Archived: Whiteladies Residential Home

There was a registered manager in place 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 2008 and associated Regulations about how the service is run.

People were not safe. Risk assessments and risk management plans did not identify and mitigate risks to people’s safety. These included risks associated with the unsafe use of equipment and risk due to lack of operational systems to check the safety of fire, water and electrical provision. People’s medicines were not safely managed. People did not receive their medicines safely and people’s medicines were not stored safely.

Quality monitoring systems were not in place to identify, monitor, manage and mitigate risks to people’s safety and welfare.

Staff that had received training with regard to safeguarding people from harm and abuse. However, they had not always fulfilled their responsibilities and people’s concerns were not always recorded or reported.

Consent to care was not always sought in line with legal requirements and there was insufficient detail of best interest decisions made on behalf of people.

We have made a recommendation for the provider to review the staffing levels in the home. We also made a recommendation for the provider to introduce a nationally recognised tool to identify people at risk of malnutrition.

Staff had access to, and obtained support and guidance from, external health care professionals.

Staff demonstrated a kind and caring approach when they were supporting people who used the service. When staff spoke with each other, they did not always refer to people in a respectful or dignified way. Staff knew people well. However, people’s likes, dislikes, choices and preferences were not always recorded.

There were activities that people could participate in and people were enjoying group activities on the days of our visit.

People and relatives told us the registered manager was readily accessible and available to them. Staff told us they were well-supported and described the home as a good place to work.

Following this comprehensive inspection, the overall rating for this provider is ‘Inadequate’. This means it has been placed in ‘special measures’. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Full information about CQC's regulatory response to these concerns will be added to reports after any representations and appeals have been concluded.

During this visit, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had been inspected in June 2015 and we found the service had breached eight separate regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served four Warning Notices for breaches under two separate regulations following this inspection and set requirement actions for the other six regulations. Following the inspection in June 2015, the registered manager wrote to us to say what they would do to meet the legal requirements of these six regulations.

We undertook a focused inspection on 10 August 2015 to check the service was meeting the legal requirements for the two regulations they had breached that resulted in Warning Notices being served. Between June 2015 and August 2015, the people to whom we made reference to in our Warning Notices that had high level support needs had left the service. As a result of this, when we followed up the Warning Notices the service could not demonstrate they had achieved full and sustained compliance with these regulations. The Warning Notice enforcement procedures were closed as the people they applied to had left the service. We did however request the registered manager to provide the Commission with information to explain how they would meet the legal requirements of these two regulations.

You can read the reports from our last comprehensive and focused inspections by selecting the 'All reports' link for ‘Whiteladies Care Home’ on our website at www.cqc.org.uk

There was a registered manager in post. 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.

We found the service had made numerous improvements since our last inspection in August 2015. However, we found that despite these improvements the registered manager had not ensured that people were always fully supported by staff who had received appropriate training. In addition to this, we made observations of care that was not appropriate for a person’s assessed needs. The environment had undergone some improvements, however some areas still required attention. The registered manager ensured immediate safeguards were put in place in relation to staff training following our inspection to reduce the risk of harm to people.

The registered manager could not demonstrate they had the required understanding of the Deprivation of Liberty Safeguard (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. This placed people at risk of being unlawfully deprived of their liberty. Staff knowledge of the Mental Capacity Act 2005 was also poor.

The provider had ensured there was enough staff on duty to meet people’s needs and recruitment procedures had improved. People had an accurate assessment of their needs and risks recorded to reduce any identified risks to people’s health and welfare. People’s medicines were managed safely and accidents and incidents were reviewed. Staff we spoke with were knowledgeable about procedures around safeguarding and whistleblowing.

People’s nutrition and hydration needs were met. There were systems that monitored people’s weight that had proven effective in identifying weight loss. People spoke positively about the food at the service. An induction and supervision process was in place, and staff told us they felt supported by the registered manager. The service communicated with healthcare professionals as required.

We observed good interactions between people and staff. We made observations where people’s dignity was maintained. Communication between staff and people was caring and reassuring when people were distressed or anxious. The service had made improvements in being responsive to people’s health needs and we saw examples of how this had been achieved. People said care was delivered in line with their preferences. Staff we spoke with understood the needs of the people they cared for and our observations supported this.

People’s care records had been personalised and contained information that allowed staff to support people in a person centred way. There was a system in place to ensure people’s needs were continually monitored. The service had a complaints policy and complaints investigated by the registered manager had been responded to in accordance with policy. The equipment and environment in which people were cared for was monitored to ensure it was safe. People had the opportunity to partake in activities at the service.

People and their relatives spoke positively about the management of the service. Staff felt supported by the registered manager. There were systems to obtain the views of staff and key messages were communicated to staff. There were now regular auditing systems to monitor the quality of care provided and the accuracy of records and documentation used by staff.

The service remains in breach of two regulations 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 the report.

We spoke with four people who lived at the service. We also spoke with a visiting health professional, eight members of staff and the manager.

The people we spoke with who lived at the service generally provided positive feedback regarding their experience of the service. Comments included "staff listen to what I want and do what I ask' and '"they discuss everything with me".

The care plans recently introduced by the provider were specific to the individual's needs and preferences. People told us that they were involved in discussions about their care and support.

Staff were provided with training appropriate to their roles and they were regularly supervised and appraised.

We found that the provider had implemented robust systems to regularly assess and monitor the quality of the services provided.

We found that the provider kept personalised care, treatment and support records secure and confidential for each person who used the service. Records were stored in a secure accessible way that allowed them to be located quickly.

During our visit we spoke with ten people who used the service, six members of staff, the manager and the provider.

We observed staff supporting people in an appropriate manner ensuring their privacy and dignity was maintained. Comments from people we spoke with included 'I don't think I could have made a better choice' and 'staff always speak to me respectfully'.

Although staff we spoke with had a good knowledge of people's needs this knowledge was not always included in the person's care plans. We found that care plans did not accurately reflect the needs of the people living in the home.

People were supported to lead full and active lives including accessing the community. This included working in a charity shop and being involved with the local church. We observed that people were engaged in a number of activities which included an exercise class, participating in puzzles from the daily newspaper and afternoon bingo.

We found that there were not suitable records in place to ensure that staff had received appropriate training, supervisions and appraisals.

We found that the provider did not carry out robust risk assessments of people's needs. This meant that people were not protected against the risks of receiving care or treatment that is inappropriate or unsafe.