Whitegates Care Centre Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last inspection in March 2023 the provider was in breach of regulation because they had failed to ensure people's care was provided in a safe way and medicines were managed safely. We did not review this breach fully at this responsive assessment as we did not review safe management of medicines. However, we saw improvements were made in relation to how people’ s individual risks were assessed and managed. The provider did not ensure appropriate processes were in place and operated effectively to review and adjust staffing levels in the service, so people’s changing needs could be addressed consistently and effectively. Staff told us pressures caused by lack of oversight and effective roster management caused them to provide care in a task-based manner and affected the quality of the care people received. People told us they felt safe in the home and staff knew how to protect them from abuse and neglect. Staff were recruited safely and received appropriate training. People’s individual risks were assessed, and staff knew how to support people safely.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and people’s relatives told us people felt safe in the home and with staff. One person said, “I have never worried about anything. I feel safe. I would speak with the manager if I was not. I wouldn’t put up with it.” A relative commented, “I believe [person] is safe because they seem quite content and never say they have been hurt or anything like that, so I am sure they’re safe.”

Staff knew how to recognise and raise safeguarding concerns. For example, staff explained they would report any unexplained bruises, skin marks or incidents which put people at risk of abuse to the nurse in charge and the manager. The manager told us they led the safeguarding in the home and could access provider’s support when needed to protect people. One staff member described how safeguarding concern around a person’s care was immediately acted on and changes were made in how the person was supported to protect them.

There were no overall safeguarding concerns observed during the visit to the home. We followed up with the manager on one situation we observed around how staff communicated with a person, but we received assurances on measures in place to support this person and staff.

The provider had a safeguarding policy in place and staff could easily access information on how to raise safeguarding concerns. Staff received training in safeguarding. The manager kept a log of safeguarding referrals and investigations and worked with the local authority to address any concerns. The provider supported the service to take action to protect people from the risk of abuse and neglect when needed.

People and their relatives told us staff knew people’s individual risks and needs and were competent to support them safely. People’s relatives said, “[Staff] understand [person’s] needs. I have said a few things when [person] seems a bit strange and [staff] said they have already asked for a GP to come.” and “[Staff] are pretty good at keeping an eye on [person] and monitor them closely.” However, some relatives told us in their opinion staff initially did not fully understand people’s needs when they first moved in, but this had since improved.

In general, staff we spoke with were aware of people’s individual risks and how to support them safely. For example, one staff member explained which people needed support or modified food textures to enable them to eat safely. Staff we spoke with knew what to do in an emergency.

During our visit, we observed people in communal areas and saw staff provided them with safe care. For example, staff explained to people when they needed to use care equipment to safely support people around their mobility.

People’s care plans were detailed enough to guide staff on what support people required to stay safe and well. For example, people‘s individual risks around falls, mobility, nutritional status and skin integrity were addressed in their care plans.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Overall, people and their relatives told us there were enough staff on duty to support people. People told us, “I don’t expect staff to arrive instantly. I probably wait 3-4 minutes. Night staff are the same. I’m happy.” and “It’s lovely. Staff come when I need them.” Relatives said, “Yes, I think there are enough staff and I don’t have a concern there aren’t enough staff to look after [the person].”; “There are agency staff at the weekends, but they are regular agency staff and are pretty good.” Whilst people’s direct safety was not impacted, some relatives thought staff deployment was not always effective to provide people with timely care. Relatives’ comments included, “Sometimes (there is enough staff), sometimes not quite so, sometimes [people] need more and the ones who don’t make a fuss get left too long.” and “I always think they could do with a couple more members of staff. I know they have carers in the lounge but for the people who stay in their rooms I do feel perhaps another staff member would be better. Having said that, the staff they do have are brilliant and pop in to see [person] because they are bed bound.”

Staff told us there was not always enough of them to provide quality care to people and that the rosters were not always effectively planned to factor in the needs of people who moved into the home from hospital. They told us this caused pressures on the staff team and affected people’s care. Staff told us they struggled with the high pressures of supporting people whose needs were often complex, could quickly change and whom they were only just getting to know. One staff member explained there were occasions when multiple people moved into the home, but staffing was not adjusted which “put pressure on staff and necessitated hours of extra work.” Another staff member said, “It’s been so stressful since we started (to support people discharged form hospital). We don’t get to know people or build bonds. Sometimes we can’t cater for their needs. There is not enough staff. I think one more would help. We can’t give baths. Either they are not working; or we haven’t got time. I don’t think I’ve given anyone a bath for a long time. The management look at the number of people and not the number of staff that are needed. We have so many people that need 2 staff. We can’t just drop everything and go to answer someone else’s call bell.” A third member of staff told us, “There is not enough staff. Any meeting we go to, we say we need more staff, but we are told it is what it is. They are not adjusting the staffing levels. We can’t give people the attention they need or spend time talking to them.” The regional manager explained during the factual accuracy process the ‘core’ staffing level was maintained every day and monitored through provider’s online rostering tool. They also added staffing was not reduced when there were fewer people receiving care in the home and when additional staff were needed, this was raised for their approval. The provider increased senior leader support to 3 days a week in order to better support staff.

People received safe support on the day of our visit. We saw some people were supported promptly, but at times, others had to wait for prolonged periods to receive support or to have their requests met. There were enough nursing staff with the right qualifications, skills, training and experience to keep residents safe from avoidable harm and to provide the right care.

The provider did not always manage staffing effectively to ensure staff were able to meet the needs of all people living in the home, including those who were receiving short term care following hospital treatment. Staffing was set according to the numbers of people living in the home and the provider’s dependency tool. However, the provider did not effectively consider the changing and often complex needs of people which impacted on staff’s ability to provide consistent and timely care. We were told there were occasions when more than 1 person moved in on the same day, but staffing was not adjusted to ensure appropriate support was provided to all people. The provider recognised this issue and told us, “Since (this was recognised), the policy is that usually only one person per day is accepted.” There had not been a clinical lead in the home, so extra nursing shifts were added to support with the additional workload, but staff told us these was not always effective and caused delays in reviewing people’s care needs after they moved into the home which could put people at risk. Following this inspection, the provider acted on our feedback and immediately reduced the number of people they would support for short term stays. They also told us they would put in place a robust policy on how admissions and staffing should be managed safely and would review their staffing. Staff received appropriate training to be able to safely support people. The management team completed competency assessments with staff to support their skills. The provider followed safe recruitment practices. A new clinical lead was recruited and due to join the staff team shortly after the inspection to support nursing staff.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.