Whittingham House

Whittingham House is a care home providing accommodation for persons who require nursing or personal care for up to 70 people including people living with dementia. At the time of our inspection, 59 people were living at the service.

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

The provider had not identified or managed health and safety risks and hazards. Risks were not always safely monitored or managed, for example risks relating to falls, moving and handling, distressed reactions and eating and drinking. A lack of information and follow up across people's care plans meant people were at risk of harm. Systems in place to protect people from the risk of abuse were not effective. The provider had not always reported concerns to external agencies, such as the local authority and CQC where required. Whilst we found medicines were administered safely, we found medicines were not safely secured and other minor improvements were required. Staff were deployed to meet people's needs but were often task focused.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Capacity assessments had not always been completed, and conditions on Deprivation of Liberty authorisations had not been met. People's needs and choices were not always updated in care plans to reflect current needs.

The providers quality assurance systems were not effective. Whilst some audits were being completed, they did not identify any of the concerns found at this inspection. There were also no effective checks at provider level. We received mixed feedback about the culture of the service from staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good (published 04 June 2021).

Why we inspected

We received concerns in relation to safeguarding staffing and poor care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to inadequate based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well led sections of this full 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 Whittingham House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk, safeguarding, consent, meeting nutritional needs and governance at this inspection.

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 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.

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 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.

Whittingham House is a residential care home providing accommodation and personal care for up to 70 people, including people living with dementia. At the time of our inspection, 45 people were living at the service.

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

People told us they were happy living at the service. One person said, “The staff are really good, nothing is too much trouble for the carers.”

Care and treatment were planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after the required checks had been completed. Staff had received appropriate training. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. Medication was dispensed by staff who had received training to do so.

The manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 support this practice.

People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for people.

People and their relatives and advocates were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The manager responded to complaints received in a timely manner. People were supported to make plans for the end of their life.

The manager had systems in place to monitor and provide good care and these were reviewed on a regular basis.

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 requires improvement (published 26 February 2021) and there were multiple breaches of 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.

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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.

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

Whittingham House is a residential care home providing accommodation and personal care for up to 70 people, including people living with dementia. At the time of our inspection, 47 people were living at the service.

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

At this inspection, we found some improvements had been made to improve the quality of the service, this included the safe management of medicines. However, governance systems were not always effective and further improvements were required. This included the monitoring and oversight of safeguarding alerts and information contained in people’s care plans. The quality of information in care plans varied and some records we looked at did not include sufficient information about individual risks to ensure people were safe. Care plans were currently being updated to ensure they reflected people’s up to date care and support needs. The provider did not always comply with their legal duty to notify us of incidents, including safeguard concerns where alleged or suspected abuse took place.

People's care and support needs were met by sufficient numbers of staff. People were relaxed and comfortable in the presence of staff. The management of medicines was safe. Medicines were administered by staff who had received training to do so. There were systems in place to minimise the risk of the spread of infection.

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 21 August 2019)

There were multiple breaches of regulation. A Warning Notice was served on the provider in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A meeting was held with the provider and registered manager on 26 September 2019.

At this inspection enough improvement had not been made and the provider was still in breach of regulations 12 and 17. The service remains rated requires improvement. This service has been rated inadequate or requires improvement for the last five consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 16 and 18 July 2019. Breaches of legal requirements were found: Regulation 9 [Person centred care], Regulation 12 [Safe care and treatment] and Regulation 17 [Good governance].

We undertook this focused inspection to check the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe and Well-led.

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 not changed following this focussed inspection and remains requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whittingham House 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 a breach of Regulations 12 [Safe care and treatment] and 17 [Good governance] of the Health and Social Care Act 2008 (Regulated Activities) Regulations

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.

Whittingham House is a residential care home and provides accommodation and personal care for up to 70 older people, including people living with dementia. At the time of our inspection, 32 people were living at the service.

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

At this inspection, we found some improvements had been made which had improved the service. However, further improvements were required to ensure the quality assurance systems and processes in place were robust, fully embedded and sustained.

People were supported to take their medicines from staff who had received training to do so, however further improvements were required to ensure the safe management of medicines; this included the safe management of PRN (as and when required) medicines.

