Archived: Whittington Care Home

Whittington Care Home is a nursing home providing regulated activities personal and nursing care to up to 48 people. The service provides support to older people, including those with dementia. At the time of our inspection there were 28 people using the service. The home provides care over 2 of the 3 floors with a range of communal spaces for dining, activities and relaxation.

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

People were protected from the risk of abuse. Staff understood safeguarding procedures and how to raise a concern. Risks to people’s safety were managed and regularly assessed.

There were enough staff to meet people’s needs. Safe recruitment processes were in place and appropriate pre-employment checks were completed prior to staff starting employment.

People’s care needs were assessed and risk assessments were in place for staff to support people safely. 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.

People told us staff were kind and caring and staff maintained positive relationships with people. Care plans were personalised and included details of people’s wishes and preferences. These were reviewed and updated regularly. Complaints were investigated promptly and people understood how to raise a concern.

Relatives and staff confirmed the registered manager was approachable and supportive. Staff received regular training and supervision to carry out their roles. The service had access to a wide range of professionals to ensure people’s outcomes were met.

There were quality assurance systems in place to monitor the quality of the service. Regular audits were carried out to ensure risks were identified and actions taken to drive improvements.

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 (27 September 2022) and there were breaches in regulation. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Whittington Care Home is a nursing home providing regulated activities personal and nursing care to up to 48 people. The service provides support to older people, including those with dementia. At the time of our inspection there were 28 people using the service. People’s bedrooms were located on two of three floors. The home has communal lounges and dining spaces, a conservatory and a secure outdoor space.

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

Although people’s needs were assessed and reviewed, the guidance within people’s care plans for staff to follow was not always reflective of their current needs. Some areas within the service were not cleaned to a high standard.

Governance systems were not always in place, reliable or effective in identifying issues. The provider did not ensure people were fully supported to feed back into the running of the service. Improvements were required to ensure people were consistently supported to achieve good outcomes. Staff felt supported in their roles and listened to by the manager.

There were enough staff to meet the needs of people using the service. Whilst the service regularly used agency to ensure safe staffing levels, consistent staff were requested which allowed people to build relationships with familiar staff. People were kept safe from the risk of abuse and staff had received up to date training in safeguarding. Lessons were learned from safeguarding concerns, accidents and incidents which were also shared with staff. Medicines were managed safely.

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.

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 inadequate (published 4 March 2022).

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 the provider remained in breach of a regulation.

This service has been in Special Measures since 3 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 October 2021 which was published on 4 March 2022. Breaches of legal requirements were found.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. 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 Whittington Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to governance at this inspection.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Whittington Care Home is a care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 48 people.

The home is set across two floors, each containing bedrooms and bathing facilities. The ground floor has two communal spaces and access to outside space.

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

The service lacked provider and management oversight. There had been no audits for six months and therefore no actions taken in these auditable areas to drive improvement or reduce risks. The culture of the service was not in accordance with empowering people or encouraging independence. Maintenance in the home was not always completed to meet national regulations or to follow advice in relation to best practice.

There were not enough staff to support people’s needs. Staffing was not always provided in line with the agreed rota, which reflected the tool used to show each persons needs. Staffing levels had not always been reviewed to consider changing needs or health impacts. Staff had not always received the required training to support their roles or people’s needs; and staff had not received supervision as part of their development or support network.

Infection prevention and control was not always well managed to ensure people were protected from the risk of infections. Risks to people were not always assessed or any identified risks mitigated.

Safeguarding concerns were not always reported to local authorities to protect people from harm and identified safeguards had not been investigated or actions taken to reduce the risk of harm.

People were not always supported with their hydration or nutritional needs. People’s weight had not been routinely recorded or action taken to ensure dietary needs were met. Medicines were not always managed safely in relation to the administration of medicines and the application of topical creams.

People’s dignity had been compromised by the lack of staff and the culture of the home. Communication with relatives was poor and complaints had not been addressed.

Care plans were not up to date and did not contain individual details to ensure the care was person centred. There was no stimulation provided and people were not encouraged to make decisions on how they spent their day.

The provider worked in partnership with other professionals and referrals had been made appropriately. However, communication in relation to guidance or required health actions were not always shared with care staff , or followed.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; 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

This service was registered with us on 21 September 2020 and this is the first inspection.

The last rating for the service under the previous provider was Good, published on (14 December 2017). At this inspection we have found improvements were required and the rating has deteriorated to Inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, levels of care and provider oversight. A decision was made for us to inspect and examine those risks. We found evidence the provider needs to make improvements, please see the full inspection report.

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 Whittington Care Home 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 safety, safeguarding, staffing and staff training, complaints, people's dignity and overarching governance at this inspection.

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

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 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.

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 six 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.