We carried out a review of the data available to us about Whittington House Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Whittington House Nursing Home, you can give feedback on this 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.
We found the following examples of good practice.
People were supported to remain in contact with those who mattered to them. Staff kept people’s representatives and relatives updated with relevant information; about people’s health and changes taking place in the home.
Managers had followed advice given by infection control specialists on how to reduce the spread of COVID-19 infection in the home. The cohorting of people had been implemented following specialist advice. This meant the buildings layout was used to further segregate people who had tested positive to COVID-19, from those who had tested negative, but who had been potentially exposed to COVID-19.
People were supported to self-isolate in individual bedrooms, which had individual toilet and washing facilities attached. Staff were also cohorted and designated to work in specific areas of the home. These combined actions help to reduce potential spread of infection.
Staff had been supported to adhere to relevant training and guidance for the use of personal protective equipment (PPE). There were arrangements in place to monitor the wearing of PPE and use of hand santiser, as well as handwashing practices. The provider had ensured an adequate supply of PPE at all times.
Staff provided support to those people who needed additional help to understand why PPE was being worn. People who had wanted to also wear a face mask had been provided with these.
People had been safely admitted to the home following a negative COVID-19 test result and had been supported to self-isolate in their bedrooms for 14 days immediately following admission. People who lived with dementia were supported to self-isolate as far as was possible without causing them distress.
The service followed national guidance in relation to COVID -19 testing of people and staff. Testing was completed with people’s consent and where additional support was needed to understand why regular testing was required, this was provided.
Staff in the home worked closely with external healthcare professionals to support people with COVID-19 symptoms. This ensured the person’s care and treatment plan was reviewed daily. This meant people received medical and end of life support, quickly, to meet their needs.
The provider had organised additional cleaning support to ensure the home’s environment was kept clean. All staff had helped with additional cleaning tasks, when needed, to help prevent the spread of infection.
Arrangements were in place for the safe management of laundry, waste and delivery of people’s food and refreshments.
Staffs’ individual risks to COVID-19 had been assessed and staff had been supported to work safely or to shield where required.
The provider had in place appropriate policies and procedures and there were processes in place to ensure these were reviewed and updated as COVID-19 guidance altered. Alterations in policy and guidance were communicated to managers in the home who ensured staff were kept up to date with these.
Managers had communicated effectively and regularly with Public Health England and local health protection team specialist and had reviewed and revised their outbreak management plan accordingly.
About the service
Whittington House is a residential nursing home providing personal and nursing care to 45 people aged 65 and over at the time of the inspection. The service provides care for people in one adapted building with four floors, one of these floors specialised in providing care for people living with dementia. At the time of our inspection, one of these floors was not being used. The service can support up to 66 people.
People’s experience of using this service and what we found
People were exceptionally well supported to develop and maintain good social networks. People were supported to maintain relationships that were important to them, this included relationships with friends, families and religious communities. The service maintained a social and friendly atmosphere and supported people in forming new and meaningful relationships with those around them. Relatives were able to visit at any time and told us, without exception, they felt the service was friendly and welcoming to them.
People who lived at the service were empowered to run their own activities and social clubs. The service organised activities and social events that were tailored to the preferences of people who live at Whittington house.
People were supported to make decisions regarding their end of life care and these were respected by the staff who cared for them. Peoples spiritual and religious needs were respected at the end of their lives and people were supported to die pain free and with dignity.
People were safe. Staff had received training and demonstrated good knowledge of safeguarding principles. There were systems in place to safeguard people from abuse and staff knew how to raise concerns if needed.
Medicine was received, stored and administered safely and in line with best practice guidelines.
People were complimentary about the care they received and the quality of staff. People told us staff knew them well and cared for them in the way they wanted. Staff respected people’s privacy and dignity and supported people to be as independent as possible.
People’s needs were assessed with a person-centred approach. Assessments and care planning considered people’s diverse religious, cultural and spiritual wishes. People told us they enjoyed the food and were offered choices of what they preferred to eat.
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.
The service was well led. Management maintained good oversight and encouraged continued improvement and innovation within the staff team. Staff told us the management supported them and were accessible.
