Huntley House Extra Care

We found the following examples of good practice

Visitors had their temperature automatically recorded, health questions asked, personal protective equipment (PPE) provided if needed, and track and trace information taken when visiting the service.

There were various visiting areas, with clear instructions to ensure chairs were appropriately distanced and perspex screens to keep people safe. A befriending volunteer had been sourced to visit one lady who felt particularly isolated. Virtual visits were arranged regularly using the 57tablet devices the provider had received from the government scheme and donations. People were part of a pen-pal scheme with a local school and had received over 170 letters from children.

Staff had received training in the use of personal protective equipment. One infection control lead and two infection control champions ensured the service had enough PPE and that staff used it effectively. Staff had personal sanitiser bottles on a belt clip which could be replenished at the many PPE stations located around the site.

An on-site clinical support team had carried out assessments for people which reduced the need for external NHS support. Assessments included moving and handling equipment, speech and language support, occupational therapy and physiotherapy.

Whiteley Village is a large community with two purpose built residential services and a homecare service supporting people within their homes in the village. The Eliza Palmer Hub is a care home service for people who require support with nursing care and 30 people lived there. Ingram house provide a residential service and there were 27 people living in this part of the service. Whiteley Village provided home care to 60 people in their houses and flats within the village. In total, 117 people received support in the residential services and the community.

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

People told us there were not always enough staff to support them, particularly in the Eliza Palmer Hub. In this building and Ingram House, there were inconsistencies and shortfalls relating to risk management and medicines, but people told us they felt safe. There were activities for people who lived in the residential buildings but we found these were not always impacting positively upon them. We also found instances where information about how to meet people’s needs was inconsistent or lacked personalised details. People gave negative feedback about the food they were served and the provider was in the process of making improvements to this at the time of our visit.

The governance across the services was not robust enough to identify and address the shortfalls found at this inspection. We saw positive examples of work to involve people and communicate with them, but we received feedback this was not consistent where there had been recent changes to the service. The quality of the service received was not consistent across the different parts of the community. People who lived in the Eliza Palmer Hub and Ingram House were not receiving the same level of care and personalised support as people who lived in the community. People who lived in the community told us they received personalised and safe care from staff who arrived on time.

People’s healthcare needs were met and we saw evidence of staff working alongside professionals to meet their needs. Some records relating to people’s healthcare needs and health appointments were not consistent with care delivery. Staff asked for consent from people and had a good understanding of the Mental Capacity Act 2005, but we found one instance where the correct process had not been followed, we received confirmation this was addressed after our visit.

People knew how to raise a complaint and despite sharing negative feedback with us, they told us they had productive meetings where they could raise these concerns. There were regular surveys and systems to communicate with people, relatives and staff. Complaints were documented and responded to and the provider analysed these for patterns and trends. There was a robust framework for accidents and incidents, to ensure these were escalated where required and monitored by the provider. Despite some inconsistencies in how end of life care was planned and delivered, the service had received accreditation in this area and we saw evidence of plans to develop and improve this area of the service.

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

Rating at last inspection

Good (Inspection Report Published 22 October 2016)

Why we inspected

This was a planned inspection based on the previous rating. However we had also been made aware of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation which had not reached a conclusion at the time of this inspection. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of choking risks. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern, but we did identify a need to improve record keeping. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

Enforcement

We have identified breaches in relation to staffing, medicines and risk management, care planning, activities and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

The inspection took place on 20 and 21 September 2016. We announced the inspection to the provider at 4.30pm on 19 September 2016. This was because the registration covers a range of different services and we wanted to make sure managers from each service would be available to meet with us and arrange for us to visit and meet with people using the services.

The last inspection took place 27 September 2013

Whiteley Village is a retirement community near Walton upon Thames in Surrey. The Village includes a nursing home, Whiteley House, for up to 86 older people and a residential home, Ingram House, for up to 27 older people, known collectively as the Care Centre. There is also an extra care scheme, Huntley House, for up to 51 older people living in their own flats and receiving personal care when they needed. The service is also registered to provide personal care to anyone living within the village in one of their 262 almshouse cottages and 16 privately owned houses.

The village is run by The Whiteley Homes Trust, a registered charity. The Trust states that it's role is ''To enable our older residents to be as independent as possible and contribute as much as they can to Village life.'' The Trust's admission criteria for people wishing to live in the almshouses or Huntley House is “older generations” (those who have reached state pension age) who are of limited financial means. The Trust accepts people who fund or part fund their own care at the Care Centre.

Whiteley Village is registered to provide four regulated activities. Three of these, accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for the Care Centre; and the regulated activity of personal care for Huntley House and the domiciliary care service in the rest of the village. At the time of our inspection 95 people were living in the Care Centre and 62 people were receiving personal care and support at Huntley House or in the rest of the village.

There was a registered manager in post for the regulated activity of personal care. The registered manager for the Care Centre had left the organisation earlier in 2016. The person who managed Whiteley House and Ingram House had applied to be registered with the Care Quality Commission and this application was being processed. 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 and associated Regulations about how the service is run.

People living at Whiteley Village were happy there. They felt their needs were met. People felt safe with the care provided and within the environment. There were clear procedures to safeguarding people from the risk of abuse and to investigate any allegations of abuse. The risks to people's safety and wellbeing had been assessed and the staff had guidance on how to help keep people safe. People received their medicines safely and as prescribed. There were enough staff and they were recruited in a suitable way.