Although people felt safe living at the service, improvements were required to ensure people’s care plans, including any associated risks, were up to date and reflective of their current care and support needs. Improvements were also required to make sure contemporaneous records were kept at all times and people’s communication needs met. We have made a recommendation about good practice on meeting people’s communication needs.

Staff had received safeguarding training and were aware of how to report any concerns about neglect or abuse and were confident any concerns would be addressed. Whilst there had been no safeguarding alerts raised since our last inspection, the service had received a complaint which indicated a safeguarding concern and a safeguarding alert was not made. We have made a recommendation about seeking good practice guidance on recognising and acting on safeguarding concerns.

Recruitment procedures were safe. Staff had been recruited following relevant checks being completed. Staff enjoyed working at the service and told us staff morale had improved since our last inspection and could approach the registered manager for support and guidance at any time. Staff received on-going training, supervision and appraisal to enable them to fulfil their role and responsibilities.

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 were supported to maintain good health and access health care professionals. However, people were not routinely supported to access dentists and people did not have oral care plans in place. We have made a recommendation the provider seeks oral health care guidance.

Where required, people were supported with their nutritional needs.

People told us staff were caring. They, and their relatives, told us they were very happy with the care and support they received. They spoke positively about the kind, caring attitude of staff and felt safe in the presence of staff. Our observations and feedback from people and relatives confirmed improvements had been made since our last inspection.

An activities coordinator had recently been recruited and people had access to a range of activities during the week.

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 18 February 2019) and there were multiple breaches of regulation. At this inspection, we found improvements had been made, however there were continued breaches of regulations 9 [person centred care], 12 [safe care and treatment] and regulation 17 [Good governance].

This service has been in Special Measures since 7 February 2018. 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, responsive and well led sections of this 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 Whittingham House on our website at www.cqc.org.uk.

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.

Whittingham House provides accommodation and personal care for up to 70 older people and people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Whittingham House is a large detached building situated in a quiet residential area in Southend on Sea and close to all amenities. The premises is set out on two floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service on each floor. The service is separated into units and consists of Lemon and Lavender suites on the ground floor and Blossom and Bluebird suite on the first floor. At the time of this inspection Bluebird suite was not in use.

This inspection was completed on 27, 28 and 30 November 2018 and was unannounced. There were 44 people living at the service.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

A registered manager was 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.

Quality assurance checks and audits were not robust, as they did not identify the issues we found during our inspection and had not recognised where people were placed at risk of harm and where their health and wellbeing was compromised. The management team of the service had not taken appropriate steps to ensure they had sufficient oversight of the service which ensured people received safe care and treatment. The lack of managerial oversight at both provider and service level had impacted on people, staff and the quality of care provided. Therefore, the management team were unable to demonstrate where improvements to the service were needed, how these were to be made and had been addressed; and lessons learned to ensure compliance with regulatory requirements and the fundamental standards.

The management team had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people using the service, we observed some interactions which were not respectful or caring and failed to ensure people were treated with respect and dignity. People’s healthcare needs were not consistently monitored and referrals to appropriate healthcare professionals made. Staffing levels were being maintained but the deployment of staff was not always responsive to meet people’s care and support needs. Improvements were also required to the service’s medication arrangements as discrepancies relating to staff’s practice and medication records were found.

The dining experience for people was not consistently positive and improvements were required, particularly in the way this was organised. Although the service was without an activities coordinator, people received little opportunity to participate in meaningful social activities.

Care records were not accurately maintained to ensure staff were provided with clear up to date information which reflected people’s current care needs. Where people were judged to be at the end of their life, information relating to their end of life care needs were not recorded and not all staff had received appropriate training. Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered, and risk assessments had not been developed for all areas of identified risk.

People’s capacity to make day-to-day decisions had been considered and assessed. Nonetheless, improvements were required to ensure staff had a better understanding of the main principles of the Mental Capacity Act and best interest assessments completed for all areas.

Not all staff that were newly employed had received a comprehensive robust induction and the role of senior members of staff was not effective in monitoring staff’s practice and providing sufficient guidance and support. The majority of staff had attained up-to-date training but improvements were required for newer members of staff to receive training in a timely manner.