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 31 March 2017)
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.
A registered manager was in place as required by their conditions of registration. 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 registered manager had been in post since August 2015.
This home had recently been acquired by Caring Homes Group and renamed Whittington House Nursing Home. The new provider had been proactive in monitoring the service and driving the quality of care being provided and the governance of the home. They had consulted with people, their relatives and staff and were implementing their systems and processes to standardise the quality of care.
People had their individual needs regularly assessed, recorded and reviewed. People were supported to have care plans that reflected how they liked to receive their care, treatment and support. Their risks were mainly managed well however people’s risks associated with their equipment had not always been considered and documented. We have made a recommendation about the use of people’s safety equipment.
Staff referred people to the appropriate health care services if their physical and mental well-being changed. There were safe medication administration systems in place and people received their medicines when required, however their some discrepancies in the stock of some people’s medicines and whether they had received their prescribed creams. The management were aware of these shortfalls and were actively working with staff to address these issues.
Staff encouraged people to make choices about their day and respected their decisions. Where people lacked capacity to understand significant decisions, other significant people such as GPs and family members had been involved in the decision process.
People had been given the support they required with maintaining a healthy nutritional diet. Risks relating to people’s nutrition had been identified and addressed. People’s weights were monitored and GPs were made aware of any nutritional concerns.
People and their relatives complimented the caring nature of staff. We received many positive comments about the home. Staff delivered compassionate care which was focused on people’s individual needs.
Two activity coordinators had been recently employed. They were consulting with people about their recreational interests and personal histories. Plans were in place to provide a selection of personalised and group activities to prevent social isolation.
There were sufficient staff to meet people’s care and support needs. Staff had been recruited well and trained to carry out their role. People were supported by staff who had access to support and a range of training to develop the skills and knowledge they needed to support people. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.
This full comprehensive inspection took place on 14 and 15 December 2015 and was unannounced.
Summerfield Nursing Unit provides accommodation and nursing care for up to 66 people who have nursing needs. At the time of our inspection there were 27 people living in the home across two floors. The home is a four floor, purpose built building. Each floor had a lounge, dining room and small kitchen. A cinema, library, hairdresser’s salon and gardens were available to people who live in the home.
A new manager had recently been appointed to run the home and was in the process of applying to become the registered manager. 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.
At the last comprehensive inspection on 1 and 2 June 2015, this provider was placed into special measures by CQC. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do meet legal requirements in relation to breaches of regulations relating to people’s consent to their support and care which was personalised and focused on them.
We undertook this full comprehensive inspection to check they had followed their plan and to confirm they now met legal requirements. This inspection found there were enough improvements to take the provider out of special measures. The provider now met their legal requirements but further improvement was required. We have made some recommendations which we will follow up at our next inspection.
A care management company previously commissioned by the provider and the new manager had made significant improvements to the standard of care that people received. They were working through a series of action plans with clear time frames to ensure the service progressed and improved. Effective systems and protocols were being developed and implemented to ensure people received appropriate care and support to meet their needs. The manager was aware of that the home had previously fallen below the required standards of care and was working with the provider and staff to ensure people received the care and support which they required. The manager recognised that whilst significant progress had been made in the care of people; there was still need for further improvement.
During the inspection we found the delivery of people’s care had significantly improved, however there still remained some inconsistencies in some people’s care and their records, although we found no negative impact on people as staff were knowledgeable about people’s needs.
People benefited from a service where staff understood their responsibility to protect people. Risk assessments were in place to support people but the monitoring of people’s risks was not consistently recorded. Systems were in place to ensure people’s medicines were ordered and given to them when required. People’s records of their daily administration of their medicines were accurate. However further details were required for some medicines which would provide staff with additional guidance.
Staff recruitment procedures ensured that people were supported by sufficient numbers of staff to meet their basic care needs. However, there was no formal system in place to monitor people who were left unsupervised for periods. Social interaction and encouragement was not consistently carried out when staff supported people with their meals.
Some people did not engage in meaningful activities or social interaction throughout the day. However an activities coordinator had recently been employed to provide recreational and social activities to people. Some people’s bedrooms had been personalised, though the home’s environment did not support people with cognitive impairment or dementia. We have made a recommendation about improving the home’s environment.
