Archived: Whitway House

Whitway House Nursing Home is a residential care home providing personal and nursing care. The service can support up to 39 people. There were 24 people living in the service at the start of this inspection.

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

People were at risk of harm because the systems in place to ensure they received safe and appropriate care were not effective. Risks were not assessed, and care plans were not in place to direct staff to provide safe care and treatment. Risk management systems in place were not implemented consistently.

Staffing levels had been changed without reference to the dependency needs of people living in the home. Staff told us that the levels were currently better but that this had been very difficult to manage.

People did not always receive health care in a timely manner.

Staff understood how to identify and report abuse and spoke with care about the people they supported. However, the systems in place did not ensure that allegations were responded to robustly and appropriately. This meant people were at risk because potential abuse was not adequately investigated.

The governance of the home was not sufficient. Policies were not implemented. Improvements identified in action plans were not always reflected in 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 Inadequate. (published January 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing, risk management, responses to safeguarding concerns and access to healthcare. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

We have been told by the providers that action has started to mitigate omissions found, and that communication is improved between the acting manager of the home and the provider organisation. The acting manager sent through care plans they had completed following the inspection site visit.

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 monitor the service and 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 breaches in relation to safe care and treatment, safeguarding, and the oversight of safety and risk.

We varied the registration of the provider by removing regulated activities from this location. This meant the service was no longer registered. There were no people living in the home after 9 September 2020.

Whitway House Nursing Home is a residential care home providing personal and nursing care. The service can support up to 39 people. There were 30 people living in the service at the start of this inspection.

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

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. Senior staff had left and the governance of the service was under strain. As a result, the registered manager had identified that they did not feel supported to continue to manage the service effectively. The providers had been aware that this was the situation. The registered manager acknowledged that some aspects of care provision and oversight had deteriorated. Poor care practice was not identified and rectified by the provider.

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. Decision making about care practice was made by nursing staff and was not always reflected in people’s care plans. The culture reflected the needs of the service rather than the needs and preferences of the people.

Risks to people's health and wellbeing were not consistently managed. Where advice had been received from health care professionals this was not always followed. Staff did not always know or follow guidance regarding people’s oral care.

Care staff raised concerns with nursing staff, but these concerns were not always acted upon promptly.

Improvements were needed to ensure incidents of suspected abuse were investigated and reported to the local authority when required.

A boiler providing heating and hot water had been turned off on the advice of the fire service. Emergency plans were not robust. Portable heaters and immersion hot water heaters were used to maintain care. Staffing was increased in response to a request by the CQC that a plan be instigated to respond to the risks associated with the removal of the boiler.

Appropriate records were not maintained. Charts for monitoring people’s fluid intake and how they had been helped to move to keep their skin safe were not completed accurately. Care plans were not always an accurate reflection of people’s needs and were not used to ensure people received appropriate care that was appropriate to their needs and reflected their wishes.

Checks on the appropriateness of agency staff were not always recorded.

Agency staff had not all received an effective induction and staff told us they learned about people’s needs from each other and took direction from nurses.

People enjoyed a range of activities but when activities staff were not able to work they were not covered, and this led to long periods of isolation for people who stayed in their rooms.

People received their medicines as prescribed although some practice was not person centred. We have made a recommendation about how medicines are given.

People enjoyed the food and the chefs were committed to ensuring high quality nutrition. However, opportunities were missed for people to benefit from their experience of meal times. We have made a recommendation about the meal time experience.

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 May 2017). At this inspection the service has deteriorated to Inadequate. Previous to the Good rating the service was rated Requires Improvement at inspections in June and November 2016.

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 Whitway House Nursing Home on our website at www.cqc.org.uk.

Why we inspected

The inspection was planned based on the previous rating. Whilst we were planning the inspection we were made aware of specific concerns related to the safety of people. A boiler providing heating and hot water had been turned off on the advice of the fire service. This boiler was later decommissioned after advice sought by HSE. This inspection did not fully examine the circumstances of these concerns. This continued to be reviewed separately to the inspection.

Enforcement

At this inspection, we have identified breaches in relation to the management of risks, protecting people from abuse, decision making not being made in line with the Mental Capacity Act 2005, a failure to provide person centred care and the overall governance 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 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 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 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.

The service had a registered manager at the time of inspection. 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.

At our last inspection in July and August 2016 we found people were at risk of harm, the requirements of the Mental Capacity Act 2005 were not being met and the systems in place to ensure the quality and safety of the care people received were not effective. There were continued breaches of regulation. We took enforcement action and required the provider to detail the improvements they would make and make monthly reports on their actions to the Care Quality Commission. At this inspection we found that the actions detailed in reports had led to significant improvements.

People felt safe and well cared for. They were protected from harm because staff understood how to reduce the risks people faced. They also knew how to identify and respond to abuse and told us they would be confident to do so.

People had support and care when they needed it from staff who had been safely recruited and understood their needs. Staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet these needs. They told us they felt supported in their roles and had received appropriate training that provided them with the necessary knowledge and skills. Staff also told us they felt valued and part of a strong team. Staff were cheerful and treated people and visitors with respect and kindness throughout our inspection.

People saw health care professionals when necessary. Records and feedback from healthcare professionals reflected that staff responded appropriately to both on going healthcare needs and health emergencies. People received their medicines as they were prescribed.

Staff understood how people consented to the care they provided and encouraged people to make decisions about their lives. Care plans and practice reflected the framework of the Mental Capacity Act 2005. Deprivation of Liberty Safeguards had been applied for when people needed to live in the home to be cared for safely but did not have the mental capacity to consent to this.

People were engaged with a wide range of activities that reflected their preferences, including individual and group activities.

