Whittington House Nursing Home

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 good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 50 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The provider had a report of accidents and incidents that had occurred. However, not all accidents and incidents were recorded. For example, where time specific medicine had been given outside of the specified time. While management had processes in place to promote a culture where reporting concerns was encouraged, this was not consistently embedded. Where records of incidents and accidents were raised, concerns regarding staff behaviour had not have been identified and acted on.

We found repeated medicine errors that were not identified or escalated appropriately, and therefore no action was taken to rectify these continuous errors.

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.

A referral process was in place, with individual records demonstrating timely and appropriate referrals to relevant professionals. Policies and procedures relating to referrals and transitions was effective.

Pre-admission assessments were undertaken prior to admission, with information obtained from people, their relatives, and relevant healthcare professionals. This ensured the provider had sufficient information to assess and safely meet people’s individual needs. However, some pre assessments did not happen in person.

A relative told us “The home didn’t visit him in hospital, it was all done over the phone.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The management team told us there were systems in place to monitor and act on safeguarding concerns. However, we could not be assured these processes were always followed. We identified incidents with medicine errors that had not been escalated and reported appropriately. We found an incident where a carer continued to provide a person with personal care against their wishes. This had not been reported to the appropriate authorities.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. DoLS authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions they had choice, control and freedom over their lives. The provider had systems to record DoLS applications and associated conditions.We found some mental capacity assessments and best interest decisions for specific decisions that presented a high risk of harm to a person were not completed, but some other mental capacity assessments and best interest decisions were detailed and comprehensive. We raised this with the provider.

Staff told us they knew how to identify signs of abuse and what to do if they were concerned about a person. A staff member told “If I notice a bruise on a resident we take pictures and we relate it to the nurse in charge and they do further observations and refer to professionals and get creams etc.”

“One staff member told us, “I would go to the home manager. If the home manager didn't take action I would go higher up or CQC, adult safeguarding. I would go to the regional manager.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were exposed to risks because the provider did not always operate an effective system or process to record, recognise or act on risks. As a result, not all risks were identified and acted on.

We found risk assessments and care plans did not always reflect significant risk to people and did not always record where people were choosing to make unwise decisions within risk assessments and care plans.

For example, where care plans and risk assessments showed the person should follow a specific diet, assessments did not show how the person should be supported to be able to decide about the risk with eating the food they chose, or how the risk was mitigated. Risk assessments were not in place for high-risk medicines such as anticoagulants.

We observed one person who was prescribed protective items not using the protective item prescribed. Whilst staff expressed concerns about this to management, they were told the person had capacity to make that decision and understand the risk of not using the equipment. This was not clearly reflected in a risk assessment, care plan or Mental Capacity Assessment. The person has been assessed as lacking capacity to make a decision about their care. A recent review of their care had taken place with the relative but records showed this did not involve the person.

Staff told us they did not receive specific training relating to seizures but they were told what to do if someone had a seizure. A staff member told us “You have to look for the signs and distressed reactions usually come from an unmet need. We have to figure out a way to de-escalate. There is training for it but it is about getting to know the individual person. You get to know them well”.

Feedback from people and relatives was generally positive in this area. Although we did receive some feedback where people told us they had some concerns.

One relative told us “Dad is safe. He’s always up”. A person told us “I don’t like it here.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The outside environment was not maintained well. The area designated for rubbish held a skip for domestic waste, which was overflowing with black bags and numerous bags surrounded the skip. We observed broken furniture outside and plastic containers. The rubbish was blocking the signposted designated fire assembly point. We addressed this with management during the assessment. We were told there were difficulties with the contractors collecting the rubbish, however correspondence we viewed identified issues with the home not recycling rubbish correctly.

There was exposed plaster along one of the walls in the laundry room, the area behind and at the side of washing machine was not maintained well.

The home was in need of redecoration, however, we were shown a proposal that was due to go to tender for the refurbishment of the home.