There were mixed comments about the meals and food provided. A cook had been employed to review the meals and provide a choice of homemade meals and snacks to be made on site.
People and their relatives were positive about the care and support they received from staff. Their individual needs were assessed, planned and recorded. Some people’s care records did not always provide staff with adequate guidance; however staff were knowledgeable about people’s needs. People were encouraged to make decisions about their care and support. Documentation of people who had been elected power of attorneys was limited and not always reflected in peoples’ care records. Where people had a ‘Do Not Attempt to Resuscitate’ order in place, their records did not always follow guidelines. We have made a recommendation about the recording of these orders in line with national guidelines. When necessary, people had received additional support from other health care services if their needs had changed.
People were cared for by staff that had been trained and supported to carry out their role. Plans were in place to provide further support and training to staff. The manager had a good understanding of their role and how to manage the quality of the care provided to people. Plans were in place to improve the quality monitoring systems to check and address any shortfalls in the service. People and their relatives felt that any concerns raised were dealt with immediately.
We carried out an unannounced comprehensive inspection of this service on1 and 2 June 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to people’s safety and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to people’s care records.
We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerfield Nursing Unit on our website at www.cqc.org.uk.
Summerfield Nursing Unit provides accommodation and nursing care for up to 66 people who have nursing needs. At the time of our inspection there were 28 people living in the home across two floors. The home is a four floor, purpose built building. Each floor had a lounge, dining room and small kitchen. A cinema, library, hairdresser’s salon and gardens were available to people who live in the home.
The provider had recently appointed a new manager for the home who would be applying to be registered with the Care Quality Commission as required by their conditions of registration. 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. An ‘improvement lead’ from a care management company acted on behalf of the provider and supported us with our inspection as the new manager was not available on the day of our inspection. The provider had commissioned the care management company to help improve the quality of the service.
At this inspection we found the support and care provided was now safe and responsive to people’s care needs. The layout and detail of people’s care records had been reviewed and updated. People’s individual risks were being assessed, monitored and recorded. This gave staff with sufficient information to guide them on how best to deliver care that was centred on people’s needs and helped to reduce risks. There were improved links with other health care professionals.
The knowledge and clinical skills of staff was being monitored and updated to ensure people were cared for by staff with current care practices. The medicines policy had been updated to give staff clear guidance on how people’s medicines should be managed. Protocols were in place for people who needed their medicines ‘as required’.
This inspection took place on 1 and 2 June 2015 and was unannounced.
Summerfield Nursing Unit provides accommodation and nursing care for up to 66 people who have nursing needs. At the time of our inspection there were 31 people living in the home across two floors. The home is a four floor, purpose built building. Each floor had a lounge, dining room and small kitchen. A cinema, library, hairdresser’s salon and gardens were available to people who live in the home. A registered manager was not in place as required by their conditions of registration. 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 commissioned a care management company to help improve the quality of the service. An ‘improvement lead’ from the care management company acted on behalf of the provider and supported us with our inspection.
People and their relatives were mainly positive about the care they received from staff. However, people’s safety and well-being continued to be compromised in a number of areas. The care of people with complex medical needs were not always supported and treated effectively. People’s care records did not always provide staff with enough personalised information and guidance on how best to support them. The management and assessment of some people’s risks had not been recorded accurately. Action taken when people became unwell had not always been recorded or managed in line with their care records or recommendations by other health care professionals. Whilst people were supported to have a nutritious diet those with specific needs such as being at risk of weight loss were not being managed well. Staff did not fully understand the princples of gaining people’s consent to their care if they lacked mental capacity. Activities in the home were limited and some people were socially isolated. There were adequate numbers of staff to meet people’s needs.
Systems to recruit suitable staff were in place but not as thorough as they should be. The reasons why staff had left their previous employment were not always investigated. Some improvements had been made in the planning and delivery of staff training which was deemed as mandatory by the provider. However the clinical skills and knowledge of staff had not been assessed or updated. A plan was in place to ensure that staff were regularly supported and mentored. Staff meetings had been implemented so staff could share information about people and the running of the home. The home had an established staff team who were familiar with people who lived in the home.