Everyone described the food as good and there were systems in place to ensure people had enough to eat and drink. When people needed particular diets or support to eat and drink safely these were in place.

Quality assurance had led to improvements being made and people, relatives and staff were invited to contribute their views to this process. Staff, people and professionals spoke positively about the management and staff team as a whole.

Whitway House is registered to provide accommodation and nursing care for up to 39 people in a rural area of West Dorset. At the time of our inspection there were 33 older people living in the home.

There was a registered manager in post at the time of our inspection. 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 home was last inspected in December 2015 and found to be in breach of regulations relating to: good governance and safe care and treatment including concerns about the safe administration of medicines. We told the provider to make improvements regarding the monitoring of the service people received by 7 March 2016. The provider told us they would make improvements regarding the safe care and treatment of people living in the home. At this inspection we found that the leadership of the home had not made adequate improvements and did not have sufficient systems to monitor the service people received and ensure that their care and treatment was safe. People remained at risk of harm because these improvements had not been made.

Audits had been undertaken but missed areas identified by inspectors. This meant health and safety issues had not been addressed and care plans were sometimes inaccurate or had omissions. Incidents and accidents were not always recorded and when they were their analysis did not always lead to people receiving safer care.

Staff used their knowledge of people to develop caring relationships with people. They also sometimes audibly discussed care tasks with reference to people in communal areas which did not promote dignity and respect. We have made a recommendation about promoting people's dignity and autonomy.

People felt safe but some people’s risks were not reduced effectively because their care plans were not followed or records were not kept to review how these plans were working.

Staff understood the need to make decisions in people's best interests but decisions made did not always reflect the principles of the Mental Capacity Act 2005 (MCA). Opportunities for day to day choice making were missed.

People told us they saw health care professionals when necessary and were supported to maintain their health by staff. With the exception of evidence around care of people’s skin, we found people’s needs related to ongoing healthcare and health emergencies were met and recorded. People received their medicines as they were prescribed although the recording of creams was not consistent. We have made a recommendation about the recording and monitoring of people's creams.

People were positive about the care they received from the home and told us the staff were kind. Staff were cheerful and treated people and visitors with respect and kindness throughout our inspection. care was not, however, always delivered in ways that reflected people's assessed needs. We have made a recommendation about embedding person centred approaches to the care people receive.

People usually had support and care when they needed it from staff who had been safely recruited. These staff understood people’s care needs and spoke confidently about the support people needed to meet those needs. They told us they felt supported in their roles and had undertaken training that provided them with the necessary knowledge and skills. There was a plan in place to ensure staff received the training they needed to stay up to date with the care needs of people living in the home.

People were at a reduced risk of harm because staff knew how to identify and respond to abuse. Information about how to report abuse was available to staff.

Deprivation of Liberty Safeguards (DoLS) had been applied for when people needed their liberty to be restricted for them to live safely in the home.

People described the food as good and there were systems in place to ensure people had enough to eat and drink. When people needed particular diets these were in place.

People were involved in a range of group and individual activities that reflected their personal preferences.

Staff, relatives and people spoke positively about the management and staff team as a whole and held Whitway House in high regard.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Whitway House provides care and support for up to 39 older people. At the time of the inspection there were 37 people living at the home.

The leadership within the home needed to be improved. The provider did not have an effective system to check the quality of care people received at the home. Peoples individual care records were not always complete and the systems in place to evaluate and improve the care being given were not robust.

The systems and procedures for handling medicines were not safe and improvements were required. The system in place for the auditing of medication required improvement as it had not identified areas that needed improvement.

Care records were not always accurate and reliable. Where people said they needed assistance to achieve certain outcomes they we not supported to do so, care records did not consistently record these wishes.

People’s care records were not kept in a safe and confidential manner. During the inspection we noted people’s personal records were left unattended in communal areas.

People were able to raise concerns with the staff who in general terms took action to resolve the presenting issues. One person told us about how they were able to negotiate a different room when they were unhappy sharing. However, when a person expressed a wish to live somewhere else they provider had not responded appropriately.

People told us the staff were kind and caring and supported them in a caring way. One person told us “if I ask for help there is always someone around, they are patient with me when I want to do things myself” another person described the staff as “very kind to me”. A visiting relative told us about how kind and compassionate staff were.

People and their relatives were given information about the running of the home and how they could comment on areas for improvement.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

People's medicines were not always administered. We found that a number of people had not received their medicines on one occasion. Medicines were stored securely and appropriately.

The provider carried out appropriate checks before staff started work. We looked at staff recruitment files and found that appropriate checks and references had been completed.

The home had a complaints procedure and responded to people's complaints and concerns. People felt able to raise complaints. One person told us, 'I have nothing to complain about, if I had I would ask to see the manager and I'm sure she would listen.'

People's agreement was sought prior to staff supporting them. One person told us, 'They help me out of bed in the morning, they ask if I want to get up first.' People's needs were assessed and care was planned and delivered to meet their needs. One person told us, 'They always make sure you are alright.' Another person said, 'We get everything we need, we are very happy.'

There were sufficient numbers of staff who were knowledgeable about people's needs and how these should be met. One person's relative told us, 'There is always someone around, there are enough staff.' Another person's relative reported, 'There are enough staff, they are always quick to meet his needs.'

Medicines were administered appropriately. One person told us, 'My tablets are given to me before my meals, there is no problem with that.' However, controlled drugs were not always recorded appropriately in the controlled drugs register, and hand written entries on medication administration records were not countersigned as required to confirm accuracy.

The provider operated an effective quality monitoring system and people felt able to express their views as to the quality of the service they received. One person's relative told us, 'We have regular meetings with the manager. We feel listened to.' One person said, 'I feel able to raise concerns if I needed to.'