, shop and cook meals of their choice, according to their ability.

The service was well led by the registered managers, who led by example. Some aspects of quality monitoring systems were effectively used to monitor quality of care and continually improve. Other aspects, needed further improvements such as need to audit care records and need to strengthen arrangements for ensuring improvements needed were carried out in a timely way. The service worked in partnership with local professionals and regularly consulted and involved people, relatives and staff in future developments. Staff used evidence of what works best to review and improve their practice.

We found the service had taken a range of actions to achieve compliance, including reviewing and improving the care plans and risk assessments. A new office had been created which meant staff had good access to the care plans and relevant documents and guidance at all times. De-briefing sessions had taken place after incidents, and meetings had also been held where staff shared ideas and suggestions to improve the service. Guidance was provided to staff was easy to read and detailed.

Good staff support systems were in place including regular supervision sessions, handovers between shifts and a range of training. Staff were experienced and knowledgeable. We spoke with three staff on duty at the time of our visit. They told us they were well supported and had received a good range of training. They confirmed recent changes in care planning systems and management support were working well.

At the time of our inspection people living at Otterhayes were cheerful and relaxed. They were engaged in a range of activities including cooking, menu planning and games.

On the day of this inspection the registered manager was away on holiday. Two acting managers were managing the home in their absence. A further incident had occurred just before we arrived. A member of staff had diffused the incident without the need to use physical intervention. We looked at the actions taken by the home to reduce the risk of further incidents. We found that two care plans did not provide sufficient information or instructions to staff about the things that may cause people to become upset or angry, how to prevent this happening or what to do if it occurred. Therefore behaviour that could be challenging for staff and distressing for people living at the home was not well managed and adequate steps were not taken to minimise challenging behaviour?

We looked at the support and training given to the staff team specifically around conflict management, restraint and safeguarding people from abuse. Some staff had worked in the home for many years and had received training in the past. For newer staff the level of training in these topics was low. The acting managers told us they were planning to provide further training in the near future. Records showed that formal supervision sessions for staff had recently been introduced. Staff told us there were informal support systems in the home. We did not see records of staff handover sessions during our inspection. The provider told us after the inspection these records were kept on the home's computer system.

The provider had failed to notify the Commission without delay about two incidents that occurred in the home. Since the safeguarding meeting the home has notified the Commission promptly when further incidents have occurred. This showed they are now aware of their legal duty to notify the Commission about matters affecting the service.

People told us the care and support they received met their needs and protected their rights. One person told us 'They help us with what we have to do every day. They explain things. They always listen to us.'

People received a healthy and varied diet. They were supported to plan and prepare their own choice of meals and drinks. Comments included 'The food is fab!'

People told us they felt safe. They were encouraged and knew how to speak out and raise any concerns or complaints. Staff knew how to protect people from the risk of abuse. Medicines were stored and administered safely.

People who lived in Otterhayes lived in comfortable, safe and well maintained premises. A person who showed us their bedroom told us 'It's perfect!'

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. They told us 'The staff are nice!' and 'The staff are fun ' they are all friendly.'