About the service: 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