Archived: Whitewaves Care Home

Whitewaves Care Home provides support and accommodation for up to19 older people, some of whom were living with dementia. The care home provides accommodation for older people with a passenger lift and stair lift available to access all floors. At the time of our inspection there were eight people living at the home. The service also offered respite care.

We previously inspected the service on the 22 October 2017, following concerns about people’s safety which were raised by social services The inspection was focused and looked at the ‘key questions’ of ‘safe’ and ‘well-led.’ At this inspection the service was rated as ‘requires improvement’ with a breach of regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a warning notice for this breach. At this inspection we found the required improvements had not been made.

This was an unannounced comprehensive inspection which took place on 16 and 18 January 2018.

There was a registered manager when we completed this 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 2008 and associated Regulations about how the service is run.

A lack of robust systems and processes, poor management and leadership and ineffective staff training meant that people were not always safeguarded from abuse and avoidable risks to them. Safeguarding concerns had been identified by social services, but these concerns had not been reported to us. Staff at the home had not raised concerns outside of the organisation demonstrating that they did not understand the processes for whistleblowing when care and treatment for people was unsafe or resulted in harm for people.

Risks to people’s safety were not always assessed or managed properly. People were not kept safe by suitably skilled or competent staff and training for staff was not always effective. For example, people were not always supported with their mobility needs in a safe way because staff were not adequately trained or aware of managing risks to people in their bets interests.

People did not always experience care and treatment that was in their best interests, because staff did not have a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). An example of this was seen for a person who was assessed that they lacked the mental capacity to consent to their care and treatment. This person suffered a serious injury to their leg due to staff not making appropriate best interests decisions to keep them safe. People and appropriate others, which included advocates and named relatives who may hold relevant legal decision making powers, such as Lasting Power of Attorney (LPoA), were not always involved in the design and review of care plans and risk assessments. This meant that care and treatment decisions were not always provided in line with peoples own preferences or in their best interests when they may lack the mental capacity to consent for themselves.

Although people were supported to take their medicines in a safe way, there was a lack of detailed ‘As required’ (PRN) protocols for pain relief for people. People did not always receive their pain control medicine when they needed it, which resulted in a person experiencing pain while being supported to move by staff.

People did not have their nutrition and hydration needs met. There was not enough food for people to eat, and meals were decided on a daily basis rather than being planned in advance. People had limited choice about the food they did eat. The management of the home did not follow national nutritional guidance regarding appropriate foods for people living with dementia despite this being advised by social services. People did not always receive the nutritional supplements that had had been prescribed for them which placed them at risk of malnutrition. People’s health and wellbeing was put at risk because they were not supported to eat well.

People were not always protected by safe recruitment systems. The registered manager had not obtained a DBS (Disclosure and Barring Service) check or employment references for one member of staff. This meant that they could not be assured that they were of good character. Staff were not always suitably trained or skilled to provide safe or appropriate care and treatment to people which had resulted in a lack of staff understanding regarding appropriate action to take for people. Delayed contact with appropriate health and social care professionals when people’s health had deteriorated was seen. Staff meetings had taken place, although these meetings did not focus upon the serious safeguarding or service quality concerns raised by social services which meant that staff were not informed of the seriousness of concerns about the service provided at Whitewaves Care Home. This left staff feeling confused about the reasons why social services had taken significant action. Social services suspended any new placements to the home and terminated placements for people at the home due to these concerns for people’s safety and wellbeing. Lessons had not been learned by the provider when things had gone wrong regarding the quality and safety of the service provided. Appropriate adjustments were not made and the registered manager did not accept the concerns identified by social services, community healthcare professionals or the Care quality Commission (CQC). Staff had received some supervisions and annual appraisals, although the concerns that surrounded the home were not noted in these which meant that staff did not collectively contribute to the improvements required at the home.

People were not protected by effective infection control systems and processes at the home. We observed that toilet facilities were unclean and cleaning schedules were not established. A staff member was allocated to clean the home but was not at the service with the required frequency to keep the service clean. The staff rota confirmed this. We observed overflowing bins and unclean toilets and scaled shower heads during the inspection which placed people at risk of infection. Areas of the home were also observed by visiting professionals to be damp and dusty. A number of people had experienced serious chest infections whilst at the service. There had been unexpected deaths for people with serious chest infections.

Records for people were not always up to date to reflect their current needs and risks to them. Records were not held securely for people in line with legislative requirements which meant that people could not be assured of the confidentiality of information held about them. We saw end of life care plans that did not reflect that DNAPCR (Do Not Resuscitate) instruction were agreed for people. This meant that people may receive care and treatment at the end of their lives that is not appropriate to meet their wishes or in their best interests. People were not always identified by staff as being at the end of their lives which resulted in people not always receiving timely care and treatment from appropriate healthcare professionals. Staff weren’t always clear about which people had DNACPR’s in place. Nutrition and mobility records and risk assessments weren’t up to date for one person. The staff were seen to be kind and caring towards this person, but did not know how to care for them safely or appropriately. This meant that the person experienced pain and discomfort when being moved inappropriately by staff and were moved urgently by community healthcare professionals to an alternative place of residence where their needs and risks to them could be met safely.

