This inspection took place on 1 and 4 September 2015. It was unannounced on the first day and announced at short notice on the second day. Whitby Court Care Home is registered to care for up to 50 older people with nursing needs. On the day of inspection there were forty five people living at the home. The building was recently built for purpose and presents an attractive living environment. There is a passenger lift to assist people to the upper floors and the home is located close to transport links and the local park.
The home had a registered manager in place. 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 inspection on 17 November 2014 we found three breaches of regulations. We received an action plan from the provider setting out how they would meet the relevant legal requirements.
We found that the registered person had not protected people because of shortfalls in the way they assessed and managed individual risk. This was in breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At this inspection on 1 and 4 September 2015 we found this area had improved with risk management plans in place to protect people. This meant there was no longer a breach of regulation 9.
At the last inspection on 17 November 2014 we found that the registered person had not protected people against the risks associated with the safe handling of medicines. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At this inspection on 1 and 4 September 2015, we looked at the management of medicines and found that this had improved. People received their medicines as prescribed and when they needed them. This meant there was no longer a breach of regulation 12.
At the last inspection on 17 November 2014 we found that the registered person had not protected people against the risks associated staff who were insufficiently trained to deliver effective care. This was in breach of regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At this inspection 1 and 4 September 2015 we found that staff training had improved so that they had the skills to give effective care. Regulation 18 was no longer in breach with regard to staff training.
Staff were safely recruited. However, staffing levels were not always sufficient to care for people safely or to enable all people to pursue interests of their choice. This was a breach of Regulation 18 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.
We noted gaps in records which monitored people's clinical care needs, for example fluid and nutritional charts and moving and handling charts. Records of people's involvement in decisions about their care were not sufficiently detailed to ensure staff had the information they required. This meant there was a breach of Regulation 17(2) 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.
People had their clinical care needs met, however, people sometimes had to wait for staff to attend to them in terms of these needs, for example in relation to repositioning or receiving drinks. Required charts to monitor this care were not consistently completed. We have made a recommendation about this.
Staff were kind and usually offered compassionate care, including when people reached the end of their lives. People had written thank you cards and letters praising the kind and compassionate care offered by the service. However, staff were sometimes rushed which led to care being task led at times.
The environment, though attractive and well decorated was under used and its potential not fulfilled. People did not feel encouraged to use certain areas of the home. The environment was not well adapted to the needs of people with memory impairment. We have made a recommendation about this.
Staff and people who lived at the home told us that the culture of the home did not always put each person at the heart of care. Lines of communication between the providers, the registered manager, staff and the people who lived at the home and visitors were not sufficiently transparent or responsive. People and staff were not sufficiently involved in developing the service. Although surveys and meetings took place, there was insufficient evidence that people were consulted in a meaningful way over how the service was run. We have made a recommendation about this.
People were protected with regard to seeking consent before undertaking day-to-day care and treatment, however, they had not always received assessment for their mental capacity when this was needed to ensure their rights were upheld and their freedom to make decisions maximised. We have made a recommendation about this.
People told us they felt safe at the home. Risks to people were assessed and acted upon. Staff were trained in safeguarding and understood how to recognise and report any abuse.
People were protected by the infection control practice within the home. The home was clean and fresh throughout.
Most staff were supervised and trained effectively to feel supported to offer good quality care. However, nurses felt that they needed more clinical supervision support.
People had access to health care support and the service was proactive in referring to specialist professionals and acting on their advice.
People received well balanced nutritious meals. They were offered freshly cooked breakfast and tea time meals. Main meals were pre- prepared frozen meals which the service re heated. People told us they enjoyed the food, however, some people told us they would have preferred a choice of a freshly cooked main meal and staff confirmed that at the time of inspection people did not have this option for main meals.
People were supported to take part in activities and daily occupations. However, some people were at risk of being under stimulated because staff did not have time to work with everyone in this way, particularly those on the nursing floor.
If people raised concerns or complaints these were usually dealt with promptly and recorded with actions.
The registered manager carried out a system of checks and monitoring audits to ensure the service was safe and that plans could be drawn up for improvement.