Background to this inspection
Updated
11 November 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
One inspector and an Expert by Experience carried out this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Whittington House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Whittington House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. The previous registered manager had left in May 2022. The manager had completed an application to register with CQC but, confirmed during this inspection, they were leaving Whittington House so their application will not be forwarded to us.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used all this information to plan our inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with nine people who used the service and 13 relatives to gain their view of the services and care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with two care staff, the activities co-ordinator, housekeeper, chef, maintenance person, deputy manager, interim manager, regional manager, quality manager and a health care professional.
We reviewed a selection of care plans and risk assessments relating to the care of seven people. We reviewed records relating to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) including records relating to the administration of covert (hidden in food or drink) medicines. We reviewed two staff recruitment files and the service’s training record. We reviewed a selection of records and documents relating to the management of the service. These included a selection of in-house and provider audits, the home improvement plan, meeting minutes, feedback surveys, selection of policies and procedures and information on the provider’s dementia strategy called ‘My World’.
Updated
11 November 2022
About the service
Whittington House is a residential care home providing personal and nursing care to up to 66 people. The service provides support to older people predominantly, some of whom live with dementia. At the time of our inspection there were 38 people using the service.
Whittington House is a purpose built care home and people are accommodated in one building. There are four named units, although at the time of our inspection, people were only living in three of the four units. One of those units specialises in providing care to people living with dementia.
People’s experience of using this service and what we found
People told us they felt safe and there were processes in place to safeguard people from abuse. People confirmed they received their medicines and support to take these as prescribed. Monitoring arrangements were in place to reduce the risk of medicine errors. Risks to people’s health were assessed and action taken to reduce or mitigate risks. Environmental risks were assessed and managed, so these were reduced or mitigated. Arrangements were in place to maintain the safety and upkeep of the building as well as the outside spaces. Maintenance and servicing arrangements ensured the service’s equipment, utilities and emergency systems remained in working order.
The provider had experienced significant challenges in retaining and recruiting staff, but some progress had been made with the recruitment of new staff. The provider used agency staff to support safe staffing numbers and to support the running of the service overall.
At the time of the inspection the manager and deputy manager were providing leadership and support to the staff. The provider had arrangements in place to support this management team. Just prior to the inspection, the manager had resigned so the provider had organised for further management support arrangements to be in place once the manager had left.
There were systems and processes in place to assess and monitor the quality of the services provided to people, including to assess and monitor the service’s compliance with necessary regulations. The provider had sought and acted upon feedback from people, their representatives and staff to improve the service. Improvements had been made to monitoring clinical and environmental risks, records systems and care plans, the management of concerns and complaints, people’s food choices and support for nursing.
Progress against ongoing areas for improvement was monitored through the provider’s quality monitoring process. For example, this included the current continued monitoring of the cleaning and support for the housekeeping team whilst waiting for the recruitment of additional housekeepers. Staff who wished to be dementia ambassadors had been identified and were due to start their training as part of the provider’s new dementia strategy.
People and relatives told us they had appreciated the improved communication and engagement arrangements which the manager had put into practice. They described the manager as being visible and approachable; willing to listen to their concerns and take action to try and resolve them. Lessons had been learnt from the feedback provided from relatives about the previous lack of response in relation to their concerns and complaints.
Nurses and senior care staff were being empowered and supported to develop their leadership and supervisory skills. Processes were in place to improve communication between departments and to ensure all departments worked together to support people who used the service.
Managers and staff worked with various health and social care professionals to support people’s access to the service when needed and to ensure their health and social care needs were met.
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 15 November 2019).
Why we inspected
We received concerns in relation to staffing numbers, staffs communication skills, the management of people who live with dementia and who have behaviours that can cause distress or potential harm to others, the management of medicines and complaints and the cleanliness of the care home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We 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 COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection these were rated to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whittington House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.