The provider had put systems in place to understand the views and experiences of people and their relatives. The improvement lead had started to implement systems to monitor and check the quality of the service. Actions plans were being produced to address the identified shortfalls. The provider was actively recruiting a manager to run the home.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of this report.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
At an inspection of this service in November 2014 we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to take action with five of the breaches and issued a warning notice for one other breach, stating they must take action.
We undertook this focussed inspection on 25 March 2015 to follow up on the warning notice and to check if the provider had made improvements to the care and welfare of people. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerfield Nursing Unit on our website at www.cqc.org.uk.
At this inspection we found the support and care provided was not responsive to some people’s care needs. Some people still remained at risk because their care records still did not give staff the specific guidance required to meet people’s needs. Information was held in both electronic and paper form. However not all staff were able to access electronic records and so had to rely on verbal handover from paper records. Paper records did not always give enough information about people’s needs.
This inspection took place on 21 and 24 November 2014 and was unannounced.
Summerfield Nursing Unit provides accommodation and nursing care for up to 66 people who have nursing needs. At the time of our inspection there were 53 people living in the home. The home is a four floor, purpose built building. Each floor had a lounge, dining room and small kitchen. A cinema, library, hairdresser’s salon and gardens were available to people who live in the home.
A registered manager was in place as required by their conditions of registration. 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.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what actions we told the provider to take at the back of the full version of this report. People and the relatives were mainly positive about the care they received however we found people’s safety and well-being was compromised in a number of areas.
Some people’s individual risks were not being assessed, monitored or recorded. Their care records were not kept up to date and did not always provide staff with relevant and detailed information about the care and support needs of individuals. People’s preferences, goals and personal histories were not recorded. Some people had moved into the home without a comprehensive assessment of what help they needed with their care to ensure that the home and staff could meet these needs.
Staff were not familiar with the Mental Capacity Act 2005 and their legal responsibility on how to support people who lacked capacity. People’s mental capacity to make day to day or significant decisions had not been thoroughly assessed or recorded, although some staff knew people well enough to understand their preferences. Records of best interest decisions made on behalf of people were not in place. Staff were knowledgeable about protecting people from harm and abuse but they were unable to tell us where they would report their concerns outside the home.
The provider’s management of medicines policy did not reflect the practices in the home. Although most people’s medicines were managed effectively this was not consistent for all people. Some people were not given their medicines at the correct time.
Staff training was not effectively managed and monitored to ensure people were being cared for by staff with the appropriate skills. There were gaps in some of the staff recruitment processes which are intended to ensure the suitably of staff is checked before they care for people.
People gave mixed comments about the meals. Some people enjoyed their meals, others felt there could be more choices especially at breakfast. People who had specific dietary needs were catered for. However the fluid and food intake for some people who were at risk of not eating and drinking was not always monitored and recorded.
People and their relatives spoke positively about the staff and the registered manager. We saw they were kind and considerate when they helped people with their personal care but there was very little meaningful social interaction between people and staff.
The provider had not actively sought feedback from people about their experiences and views of living in the home. However, the provider had acted on some people’s concerns such as helping them keep in contact with their families. The provider dealt with complaints and concerns on a day to day basis.
Quality monitoring of the building and facilities had been carried out but there was no system in place to audit and monitor the quality of the service provided to the people who lived in the home. Information which the provider sent to us was not detailed and not sent to us in a timely manner.
The provider had recently moved locations after purchasing another service and combining the two. We had been told that a number of people had been asked to leave this service as the provider no longer wanted to provide a service to them. These people had a diagnosis of dementia. The provider told us the service they provided at the previous location was to people whose primary need was nursing care and not personal care. They also said they still provided care for people with dementia if their primary need was nursing.
The provider's terms and conditions stipulated the notice period they would give to a person if they felt they could no longer meet their needs.
The provider's Statement of Purpose informed people of the services provided and range of needs this location was intending to meet and those needs it was not able to meet.
People and their relatives/representatives had access to a complaints system. Comments and complaints people made were responded to appropriately.