Background to this inspection
Updated
12 March 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Whitehorse Care 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and one relative about their experience of the care provided. We spoke with five members of staff including the registered manager, senior care workers and care workers.
We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with two relatives and one professional.
Updated
12 March 2020
About the service
Whitehorse Care is a residential care home providing personal care to seven people at the time of inspection in one adapted building.
The service has 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to eight people, seven people were currently residing at the home which 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 fitting into the residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
The provider’s governance and auditing systems was inadequate and further improvement was needed to ensure that they were consistently effective in ensuring people consistently received safe care and treatment. The provider had failed to send notifications into CQC as required by law.
Whilst staff understood the importance of recording any accidents or incidents, the provider’s systems to safeguard people from the risk of harm or abuse were not robust and therefore we could not be assured people were consistently safe. The provider’s systems for monitoring the safe administration of medication was not effective. There were sufficient numbers of staff to meet people's needs and the provider had a system in place to recruit staff safely.
At our last inspection, we found people were subject to restrictions on their liberty without the legal safeguards in place. At this inspection, we found improvements had been made and people's mental capacity had been assessed, however, this was not done in line with the Mental Capacity Act.
People were not consistently supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.
Whilst people received support from kind and caring staff, systems in place did not always support the service to be caring. Staff received specialised training to give them the knowledge to support people’s individual needs. People were supported by regular staff who knew them well. People’s religious and cultural beliefs were respected.
Whilst care plans and risk assessments had improved since the last inspection, further improvement was required to make them easy to follow. People knew who to speak to if they had any concerns. People who wished, had an end of life care plan in place.
The service 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills and become more independent.
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 this service was requires improvement (published 04 January 2019) and we found multiple breaches of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
At the last inspection the provider was in breach of Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good Governance and Regulation 18 (Registration) (Notification of other incidents). We imposed conditions upon the provider’s registration to drive forward improvements. The provider completed an action plan following the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvements had been made and the provider was still in breach of the same regulations identified at the last inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.