People consented to their care and treatment. Where people had difficulty making decisions the principles of the Mental Capacity Act 2005 were followed to ensure people's rights were protected. People's nutritional needs were being met and people living in the Care Centre, Huntley House and the rest of the village had access to freshly prepared nutritious meals if they wanted these. People were supported to stay healthy and their mental and physical health were assessed, monitored and their needs were met. They had access to doctors and other healthcare professionals and the staff worked closely with these professionals to ensure people received the right support.

The staff liked working at the village and felt their views and opinions were listened to. They had access to a range of training and they had good support and guidance. There were regular meetings of all levels of staff and information was shared appropriately.

People received support from staff who were kind, caring and polite. Whilst we witnessed some interactions which were not positive, the overwhelming feedback from people using the service and their representatives was that the staff were very caring. The provider responded appropriately to the concerns we witnessed and spoke with the staff concerned who acknowledged and recognised where their behaviour may have appeared uncaring. People told us they had good relationships with the staff. They staff spoke fondly about the people who they cared for. People's privacy was respected and they were supported to maintain independence and live the life they wanted to. The staff had a good awareness of how to support people at the end of their lives and people were able to receive care at this time which reflected their personal wishes and preferences because these had been discussed in advance with them.

People were involved in planning their own care and their views and opinions were acted upon. The service valued the importance of family and friendships and, where people wished, their families were involved in planning and reviewing their care. People's care needs were met in a person centred way and their individuality was valued and respected. There was a wide range of social events and activities within the village and in the different locations. People were supported to access these, although some people in the Care Centre wished for more opportunities for social activities designed specifically for them.

Senior managers within the Trust were positive role models who were well respected. They valued people who lived at the village and the staff and regularly asked for their opinions. They responded appropriately to feedback and concerns. There were good systems for monitoring the quality of the service and identifying themes and trends. The service worked in partnership with other organisations whilst striving for continuous improvement. There was a very positive culture and a sense of community which was felt by people living there and staff alike. The values of the organisation represented the views and opinions of the people who lived there.

During our inspection, we spoke to seven people who lived in the house, six staff, one volunteer and four relatives as well as the registered manager. We carried out this inspection to look at the care and treatment of people who used the service.

We found that each person had a comprehensive care plan that included up to date information. Staff that we spoke with were knowledgeable about the information contained in people's care plans.

Everyone we spoke with was happy with the care provided. We were told 'All staff have an understanding of their needs' and that people were 'Generally well cared for.'

We saw evidence that staff had received training in how to identify possible signs of abuse.

We saw on the day of our inspection that the premises were well maintained and safe for the people who lived there.

People that we spoke with told us that generally they felt there were enough staff on duty each day. They said that they did not have to wait for their call bell to be answered. We looked at staffing rotas and call bell records to confirm this.

We saw that staff received regular appraisals and had the opportunity to develop professionally. Staff were happy working at Whiteley House. We were told 'There's a good team spirit.'

The provider monitored the quality of the service and we looked at the results of the latest surveys.

We saw that the manager had made lots of changes to the way that people's nutritional needs were met. We also saw that they had implemented several new forms to ensure accurate and adequate monitoring for people at risk of malnutrition and dehydration. For example, each duty room had a file specifically for staff to read, record and sign in relation to monitoring and assessing people at risk. We saw that there was an element of person centred care within people's care plans and we found that people's care plans had an up to date nutritional needs assessment.

We spoke to the manager with regards to people using the service having access to specialists. We saw that a meeting had taken place with several healthcare professionals. For example, GP's (General Practitioners), RN's (Registered Nurses) and the Community Matron. This was to discuss the importance of recording referrals and we saw that all relevant parties had agreed to record communications appropriately. We saw that the manager had implemented an action plan to record any changes in a person's dependency. The manager told us that this was done so that any referrals to other healthcare professionals could be identified and acted upon immediately.

We spoke to the manager and also reviewed the care plans for four people using the service. We saw that there had been significant improvements to records within the care plans that we reviewed and also saw evidence of new practice's that had been introduced in order prevent any further shortcomings. This included a new protocol for people at risk of malnutrition, themed audits and a new action plan for changes of dependency. The manager told us further training was being implemented to ensure that all staff were aware of the importance of carrying out nutritional risk assessments and adapting care plans to reflect those needs.

The care plans reviewed had all been audited and all concerns that were identified had been addressed. No other concerns were identified.

We saw that staff were communicating with people respectfully and were giving encouragement at all times throughout the day. People we spoke with told us that they felt they were treated with dignity and respect and felt safe with staff.

One person said "They are very good, they have a lot to put up with here. They do everything everyone asks them to do. I am amazed."

We saw that there was a wide range of nutritious food and hydration available and the people we spoke to all agreed that they felt they had enough food. One person told us 'I have asked for a sandwich in the middle of the night before and got it.'

People we spoke with told us that they had no concerns relating to their medications and that they understood the reasons why they were taking their medication. We observed good practice during the medication rounds and saw that the nurse was engaging with the people in a manner which was understandable. However, we did see that records were not always accurate for the recording and obtaining of medicines.

We found shortcomings in relation to people receiving adequate assessments of their needs and some people not being supported with eating and drinking where necessary.