Whitebourne

The provider had implemented measures to reduce the risk of infection. Staff were observed wearing appropriate Personal Protective Equipment (PPE) and they received ongoing training in its correct use.

The service was clean and hygienic. Additional domestic staff had been allocated to each shift to enable the continuous cleaning of high-touch areas such as door handles, hand rails and switches, in addition to maintaining high levels of cleanliness throughout.

The provider had an infection prevention and control (IPC) policy. Designated staff carried out regular IPC audits to ensure appropriate standards in this area were maintained.

The registered manager had taken action to minimise risks to people who used the service, staff and visitors. Risk assessments had been carried out to identify and mitigate risks, including for people in vulnerable groups.

The testing of people, visitors and staff was undertaken in line with government guidelines. If staff returned positive test results or had Covid symptoms, they did not return to work until they had completed the required period of self-isolation.

People had received their Covid vaccinations. Where people lacked the capacity to consent to either their vaccines or testing, the registered manager had ensured decisions were made following best interests' principles.

If people displayed symptoms or tested positive for Covid, staff encouraged them to self-isolate in their bedrooms. Where this was not possible, people were supported to remain on their own units to minimise the risk of spread across the service.

Staff supported people to access the healthcare treatment they required. The registered manager had good links with the allocated GP and the local District Nursing service who visited the service regularly.

Staff had been well supported during the pandemic through the provision of information and guidance, at team meetings and at individual meetings. Staff had been encouraged to speak up about any anxieties or concerns reasonable adjustments had been made as required.

We found the following examples of good practice:

The staffing model ensured people received consistent support and minimised the risk of cross-infection across the service. As far as possible, staff were assigned to work in only one area of the service. Core staff had worked additional hours and been flexible with their shifts to mitigate the need for agency staff to work within the service.

Further information is in the findings below.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Whitebourne 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.

Whitebourne accommodates up to 66 people in one purpose built building. Care is provided across two floors, each with their own communal areas. The service specialises in providing care to older people who are living with dementia. At the time of our inspection, there were 45 people living at the home.

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.

Risks were managed safely, in line with people’s needs. Detailed plans were drawn up to manage individual risks and staff were knowledgeable about them. Where incidents, such as falls, had occurred, staff took action to ensure people’s safety. Staff understood their roles in safeguarding people from abuse and where necessary had raised concerns appropriately. The provider worked alongside the safeguarding team where necessary and had been notifying CQC of important events.

People’s care was planned in a person-centred way. People were given regular opportunities to express wishes or preferences and these were responded to by staff. People’s care was planned in a way that reflected their needs and was regularly reviewed. Staff knew people well and routinely involved them in their care. People received care promptly and in a dignified manner. Staff were respectful of people’s privacy, as well as finding ways to encourage people to maintain independence. Staff sought people’s consent and where appropriate, applied the Mental Capacity Act 2005.

Staff felt supported by management. The registered manager delegated tasks appropriately which had caused a significant improvement in staff support and communication. Improvements were being identified and implemented as planned and these involved people, relatives and staff. The provider had improved the communication systems in place and was finding ways to reward staff for good practice. The provider had developed important links with the local community that had led to improvements in activities and staff training. Staff had received training to enable them to be confident in their roles and they received regular one to one supervision meetings with their line managers.

People’s medicines were managed and administered safely. Staff followed best practice in administering medicines and the provider had systems in place to regularly audit this area. People were supported to access healthcare professionals when required. The home was clean and regular checks were undertaken to reduce the risk of the spread of infection. The environment was suited to people’s needs and work was underway to further improve the decoration of the home. There was a range of activities available to people and people had choices with regards to food. People’s individual dietary needs were met.

There were sufficient numbers of staff at the home and all staff had undergone appropriate checks to ensure that they were suitable for their roles. The provider carried out regular checks and audits to identify any improvements that were necessary at the home. There was a complaints policy in place and this showed complaints had been investigated and responded to.

Whitebourne is a care home providing residential care for up to 66 people, some of whom are living with dementia. At the time of our inspection there were 63 people living at the service.

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. Since the inspection management arrangements at the home have changed. At the last inspection in 2015 we did not identify any breaches of the regulations. Since then the service quality had deteriorated and the provider failed to have effective oversight in order to identify what was going wrong and to make improvements. Since this inspection the provider has increased their quality assurance checks and has implemented a new action plan to make the improvements needed. The local authority and the CCG have informed us that some improvements have been made and others are still in progress.

Some people were not being protected against potential risks because risk assessments and guidelines for staff were not in place for people who have behaviour that challenges the service. Mobility care plans lacked the detail required for people to be adequately supported and to enable staff to attempt to prevent falls. Some staff did not have a good understanding of what might constitute abuse. Where potential abuse had occurred due to the behaviour of a small number of people this had not been identified or reported appropriately.

There were not sufficient staff to meet people’s needs. People and staff members confirmed this. Staff did not have enough time to spend with people and staff told us they did not have time to update care plans so these were out of date. Due to a lack of staff people’s needs were not always being met and there was a high incidence of unwitnessed falls. We spoke to the provider about this. They accepted they did not have sufficient staff to meet people’s needs and agreed to increase the staffing, and to not accept any more referrals at this time.

