Archived: Whistley Dene

We found the following examples of good practice.

The service had been proactive in helping people to maintain relationships in ways that met their individual needs. Some people enjoyed video calls, others telephone calls. Some people were supported to write letters to friends and relatives.

The service had introduced measures to prevent visitors from catching and spreading infections. Visitors were screened for COVID-19 and were provided with personal protective equipment (PPE).

Staff had received training on infection prevention and control measures and how to use PPE safely. PPE was available to staff throughout the service and staff were seen using it effectively. Staff competence and knowledge was regularly assessed.

Additional cleaning measures had been introduced in the home. All areas of the home were clean.

COVID-19 testing was being carried out for people using the service and staff in line with the latest guidance.

The provider had effective systems in place to check staff and professional visitors were vaccinated against COVID-19.

The provider had updated their infection prevention and control policy to reflect the COVID-19 pandemic and additional measures that had been introduced.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good. At this inspection we found the required improvements had been made.

Whistley Dene is a ‘care home’. 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.

Whistley Dene provides accommodation and personal care for up to five people with a learning disability, some with complex needs. At the time of our inspection five people were living in the home. The service is run by the White Horse Care Trust, within Wiltshire and Swindon.

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.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were safeguarded and staff knew how to recognise the signs of abuse and how to address any concerns they had. People had risks assessed which balanced their rights to freedom as well as keeping them safe.

People’s medicines were managed safely. The registered manager had signed up to a national initiative to reduce the over use of psychotropic medicines for people with learning disabilities.

Staff understood the principles of the Mental Capacity Act (2005) and how to apply its principles when supporting people. Staff were supported through regular one to one supervision and had access to regular training and personal development.

People’s needs were assessed and a multi-disciplinary support plan developed to meet those needs. The service was responsive to people’s changing needs and support plans were regularly reviewed.

The staff were very caring and treated people with respect and dignity. People were fully encouraged to be involved in their care and treatment and in making daily choices. The service was committed to promoting people’s independence.

There were quality assurance audits in place to monitor the service and improvements were continuously sought. People and their relatives were encouraged to give feedback to facilitate change. There was a clear ethos of promoting person centred values throughout the staff team.

The provider had introduced a new management structure which was well received by staff. This had improved accountability, leadership and support for people who used the service and for the staff team.

The inspection took place on 3 October 2017 and was unannounced. At the last inspection in August 2015, the service was rated as ‘Good’ overall. We rated Responsive as requires improvement, as some information in care plans needed clarifying. At this inspection we found the provider did not satisfy all of the legal requirements in the areas that we looked at.

A registered manager was employed by the service but was not present during our inspection. Our inspection was supported by two area care managers who have responsibility for overseeing the services within the Trust. 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.

Assessments were undertaken to identify risks to people’s safety. However, assessments had not been completed for all areas where risks had been identified in their care plan. There was not always guidance in place to support staff to keep people safe.

Staff undertook training in how to safeguard people from potential abuse and harm. Staff were aware of their responsibilities to report any concerns they had. Appropriate actions were taken when safeguarding concerns were raised.

The planning of staffing was flexible to support such things as outings or appointments. However, there were some concerns raised by staff about the lack of consistent staffing. Staff vacancies were currently being covered by bank staff and agency staff. The area care managers were reviewing staffing arrangements.

The CQC is required by law to monitor the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Mental Capacity Act 2005 sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this.

Where people’s capacity to consent had been assessed, assessments had not been reviewed since the last inspection in August 2015. DoLS that had been applied for had also not been reviewed to ensure they remained the least restrictive practice. Staff were able to explain how they promoted people’s day to day living choices.

People were supported to eat and drink sufficient amounts. We observed people accessing food and drink throughout our inspection. Where people had fluid monitoring charts in place these were not reviewed to ensure people were receiving sufficient fluids.

Staff spoke about how they maintained people’s privacy and dignity. However, interactions we observed did not always uphold people’s dignity. The culture of the home was not consistently enabling and promoting people’s independence.

During our last inspection we found the service was responsive to people’s needs and wishes. However some information in care plans needed clarifying. During this inspection we found the care plans had not been updated and some care plans had information missing.

People had access to some structured activities throughout the week but on the days when nothing was planned staff told us they felt access to opportunities could be improved.

People looked comfortable in the presence of staff and didn’t hesitate to seek support when required. We observed individual staff were kind and caring towards people when offering support.

Medicines were stored safely and securely. All medicines in the home were given by staff who had received training and had their competencies observed. Records showed that people had access to healthcare services to maintain good health.

Quality audits and monitoring had not been completed to ensure improvements to the service were identified and acted upon. The service worked in partnership with other appropriate health and social care professionals to ensure people’s care needs were met.

Staff spoke positively about the support they received management.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection, we saw improvements had been made.

Staff spoke to people in a friendly, caring and attentive manner. They spent time with people on a one to one basis and were responsive to their needs. People were encouraged to make choices, supported to participate within discussions and were fully involved in what was going on in the home. People responded well to interactions taking place.

In response to our last inspection, the manager met with each staff member on a one to one basis, to discuss their expectations of care provision. A range of staff training sessions were organised to increase awareness of dignity and inclusion. Staff completed detailed workbooks, as part of their training. These were assessed to ensure staff fully understood the information they had been given.

People were supported to make choices in their everyday lives. Staff promoted people's privacy but not all interactions promoted their dignity. Whilst there were some good interactions, some staff talked between themselves and spoke over people.

People looked well supported in relation to their personal care needs. They had access to a range of health care services and had up to date health care management plans in place. Staff were aware of people's nutritional needs and there was an emphasis on people receiving healthy, balanced meals of their choice.

The home was homely, clean and safe. All areas were well maintained. Bedrooms were personalised and reflected people's individual interests and preferences.

Staff felt well supported by each other and the manager. They were positive about the training they received and felt it equipped them to do their job effectively.

People had detailed support plans, which identified their needs and the support they required. Other records demonstrated the range of management systems within the home. Records were organised and stored appropriately.

We spoke on the telephone to two relatives of people living at the home. One relative told us "staff are so kind and thoughtful, their general attitude is that they treat everyone like family, wonderfully run home." Another relative said "very helpful staff, no complaints."

We looked at people's care plans, personal care needs, risk assessments and daily routines and found that they encompassed the safety and well-being of people who use the service.

Training records showed that staff had received all relevant training. We noted that staff received regular supervision with annual appraisals in place.

We found that people living at Whistley Dene had an ongoing assessment of their needs, wellbeing and independence. Feedback indicated that people's needs are being met but record keeping did not always support good practice. The quality of the service was monitored at local and provider level through regular checks but records did not always evidence that actions were taken to rectify any shortcomings identified.