This inspection took place on 24 April and 2 May 2017. Both visits were unannounced. Whitebourne is a care home providing residential care for up to 66 people, some of whom are living with dementia. At the time of our inspection there were 63 people living at the service.
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. Since the inspection management arrangements at the home have changed. At the last inspection in 2015 we did not identify any breaches of the regulations. Since then the service quality had deteriorated and the provider failed to have effective oversight in order to identify what was going wrong and to make improvements. Since this inspection the provider has increased their quality assurance checks and has implemented a new action plan to make the improvements needed. The local authority and the CCG have informed us that some improvements have been made and others are still in progress.
Some people were not being protected against potential risks because risk assessments and guidelines for staff were not in place for people who have behaviour that challenges the service. Mobility care plans lacked the detail required for people to be adequately supported and to enable staff to attempt to prevent falls. Some staff did not have a good understanding of what might constitute abuse. Where potential abuse had occurred due to the behaviour of a small number of people this had not been identified or reported appropriately.
There were not sufficient staff to meet people’s needs. People and staff members confirmed this. Staff did not have enough time to spend with people and staff told us they did not have time to update care plans so these were out of date. Due to a lack of staff people’s needs were not always being met and there was a high incidence of unwitnessed falls. We spoke to the provider about this. They accepted they did not have sufficient staff to meet people’s needs and agreed to increase the staffing, and to not accept any more referrals at this time.
Staff did not always work in accordance with the Mental Capacity Act 2005 (MCA). Staff were unable to describe the principles of the MCA and some people did not have their capacity assessed to consent to their care or other important decisions.
Staff had not always received the induction training needed to meet people’s needs. Staff had received on-going training.
People were not supported by staff who had regular supervisions (one to one meetings) with their line manager. The provider had a supervision and appraisal policy, which set out how many one-to-one meetings staff should have each year and included staff at all levels. This was not being followed. Since the inspection this has improved and staff are being supervised.
Staff were not always caring or treating people with dignity and respect. Although other individual staff did show compassion and care. People were not being assisted with personal care regularly.
People’s care was not always planned and plans lacked the detail required for staff to know what care to provide to people. Staff told us the care plans were out of date.
Care that was provided was not always person centred. People were unable to choose when they received care. Staff did not always know people very well.
People did not have a sufficient range of activities to stimulate and interest them especially for those who remained in their rooms and there was little if any activity at weekends.
The provider had systems in place to monitor the quality of the service and make improvements. However, these were not always effective. They did not identify that some people’s care was not planned, that care plans lacked detail or that care plans were out of date. The incident analysis had not been completed since December 2016. This meant that the registered manager was unable to learn from what was taking place and did not put prevention plans in place. People’s feedback was not acted upon.
The registered manager had not notified CQC of some significant events
Medicines were administered safely. Medicines were stored securely and in an appropriate environment. Staff authorised to administer medicines had completed training in the safe management of medicines.
The provider followed safe recruitment practices.
The risk of fire had been assessed and plans were in place to minimise these risks.
The staff met people's dietary needs and preferences. Staff offered people help with eating and drinking and provided support where people wanted it. We saw some individual examples of staff being caring towards people.
People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.
People were encouraged to be independent and people and relatives knew how to complain.
The registered manager and senior staff were not always supportive to care staff.
Staff were involved in the running of the home. Regular meetings took place and staff were able to contribute to the agenda.
During the inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We also made four recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.