Whitchurch Lodge

Whitchurch Lodge is a care home registered for a maximum of 32 people. People living in the home may have health and mobility issues associated with old age, physical disabilities or sensory Impairment. The home is located close to shops and transport links. At the time of our visit, there were 31 people living in the home.

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

People were kept safe in the service by enough staff who knew them well and who had the right skills, experience and knowledge to look after them. People were protected from harm and abuse and treated with respect. There were systems in place for managing and administering people’s medication which were reviewed regularly.

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’s needs were assessed including risks to people’s health and the environment they lived in and they were monitored to ensure safety. The service was well maintained, clean and homely. Staff received training, guidance and support to do their job well.

The registered manager delivered an effective service because they worked in partnership with other health care professionals. There were up to date systems in place to monitor the quality of the service and any learning was identified and acted upon.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 09 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform us when we next inspect.

Whitchurch Lodge is a care home registered for a maximum of 32 people. People living in the home may have health and mobility issues associated with old age, physical disabilities or sensory Impairment. The home is located close to shops and transport links. At the time of our visit, there were 26 people living in the home.

People’s experience of using this service

People told us they were satisfied with the care provided. They stated that staff treated them with respect and dignity and they felt safe in the home. We observed that staff interacted well with people and were caring and attentive towards them.

Risk assessments had been documented. Risks to people’s health and wellbeing had been assessed. There was guidance for staff on how to minimise risks to people.

Staff had received training on how to safeguard people and were aware of the procedure to follow if they suspected that people were subject to abuse.

People received their prescribed medicines. Staff had received medicines administration training and knew how to administer medicines safely.

Staff had been carefully recruited and essential pre-employment checks had been carried out. The home had adequate staffing levels and staff were able to attend to people’s needs. Staff had received training and had knowledge and skills to support people. There were arrangements for staff support, supervision and appraisals.

People were satisfied with their accommodation. The premises were clean and tidy. There was a record of essential maintenance carried out. Fire safety arrangements were in place.

Staff supported people to have a healthy and nutritious diet that was in line with their individual dietary needs and preferences.

The healthcare needs of people had been assessed. People could access the services of healthcare professionals when needed.

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 services supported this practice.

People’s care needs had been assessed prior to them coming to the home and staff were knowledgeable regarding these needs. The service provided people with person-centred care and support that met their individual needs and choices.

Staff supported people to participate in a wide range of social and therapeutic activities. The service arranged events to celebrate special cultural and religious days.

There was a complaints procedure and people knew how to complain. No complaints had been recorded since the last inspection. The registered manager stated that none had been received.

The service was well managed. People and their relatives stated that management listened to them. Management monitored the quality of the services provided via regular audits and checks. The results of the previous satisfaction survey indicated that people were satisfied with the care and services provided. However, a report following the survey had not yet been prepared.

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 26 April 2017). The service remains rated as Good.

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 previous comprehensive inspection on 24 March 2016 we rated the service as “Requires Improvement”. We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment. The registered provider did not ensure that at all times the premises and equipment were safe and did not do all that was reasonably possible to mitigate against health & safety risks to people. At this inspection the service demonstrated that they had taken action to comply and the required checks and documented evidence were in place. The second breach was in respect of Regulation 17 Good governance. This service did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service. At this inspection the service had the necessary checks and audits for ensuring quality care.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a safeguarding adult's policy and suitable arrangements for safeguarding people.

The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people confirmed that they had been given their medicines.

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. Care workers prepared appropriate and up to date care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen by us. People’s healthcare needs were monitored and attended to. Arrangements had been made with healthcare professionals when required.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Fire drills had been arranged.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that no authorisations had been applied for. The assistant manager was aware of the requirements of the law, however, at the time of this inspection she stated that no person needed a DoLS authorisation.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and special preferences were met. People informed us that they were satisfied with the meals provided. Catering staff checked daily with people to ensure that their preferences were responded to.

There were enough care workers deployed to meet people's needs. They were knowledgeable regarding the needs of people. Teamwork and communication within the home was good. Care workers had received induction and training to enable them to care effectively for people. There were arrangements for support, supervision and appraisals from their managers.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Care workers were caring and knowledgeable regarding the individual choices and preferences of people. Regular residents’ meetings had been held for people and the minutes were available for inspection. The home had an activities programme to ensure that people could participate in social and therapeutic activities.

People knew who to complain to if they had concerns. Complaints made had been recorded and responded to. In addition, the service had a record of how people felt about their progress and the care provided. This enabled care workers to better understand people.

Audits and checks of the service had been carried out by the registered manager and one of the directors of the company. These were carried out monthly and included checks on care documentation, medicines, and maintenance of the home. Evidence of these was provided. A recent satisfaction survey indicated that people were satisfied with the care provided.

Care workers were aware of the values and aims of the service and this included treating people with respect and dignity and encouraging them to be as independent as possible.

At our last inspection on 10 July 2014 the service met all the regulations we looked at.

