Whitegates Care Centre Limited

People’s experience of using this service:

Where risks had been identified to people’s health and wellbeing, measures had not always been implemented to mitigate these. For example, pressure-relieving mattresses designed to reduce the risk of people developing pressure ulcers were not always set correctly. People’s medicines were not always managed safely.

Governance systems were not always effective in identifying shortfalls. For example, medicines audits had not identified the concerns we found in relation to medicines management. Guidance for staff about the care people needed and records of the care people received were held on a number of different systems, which meant we could not be assured people were receiving safe and effective care. Some guidelines about people’s care was inconsistent or lacking in clarity, which meant we could not be sure people were being supported in a consistent way.

The provider had an arrangement with the local health trust to admit people being discharged from hospital when they were fit for discharge. This was called the Discharge to Assess scheme. People were admitted to the home with the aim of having a short stay before returning to their own homes or moving to another care setting. The hospital had a responsibility to provide information to the home about people’s needs and the care they required before they were discharged.

Managing admissions under the scheme presented challenges for the home, as information provided by the hospital was sometimes inaccurate or insufficient for staff to plan their care. Additional challenges were presented by poor communication from the hospital, frequent changes of plan, and people being discharged to the home without the correct medicines. The provider recognised the pressure this placed on the home and had scheduled a meeting with the hospital and the local authority to discuss their concerns and ways in which the scheme could be coordinated safely and effectively.

There were enough staff on duty to meet people’s needs. Staff were recruited safely and understood their role in safeguarding people from abuse. The home was clean and hygienic, and people were protected from the risk of infection.

People who lived at the home and their relatives had opportunities to give their views and these were acted upon. Relatives told us communication with them from the home was good. Staff received good support from the management team and worked well together as a team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

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 7 July 2021).

Why we inspected

We received safeguarding concerns in relation to the quality of information held about people needs and the care they required and the potential impact of this on people’s 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 COVID-19 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 requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

We shared feedback about our findings with the provider at the end of our inspection. The following day, the provider sent us details of how they planned to address the shortfalls we had identified.

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

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.

Whitegates Care Centre Limited is a care home providing personal and nursing care to up to 51 people aged 65 and over. At the time of the inspection 32 people lived in the home and received support and care due to their physical and health support needs. Some people also lived with dementia.

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

People and their relatives told us the home was safe and they felt staff provided good care and knew people’s needs well. Staff regularly reviewed people’s individual risks and protected them from avoidable harm. Staff also worked with other healthcare professionals where needed to ensure people’s health and care needs were appropriately addressed.

The home manager recently reviewed staff deployment and made sure there were enough staff on duty, so people received timely care meeting their needs. The provider followed safe recruitment practice to safeguard people.

Staff demonstrated good infection and prevention practice which protected people from spread of infections, including COVID-19. People received safe support with their medicines.

The home manager had a good oversight of the quality and safety of care and was supported by the provider to improve the service. There was a robust service improvement plan in place, and we saw actions were progressed as planned. For example, people’s hydration needs were now closely monitored, and staff were aware how to support people to have regular drinks.

Staff felt supported to raise any concerns and were complimentary about the manager and the regional manager. The manager improved communication within the staff team by implementing clear structures for discussions and gathering staff’s feedback. People’s relatives felt informed and involved in the service. They were able to visit their loved ones and spend time together in the community in COVID-19 secure way.

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 4 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 30 January 2020. A breach of regulation 12 (Safe care and treatment) legal requirements was found. The provider completed an action plan after the last 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. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whitegates Care Centre Limited 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.

Whitegates Care Centre is a ‘care home’ providing personal and nursing care for up to 51 people. At the time of our inspection 40 people were living at the service, a number of whom were living with dementia.

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

People told us they felt safe living at the home. We observed that people were kept safe as most staff knew people and understood their needs. The service did use a number of agency staff and had been open and honest about recruitment problems. Some people felt the use of agency staff had some effect on the continuity of care. We have issued a recommendation.

People's medicines were stored and administered safely, and infection control practices were followed. Staff understood how to protect people from harm and knew when to report any abuse. People's risks were identified, and staff acted to address any known risks. Appropriate recruitment checks were carried out to ensure staff were suitable to support people in the home. Incidents and accidents were recorded and analysed for any trends to prevent future incidents such as falls.

People were supported to maintain good health and they had access to relevant healthcare professionals when they needed them. People received good care around any pressure sores or wound care and staff followed advice given by the nurses or healthcare professionals.

People had a varied and balanced diet and said they enjoyed the food. Staff were knowledgeable about people’s likes, dislikes and allergies with food.

We identified a concern around levels of fluid being provided to people in their rooms. On a few occasions daily fluid charts had gaps in recording which meant it appeared that those people had less fluid each day than the total amount needed or recommended for them. We did not observe any direct incidents of dehydration on the day of inspection. We did observe one person who had two jugs of water from the previous two days and no fresh water for the day in their room. The registered manager sent us examples of fluid being recorded following the inspection to show this concern had been acted on. We have issued a breach of regulation around this concern.

People told us they were supported by caring staff that respected their equality, diversity and privacy. Staff also supported people to be independent and achieve goals. People were supported by staff to have access to health and social care professionals.

People had access to a variety of daily activities. Staff also conducted one to one sessions with people who chose not to take part or who were cared for in bed. People also had the opportunity to go out into the community either as a leisure activity with staff or a personal trip with family.

There was a complaints procedure in place for management to investigate any concerns and implement measures to prevent any future incidents.

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 identified some shortfalls with the quality of the audit process. Despite previous issues being raised with the recording of fluids, quality checks had failed to ensure improvements had been maintained to identify gaps in recording for people’s daily fluids which we identified on inspection. We have made a recommendation for the provider to ensure quality checks are consistent.

People, relatives and staff told us that overall, they were happy with the management of the service. Feedback received for the service from relatives and healthcare professionals had been positive.

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 02 February 2019). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

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.