Staff did not always work in accordance with the Mental Capacity Act 2005 (MCA). Staff were unable to describe the principles of the MCA and some people did not have their capacity assessed to consent to their care or other important decisions.

Staff had not always received the induction training needed to meet people’s needs. Staff had received on-going training.

People were not supported by staff who had regular supervisions (one to one meetings) with their line manager. The provider had a supervision and appraisal policy, which set out how many one-to-one meetings staff should have each year and included staff at all levels. This was not being followed. Since the inspection this has improved and staff are being supervised.

Staff were not always caring or treating people with dignity and respect. Although other individual staff did show compassion and care. People were not being assisted with personal care regularly.

People’s care was not always planned and plans lacked the detail required for staff to know what care to provide to people. Staff told us the care plans were out of date.

Care that was provided was not always person centred. People were unable to choose when they received care. Staff did not always know people very well.

People did not have a sufficient range of activities to stimulate and interest them especially for those who remained in their rooms and there was little if any activity at weekends.

The provider had systems in place to monitor the quality of the service and make improvements. However, these were not always effective. They did not identify that some people’s care was not planned, that care plans lacked detail or that care plans were out of date. The incident analysis had not been completed since December 2016. This meant that the registered manager was unable to learn from what was taking place and did not put prevention plans in place. People’s feedback was not acted upon.

The registered manager had not notified CQC of some significant events

Medicines were administered safely. Medicines were stored securely and in an appropriate environment. Staff authorised to administer medicines had completed training in the safe management of medicines.

The provider followed safe recruitment practices.

The risk of fire had been assessed and plans were in place to minimise these risks.

The staff met people's dietary needs and preferences. Staff offered people help with eating and drinking and provided support where people wanted it. We saw some individual examples of staff being caring towards people.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

People were encouraged to be independent and people and relatives knew how to complain.

The registered manager and senior staff were not always supportive to care staff.

Staff were involved in the running of the home. Regular meetings took place and staff were able to contribute to the agenda.

During the inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We also made four recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed 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.

The inspection took place on 20 May 2016 and was unannounced.

The home had 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.

Staffing levels were sufficient to meet people’s needs, call bells were answered promptly and people did not have to wait for their care. However, staffing levels varied from day to day and the service did not use a staff tool to determine how many staff were required. We have made a recommendation regarding this.

There was an effective recruitment process that was followed which helped ensure that only suitable staff were employed.

People told us that they felt safe and relatives said they felt confident that their family members were well looked after. Staff received training in recognising the signs of abuse and were aware of how to report concerns. Risk assessments were completed to identify potential risks and these were regularly reviewed and updated.

Medicines were managed well and staff were aware of emergency protocols in place for people. People were supported to maintain good health and had regular access to a range of healthcare professionals.

People told us that the quality of food was good and a choice was always available. People were supported to maintain a healthy diet. Where people required support to eat this was provided in a dignified and unhurried way.

Staff received necessary training and support to enable them to do their jobs. There were monitoring tools in place to ensure that training, supervisions and appraisals were kept up to date.

People described staff as “Obliging, “Friendly” and “Kind”. We saw positive interactions between staff and people who took time to explain what was happening. Staff had a good understanding of people’s legal rights and took time gain consent from people.

Each person had an individualised plan of care which gave details of the person’s preferences and needs. Staff knew people well and approached them with kindness. People’s dignity and privacy was respected.

There were a range of activities for people to participate in both within the service and within the local community. People were encouraged to maintain their hobbies and interests.

People and their relatives spoke highly of the registered manager who they said was approachable. Feedback was sought from people regarding the quality of the service and action was taken to address any concerns raised. A complaints policy was in place and people told us they would feel comfortable in raising any concerns.

People had up to date care plans and risk assessments that were regularly reviewed and that met their support needs.

We found that staff received annual safeguarding training and had a good understanding of their responsibilities regarding this.

We saw that the provider had an adequate number of skilled staff in order to provide individualised care. All staff received regular training and were well supported. We saw that staff had appropriate qualifications and experience in order to meet the care needs of the people.

The provider had systems in place to assess and monitor the quality of the service people received.

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they received and whether they had positive experiences. We spent time on each of the floors observing care and found that people had positive experiences.

Families spoken with during the inspection told us that where possible their relative had been asked to give their consent prior to any care or activities being undertaken. They also told us "staff always included them in discussions" about their relative's care.

People who could express a view told us they enjoyed the food, and that if they did not like what was on the menu, the chef would provide an alternative. Family members spoken with told us that their relative always enjoyed the food provided at the home.

People who could communicate with us in a meaningful way told us told us their rooms and the rest of the home was clean. Relatives spoken with told us the home was very clean. People who could express a view told us they had not had to make a complaint. Relatives spoken with told us that on occasions where they had minor concerns, staff dealt with them quickly and resolved the issues.