The service worked with other organisations to enable collaborative joined-up care. The registered provider’s arrangements for the prevention and control of infection at the service was satisfactory. Effective safeguarding arrangements were in place whereby the Care Quality Commission was notified of safeguarding concerns and staff had received training.

Whittingham House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 70 older people and people living with dementia.

Whittingham House is a large detached building situated in a quiet residential area in Southend on Sea and close to all amenities. The premises is set out on two floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service on each floor. The service is unitised and consists of Lemon and Lavender Suites on the ground floor and Blossom and Bluebird Suite on the first floor.

The Local Authority had placed a restriction on the service provision following our last inspection to the service in July 2017. This inspection was completed on the 5 and 7 February 2018 and was unannounced. At the time of this inspection there were 38 people living at the service.

Since our last inspection to the service in July 2017, a new manager had been appointed and had been in post at Whittingham House since the 14 August 2017. The manager was registered with us on 2 March 2018. 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.

The overall rating for this service is ‘Requires Improvement.’ However, the service remains in ‘Special Measures.’ We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Whilst a number of improvements were noted since our last inspection in relation to the registered provider’s arrangements for safeguarding, staffing levels, staff training, induction, supervision and some aspects of care provision, further improvements were still required. Quality assurance arrangements at both provider and service level were not as effective as they should be. Where issues were highlighted as part of the management teams auditing arrangements, information was not always available to show actions required had been addressed. The registered provider and manager had failed to monitor and evaluate this progress properly so as to assure themselves that sufficient improvements had been undertaken to their audit and governance arrangements and these were effective and any improvements made were sustained.

Not all risks to people were identified and improvements were required to record how these were to be mitigated so as to ensure people’s safety and wellbeing. Improvements were required to ensure that people’s care plan documentation reflected all of their care and support needs and how the care was to be delivered by staff.

Although people told us that staff cared for them in a kind and caring manner and whilst some aspects of care by staff was seen to be good, other arrangements were not as effective as they should be and could potentially impact on the delivery of care people received. Improvements were required to the service’s dining arrangements to ensure people were not seated for long periods of time waiting for their meal. The deployment of staff was not always appropriate to meet people’s care and support needs and this required review.

Systems were in place which safeguarded people who used the service from the potential risk of abuse and harm. Staff understood the various types of abuse and knew who to report any concerns to should the need arise. People living at the service confirmed they were kept safe and had no concerns about their safety.

Training for staff was now much improved and the majority of staff had achieved up-dated training in a range of subjects and topics. Newly employed staff had received an induction relating to their role and responsibilities. Staff felt supported and now received regular supervision.

People received sufficient food and drink throughout the day and their healthcare needs were supported, having access to a range of healthcare services and professionals as required. Medicines management within the service was appropriate and safe. Staff had a good relationship with the people they supported. People were supported to maintain their independence where appropriate and had their privacy respected. They were able to participate in a range of social activities of their choice.

We have made recommendations about the management of risk and the deployment of staff within the service to meet people’s care and support needs.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of the service on the 10, 11, 12, 13 and 14 July 2017. Previously, the service had been inspected in November 2016 and received an overall rating of requires improvement.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this time frame so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of this registration.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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. The Care Quality Commission is now considering the appropriate regulatory response to resolve the problems we found during our inspection.

The service did not have a Registered manager. It is a requirement of the service’s registration with the Care Quality Commission that there is a registered manager in place. 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.

There were no systems in place to ensure that staff were deployed in a way which met people’s changing needs and circumstances. This meant that staffing levels were not adequate to ensure that people’s needs were met and people were put at potential risk of harm.

Care records, plans, and assessments were very generic and did not take account of people’s individual needs effectively. Information had not always been recorded or assessed to demonstrate how the service was going to mitigate any risks to people’s safety. People were at risk as the processes in place to safeguard people from potential incidents remained inadequate.

Staff training had not been embedded in everyday practice. Staff training was out of date in some cases and their competency to perform their duties had not been reviewed. Staff did not receive regular supervision and support, which meant that staff lacked the skills and support to perform their roles effectively.

