Whitestones Care Home

Whitestones Care Home is a residential home providing accommodation and personal care for up to 41 people. The service provides support to people who have a physical disability, sensory impairment, dementia or mental health. At the time of the inspection there were 21 people using the service.

The accommodation was all on 1 floor, with communal lounge and dining areas. People had access to secure outdoor space.

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

Medicines were not always safely managed. Where people took medicines ’as and when required’ there was a lack of guidance for staff to know how and when to support people to take these and reasons for the medicines being given were not always recorded.

The provider had not always explored how people would prefer to be cared for at the end of their lives. Complaints were not always reviewed for lessons to be learnt.

There were enough staff to support people and checks were made on their suitability to work in the service. People were protected from the risk of abuse. Staff understood their responsibilities and appropriate referrals were made. People were protected from the risk of infection and were able to have visitors as appropriate.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 February 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

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

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

Enforcement and Recommendations

We have identified breaches in relation to good governance. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

Whitestones Care Home is a residential care home. They were providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 41 people.

The service is one purpose-built bungalow with a secure garden, six communal rooms, three adapted bathrooms and 39 en-suite bedrooms.

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

Staff were not always deployed effectively to support some people to stay safe. At times, people using the service were relied upon to offer support and reassurance to each other because staff were busy elsewhere. The provider failed to implement appropriate safety measures to always keep people safe.

Governance and performance management were not always reliable or effective. The registered manager did not review, investigate or audit the documents staff were completing when people displayed behaviours that challenged.

People did not always have choice at mealtimes or access to drinks and snacks throughout the day. The mealtime experience was not always pleasant for all people. The provider had failed to effectively implement positive behaviour support plans for people who displayed behaviour that challenged.

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. The decoration and adaptation of the home had been completed in a way that was accessible and promoted people’s independence.

Concerns were investigated in a sensitive and confidential way. The registered manager demonstrated a strong focus on continuous learning. However, some improvements they had implemented were still in the process of being imbedded. The registered manager was supportive and led by example. Staff told us they felt valued and respected. Without exception, people, relatives and staff spoke highly of the registered manager.

People were treated with kindness, dignity and respect during all the interactions with staff that we saw. People who were able were supported to direct their own health care. Some people managed their own medicines and staff monitored their safety without compromising their independence.

People who were known to be approaching the end of their lives were supported to have a dignified death. Staff knew people well and understood people’s life history and what was important to them. Care plans contained detailed information about how people had spent their lives before moving into a care home. People were supported to take part in a variety of activities.

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 Good (published July2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the Safe 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.

This included people living with dementia.

The first day of inspection took place on 13 June 2017 and was unannounced; we completed a second day on 15 June 2017 and this was announced. The service was last inspected on 15 May 2015 and was rated 'Good' overall. At this inspection we found the service remained 'Good' in four out of five questions, which gives a rating of 'Good’ overall.

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.

Systems and processes to monitor and coordinate staff training in line with the provider’s requirements were not always effective. Prescribed creams were not dated when opened in line with the provider’s policy on medicines management.

Other systems and processes to check on the quality and safety of services were in place. Risks were identified and managed. Accidents and incidents were reported and monitored. Other systems for medicines management were in place and helped to ensure people received their medicines as prescribed.

Systems were in place to ensure people’s care was in line with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff created a cheerful, relaxed and happy atmosphere for people. Staff were friendly, polite and took time to greet people. People were treated with dignity and respect. People were supported to maintain relationships with family and friends and to stay connected to their local communities.

People were able to access healthcare professionals when needed to maintain good health. People were supported by staff and other professionals who worked together to provide appropriate end of life care.

People enjoyed their meals and their preferences were met. People were supported to maintain good levels of hydration that helped their overall health. Special diets, such as any modified texture diets were provided when appropriate.

Activities for people and the general environment had been used creatively to enrich people’s experiences of living at Whitestones Care Home.

Individual care plans had been developed with people and their families; and meant people received personalised and responsive care.

People and relatives were involved in the service and their views were listened to. The management team and staff were viewed as approachable.

Further information is in the detailed findings below

Three people told us they were mostly satisfied with their care and support and two people told us about some of the activities regularly organised, which they could choose whether to join. One person said, 'I like the music sessions, I love old time music and dancing.' Another person told us, 'I think I pretty much get the care I need. We found activities were planned in a way that suited people's preferences and dementia care needs.

We saw that people were supported to eat and drink sufficient amounts to meet their needs. They were also cared for in a clean hygienic environment and protected from any risks from infection.

However, we found that people's recorded needs assessments and care plans did not always ensure their welfare and safety. This included risks from their nutritional status and their medicines, which were not always safely administered. We also found that sufficient numbers of care assistant staff were not always provided to meet people's needs. However, we found the provider and manager, were taking action to address this.

During this visit to the home we found that peoples' needs were being appropriately assessed and that guidance was available to staff on the support people required. Detailed risk assessments were in place and were specific to the person concerned. This showed that peoples' safely and welfare were being protected.

The number of staff was more consistent and peoples' needs were being met. Additional members of staff had been employed in order to increase the numbers of staff working overnight and the registered manager was in the process of recruiting to newly vacant positions within the home.

We spoke with three members of staff during our visit. They felt that the number of staff working at any one time had improved and they found they were able to meet people's needs more effectively.

During our visit we looked at the care files for five people living at Whitestones. We found that everyone did not have a care plan and that risk assessments for falls were not being completed.

As a number of the people at Whitestones are living with dementia, we were unable to speak with them to gain their views. We did speak with the relatives of three people living at Whitestones and they told us 'I am more than happy with the care my (relative) receives but staff have a lot on their plate', 'I feel sorry for staff as I feel they are understaffed but they all do work very hard' and 'My (relative) seems happy there, I haven't seen their care plan but it would be nice to.'

We looked at the staffing rota for Whitestones for the six weeks prior to our visit and these showed that staffing levels Monday to Friday had improved although this was inconsistent. Staffing levels on a weekend were considerably lower than during the week. Staff we spoke with raised concerns about the needs of people in home not being met consistently as they were busy and didn't have enough time.