Policies and procedures relating to health and safety were current and supported good practice. Records evidenced up-to-date certification for health safety checks. Equipment, including hoists and slings, had been serviced and inspected. Fire safety arrangements were in place, with systems for testing alarms, maintaining fire equipment and supporting safe evacuation where required. The service had an emergency evacuation and fire contingency plan.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Systems were in place to ensure staff were safely recruited. However, during the assessment we identified one staff member had provided conflicting information regarding their employment history and references. This did not appear to have been followed up by the provider. We were unable to ascertain the person’s working history and references. This was raised with the provider.

Staff told us agency staff working at the home did not have sufficient information to support people safely. We asked the provider about how agency staff were inducted into the service, and we were told they were given an orientation around the building. Agency staff profiles showed some agency staff did not have specific training in relation to their role and not all had upto date training.

Some permanent staff had training that was out of date, including one staff member with medicine competency that was out of date. Some staff told us they had a good induction when they started with the service “One staff member told us “Very good planned induction and was very structured”.

We received mixed feedback about staffing levels.

Care staff we spoke with told us they did not always have enough time to provide person centred care for people. Some staff told us they were working long hours, feeling tired and exhausted. They said they did not feel supported when they were genuinely unwell.

One staff member told us “I love helping residents. I do not have a least favourite thing. The home is not a bad home I would let my relative live here. But the issue is not enough staff on the floors.”

And another told us“There are only 2 carers on this floor from 2 to 8, the 3rd carer will be told to float. We cannot interrupt nurse duties like medication.”

One relative told us “I think their carers are wonderful. All of them, and they have care and respect. I go home at night knowing they are safe. On the flip side there are definitely not enough staff”.

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.

Whilst the care home generally appeared clean, some rooms and communal areas were in need of redecoration. One room we observed bare plaster exposed and the bed rails covers were peeling presenting a poor hygiene risk. We raised this on day 1 of the assessment it was still like it on day 2. The person spent a lot of time in bed and was totally dependent on others to help minimise the risk of infection.

During the assessment we identified a gap in how personal protective equipment (PPE) and bags were ordered. There was not a clear line of responsibility for who should ensure supplies at various points in the home were topped up. Staff told us this meant there were not always bags and PPE available. However, during the assessment there was PPE and bags available on each floor. Staff told us they did not have time to clean all 4 floors every day.

Staff told us they were informed by the nurses if there was an outbreak of an infection. They had a procedure in place to manage this safely. A relative told us “I think it’s OK. Usually clean, not horrible smell”

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

We identified multiple times time sensitive medicines used to treat Parkinsons was not given on time. This was not in line with specific health guidance and can increase the risk of a return of Parkinson’s symptoms, putting people at risk of serious harm. Governance processes had not identified these serious errors.

Topical creams were not locked away and there were no risk assessments in place for their use. Salbutamol inhalers had been stored in the fridge, against manufacturers instructions which state they should be stored at room temperature. Risk assessments were not in place for high-risk medicines such as anticoagulants.

Some epilepsy care plans and PRN protocols (Medicines prescribed to be taken when required) for seizure management medicines did not consistently contain adequate detail to support staff to safely manage people’s epilepsy.

Some people who had their medicines administered through PEG (percutaneous endoscopic gastrostomy) tubes, did not have a clear record to demonstrate that the correct flush volumes were being given between medicines. Staff were unable to show records of daily PEG site checks being carried out.

Where people missed doses of their medicines, care plans often stated staff should take action after a person refused their medicines for 3 days. There was no recognition that for medicines such as anticoagulants or sodium valproate, this period would be too long to wait. Staff we spoke were not aware of this.

Where people had topical pain patches in place here was no system to ensure these had remained in place between weekly changes.

Medicines were well organised in people’s rooms, CD stock records were being maintained correctly, liquids and creams all had opened/expiry dates recorded.

A relative told us “Pain management is done very well. They have a button he can press.”