People were not always supported to take part in stimulating activities that were important to them. An identifiable group of people were observed to be engaged with staff in nail care activities with although another group of people who were not supported to take part in any stimulating activities or engagement with staff. This group of people looked disinterested whilst sat in the lounge area of the home and were seen sleeping for long periods during the inspection.

The provider had not made sure there was a robust quality assurance system in place and had not identified the significant concerns we found at this inspection. Social services terminated the care contracts for three people at the home due to the on-going lack of engagement from the registered manager and lack of improvements made to the service in the required timescales. People were not asked for their views of the service they received in any formalised way. Complaints had not been captured. However, complaints had been received about the service from social services. This indicated that the provider was not monitoring or handling complaints appropriately.

Due to the seriousness of our concerns and the lack of engagement from the registered manager and provider we served an urgent Notice of Decision (NoD) to prevent new people from being admitted or people being readmitted to the service. We also served a Notice of Proposal (NoP) to cancel the registration of this service to prevent regulated activities being provided at this location. We received confirmation from the provider that they were not appealing this proposal notice. We then issued a further Notice of Decision (NoD) to cancel the registration of this service in line with our civil action procedures.

During this inspection we found breaches of the Heal

Whitewaves Care Home provides support and accommodation for 19 older people, some of whom were living with dementia. Nursing Care is not provided. The home provides accommodation over three floors with a passenger lift and stair lift available to access all floors. The premises are located close to the seafront and amenities of Selsey West Sussex. At the time of our visit there were ten people living at the home.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At an inspection in April 2016 we found five breaches of regulations. This was because the provider failed to assess and keep up to date the risks to the health and safety of service users and failed to ensure the safe management of medicines. The provider had also failed to act in accordance with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and had not ensured that people were consulted or involved in planning their care or in the reviews of their care and treatment. The provider had also failed to notify the Care Quality Commission of events that affected the health, safety and welfare of people and had not operated systems and processes effectively to ensure good governance. We asked the provider to take action and the provider sent us an action plan In June 2016 which told us what action they would be taking. We undertook an inspection in April 2017 and found that improvements had been made and the regulations previously in breach were now met. However further development and embedding was needed once new people came to live at Whitewaves. The overall rating for Whitewaves Care Home was Requires Improvement.

After that inspection we received new information of concern in relation to people's safety, staffing levels and the communication breakdown between the service provider and the local authority and visiting health professionals. As a result of these concerns we undertook a focused inspection 22 October 2017 to ensure that people were safe. This report only covers our findings in relation to the safe question and the well-led question. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Whitewaves Care Home on our website at www.cqc.org.uk

Before the inspection we received concerns from health professionals and local authority in respect of the behaviours of the registered manager who is also the registered provider. These concerns were being investigated by the Local Authority. At this time working relationships were difficult and if not resolved will impact on the running of the home and potentially impact on the health and well-being of people who lived at Whitewaves Care Home. The Local Authority were considering what action they were going to take if the situation was not resolved.

Whilst quality assurance systems were in place, we found that actions undertaken to improve were not always documented or recorded and therefore were difficult for the provider to monitor and take forward. We also found that statements in the audit were not always supported by thorough analysis.

There were systems in place to manage medicines safely however there was a lack of protocols to support the safe giving of ‘as required’(PRN) medicines such as pain relief.

Improvements were needed to ensure that care delivery was supported by risk assessments that ensured that people's health needs were monitored and acted on when needed. We found some peoples' recorded weights indicated substantial weight loss over the past six months and no action had been taken or advice sought from health professionals.

People told us they felt safe in the home. Staff were knowledgeable about safeguarding policies and how to recognise different types of abuse. The service ensured risks to people were identified and action taken to reduce risk, for example risk of falls and weight loss. Routine health and safety checks were undertaken covering areas associated with fire safety, health and safety and servicing. The service had contingency plans in the event of an emergency evacuation. Staff and records indicated that fire training and testing was undertaking regularly. People were protected, as far as possible, by a safe recruitment system. Staff had been checked to ensure they were suitable before starting work in the service. There were sufficient staff at this time to meet peoples’ needs. People felt comfortable with staff and said, “Great staff, caring with a sense of humour.” There was laughter and banter between people and the staff. We also saw some positive interaction between staff and the people they supported.

