Whittle Hall House Care Residence

We found the following examples of good practice.

Comprehensive policies and procedures were in place to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis. The policies and procedures were updated regularly following any changes in national guidance.

The registered manager had identified, assessed and mitigated COVID-19 related risks to people, staff and visitors.

There was a robust programme of regular COVID-19 testing for both people living in the home, staff, essential carers and visitors to the home. Screening procedures included temperature checks, healthcare questionnaires and a negative lateral flow test.

Enhanced cleaning and disinfection took place throughout the home to reduce the risk of the spread of infection. This included increased daily cleaning schedules throughout the home.

Staff used personal protective equipment (PPE) and followed guidance and practices. There was abundant PPE available to staff.

Regular infection control audits were completed and the provider and manager had oversight of infection prevention and control processes.

People living in the home and their relatives were supported to maintain contact. There was separate visiting area outside the front entrance so relatives could visit their loved ones regularly reducing the risk of infection to visitors and people living at the home. Indoor visiting was also facilitated.

Whittle Hall is a ‘care home’. Whittle Hall accommodates 74 people across four separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia. The other two units specialise in supporting people with nursing needs and dementia. At the time of our inspection there were 69 people living in the home.

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

People said there were enough staff available to help them when needed. Comments included, “The staff come quickly when I need them” and “Staff come quick, press my bell and they are there, always enough staff.” Staff were available to promptly assist people throughout our inspection and staffing levels were regularly monitored, reviewed and amended when needed by the registered manager.

People told us the home was a safe place to live. One person commented, “I feel safe with the staff, I trust them. I know all the staff, it makes me feel safe.” Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns.

We observed a helpful, caring and attentive culture amongst staff at the home. Staff were familiar with the people they were supporting and had a good rapport with them.

Relatives said they had good communication with staff at the home and staff helped them to keep in touch with their loved ones whilst COVID-19 visiting restrictions have been in place. One relative commented, “We've developed a positive relationship with the staff. We have regular and honest communication with the staff and trust they'll contact us about [relative] if needed.”

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.

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 27/06/2018).

This focused inspection included the key questions of safe and well-led and was prompted in part due to concerns received about staffing levels at the home and medication procedures. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Whittle Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Whittle Hall accommodates 74 people across three separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia. The other two units specialise in supporting people with nursing needs and dementia.

At the time of our inspection there were 43 people living in the home.

Whittle Hall is owned and run by London and Manchester (L&M) Healthcare, specialist providers of luxury care residences with particular emphasis on general nursing and dementia nursing care.

A registered manager was 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.

Staff were aware of the reporting protocol to keep people safe from abuse or potential harm. Staff could clearly describe in what instances they would raise concerns and knew what the characteristics of abuse were.

There had been a number safeguarding concerns raised with the local authority and incidents with relation to falls. We checked the procedure for falls management, including recording and reporting the fall appropriately, analysing records for patterns, trends, or any re-occurrence that would warrant further investigation and referrals. We saw the service was doing this, and in some cases, additional investigations into incidents were being conducted.

There were no open safeguarding investigations at the time of inspection. We discussed how improvements had been made from historical safeguarding concerns including the opportunities for lessons learned.

Staff were recruited and selected to work at the home following a robust recruitment procedure. The registered manager retained comprehensive records of each staff member, and had undertaken checks on their character and suitability to work at the home.

Risk assessments were in place and were reviewed every month or when there was a change in people's needs. We saw risk assessments in place to manage people's mobility needs, falls, pressure areas, personal care, mental health and behaviour. Risk assessments were linked to an accompanying plan of care which was informative and fully described how staff were required to support the person.

We saw that rotas were fully staffed; There were some agency nurses being used, however, most of the agency staff were used regularly. This meant that they were familiar with the home. The registered manager had a process in place to recruit new staff and we saw that some new staff were due to start working at the home.

Medication was managed, administered and stored securely by registered nurses or senior advanced practitioners on each unit. Each person had a medication file in place which contained information about them and their preferences for taking medication.

There were domestic staff around the home ensuring that rooms and bathrooms were kept clean. There was hand gel available around the home and personal protective equipment (PPE) for staff to use to prevent the spread of infection.

People's needs and choices were assessed prior to them being admitted to the home.

The training matrix showed that staff were trained in all subjects which were mandatory to their role, and as stated in the registered provider's training policy. We saw that additional training was sourced into the home by an external provider which was specialist around communication and supporting people with dementia and limited engagement. We were given an over view of this training. Additionally, opportunities were provided for senor staff to complete additional courses which enabled them to complete more clinical tasks.

Staff received regular supervision and appraisal.

People were supported to eat and drink in accordance with their needs. People, who were assessed as at risk of weight loss, had appropriate documentation in place to monitor their food and fluid intake. Where specialist diets were needed for some people, the chef had knowledge of this.

The service was operating in accordance with the principles of the Mental Capacity Act, 2005 (MCA). Applications to deprive people of their liberty had been appropriately made following best interest decisions.

The environment was exceptionally well decorated and appropriate for people living with dementia. There were different coordinating colours on the dementia unit, and a large living wall mural which appealed to people's senses of touch.

Staff were observed to be caring, kind and knowledgeable concerning the people they supported. Our conversations with staff evidenced that they knew people well, and supported them in caring and dignified way

There were positive examples of person centred information in peoples care plans. People likes, dislikes and routines were well recorded and regularly reviewed.

There was a varied and relevant timetable of activities offered at the home. Public events, such as the upcoming royal wedding had been well planned and there were various activity 'stations' around the home which contained objects of reminisce, fiddle muffs and creative drawing.

Complaints were well recorded, addressed and responded to in line with the organisations complaints procedure. This was also available in different formats to support people's understanding of the policy. Additionally, there was information around the home which clearly described the complaints process and whom people should raise concerns with.

There was a robust approach to governance within the home. The quality and compliance director spent time describing the process of quality assurance within the organisation and how this improved service provision and in turn, people's experiences of living at the home.

People's views and opinions were regularly acted upon. In addition to feedback being gathered from people and their relatives, there was also a 'you said we did procedure'.

The service was working well with local stakeholders by ensuring that actions set at recent monitoring visits were addressed.