Improvements were required to the way in which the service assessed people’s capacity to make decisions and how they supported people to make choices. People’s dining experience was not always positive. The service needed to improve the way mealtimes were organised and how choices were offered to people, including offering clear support and explanations to people which choices were being served.

Some staff were not knowledgeable of people’s individual care needs nor did they have knowledge of their histories and backgrounds so as to enable them to deliver personalised care in all instances. People’s care was not always planned and assessed to ensure their safety and welfare. Individual’s preferences relating to their diet had not been considered. Where there had been efforts made to provide people with specific care this was not being adhered to. People did not always receive care in a person centered way because the deployment of staff meant the approach was mainly task and routine focused.

Roles and responsibilities were unclear and staff were unsure what they were accountable for. The culture of the service was not a positive one and staff lacked time, knowledge and understanding. Quality assurance systems and processes, which assessed, monitored or improved the quality of the service were not effective or established. Support and resources needed to run the service were not available and the provider was not operating the service in line with their own philosophy of care. The lack of good quality governance had impacted on the delivery of safe and effective care.

There was a complaints procedure in place. Relatives told us that they would speak with the manager if they had any concerns or complaints, however some relatives were unsure if they would be listened to. There was not a comprehensive system in place to demonstrate that lessons were learnt from past concerns and complaints or that formal analysis of concerns and complaints had been undertaken.

There was thorough recruitment procedures in place to ensure staff were suitable to work with vulnerable adults. This was carried out by the head office. Medications were managed safely and as needed.

The inspection was completed on 22 and 24 November 2016 and was unannounced. There were 53 people living at the service when we inspected.

The service is required to have a registered manager. 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 registered manager had not been in post since November 2015. However a new home manager had been appointed in October 2016.

Arrangements to manage and mitigate against risk, so as to ensure people’s safety and wellbeing, required improvements to make robustness certain. Risk assessments had not been developed and documented appropriately for all areas of identified risk such as; pressure ulcers, diabetes and people’s behaviours that challenged care workers. Improvements were required to ensure that the care plans for people were detailed accurately to ensure staff had adequate information to support people. Improvements with regard to the recording of care and treatment provided had been considered by the provider and plans were in place to introduce computerised systems to increase efficiency of care workers.

The service needed to improve their quality assurance systems. Systems were in the process of being developed by the newly appointed home manager to embed robust quality monitoring of the service. Although systems were in place to make sure that people’s views were gathered, feedback from people and relatives had not been acted upon to drive improvements within the service. There had been a lack of oversight by the provider with regards to ensuring leadership was present and high quality care was consistently delivered.

Improvements were needed in the way the service and staff supported people to lead meaningful lives and participate in social activities of their choice and ability. The provider advised us this had been addressed and a new activity co-ordinator had been recruited.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient members of staff enabled peoples individual needs to be met adequately. Qualified staff dispensed medications and monitored people’s medication needs satisfactorily.

The manager was making developments within the service. A new workforce was being created and effective teamwork was being promoted. Care workers were being supported to obtain further skills and knowledge and were supervised effectively to ensure consistent best practice. The service worked well with other professionals to ensure that people's health needs were met. Where appropriate, support and guidance were sought from health care professionals, including Community District Nurses and social workers.

Assessments had been carried out where people living at the service were not able to make decisions for themselves. Care workers understood the importance of consent and ensured that people were given choice. Although care workers knowledge of Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) was variable the manager had arranged for external training to increase staff confidence around the subjects. ‘Best interest’ meetings were being held to ensure that people’s decisions were protected and respected.

Staff understood people's needs and treated people with dignity and respect. Positive relationships had been created between people and care workers. Advocacy services were provided where needed to ensure people’s voice was heard.

We looked at five people's care records. Other records viewed included staff training records and rotas, health and safety checks and staff and resident meeting minutes.

If you want to see evidence supporting our summary please read our full report.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

When we arrived at the service our identification was checked and we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

The Care Quality Commission, (CQC,) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate actions had been taken to safeguard people's rights. Relevant staff had been trained to understand when an application should be made and how to submit one.

We saw appropriate arrangements were in place in relation to the management of people's medicines. People could therefore be confident that they were protected from the unsafe use and management of medicines.

