Whiston Hall

Whiston Hall is a residential care home providing personal care to older people with a range of support needs. Whiston Hall can provide accommodation for up to 48 people. At the time of our inspection 15 people were using the service.

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

The home had a process in place to ensure people were safeguarded from the risk of abuse. Risks associated with people’s care were identified and managed safely. The provider had a recruitment system in place to ensure appropriate staff were employed. Accidents and incidents were monitored, and trends and patterns identified to minimise future incidents.

The provider had systems in place to ensure people received their medicines as prescribed. The provider was promoting safety through the layout and hygiene practices of the premises. However, during the tour of the home we identified some minor concerns which were addressed immediately.

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.

Staff told us they received training and support which gave them the knowledge to carry out their role effectively.

The provider had a complaints procedure and sought feedback from people. The management team used these systems to develop the service.

We looked at care documentation and found people's needs were assessed. Care plans included information about people's choices and preferences.

People and their relatives were complimentary about the home and told us they felt happy. Staff interacted well with people and assisted them in a person centred way.

Systems were in place to ensure the quality of the service was monitored and actions were taken to address issues as they arise.

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 requires improvement (published 23 October 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Whiston Hall provides personal care to older people with a range of support needs, including dementia. It accommodates up to 48 people, and 17 were using the service at the time of the inspection.

People’s experience of using this service:

People gave us positive feedback about the home. One person’s relative described the service as the best they had ever visited and another said they were very happy with the home. One person using the service said: “I have nothing to complain about, everything is going really very well.”

People were supported by staff who were deployed in sufficient numbers to meet their needs. Staff were aware of how to safeguard people from abuse and had received training about how to recognise and respond to concerns.

We found some shortfalls in the training programme, and some staff told us they felt they had not received enough training. The manager told us training had been difficult during the COVID-19 lockdown, but they had recently commissioned a new trainer and training programme, and expected to see progress very soon in this area.

Medicines were managed in a way that had improved since the home was last inspected, and audits ensured managers had a good oversight of this. We found some minor shortfalls in the medicines we looked at, but the manager assured us this would be addressed.

We identified infection control systems could be improved in the home. Not all staff had received infection control training, and none of the staff we spoke with could remember having any training about how to use personal protective equipment (PPE) during the pandemic. We observed staff using PPE correctly, although noted staff did not observe social distancing guidance at all times.

The manager was committed to raising standards in the home, and had devised a comprehensive improvement plan to support this. Staff gave us a mixed picture about governance at the home, with some saying they felt very supported, but others saying this was not the case.

Rating at last inspection:

The last rating for this service was requires improvement (published February 2020) At our last inspection we found management systems were not sufficiently robust to ensure the service was managed effectively. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 17, although further improvements are required.

Why we inspected:

This was a planned focussed inspection based on the rating at the last inspection. As this was a focussed inspection, we reviewed the key questions of safe and well led only. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Whiston Hall is a residential care home providing care and support for up to 44 older people, including those living with dementia. At the time of the inspection 25 people were using the service.

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

We found the provider had failed to make significant improvements since the last inspection in the way the home was run. There was a system of auditing the quality of care provided, however, this was ineffective as it did not identify all shortfalls or areas of concern.

The home had not had a registered manager for almost a year. A new manager had been recruited but they had not yet registered with CQC. 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 and associated Regulations about how the service is run.

Staff were kind and friendly in their approach to people, and people responded positively to this. However, people spent a considerable amount of time without staff contact. We also noted call bells ringing for a long time without staff attending. The provider used a dependency tool to assess what staffing numbers were required, however, this had not been updated for three months despite new people being admitted to the home since then. Staff told us, and our observations confirmed, there weren’t enough staff to meet people’s needs

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. However, improvements were needed to some documentation to fully evidence compliance with the Mental Capacity Act (MCA).

Staff understood their responsibilities in relation to safeguarding, and had received appropriate training in this area. However, we noted there had been some safeguarding incidents where the provider had not taken the correct action.

The mealtime we observed was a pleasant experience, where people obtained the support that they needed in a discreet and respectful manner, and appropriate equipment was provided to enable people to eat.

