We carried out a review of the data available to us about Whitwood Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Whitwood Grange, you can give feedback on this service.
Whitwood Grange is a residential care home providing personal to people with learning disabilities. It accommodates up to 17 people in three separate areas; there are two six bedded houses and five self-contained flats. There were eight people using the service at the time of our inspection.
Services for people with learning disabilities and or autism are supported
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.
People's experience of using this service and what we found
People felt safe. Systems were in place to safeguard people from the risk of abuse. People received their medication as prescribed by staff who had been appropriately trained.
Risks to people were effectively managed. Staff knew people well and were knowledgeable about individual risk management issues. Safe infection prevention and control (IPC) practices were in place to minimise the risk of spread of infection.
Systems in place to monitor the service had improved and were more effective in identifying and addressing areas that required improvement. This improvement needs to continue and become embedded into practice. There was a positive culture at 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
The last rating for this service was Inadequate (published 18 January 2021).
Why we inspected
This inspection was prompted through our intelligence monitoring system. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service is requires improvement.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Whitwood Grange 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 reinspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service and what we found
Whitwood Grange had experienced recent management changes. At the time of our inspection, an interim home manager was in post.
We found a lack of oversight over key aspects of the service such as the premises and infection control, assessment of people’s capacity, formal staff support and outcomes for people living in the home. Some records we requested from the provider to demonstrate their quality oversight were not available.
Some areas of the premises were in need of repair. Infection control standards required improvement as staff were not consistently using PPE correctly and supplies of toiletries were not available.
People received their medication as prescribed, although storage arrangements and some recording was not adequate.
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. Assessments of people’s capacity had not been appropriately completed. There was no evidence to show these decisions had involved people’s representatives and they had not been reviewed.
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 not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Our findings demonstrated people did not always receive care which maximised their choice, control and independence. A lack of leadership meant there wasn’t sufficient oversight of these aspects of people’s lives. From our observations and care records, we found a mixed quality of staff interactions with people living in the home.
Day to day running of the home required a high usage of agency workers. Training records we looked at showed low completion rates, in particular for understanding the Mental Capacity Act, safeguarding people from abuse and the use of restraint.
With the exception of one relative, relatives and staff said people were protected from the risk of abuse. Relatives confirm they were involved in reviews of people’s care, although they had initiated much of the contact with staff during the pandemic.
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 (published 9 October 2019).
Why we inspected
We received concerns in relation to the use of restraint, the registered manager not highlighting workforce issues and declining management support, a lack of provider oversight and a lack of person-centred care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.
Following out inspection, the provider has commenced a programme of refurbishment at this home. Additional cleaning support to address infection control issues was provided for a two week period. A new home manager has been appointed who started in October 2020.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whitwood Grange on our website at www.cqc.org.uk.
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.
We have identified breaches in relation to the management of risk, premises, infection control, safe recruitment practices and service oversight. You can see what action we have asked the provider to take at the end of this full report.
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.
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 6 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.
Whitwood Grange is a residential care home providing personal to people with learning disabilities. It accommodates up to 17 people in three separate areas; there are two six bedded houses and five self-contained flats. There were 14 people using the service at the time of our inspection.
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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of the thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
People’s experience of using this service and what we found
People told they felt safe. A lot of experienced staff had left the service over the past six months. This had been unsettling for people, but safe staffing levels had been maintained. This was being dealt with by recruiting new staff and providing extra training for agency staff to make sure they had the right skills to meet people’s needs.
Recruitment procedures were safe, and staff were trained and supported to carry out their roles.
People’s needs were assessed, and their care plans and risk assessments were detailed. This helped to make sure care was person-centred.
People’s communication needs were assessed and where needed appropriate support was provided. For example, staff were trained in the use of sign language.
People were supported by kind and caring staff, who promoted their independence.
People were supported to eat and drink a balanced diet which took account of their needs and preferences. People were supported to stay healthy and to access the full range of NHS services.
People were supported to maintain relationships with family and friends. People took part in a variety of social activities in the home and in the community.
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.
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 as many opportunities as possible for them to gain new skills and become more independent.
The provider had systems in place to check the quality and safety of the services provided.
