Whitestone Lodge

Whitestone Lodge Care Home provides accommodation and personal care for up to 20 people in a converted building over two floors. At the time of our inspection 20 people were living at the service.

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

Risks to people’s health, safety and welfare were not always assessed, monitored, and managed to ensure their safety. A risk assessment had not been completed to determine the risk level and whether a risk management plan was needed for people with conditions which posed a potential risk to their physical and mental health.

Checks on the safety of the environment, utilities and equipment were not consistently completed. Records lacked instructions on the required frequency of checks, location of checks and who was responsible and had completed them.

Staff were confident about recognising and reporting abuse, however, a significant number of staff had not updated their safeguarding training. A number of allegations of abuse were raised with the relevant local authority, however, there were no records maintained to enable us to review what immediate action was taken to safeguard people.

There were no records to show an initial assessment of some peoples’ needs and choices had been completed prior to their admission to the service. Assessments were not always completed, and care plans were not always updated following a change in people’s needs.

Staff were not always appropriately trained for their role to enable them to meet people’s needs. There were significant shortfalls in the completion of training for staff. Staff were carrying out tasks without the right training, skills, and knowledge.

There was a lack of a person-centred approach to planning people’s care. Care plans were not in place to guide staff on people’s needs and choices and how they were to be met. Outcomes recorded in some peoples care plans were not personalised.

The providers complaints procedure was not up to date and there was a lack of response to complaints received about the service. Complaints were not acknowledged, investigated, responded to, and used to improve the quality of care.

The provider lacked understanding of their role and responsibilities and regulatory requirements. The provider failed to act on and make improvements following the last inspection. There were no clear lines of responsibility for ensuring oversight of auditing systems and processes. Audits and checks were inconsistent and ineffective, they failed to identify risk and bring about improvements. Records relating to people’s care and the management of the service were not always maintained, accurate and securely stored.

Staff were caring and kind towards people when providing them with care and support.

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 July 2022).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety and the leadership of the service. A decision was made for us to inspect and examine those risks.

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 inadequate based on the findings of this inspection.

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 Whitestone Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s safety, staffing, complaints and the governance and leadership of the service.

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 following this report being published 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.

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 varying the conditions of 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.

Whitestone Lodge provides accommodation and personal care for up to 20 people, including people who are living with dementia. There are two floors accessed via stairways and a passenger lift. At the time of our inspection there were 19 people living at the service.

People's experience of using the service and what we found

During our inspection we found a number of shortfalls in relation to record keeping, reviews of people's care and a lack of person-centred information in some aspects of people's care plans. In addition, we found that systems in place to check whether improvements were needed had not been routinely followed. The provider and new manager were open and transparent about these shortfalls and recognised the need to make necessary improvements. Since starting in post, the new manager had already taken action to address some of the highlighted issues.

People spoke positively about the care they received, and family members were confident their loved ones were well looked after. People told us they felt safe and could talk to staff about any concerns they had. One family member told us, "I can't fault them [staff]. They do an amazing job. The home is always clean. [Relative] is always clean and tidy. They chat to him. I haven't even noticed the lack of manager. No issues at all."

Risks to people's health and well-being had been assessed and staff had a good level of knowledge and understanding about people's individual risks and how best to support them. There were enough staff to meet the needs of people living in the home.

The environment was clean and hygienic. Staff received training in infection prevention and control and were provided with regular updates and changes to guidance; particularly in response to COVID-19. Staff and people using the service accessed regular COVID-19 testing. The service supported family members to regularly visit their relatives safely and had processes in place to prevent visitors from catching and spreading infections.

People’s needs had been assessed and care was delivered in line with best practice guidance. Staff identified changes to people’s health and well-being and completed referrals to health and social care professionals in a timely manner.

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.

Staff spoke positively about their experience of working at Whitestone Lodge. One staff member told us “I love it here. All the staff are spot on. We are one big team. I feel very supported by [provider] and I am so glad [manager] is back.” Staff were aware of the improvements that needed to be made but were confident action would be taken.

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 11 June 2020 following a change to the provider's name. This is the first inspection. The last rating for the service under the previous provider name was good (report published 18 October 2017).

Why we inspected

This inspection was carried out in line with CQC inspection guidance for newly registered services.

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.

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.

We found the following areas of good practice :

• Relatives were able to spend time seeing and speaking with loved ones in various ways. There was a visitor’s pod outside the home so they did not need to enter the building. Where visiting was not possible, other means of communication had been created.

• PPE was available at the front door for visiting professionals and hand sanitisation was seen in various places throughout the home.

• People who required isolating were supported in a designated room and area of the home. A team of staff were also allocated who could provide support for all their needs.

• COVID-19 testing was undertaken 2 x weekly for staff and monthly for residents who were able and willing. At the time of the inspection all residents and care staff who had consented had received their first vaccination.

• Stocks of the right standard of personal protective equipment (PPE) were well-maintained and staff used and disposed of it correctly. Staff had been trained in infection control practices.