Improvements were required in the way medicines were managed; medicines were stored safely, but records of medication administered were not accurately kept.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published May 2019) and there were breaches of regulation relating to staffing, safety and governance. We asked the provider to complete an action plan after the last inspection to show what they would do and by when to improve, but they did not do so. At this inspection we found the provider was still in breach of regulation relating to governance.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have found evidence the provider needs to make improvements. We have identified a breach in relation to governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Whiston Hall provides accommodation for up to 44 older people, including people living with dementia in one adapted building. At the time of our visit there were 26 people using the service.

People’s experience of using this service:

After the last inspection of September 2018, the provider had sent us an action plan to tell us how they would address the areas we raised on inspection. At this inspection we found concerns regarding safe care and treatment, infection, prevention and control and staffing. Whilst the action plan had addressed some of our immediate concerns, it had not been fully effective in improving the service.

The service did not have a registered manager, their last day had been Monday 8 April 2019. The deputy manager was working nights due to staff shortages so there was no management. The nominated individual was at the service during our inspection. The nominated individual told us they had put in place management arrangements that the quality lead and themselves would be overseeing the service until a new manager was recruited. Since our inspection the provider has confirmed in writing the management arrangements to ensure improvements are sustained.

We completed a tour of the home with the nominated individual and found some areas, equipment and furniture were not clean, although audits had been completed they had not identified all the issues we found at inspection.

Risks associated with people's care, including moving and handling had been identified. However, we found the care plans and risk assessments in respect of moving and handling people to meet their needs were not followed. We also found they had not always been reviewed when there were changes to people’s needs. This put people at risk of harm.

We found people did not always receive care that was responsive to their needs. Care plans we looked at did not always contain the most up to date information or contained information that was contradictory. People were not always provided with opportunity for meaningful activity.

People we spoke with told us they felt there were not always enough staff, as they were not always available to provide care and support in a timely way. The nominated individual explained to us that they had a dependency tool and the hours required were maintained. However, the layout of the building was over three floors and the tool did not fully take this into consideration and the deployment of staff was not always effective.

People told us they generally felt safe. The provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in safeguarding and confirmed that they would take appropriate action if they suspected abuse. However, the unsafe moving and handling that we observed during the inspection was reported to the local authority safeguarding. This was because staff did not follow risk assessments or care plans to ensure peoples safety.

Recruitment procedures followed safe practices. Medicines were managed safely. Incidents and accidents had been recorded and analysed. However, the analysis was not always effective to ensure safe management of these to reduce occurrences. The provider improved these systems following our inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was adhering to the principles of the Mental Capacity Act (MCA). People who lacked capacity had decisions made in their best interests.

Peoples nutritional needs were met. People who required support with their diet had their needs met by staff that understood their dietary requirements. We observed the lunch time meal the food served was well presented, appetising and special dietary needs were met. However, we found the experience for people could be improved, people sat waiting for a long time for their meal to arrive. Staff did not always offer assistance in a timely manner.

Staff told us they had received the training and support they needed to carry out their roles well. They said they had been supported by the registered manager who had finished in post the week of the inspection. People had confidence in the staff and told us, although at times the service was short staffed they were happy with the care they received form the care workers. All people we spoke with spoke highly of the care workers. Staff were respectful of people’s privacy and dignity. However, although we found staff interactions to be caring and kind, due to lack of direction and effective deployment, staff became task orientated. Therefore, care was not always person-centred or individualised.

There was a complaints procedure available which enabled people to raise concerns or complaints about the care or support they received. The registered manager had kept detailed records of concerns that evidenced any issues were actioned promptly and satisfactorily. However, one concern was raised with us during our inspection and the person felt it had not been dealt with appropriately. We asked the nominated individual to look into this again.

The registered manager, when in post, had implemented an audit system, which we looked at, this had identified many issues and had an action plan in place. However, the audits had not identified all of the issues we found at inspection. The nominated individual had also compiled a quality monitoring system and this was being implemented to drive improvements. The nominated individual explained they had identified progress with improvements was slow, so had employed a quality lead to ensure improvements were implemented and embedded into practice.

We found three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 12; safe care and treatment, regulation 17; good governance and Regulation 18; staffing.

More information is in the detailed report.

Rating at last inspection:

At the last inspection the service was rated Inadequate (report published November 2018).