The provider had notified the Care Quality Commission (CQC) of all significant events which had occurred in line with their legal obligations.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our last inspection to the service in April 2016 we found five breaches of regulations. The provider failed to assess and keep up to date the risks to the health and safety of service users and failed to ensure the safe management of medicines. The provider failed to act in accordance with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The provider did not ensure that people were consulted or involved in planning their care or in the reviews of their care and treatment. The provider failed to notify the Care Quality Commission of events that affects the health, safety and welfare of people who use services. The provider did not operate systems and processes effectively to ensure good governance. We asked the provider to take action and the provider sent us an action plan In June 2016 which told us what action they would be taking.

At this inspection we found that improvements had been made and the regulations were now met. Although there are no longer any breaches of regulations the rating for the service remains at Requires Improvement. This is because currently Whitewaves Care Home were only providing care and support for six people which is less than a third of capacity. Given the current occupancy of the home, we did not have sufficient evidence to demonstrate how improvements had been sustained and embedded to ensure good quality care will continue to be delivered when new customers move in to the service. Therefore we have not changed our ratings at this inspection. We will continue to monitor the quality of service provided and inspect Whitewaves Care Home again when the occupancy has increased to check how quality and safety has been sustained and will publish what we find.

Potential risks to people had been identified and assessed appropriately. There were sufficient numbers of staff to support people and safe recruitment practices were followed. Medicines were managed safely.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. One person living at the home was currently subject to DoLS. We found the provider understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. The manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

Care plans provided information about people in a person-centred way. People were involved in the care planning process and were consulted and involved in reviews of their care and support. People’s personal histories had been recorded and their preferences, likes and dislikes were documented so that staff knew how people wished to be supported.

The provider acted in accordance with CQC registration requirements. We were sent notifications as required to inform us of any important events that took place in the home.

People told us they felt safe with staff. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Staff were provided with training and supervision which quipped them with the skills to look after people effectively. People’s healthcare needs were met and people were supported to attend regular health screening and checks with their GP, the optician and dentist as well as with mental health services.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. People’s rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were acted on appropriately. People were involved in decisions about their care as much as they were able. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

There was a variety of activities and outings on offer which people could choose to do. Complaints were dealt with in line with the provider’s complaints procedure.

Weekly and monthly checks were carried out to monitor the quality of the service provided. Feedback was sought on the quality of the service provided through survey questionnaires. The provider told us that she met with people on a one to one basis to discuss issues relating to the home. These meetings enabled the provider to monitor if people’s needs were being met.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were not always safe. Risk assessment tools were in place but risk assessments were not updated when required to ensure people were protected from harm. Medicines were generally stored and administered safely. However the medicines policy did not meet standards specified in approved guidelines. People felt safe with the home’s staff. Relatives had no concerns about the safety of people.

Thorough recruitment processes were in place to check newly appointed staff were suitable to work with people. Staffing numbers were maintained at a level to meet people’s needs safely. People told us there were enough staff on duty and staff also confirmed this.

People told us the food was good. They were involved in planning meals and staff provided support to help ensure meals were balanced and encouraged healthy choices.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that people had not had capacity assessments undertaken and people were not protected in line with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff received training to help them meet people’s needs. Staff received an induction and there was regular supervision including monitoring of staff performance. Staff were supported to develop their skills by means of additional training such as the National Vocational Qualification (NVQ) or care diplomas. These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required.

People said they were well supported and relatives said staff were knowledgeable about their family member’s care needs.

The registered manager told us people did not really enjoy planned formal activities such as bingo and games. She said people liked to chat and enjoyed activities that were spontaneous. However people told us that they would enjoy the opportunity to get outside more and visit the local community

People’s privacy and dignity were respected. Staff had a caring attitude towards people. We saw staff interacting with people but this was mainly to do with the care they were offering.

Each person had a care plan which provided information for staff to deliver support to people. However care plans did not reflect or record the needs and preferences of people. They did not ensure that people were consulted or involved in the planning of their care or in the reviews of their care and treatment

The registered manager operated an open door policy and welcomed feedback on any aspect of the service. There was a stable staff team who said that communication in the home was good and they always felt able to make suggestions. They confirmed management were open and approachable.

There were no records of any analysis of accidents and incidents so that opportunities to learn from incidents could take place.

There was a policy and procedure for quality assurance. However the processes undertaken had not identified the areas for improvement we found during our inspection. We found that there were not sufficient systems or processes embedded in practice to evidence good governance.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We observed interactions between people and staff on duty throughout the inspection. This included supporting and assisting people with mobilising and serving hot drinks and the main meal of the day to them. We noted that staff on duty knew what support and encouragement people needed to maintain their independence. We also noted that staff demonstrated they knew how to deliver care and support in accordance with individual preferences and wishes.

We also gathered evidence of people's experiences of the service by looking at a selection of records. We found that care records ensured care delivery was safe, appropriate and in accordance with individual wishes and needs.

We examined staff rotas and discussed staffing levels with the manager. The manager confirmed how staffing levels had been established to ensure they were sufficient to meet people's needs.

We spoke with two members of staff who were on duty. They demonstrated they had a good understanding of their roles and responsibilities.