Whitestone Lodge

Updated 27 September 2023

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 Care Act 2014.

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

Both days of the inspection were carried out by 2 inspectors.

Service and service type

Whitestone Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was no registered manager in post. There was a manager in post and they were in the process of applying to CQC to become the registered manager.

Notice of inspection

The first day of the inspection was unannounced and the second day was announced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We also obtained information about the service from the local authority and local safeguarding teams. 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. We used all this information to plan our inspection.

During the inspection visit

We spoke with 5 people who used the service and 1 family member about their experiences of the care provided. We spoke with the provider, manager, 7 care staff, a housekeeper, maintenance person and the cook.

We reviewed a range of records. This included 10 people’s care records and a selection of people’s medication records. We looked at recruitment records for 2 staff members employed. A variety of other records relating to the management of the service, including audits and checks were reviewed.

Updated 27 September 2023

About the service

Whitestone Lodge Care Home provides accommodation and personal care for up to 20 people in a converted building over two floors. At the time of our inspection 20 people were living at the service.

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

Risks to people’s health, safety and welfare were not always assessed, monitored, and managed to ensure their safety. A risk assessment had not been completed to determine the risk level and whether a risk management plan was needed for people with conditions which posed a potential risk to their physical and mental health.

Checks on the safety of the environment, utilities and equipment were not consistently completed. Records lacked instructions on the required frequency of checks, location of checks and who was responsible and had completed them.

Staff were confident about recognising and reporting abuse, however, a significant number of staff had not updated their safeguarding training. A number of allegations of abuse were raised with the relevant local authority, however, there were no records maintained to enable us to review what immediate action was taken to safeguard people.

There were no records to show an initial assessment of some peoples’ needs and choices had been completed prior to their admission to the service. Assessments were not always completed, and care plans were not always updated following a change in people’s needs.

Staff were not always appropriately trained for their role to enable them to meet people’s needs. There were significant shortfalls in the completion of training for staff. Staff were carrying out tasks without the right training, skills, and knowledge.

There was a lack of a person-centred approach to planning people’s care. Care plans were not in place to guide staff on people’s needs and choices and how they were to be met. Outcomes recorded in some peoples care plans were not personalised.

The providers complaints procedure was not up to date and there was a lack of response to complaints received about the service. Complaints were not acknowledged, investigated, responded to, and used to improve the quality of care.

The provider lacked understanding of their role and responsibilities and regulatory requirements. The provider failed to act on and make improvements following the last inspection. There were no clear lines of responsibility for ensuring oversight of auditing systems and processes. Audits and checks were inconsistent and ineffective, they failed to identify risk and bring about improvements. Records relating to people’s care and the management of the service were not always maintained, accurate and securely stored.

Staff were caring and kind towards people when providing them with care and support.

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 July 2022).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety and the leadership of the service. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Whitestone Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s safety, staffing, complaints and the governance and leadership of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or varying the conditions of the 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.