This inspection took place on 10 October 2018 and was unannounced.
Whitebirch Lodge 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. Whitebirch Lodge can accommodate 19 people. At the time of our inspection there were 14 people living at the service.
Accommodation is spread over 2 floors in a large detached property. There were 2 communal lounges and a dining area where people could choose to spend their time.
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 (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Whitebirch Lodge was last inspected March 2018. At that inspection it was rated as 'Requires Improvement' overall. A number of breaches of Regulation were found during that inspection. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all of the key questions to at least good. Although we found improvements at this inspection, there were still two breaches of regulation and other areas that required ongoing improvements. This is the second consecutive time the service has been rated ‘Requires Improvement.’
People were protected from the risks of avoidable harm and abuse. Staff knew how to recognise and respond to abuse. However, the registered persons had failed to ensure staff received refresher safeguarding training in line with their own policy. The policy had been reviewed in December 2017, however it did not refer to relevant legislation. We pointed this out during the inspection and the registered manager showed us an updated policy before we left.
There were enough staff to keep people safe, however, the system to assess how many staff were needed was not clear. Staff were recruited safely. Staff had begun to receive training updates and support to enable them to carry out their roles effectively. However, many staff had not completed refresher training in several topics at the time of the inspection. A new e-learning training package had been recently introduced at the service. Staff received supervision and appraisal to discuss their development.
Care records had improved since our last inspection and each person had a care plan. The provider had invested in a new electronic care recording system since our last inspection and was in the process of fully introducing this to the service.
Checks and audits had begun to be undertaken, but were not yet fully effective. This was mainly due to the introduction of new systems and processes within the service. Policies and procedures had been reviewed, however, most were outdated.
People, relatives, staff and stakeholders were asked their views on the quality of the service. However, not all surveys had been received back so the feedback had not been fully collated or analysed. Those that had been received had been responded to. The feedback we viewed gave positive feedback about experiences at the service.
Accidents and incidents were documented and reviewed to look at ways of reducing the chance of them happening again. Risks to people were assessed and managed to ensure their health and safety. For example, there was guidance in place for staff to safely support people with unstable health conditions.
People received their medicines when they needed them and in a way that was safe. They were stored safely. Temperatures were recorded on a daily basis.
Staff monitored people’s health and referred them to health professionals when required. Staff followed the guidance from health professionals to keep people as healthy as possible. Staff supported people to live as healthy a life as possible. People were supported to eat and drink a balanced healthy diet.
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 supported this practice. People were supported to make decisions about their care and support. Staff supported people at the end of their lives.
People had access to a variety of activities. The provider had a complaints policy and any complaints received were investigated following the policy.
People were treated with kindness and respect. Staff supported people to be as independent as possible. Staff knew about people’s choices and preferences including their sexuality and religious needs and supported them to live the lives they wanted.
People were comfortable in the company of the registered manager and relatives told us the management team were approachable. The service had been designed to meet people’s needs and people were protected from the risk of infection.
The registered manager attended local forums and groups to keep up to date. The service worked with other agencies to provide joined up care for people. The building was purpose built and met the needs of people.
Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.
It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall.
You can see what action we told the provider to take at the back of the full version of the report.