The home has 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and dignity and felt safe living in the home. There was a safeguarding adults policy and suitable arrangements for safeguarding people. Care workers were caring and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them had been assessed and care workers provided with guidance on minimising identified risks.

Care workers prepared appropriate care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. People’s healthcare needs were closely monitored and arrangements made for them to be attended to. There was evidence that people had access to community healthcare professionals and specialist hospital services. This was confirmed by people and their relatives.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings had been held for people and the minutes were available for inspection. The home had an activities programme and we saw people being encouraged to participate in social activities.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of meals to ensure that people’s dietary needs and cultural preferences were met. People were satisfied with the meals prepared and healthy eating was encouraged. People had been given their medication and this was confirmed by them and recorded in their medicine administration charts (MAR)

There were arrangements to ensure that care workers were carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough care workers to meet people's needs.

People and their relatives expressed confidence in the management of the service. The results of satisfaction surveys and feedback from people indicated that they were satisfied with the care and services provided. The staff survey indicated that care workers were satisfied with the way they were managed. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity and proving a high quality of care within a homely environment.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out on equipment. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. We however, noted that there were no regular temperature checks of the hot water or any maintenance checks of the temperature mixer valves to ensure that people were not at risk of scalding. Checks of the emergency lighting had not been recorded and two windows in two bedrooms did not have restrictors. These are needed to ensure the safety of people. The provider took prompt action following this inspection to rectify the deficiencies identified.

There was a complaints procedure. Complaints made had been promptly responded to. Feedback had been sought from people and their representatives. However, the service did not have comprehensive and regular audits and checks which included checks on care documentation, accident records and health and safety checks of the premises. These are needed to ensure the safety and welfare of people.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Procedures were in place to protect people from abuse. We found staff had been trained and were able to respond appropriately to allegations or suspicions of abuse or neglect. Records showed people experienced safe and appropriate care. Their needs had been

assessed and their care and treatment planned and delivered in accordance with individualised care and risk-management plans. For example, staff followed guidance in care plans to minimise risk of falls when people were moving around the home.

The provider and staff understood their responsibilities under the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). At the time of our inspection no one was subject to a DoLS authorisation or application.

Procedures were in place for dealing with emergencies and staff were suitably trained to ensure people's safety and welfare. People told us they felt safe. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

Is the service well led?

We found the provider carried out monitoring and reviews of the service and highlighted actions were completed in a timely manner. This meant the quality of the service could be assured by people living at Whitchurch Lodge, their relatives and staff.

Staff told us they felt very supported by the manager and deputy manager. Comments included, 'The manager is very nice. She always listens to and reassures me.'

Is the service effective?

People's health and care needs were assessed and we saw evidence to show they (or their relatives where appropriate) were always involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support they needed.

Is the service responsive?

We saw the provider had effective complaints, accident and incident reporting procedures. We found these were addressed within appropriate timescales. We found the provider monitored people's support needs and was able to respond appropriately if and when those needs changed. For example, we observed a person was supported to access an emergency psychiatric assessment in hospital when their mental health needs suddenly changed.

Is the service caring?

A relative and advocate of people gave positive feedback about staff and said were caring. People were dressed in clean and appropriate clothing. Attention had been given to their personal hygiene and grooming. We found staff to be knowledgeable about people's preferences, for example, their choice of food and beverages and these were accommodated. We observed people were supported by kind, attentive staff and empathetic staff. Staff showed patience and gave encouragement when supporting people. People using the service told us, 'The staff are lovely, they really are.' A relative we spoke with told us, 'It is absolutely wonderful. I'm surprised by how good they actually are. It's a very homely sort of place compared to other places I've been to.'

People told us they were happy with the care they received. Comments included "It is a very good home. I doubt you would find a better one anywhere. On a scale on 1:10 I would give it 10." Although we observed care being provided safely, the quality of care was inconsistent.

All the people we spoke with enjoyed the food and drink that was provided. They explained they were able to have the food they wanted if they did not like what was on the menu. Although the food and drink provided was not very varied and there were instances of food stored past its sell by date, it was all nutritious and met peoples' needs.

Although there were aspects of the premises and furniture that were either not used appropriately or in need of repair, the premises was safe and checked to ensure care was provided safely.

The provider had in place appropriate policies and procedures, and records were stored appropriately. Although care plans were not very detailed, they were fit for purpose.

Care records we looked at showed people were not protected from the risk of receiving inappropriate or unsafe care because the provider had not taken proper steps to ensure care was appropriately planned and delivered. We also found that people were treated with a lack of dignity and respect. For example people were left using a toilet with the door open, where they could have been seen by other people living and working in the home as well as people visiting.

We checked the food choices available to people and looked at how people's nutritional needs were being met. We found the service was failing to ensure people had a choice of nutritious foods. They did not always receive adequate amount of fresh fruits and vegetables as directed by health professionals.

We looked at the maintenance of the home and found some areas to be in a good state of repair. We also noted that some areas that were not adequately maintained.