We saw records which showed that health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

The service was kept clean and staff practice ensured that people were protected as far as possible from the risk of infection. People were happy with how the service was kept with one relative telling us that, "The place is kept spotless, you can't fault it."

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People made comments such as, "I am quite content here, the staff are kind and the food is good," "I can't fault it so far," and, "The carers are helpful and considerate."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Staff who worked in the service were supported through induction, on-going training and supervision to offer people care and support to meet their needs. Staff were positive about their role and felt that teamwork in the service was good.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect.

Staff had a knowledge and understanding of people's care and support needs, including recognising and supporting them as individuals. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People's preferences, interests, aspirations and diverse needs had generally been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken in to account and listened to.

We saw that staff were responsive to people's changing wishes and needs and supported them well.

People told us that they felt able to raise any issues they might have and felt that the service would act upon their concerns.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

Leadership in the service had improved. A registered manager was in post supported by a deputy manager. Management cover was being provided across the week and at weekends to ensure good support and consistency of approach to managing the service.

People's care was organised through adequate care planning and recording which was kept under review and monitored. Staff allocation systems ensured that staff were accountable and that practice could be monitored. Staff also had lead areas to monitor practice in aspects such as health and safety and infection control. The provider had arrangements in place to regularly assess and monitor the quality of the service provided. Audits were undertaken to assess all aspects of the service and actions were taken where shortfalls were identified. This showed us that the provider sought to provide a good and consistent service.

People had the opportunity to express their views about the service through meetings and one to one discussions.

People we spoke with seemed generally content living in Whittingham House, and felt that they were given choices about when they went to bed.

As at our previous recent visits to the service we found that care records and practice needed improvement to show that people were receiving the care that they needed.

From discussions and records viewed at this and previous visits it was clear that Whittingham House was going through a period of change. This had led to a high turnover of staff and had on occasions had an impact on the levels of staff provided.

We found that staff were caring in their approach, and had an understanding of people's needs. The new management team at the service were working hard to ensure that all staff were properly trained and supervised on a regular basis.

Staff spoken with had an adequate understanding of individual people's needs. We found that staff were caring and responsive to people's needs. People were treated respectfully, and staff interacted well with them. We also found that staff sometimes needed to give attention to detail to ensure that people always received good and consistent care.

We found that people's needs were assessed and planned for to ensure that their individual needs would be met. We found that improvements were needed to make sure that care plans were always detailed and person centred.

The premises appeared to be satisfactorily clean and people were happy with the level of cleanliness maintained. However, improvements were needed to make sure that staff at the service followed the correct guidelines and the providers own procedures to ensure adequate levels of hygiene and infection control.

There was sufficient equipment provided to meet people's individual needs. Equipment was generally maintained in a safe and satisfactory condition.

We found that there were significant issues with the way that staff are initially trained and supported on an on-going basis through training and supervision. It was recognised that the new management team in the service were working hard to address this and other issues identified to ensure an effective and well led service.

We found that people's needs were assessed and planned for to ensure that their individual needs would be met. New care planning and recording systems had been put in place which made it easier to understand peoples' needs and to follow their progress.

People felt that there was a lack of opportunity for activity and occupation in the service. We saw that the provider was trying to address this.

People told us that the staff who worked at the service were good. One person said, "The staff are lovely." We found that staff were now supported through better levels of training to have the skills and knowledge needed to carry out their role effectively.

People told us that they were happy with the quality of the service provided. We found that the provider now had more robust processes in place to monitor the quality and safety of the service.

We found that people's needs were better assessed and planned for to ensure that their individual needs would be met. People however felt that there was a lack of opportunity for activity and occupation. The provider told us that they were trying to address this.

People told us that the staff who worked at the service were good. One person said, "I get on well with all the staff." We found that staff were now supported through regular supervision but that levels of staff training still needed to be improved to ensure that staff had sufficient and up to date knowledge and skills.

People told us that they were happy with the quality of the service provided. We found that the provider was now consulting with people more to seek their views. Although the provider was undertaking more monitoring of the service to ensure that standards of quality and safety would be maintained, development was still needed to make sure that quality and safety is established and maintained on an ongoing basis.