Whitstable House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. At our last assessment there were no effective systems to learn from incidents and people had not felt safe living at the service.

At this inspection significant improvements had been made. People now told us they felt safe living at the service and were confident the staff understood how to keep them safe.

Staff told us the culture within the service had changed and they were confident to report incidents or concerns. They explained how they had received additional training and had more understanding about what was expected of them. The new management team had worked with staff to make sure they learnt from any incident or error.

The management team had processes in place to analyse accidents and incidents for patterns and trends. There had been few incidents since our last inspection, but these had been reviewed, and action had been taken to reduce the risk of them happening again.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. There had not been any new admissions to the service since our last inspection. We discussed with the registered manager their plans to make sure people would be admitted safely in the future. The registered manager shared their plan to manage new admissions, this included a specific role responsible for ensuring people’s medicines, care plans and risk assessments are completed before being handed over to the duty manager. The role would be a clinical role to make sure people’s care plans met their needs and staff understood the support required.

During our onsite inspection, a person was due to be admitted to hospital the next day. Staff had gathered all the relevant information for them to take with them to make sure the hospital staff understood their needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. At our last inspection, people had not been protected from abuse as concerns had not been acted on and reported to the local authority as required.

People and relatives told us they were confident to raise concerns, and these would be acted on. Staff described their role in recognising potential abuse and reporting concerns. Staff told us they were now confident their concerns would be taken seriously.

The registered manager understood their responsibility to raise safeguarding concerns with the local authority and protect people. When people had raised concerns with the registered manager, they had worked with the person to understand what the concern was and supported them to raise a safeguarding concern. The management team had worked with the local authority to make sure people were safe.

At our last inspection, potential risks to people’s health and welfare had not always been assessed or documented which placed people at risk. Previously, staff had not supported people safely placing them at risk. At this inspection improvements had been made. People were involved in managing risks and care plans had improved. However, some care plans and risk assessments required some more detail, including how to move people. People’s care plans included the equipment staff needed to use but did not always include the specific guidance for each person. We discussed this with the registered manager, who provided updated detailed risk assessments following the inspection.

People told us they felt safe living at the service. People told us they were supported to decide if they used their walking frame or walking stick depending on what they were doing or how they felt. They felt in control and were happy to take advice from staff when needed.Staff could describe how they supported people and recognised if they were unwell. We observed people being moved safely using the correct equipment during our inspection.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Previously people had told us they were not confident the call system was working. At this inspection people were confident staff would come when they rang for them. The registered manager showed us the monitoring system, they had access to real time information about the call bells and how long it took staff to answer them. During our onsite visit staff responded to people’s call bells, people were wearing pendent call bells when in the communal areas.

At our last inspection the environment did not have dementia friendly signage. There had been incidents where people could not find their rooms and gone into other people’s rooms causing people distress. At this inspection there were photos on people’s doors. This had supported the person who had been unable to find their room, to know where their room was. The registered manager had also placed photos of the gardening group on the wall next to their room as they enjoyed the group. We observed the person go from the communal lounge to their room and there had been no incidents since the change.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Since our last inspection there had been changes to the oversight and structure of staff teams. There was a new registered and deputy manager in post, who had made changes to oversight and management within the service. There had been a reduction in the number of people living at the service and staffing had been reduced. However, the registered manager had retained the structure, so staff understood their role within the team and what was expected of them. Staff told us they had received additional training to understand their responsibilities and what was expected of them daily. Nurses told us, they had been supported to develop to become confident within their role. Staff had received supervision and told us they felt supported by the management team, who had an ‘open door’ policy and spent time with people and staff.

The registered manager had developed a plan to make sure when people were admitted to the service in the future, there were enough staff to support them. Staff told us they were ready to support new people, “I think we could have a couple more people, I think we are ready.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The service was clean and odour free. The deputy manager told us about some rooms where people did not like staff cleaning them. The domestic staff were aware of this and understood how to approach people to reassure and involve them in the cleaning process. People and relatives told us they were happy with cleanliness of the service.

We observed staff wearing appropriate personal protective equipment (PPE) when giving out food and supporting people. Staff followed established procedures when managing soiled laundry.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. At our last inspection we found significant shortfalls in medicines management including people not receiving their medicine as prescribed, putting their health and welfare at risk. At this inspection there were significant improvements. The deputy manager had taken over the management of medicines and the electronic system. They described how they had people’s medicines reviewed and many people had their medicines reduced or time changed including sedation. People now received their medicines including time sensitive medicines when prescribed. We observed alarms alerting staff to give Parkinson’s medicines at specific times. People told us they received their medicines when prescribed.

The deputy managed used the tools within the electronic system to monitor when people received their medicines and act if they did not. We reviewed the medicines reports, checked the numbers of medicines available and found these were accurate. Staff told us they had received additional training and understood their responsibility to make sure people received their medicines as prescribed.