Whetstone Grange

Whetstone Grange is a residential care home providing accommodation and personal care to 23 people aged 65 and over at the time of the inspection. The service can support up to 38 people.

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

The service had a newly employed manager who had not yet registered with the Care Quality Commission. This meant the provider was legally responsible for how the service was run and for the quality and safety of the care provided.

Quality assurance systems and processes were not embedded and required improvement. All legally required notifications were not always submitted to CQC. The manager and provider were open and transparent, knew improvements were needed, and were taking action to ensure these were addressed.

There was no formal process for calculating the required number of staff to meet people’s needs. However, we found there were enough suitably qualified staff on duty to meet people’s needs. A system was introduced following our inspection which was reflective of the inspection findings regarding staffing numbers.

Processes were in place to safely manage risks associated with people’s care. Care plans and risk assessments were reflective of people’s needs and staff knew people well.

There was adequate stock of personal protective equipment (PPE) for staff to use. The service was observed to be clean and odour free. We saw some staff wearing face masks below their noses, this was addressed immediately by the manager. COVID-19 testing was undertaken for people and staff in line with government guidance and the service had developed a ‘visiting pod’ to enable friends and relatives to visit people when restrictions allowed.

People felt safe and were supported by safely recruited staff who protected them from harm or abuse. Staff were trained in safeguarding and recognised the signs of abuse and the requirement to report any concerns they had.

Medicines were administered on time, accidents and incidents were reported, and lessons learnt.

People received care from staff that were kind, caring and compassionate. People and staff had built positive relationships together and enjoyed spending time together.

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 Good (Published 22 January 2020).

A targeted inspection (Published 06 January 2021) did not change the rating of the service. Targeted inspections do not change the rating from the previous inspection because they do not assess all areas of a key question.

Why we inspected

The inspection was prompted in part due to a complaint and concerns received about infection prevention and control (IPC). As a result, we undertook a focused inspection to review the key questions of safe and well-led only. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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. However, the rating for well-led has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the well led section of this full report.

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 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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• The service had good infection prevention controls in place to prevent the spread of infection.

• There was a separate isolation area in the premises to prevent the spread of the COVID 19.

• The service facilitated virtual visits through the use of information technology such as video calls.

Further information is in the detailed findings below.

Whetstone Grange is a residential care home providing accommodation and personal care to 23 people aged 65 and over at the time of the inspection. The service can support up to 38 people.

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

People did not always feel there were enough numbers of staff on duty at certain times. We have made a recommendation about the level and deployment of staff at the service.

People received safe care and were protected from the risk of harm and abuse. Where minor concerns were identified these were resolved quickly.

People were supported by experienced, well trained and safely recruited staff who received an induction to their role when they started working at the service.

People were supported by staff who were kind and caring. Staff knew the people who used the service well and held positive relationships with them treating them with dignity and respect.

Peoples medicines were safely managed, and systems were in place to control and prevent the spread of infection.

People were supported to eat and drink enough to maintain their health and well-being, and staff monitored people’s health needs closely ensuring professional guidance and support was sought when needed.

People’s care needs were assessed before they moved to the service and they were involved with planning their care. Care plans were mostly detailed and supported staff to provide personalised care. Visitors were welcomed to the service and their views always considered and respected.

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.

People felt more activities were needed. The service had a relaxed and warm atmosphere and people were comfortable in their surroundings and had formed friendships between them.

People felt comfortable raising concerns with the quality of the service and were complimentary of the recent improvements made.

People and staff held positive views on how the service was managed. People knew who the registered manager was, and staff were supported in their roles.

There were systems in place to monitor the quality of the service and actions were taken, and improvements were made when required. The registered manager was supported by the provider who took an active role in the service.

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 good (published 12 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

At our last inspection on 29 and 30 November 2016 we asked the provider to take action to make improvements in two areas. We asked them to improve practice relating to assessing people’s capacity to consent to their care and support and with regard to good governance. At this inspection we checked to see if the provider had made the necessary improvements. We found that they had.

Whetstone Grange is located in Whetstone, Leicester. The service provides care and accommodation for up to 38 older people with age related needs, including dementia and physical disability. On the day of our inspection there were 25 people living at the service.

The service had a registered manager. 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.

People told us they felt safe living at Whetstone Grange and felt safe with the care workers who supported them. The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew what to do if they suspected someone was being abused. This included reporting any issues of concern to the management team.

Risks associated with people's care and support had been assessed. These assessments provided the management team with the opportunity to reduce and manage the risks presented to both the people using the service and the staff team.

People had plans of care that reflected their care and support needs. These provided the staff team with the information they needed in order to properly support people using the service. Staff knew the people they were supporting including their preferences.

Appropriate checks had been carried out when new members of staff had started working at the service. This was to make sure that they were suitable and safe to work there. An induction into the service had been provided for all new staff members and ongoing training was being delivered. This enabled the staff team to provide the care and support that people needed.

People we spoke with felt there were currently a sufficient number staff on duty each day because their care and support needs were being met. Their relatives and members of the staff team we spoke with agreed with what they told us.