Why we inspected:

This was a scheduled inspection based on the previous ratings.

Follow up:

We will continue to monitor the service through the information we receive. We have also requested some further information from the provider to reassure us people are safe. The provider has also provided an action plan.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service was previously inspected in November 2017, when we identified four breaches of regulations. The registered provider did not ensure care was person-centred, did not manage risks to ensure peoples safety, was not meeting the requirements of The Mental Capacity Act and there was ineffective deployment of staff. The service was rated Requires Improvement. At this inspection we found the service had deteriorated and we have rated it Inadequate and it is placed in special measures.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Whiston Hall’ on our website at www.cqc.org.uk.

At the time of our inspection there was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A registered manager from another of the registered providers services was overseeing the service at the time of our inspection.

Whiston Hall is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation for up to 44 people in one adapted building. At the time of our visit there were 32 people using the service.

People were not protected as risks to their health and welfare were not effectively reviewed or managed. The risk assessments lacked detail, and were not always followed. We observed staff providing support to people and found that staff did not deliver the care and support in line with needs. This put people at risk of harm.

The home had a dependency tool in place to determine what staffing hours were required to meet people’s needs. However, this was not up to date and had not been completed since August 2018. We identified that there were insufficient staff on duty to meet the needs of people who used the service.

We found the service was predominantly meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found some people’s best interest decisions were clearly documented. However, we found others had not been considered and had no evidence in place to support the decisions made where people lacked capacity to make specific decisions.

We found there had been a lack of leadership and oversight and communication between all levels of staff had been poor. The registered manager had left and although the provider had acted to provide cover. We found the issues had not been identified in a timely way to ensure the service was improving following our inspection in November 2017.

Systems in place to monitor the service were not always followed and as a result the systems were not effective. People who used the service, their relatives and staff were not provided with forums where they could voice their opinions or be involved in the running of the service.

Systems were in place to manage medicines safely. People were provided with a nutritious balanced diet. However, we found people were not always supported with nutrition, which meant they did not always receive adequate nutrition and hydration.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action.

We observed staff interacting with people and found they were kind and caring, but identified people had to wait for assistance and some staff interactions were not person-centred.

We found care plans were in place and had been updated since our last inspection. However, we found they did not always reflect people’s current needs and were not always reviewed when their needs changed.

We observed people engaging in social stimulation and activities. People we spoke with told us they enjoyed the activities.

We looked at records of complaints received and found these had been dealt with appropriately.

We found four breaches; three of these were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service will therefore be 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.

The service did not have a registered manager. However, the provider had appointed a new permanent manager who had been in post three weeks at the time of our inspection and they had commenced the process to register with CQC. 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.

Whiston Hall is a care home which providers accommodation for up to 48 people. The home is within easy reach of the local amenities such as the shops, village hall and public transport. There were 35 people using the service at the time of our inspection.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. However, issues we identified during the day did not support this and we submitted a safeguarding referral to the local authority.

We found there was a dependency tool to determine staffing levels. However this was not reviewed when there were changes and it was not clear from talking to staff and people who used the service if there were sufficient staff on duty to meet people’s needs in a timely way.

Risks to people had not always been identified and if they were identified we found these were not always followed. Systems were in place for safe management of medicines. However, we identified some areas of documentation could be improved.

People were not always protected by the prevention and control of infection procedures. We found some areas of the service were not kept clean or hygienic to ensure people were protected from acquired infections.

We found procedures were followed for the recruitment of staff. Staff supervision took place although staff told us this was not effective. However, staff told us they felt supported by the new manager. Staff received training that ensured they had the competencies and skills to meet the needs of people who used the service.

We found the service did not always meet the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Most staff we spoke with did not have a satisfactory understanding and knowledge of this, and people who used the service had not been assessed to determine if a DoLS application was required. We also found people’s best interest decisions were not always considered.

People were offered a well-balanced diet; however, we saw people were not always supported to maintain a balanced diet. People accessed health care services when required. Referrals were made quickly to health care professionals when people’s needs changed.

People and their relatives we spoke with all said the staff were kind and caring. People also said staff respected them and maintained their dignity. However, staff did not always recognise when people required support as the call system could not be heard throughout the building.

