Archived: Whitbourne House

Whitbourne House is a residential care home providing personal and nursing care to 34 older people at the time of the inspection. The service can support up to 41 people.

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

People living at Whitbourne House told us they received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs and staff recruitment was on-going. Medicines were managed safely, and people received their medicines as prescribed.

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. People were supported to maintain good health and to meet their nutritional needs.

People told us staff were caring. Staff consistency enabled people to receive good care from staff who knew them well. The home environment had significantly improved, and people benefitted from the changes. People had access to activities to prevent social isolation.

Whitbourne House was well-led by a registered manager who was focusing on improving people’s care. A lot of significant changes had been implemented to support effective team working and improve people’s outcomes. The service had a clear management and staffing structure in place. Staff worked well as a team and complemented each other’s skills. The provider had quality assurance systems in place to monitor the quality and safety of the service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Whitbourne House 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. The home accommodates up to 41 people. On the day of the inspection there were 39 people living at the service.

There was no 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. The provider had appointed an operations manager who was registering with the CQC to become the registered manager.

Before the inspection we had received concerns citing staff shortages and poor leadership and management of the home. A month prior to our inspection the registered manager had left. The provider implemented changes to address some of the concerns which the management team were working through.

We found the provider had taken action to improve staffing levels and staff deployment. A staff rota consultation was in progress and staff were already seeing the positive impact of the changes.

The provider had made significant improvements to the environment by redecorating the home. The whole home was undergoing redecoration and the provider was working through an on-going plan for further improvements.

People did not always receive activities that met their needs and preferences. The management team told us they had a plan in place to improve activities. We found people's records were not always complete. Some of the provider's quality assurance systems had not identified the concerns we found.

People told us they felt safe living at Whitbourne House. Risks to people’s well-being were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage people’s medicines. People received their medicine as prescribed.

People had their needs assessed prior to living at Whitbourne House to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular supervisions (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.

People living at Whitbourne House were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.

People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independency. The home provided information including in accessible format to help people understand the care and support that was available to them. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager and staff had a good understanding of the MCA and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. The operations manager had a clear plan to develop and further improve the home. The home had established links and partnerships with several multidisciplinary teams to support safe care provision.

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.

People and their relatives complimented the compassionate nature of staff and told us staff were caring. On the day of our inspection we saw examples of kind and compassionate interactions that demonstrated staff knew people well. People’s dignity, privacy and confidentiality were respected.

Feedback received from some people and staff reflected people did not always receive activities, stimulation or engagement which met people’s needs, preferences and interests. There was no designated activities co-ordinator in post and there was not always evidence available that the provider ensured people had opportunities to benefit from person centred and meaningful activities.

People told us they were safe. Staff knew what to do if they had safeguarding concerns and were aware of the provider’s whistle blowing policy. People were supported by sufficient staff to keep them safe and the provider ensured safe recruitment practices were followed. Staff training was ongoing and the records confirmed staff received supervisions.

People’s care plans contained risk assessments that covered areas such as falls, mobility or nutrition. Where people were at risk, their records outlined management plans on how to keep them safe. Staff knew how to keep people safe from risk of harm however we found on one occasion this was not followed in practice. The registered manager reassured us they were going to investigate this further.

People’s medicines were stored securely. However, the provider’s policy in relation to administration of medicines was not always followed by staff which presented a risk to people. The registered manager told us they would address this.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. 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 maintain good health and access health professionals when required. We received very positive feedback from external professionals involved with the service. Staff ensured people were supported with their meals when required and people were referred to a dietician if there were concerns about their nutrition.

People were assessed prior to coming to live at Whitbourne House and people told us staff knew them well. People’s care files gave details of the level of support required and people’s wishes and choices. These also contained information about people’s personal histories, medical information, their likes and dislikes.

Information on how to complain was available to people and the provider had a complaints policy in place. The registered manager ensured when a complaint had been raised it had been investigated and responded to in a timely manner.

The registered manager ensured various audits were being carried out. We however, found a lack of consistency in how well the service was led. There was a lack of support and resources that empowered staff to develop and drive improvements and some staff did not always feel listened to. Staff were confident that as a team they were focused to deliver good care and they told us improvements were being made. The registered manager welcomed our feedback and was keen to improve the service further.

The registered manager informed us of notifiable incidents in accordance with our regulations.