The inspection was carried out on the 12 and 17 October 2017. The first day of the inspection was unannounced and the second day was announced. Staff provided personal and nursing care for up to 33 older people. The accommodation spanned two floors and some rooms had on-suite facilities. A lift was available for people to travel between floors. There were 28 people living in the service when we inspected. People had chronic and longer-term health issues associated with ageing or illness requiring nursing care and some people were living with dementia as a secondary diagnosis.
We carried out our last comprehensive inspection of this service on 05 and 06 December 2016. At that inspection breaches of legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014 were found. The breaches related to Regulation 17, Good Governance; Accurate and complete records were not being kept. Regulation 18, Staffing; Staff were not deployed in sufficient numbers. We also made six recommendations. The recommendations related to medicines audits, Deprivation of Liberty Safeguards applications, staff surveys, residents meetings and meeting people’s social needs. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Whitens Nursing Home on our website at www.cqc.org.uk
At the time of this inspection the local authority in Kent had been working with the provider on an improvement plan. This improvement plan had been implemented in response to recent concerns about incident and safeguarding management in the service. The action plan and the improvements being made had been shared with CQC by the provider. At this inspection, we found that the provider had brought in a team of senior managers to implement the improvements that were required.
There was not a registered manager employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The provider had employed a manager who had made an application to register with the Care Quality Commission on 21 June 2017, but they had left before the registration process had been completed. However, the provider was in the process of recruiting a new manager. At the time of this inspection the service was being managed by an experienced interim manager.
Staff protected people’s privacy and confidentiality whilst delivering care, but at other times, people could be observed in bed as their doors were open. It was not clear if people had consented to their doors being left open. We have made a recommendation about this.
The risk from infection were minimised by safe systems of work by staff delivering personal care and by a planned and actioned cleaning and maintenance routines. However, two areas in the service requiring maintenance posed a risk to infection control. We have made a recommendation about this.
The provider had a system in place to assess people’s needs and to work out the required staffing levels. Since the last inspection, the provider had been making changes to the way staff were deployed and simplifying recording systems to reduce the amount of time staff spent away from care task, for example completing paperwork. A recently appointed nurse deputy manager was leading on the effective delivery of nursing care.
Space in the service for the storage of confidential information was limited. However, since the last inspection, information that staff needed access to when delivering care was kept in people’s bedrooms and other larger care plans were stored in locked cabinets at the nursing station on the ground floor.
We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Nursing staff understood their professional responsibility to safeguard people. The interim manager responded quickly to safeguarding concerns and shared information with the safeguarding teams.
Incidents and accidents were recorded and checked by the interim manager to see what steps could be taken to prevent these happening again. The risk were assessed and the steps to be taken to minimise them were understood by staff.
Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills by maintaining their registration with the Nursing and Midwifery Council (NMC).
We observed that staff were welcoming and friendly. Activities were planned to keep people mentally active and to maintain skills or hobbies they were interested in. People and their relatives described that staff were friendly and compassionate. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.
There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely.
Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred.
The provider and interim manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the service had been tested and was well maintained.
Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The interim manager understood when an application should be made.
People were supported to eat and drink enough to maintain their health and wellbeing. People had access to good quality foods. The chef prepared foods that were seasonal and used fresh ingredients. People had access to food, snacks and drinks during the day and at night.
People had access to qualified nursing staff who monitored their general health. End of life nursing care was supported by links to the local hospice team. People had regular access to their GP to ensure their health and people’s health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.
Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the home. This included checking nurse’s professional registration.
Policies were in place so that if people complained they were listened to. The interim manager held regular meetings with people and their relatives and made changes or suggested solutions to issues people raised.
The interim manager of the service, nurses and other senior managers were experienced and provided good leadership. They followed their action plans to improve the quality of care people experienced. This was reflected in the changes they had already made within the service.