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. (published 31 January 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
Whitwood Grange is a purpose built home which provides care and accommodation for up to 17 people with a learning disability. The service is divided into three houses Hugh and Walton House both can accommodate up to six people. These houses have communal lounges, dining rooms and kitchens. Bedrooms have en-suite facilities. Then the third is The Fold, which are five self-contained flats.
The service had a registered manager in post at the time of our inspection. 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.
Relative's of people who used the service, who we spoke with, told us they were very happy with how care and support was provided at the home. They spoke extremely positively about the staff and the way the home was managed. People we observed who used the service were engaging with staff talking and laughing together.
There was a strong person centred and caring culture in the home. (Person centred means that care is tailored to meet the needs and aspirations of each person, as an individual.) The vision of the service was shared by the management team and staff.
We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety.
We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good understanding and knowledge of this topic. People who used the service had been assessed to determine if a DoLS application was required and some people had authorised DoLS in place and staff were aware of any conditions attached to these.
Systems were in place to ensure people received their medications in a safe and timely way from staff who were appropriately trained. Robust monitoring of medication had been introduced since our last inspection.
There was enough skilled and experienced staff on duty to meet people’s needs. Recruitment systems were robust, so helped the employer make safer recruitment decisions when employing new staff. New staff had received a comprehensive induction into how the home operated and their job role. This was followed by regular training updates and specialist training to meet the needs of the people using the service.
People were supported to eat and drink sufficient to maintain a balanced diet and adequate hydration.
People’s needs had been assessed before they moved to the home and we found they, and if required their relatives had been involved in planning care. Training was also provided to staff before people moved into Whitwood Grange to ensure staff understood how to meet their needs. Care files checked reflected people’s care and support needs, choices and preferences.
People had access to a varied programme of activities which provided in-house stimulation, as well as regular trips out into the community.
There were extensive systems in place to monitor and improve the quality of the service provided. These had been improved and implemented since our last inspection and we saw these were embedded into practice. The registered manager and staff we spoke with were very passionate about ensuing effective quality monitoring to continually improve the service and the wellbeing of people they supported.
Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were managed well and that management took steps to learn from such events and put measures in place which meant lessons were learnt and they were less likely to happen again.
This inspection of Whitwood Grange took place on 7 and 11 December 2015.
We carried out an unannounced comprehensive inspection of this service on 22 and 25 September 2015. After that inspection we received concerns in relation to the management of behaviour that challenges causing injury to staff and people who use the service due to a lack of suitably experienced, trained staff and concerns that staff were not supported appropriately. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Whitwood Grange on our website at www.cqc.org.uk
Whitwood Grange is registered to provide accommodation and personal care for up to 17 people with a learning disability. They provide a service to people with complex needs and behaviours that challenge. The service is divided into three units.
The service had a registered manager. 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 who lived at Whitwood grange, who were able to do so, told us they felt safe.
Risk assessments minimised risk whilst promoting people’s independence
There were enough suitably trained staff to meet the assessed needs of people who used the service.
Staff had a good understanding of safeguarding adults from abuse and who to contact if they suspected any abuse.
The provider had not done all that was reasonably practicable to assess, monitor and mitigate risks to staff. This was a breach of Regulation 17 (2) (b)of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The culture of the service was positive, person centred, open and inclusive and staff spoke positively about the registered manager
You can see what action we told the provider to take at the back of the full version of the report.
This inspection of Whitwood Grange took place on 22 and 25 September 2015 and was unannounced.
We previously inspected the service on 8 and 13 April 2015 and at that time we found the provider was not meeting the regulations relating to person centred care, safe care and treatment, good governance and supporting staff. We asked the registered provider to make improvements. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made. We found improvements had been made in person centred care, safe care and treatment around medicines and supporting staff. Improvements were underway with good governance; however the problems we found at the last inspection with managing risk had not been fully addressed.
Whitwood Grange is registered to provide accommodation and personal care for up to 17 people with a learning disability. They provide a service to people with complex needs and behaviours that challenge. The service is divided into three units.
