Whitecliff Care Home

Whitecliff Care Home is a nursing home providing nursing and personal care to up to a maximum 28 people. The service provides support to older people, most of whom lived with dementia and other conditions associated with older people for example, diabetes and people with mobility needs. Some people living at the service were living with a learning disability in addition to other conditions associated with older people. The service was split over three floors with communal areas, kitchen, and dining room on the ground floor. At the time of the inspection there were 22 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support

People were supported by staff that had been trained in most key areas. However, staff had not received training in respect of supporting people with learning disabilities. This was highlighted to the registered manager who took immediate steps to enrol all staff on learning disability training. Two members of staff had completed Makaton (a type of sign language) training and people were supported in communicating their needs by a staff team that knew people well.

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. However, in some care plans mental capacity assessments were not decision specific and referred only to ‘consent to care.’ We found some gaps in best interest decision recording relating to people sharing rooms.

Right culture

There was a positive culture at the service and everyone spoke well of the registered manager and wider management team. People, relatives, and staff all had opportunities to feedback about the service and raise issues and suggest improvements if needed. There were auditing processes in place that had the oversight of the registered manager. However, auditing had failed to identify the lack of training for learning disabilities and the lack of specific mental capacity assessments. The registered manager was responsive to the issues raised and took immediate steps to improve, however these improvements needed time to complete and to embed. The registered manager had established positive working relationships with other health and social care professionals which resulted in timely referrals for support for people which had resulted in positive outcomes.

Right Care

Care and support was person centred and staff knew people well. People were treated with respect and dignity and were supported to be as independent as possible without compromising their safety. We observed numerous interactions between people and staff during our inspection. People were treated with kindness and were given the time they needed during personal care or when being supported with meals. Relatives told us they were very happy with the support provided one saying, “The care is excellent, they make it feel like their own home.” A professional added, “The staff know people so well.”

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 good (published 4 February 2017)

Why we inspected

The inspection was prompted by a review of the information we held about this service and the age of the last 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.

We have found evidence that the provider needs to make improvements. Please see the effective and well-led sections of this full report.

The provider took immediate action to mitigate risk to people during the inspection.

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

Follow up

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

We found the following examples of good practice. The service used agency staff from one agency. Agency staff only worked at Whitecliff care home during the pandemic and were provided with an induction and complied with the home policies for covid-19 testing and training requirements, for example, infection prevention and control. Environmental audits of the home, carried out in response to the pandemic, had highlighted issues with dining room doors that were no longer fit for purpose and had been replaced. The home employed domestic and laundry staff that covered seven days a week.

We found the following examples of good practice.

There had been an outbreak of COVID-19 at the home and people had been supported to isolate in their bedrooms. At the time of our inspection, the home had finished its isolation period but remained closed to visitors other than garden or window meetings, due to lockdown restrictions remaining in place.

The registered manager told us that during the outbreak some people were unable to understand the need for self-isolation due to living with dementia. Steps had been taken to encourage social distancing with seating in communal areas positioned so that people did not directly face each other but could still communicate with each other. Despite the service having reduced number of residents, staffing numbers had been kept the same which enabled staff to spend more one to one time with people.

The provider had carried out some decoration of the service during lockdown. Arts and crafts created by people had been temporarily removed from walls to maximise infection control and this had been explained to and understood by people.

The service was clean throughout with personal protective equipment (PPE) stations in every corridor and room. Staff had a dedicated entrance and exit room direct into the service where they changed, washed, put on and took off PPE appropriately. On first entering the service each day, had their temperature taken.

Whitecliff Care Home provides accommodation for up to 28 people who have a dementia type illness. It is situated in St Leonards on Sea.

There are two managers in post who are going through the process to enable both of them to become registered. 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.

Staff were very attentive and people were at the heart of everything they did. Staff provided kind, considerate, compassionate care. Staff provided a range of activities and ensured people were engaged with these. Staff knew about the things that were important to people.

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems were robust.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the needs of the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the managers were accessible and approachable. Staff and relatives felt able to speak with the managers and provided feedback on the service.

The managers and provider undertook spot checks to review the quality of the service provided and made the necessary improvements to the service.

Below is a summary of what we have found. The summary is based on our observations during the inspection. 25 people were resident in the service at the time of our inspection. The purpose of the inspection was to ensure that the provider had met their action plan for non-compliance in March 2014 and had an effective system to regularly assess and monitor the quality of service that people receive.

We spoke individually with the registered manager and two care staff. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Is the service safe?

There were clear systems in place to make sure that the provider, management and care staff learnt from events such as incidents and accidents and concerns.

Staff training was available to access to undertake their roles in the service. We saw that systems to track training and refresher courses had been developed and monitoring systems were in place.

Is the service effective?

People's care plans and medication records had been regularly audited and reviewed. This had ensured that people's care needs were up to date and effective.

Is the service caring?

People had been asked to complete quality assurance satisfaction surveys and the provider acted on their comments.

Is the service responsive?

There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider. We saw that a pictorial complaint format was available to the people who used the service. People told us they had not had to raise any concerns and they were aware who to speak with if they had any concerns and that they felt they would be listened to. The manager operated an open door policy so family and visitors could always speak in private if they had questions or concerns. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well lead?

The service had quality assurance systems to develop and improve the service provided, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all time.

We found that people were comfortable living at the home. One person said, "I am quite happy here." A relative we spoke with said that the staff were very good and provided the care people needed. From direct observations we saw that staff were kind a caring, they spoke with people face to face and supported them to make decisions; and treated people with respect and protected their dignity when providing personal care.

The home works with health professionals and the local authority to ensure that people have access to appropriate health and social care as required.

There were systems in place to assess and monitor some aspects of the service provided. However, an effective monitoring system, to look at all aspects of the services provided, was not in place.

We found that the provider was now compliant. People's records were up to date and accurate. They reflected people's individual needs.

People who lived at the home told us they were happy living there.

Staff knew people well and were able to tell us about people's care needs and choices. Visitors to the home told us the care was good.

People that could talk to us told us they were happy living at the home. One person told us, 'I like it here.' Another person told us, I like it, I have my friends here.' We spoke with one person who had stayed in their room. They told us it was their choice. They said, 'I just wanted to have a lazy morning so I stayed here.' A visitor to the home told us they were happy with the care their relative received. They said, 'it's like a big, happy family here.'

We saw that people were consulted about their care and activities throughout the day. A visitor told us, 'we are kept involved with everything.'

Staff knew people well, and the care people received was good. However, not all of the care plans were up to date.

We examined the systems and processes in place for the safe management of medicines and found they were in order. We assessed that there were sufficient staff on duty to meet the assessed needs of the people living in the home.