Care plans identified people’s needs and had good detail of how to manage people’s needs. However, we identified that some documentation did not always reflect peoples current or changing needs.

People told us they were listened to by the new manager and were confident any concerns would be dealt with by them. Activities took place, however, more could be organised that met the needs of people living with dementia.

There were processes in place to monitor the quality and safety of the service. Some of the issues we had identified had been picked up and an action plan was being implemented by the new manager to resolve the issues.

During our inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

inspected in January 2015 and the service was meeting the regulations we looked at.

Whiston Hall is a care home which provides accommodation for up to 48 people. The home is within easy reach of local amenities such as shops, village hall and public transport.

At the time of our inspection the service did not have 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. The provider had appointed a manger who had commenced the registration process. A new manager had been appointed and had been in post for two weeks at the time we visited the service. They were in the process of registering with the Care Quality Commission.

We spoke with staff about safeguarding people from abuse and they were very knowledgeable about this. They told us they attended training and they had learned about the different types of abuse and how to recognise and report it.

We looked at three recruitment files and found the provider had a safe and effective system in place for employing new staff.

We looked at systems in place to manage medicines and found that they were safe. Medicines were stored and administered safely.

Care plans we looked at identified any risks associated with people’s care. For example, risk assessments were in place for falls, pressure area care and nutritional needs.

We spoke with staff who said they received appropriate training which gave them the skills and confidence to carry out their responsibilities. Training included moving and handling, first aid, health and safety, fire prevention, safeguarding, and food hygiene.

Through our observations and from talking with staff and the registered manager we found the service to be meeting the requirements of the DoLS. Staff confirmed they had received training in this subject.

People were offered a choice of food at each meal and drinks and snacks were provided throughout the day in line with their preferences and dietary requirements.

We looked at peoples care plans and found that relevant healthcare professionals were involved in their care when required. For example, district nurse and speech and language therapist.

We observed staff supporting people and found they were respectful and caring in nature. Care plans we saw included information about people’s likes and dislikes.

We looked at care records belonging to four people and found they were informative and reflected the care and support being given. However, a new process was being introduced and some information from previous documentation had not been carried over to the new document. This was being looked at by the manager.

The service employed an activity co-ordinator who was available 30 hours a week. People we spoke with were happy with the activities provided.

The provider had a complaints procedure and people felt able to raise concerns if they needed to. The manager kept a log of concerns received and addressed them effectively.

People told us the manager was supportive and there was a good leadership structure in place. People felt able to approach the manager and felt she listened to them and acted on what they told her.

We saw regular audits took place to check the quality of service provision. Action plans were devised to follow up any issues.

People were involved in the service and their views were sought. We saw evidence that people were involved in residents and relatives meetings and were able to comment about the service.

We inspected the service on 14 November 2013 and found the provider to be compliant.

People were protected from the risk of infection because appropriate guidance had been followed. People we spoke with felt the home was kept clean.

People we spoke with told us that there was always something to do. One person said, 'I love the library visits and enjoy selecting my books, staff are very helpful too.' Another person said, 'I enjoy knitting it keeps me occupied.'

We saw that the main living areas of the home were clean, but some areas such as the bathroom and laundry needed attention.

We found systems protected people who used the service against the risks associated with the unsafe use and management of medication. We spoke with people who used the service and they told us that they receive their medicines on time.

There were effective recruitment and selection processes in place. Staff told us that they had appropriate pre-employment checks before they commenced work with the provider.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

People who used the service had a care plan which was relevant to their individual needs. People were able to participate in appropriate activities throughout the day. People were happy living at the home and one person said 'We have been on a barge trip and it was lovely and restful.'

We found that the home worked well with other professionals. People who used the service were supported to access other professionals when required. One person said, 'If I am ill the staff call the doctor.' Another person said 'I have the optician visit me here.'

There was enough equipment to support people appropriately. Some people used the hoist, others used walking aids. The manager told us that all equipment was assessed for the individual using it.

We found that there were enough staff to meet people's needs. Staff were knowledgeable about their role and felt that the training they attended was good.

People knew how to complain if they needed to. The complaints procedure was available. One person said, 'When I have complained things have been sorted out for me.'