People were on the whole receiving their medicines as prescribed by their doctor. Medicines were being appropriately stored and the necessary records were being kept.

People told us the meals served at Whetstone Grange were good. Their nutritional and dietary requirements had been assessed and a balanced diet was being provided. For people who had been assessed to be at risk of not getting the food and drink they needed to keep them well, accurate records were kept showing their food and drink intake so that this could be monitored.

The staff team involved people in making day to day decisions about their care and support. Where people were unable to make their own decisions, we saw that decisions had been made for them in consultation with people who knew them well and in their best interest. The staff team were working in line with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

The staff team felt supported by the registered manager. They explained that they were given the opportunity to meet with them on a regular basis and felt able to speak with them if they had any concerns or suggestions of any kind.

People told us that the staff team were kind and caring and they were treated with respect. The relatives we spoke with agreed with what they told us. On the whole we observed the staff team treating people in a kindly manner throughout our visit.

People were encouraged to follow their interests and take part in social activities. An activities leader was employed. When on duty they supported the people using the service with both one to one and group activities which people clearly enjoyed. On the day of our visit they were also supported by two students from a local college.

A complaints procedure was in place and although not everyone we spoke with was aware of this, they all knew who to talk to if they had a concern of any kind.

Relatives and friends were encouraged to visit and they told us that they were made welcome at all times by the staff team.

Meetings were held and surveys were used to gather people's views on the service provided.

There were systems in place to regularly monitor the quality and safety of the service being provided. Checks had been carried out on the environment and on the equipment used to maintain people's safety. A business continuity plan was in place for emergencies or untoward events and personal emergency evacuation plans were in place should people using the service need to be evacuated from the building.

The registered manager understood their legal responsibility for notifying the CQC of deaths, incidents and injuries that occurred or affected people who used the service.

At our last inspection on 11 and 12 November 2015 we asked the provider to take action to make improvements in two areas. We asked them to improve practice relating to assessing people’s capacity to consent to their care and support and with regard to good governance. At this inspection we found that the provider had not made the necessary improvements. We identified that the provider was in breach of two of the Regulations 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 this report.

Whetstone Grange provides accommodation for up to 38 people who require personal care and support. There were 28 people using the service at the time of our inspection including people living with dementia.

The service had a registered manager. 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.

Not all of the concerns raised at our last inspection had been addressed. These were around assessing people's capacity and the monitoring of the service.

When people were unable to make their own decisions, capacity assessments had not always been carried out and decisions had not always been made for them in consultation with people who knew them well. The staff team involved people in making day to day decisions about their care and support. Staff members we spoke with were aware of their responsibilities under the Mental Capacity Act 2005.

There were systems in place to monitor the service being provided. However, these had not always been effective in identifying shortfalls, particularly within people’s care records.

Not everyone we spoke with felt there were always enough staff on duty to meet the needs of the people using the service. Questions were raised as to whether two waking night staff were sufficient to support 28 people when four of those needed the assistance of the two night staff at any one time.

Risks associated with people’s care and support had not always been assessed.

People’s plans of care did not always reflect the care and support that people needed and staff members did not always follow the instructions contained within them.

People had received their medicines as prescribed. Systems were in place to regularly audit the medicines held and the appropriate records were being kept.

Appropriate checks had been carried out when new members of staff had started working at the service. This was to check that they were suitable and safe.

An induction into the service had been provided for all new staff members and ongoing training was being delivered. This enabled the staff team to provide the care and support that people needed.

People’s nutritional and dietary requirements had been assessed and a balanced diet was provided, with a choice of meal at each mealtime. Monitoring records used to monitor people’s food and fluid intake did not demonstrate that people received the food and fluids they needed to keep them well.

People were supported to access the healthcare services they needed such as GPs and community nurses.

People told us that the staff team were kind and caring and they treated people with respect. Whilst this was observed, the actions of some staff members meant that people were not always treated in a caring or respectful manner.

The staff members we spoke with felt supported by the registered manager. They explained that they had been provided with the opportunity to meet with them on a one to one basis to discuss their progress. They also told us that there was always someone available for support and advice should they need it.

Staff meetings and meetings for the people using the service had been held. These meetings provided people with the opportunity to be involved in how the service was run.

An activities leader had been employed to provide activities or assist people to enjoy interests or hobbies that were important to them. However, this was only for eight hours a week. When they were not present people spent large amounts of time on their own and without meaningful interactions.

A complaints procedure was in place and people felt that any concern raised would be dealt with to their satisfaction.

Checks had been carried out on the environment and on the equipment used to maintain people’s safety and a business continuity plan was in place for emergencies or untoward events.

We looked at records for three people who used the service. The care records had a care and support plan in place which identified risks and how these could be managed. There were regular reviews.

We found that staff supported people appropriately and spoke to them in a friendly and respectful manner. Staff understood peoples’ needs and preferences and respected their choices.

Staff were trained and supported and delivered care which met peoples’ needs. Staff we spoke with had a good understanding of the different types of abuse and could explain what they would do if they suspected someone was being abused. They knew who they would report this to both within the service and to external agencies.

We found that the provider had adequate quality assurance processes to ensure the comfort and safety of the people they cared for was maintained.