The Registered Manager of Whitwood Grange had left the service in August 2015 and submitted their application to deregister as manager. There was a manager in post, however they were not registered with CQC at this location at the time of inspection. They had submitted their application to be a registered manager and were awaiting the outcome of this. 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 we spoke with told us they felt safe at Whitwood Grange. We found there was a lack of consistency in how risk was managed which meant the provider was not always doing what was reasonably practicable to reduce risks to people. This was in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
There were not always enough suitably trained staff to meet the assessed needs of people who used the service. For example one person was unable to access the community in line with their care plan on a number of occasions. This was a breach of Regulation 18 of the health and Social Care Act (2014)
Staff had a good understanding about safeguarding adults from abuse and who to contact if they suspected any abuse and medicines were managed safely for people.
The provider had effective recruitment and selection procedures in place. Staff had received an induction, supervision, appraisal and specialist training to enable them to provide support to the people who lived at Whitwood Grange. This ensured they had the knowledge and skills to support the people who lived there.
People’s capacity was considered when decisions needed to be made and advocacy support provided when necessary to support and enable people to air their views. This helped ensure people’s rights were protected when decisions needed to be made
People enjoyed the food and had plenty to eat and drink and meals were individually planned. A range of healthcare professionals were involved in people’s care.
Throughout our inspection we observed staff interacting with people in a caring, friendly, professional manner. Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for and supported. People were supported to be as independent as possible throughout their daily lives.
People and their representatives were involved in care planning and reviews.
Individual needs were assessed and met through the development of personalised care plans. People’s care plans detailed the care and support they required and included information about peoples likes and dislikes
People engaged in social activities which were person centred. Care plans considered people’s social life which included measures to protect people from social isolation.
People told us they knew how to complain and told us staff were always approachable. Comments and complaints people made were responded to appropriately.
The culture of the organisation was open and transparent. The manager was visible in the service and the deputy managers knew the needs of the people in the home. The new manager had made improvements to support and retain staff, however some staff worked long hours and were unclear about rest breaks.
The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of the people were met however this system had not picked up and addressed the problems we found with managing risk and staffing.
You can see the action we have told the provider to take at the end of this report.
This inspection took place over two days on 8 and 13 April 2015. The first day of the inspection was unannounced and the second day was announced. At the last inspection in January 2014 we found the provider was meeting the regulations we looked at.
Whitwood Grange is registered to provide accommodation and personal care for up to 17 people with a learning disability. They provide a service to people with complex needs and behaviours that challenge. The service is divided into three units. The service had a registered manager. 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.
Although people told us they felt safe we found this service was not providing consistently safe care. The provider did not have effective systems in place to manage risk so people were safe and also had the most freedom possible. Medicines were not always managed consistently and safely. Staffing levels were adequate but a high turnover of staff impacted on care delivery. The provider had effective recruitment and selection procedures in place. Staff had a good understanding of safeguarding people from abuse.
Staff were not always provided with training and support to ensure they were able to meet people’s needs effectively. People enjoyed the food and had plenty to eat and drink but involvement in the meal planning process was limited. A range of healthcare professionals were involved in people’s care although some health professionals raised concerns with us about the service provided at Whitwood Grange.
People we spoke with told us staff were caring and could make decisions about their care. However, we saw examples where people had not been consulted and the service could not demonstrate they had been made in the person’s best interest. Staff understood how to provide care that respected people’s privacy and dignity.
Aspects of people’s care was not assessed, planned and delivered appropriately. There was not always enough information to guide staff on people’s care and support. They engaged in social activities which were person centred.
The provider’s systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not implemented. Most of the management team were new and were focussing on allocating key responsibilities. The registered manager was confident once they were established improvements would be made to the service provision.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.
We reviewed three sets of treatment records in detail. We noted that service users had individual care records including assessments of individual need and clear guidelines for staff to follow, in order to ensure the person's health and personal care needs were met. We observed staff supporting people in a positive way. Some people living at the home have Autistic Spectrum Disorders (ASD). We saw staff interacting with people with ASD with a structured and therapeutic approach.
We inspected the planned menus for each month. We were told that the menus were professionally prepared to ensure a balanced and varied diet. Our observation of the menus concluded that the service was ensuring people received appropriate nourishment.
We looked at medication charts and reviewed records for the receipt, administration and disposal of medicines and conducted a sample audit of medicines to account for them. We found that records were complete and that people had received the medication they had been prescribed.
We observed that people who lived at the home received support and assistance in an unhurried manner. Care staff were able to spend quality time with people to assist them with physical care and to provide social stimulation.