OSJCT Whitefriars

OSJCT Whitefriars home is a residential care home providing personal and nursing care to 57 people aged 65 and over who may be living with dementia. The service is in a purpose-built building all on one level with access to secure gardens. There were 32 people living at the home when we inspected.

We found the following examples of good practice.

¿ Effective systems were in place to ensure visitors to the service followed government guidelines for wearing Personal Protective Equipment (PPE). Screening questions and a temperature check were standard requirements for all visitors. Handwashing facilities were available at the entrance to the home for visitors.

¿A ground floor room had been converted to allow safe visiting for relatives and friends of people. The room was nicely decorated and had a purpose-built screen to reduce the risk of spreading infection.

¿There was a good understanding of social distancing. Each corridor had formed a social bubble and the provider had rearranged the facilities to ensure each area had access to separate lounge and dining facilities.

¿ Supplies of PPE including masks, gloves, aprons and hand sanitiser were readily available for staff.

¿ Staff were trained in current Infection Prevention and Control (IPC) guidance and in the use of PPE. Staff’s handwashing technique was checked regularly to ensure it was effective.

¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This included rapid testing for visitors.

¿ Enhanced cleaning took place daily and the home was clean and hygienic. Systems were in place to measure the level of germs in the home to ensure cleaning was effective. The provider had invested in a fogging machine to sanitise rooms and this was included in the cleaning schedule.

¿ The service's IPC policy was up to date and in line with current guidance. The service had plans in place and knew how to respond to an outbreak of infection to ensure the safety of people and staff.

¿ People admitted to the service were supported following government guidance on managing new admissions during the COVID-19 pandemic.

OSJCT Whitefriars is a residential care home providing personal and nursing care to 53 people aged 65 and over at the time of the inspection. The home can support up to 57 people.

The accommodation is a purpose built, single storey property. It is divided into five self-contained units or 'households' each of which has its own communal facilities and bedrooms. The households are called Fern, Poppy, Lavender and Primrose in each of which nine people can live. The other household is called Jasmine where 20 people can live. All the households are intended to accommodate people who live with dementia, with Primrose and Jasmine being reserved for people who need the most support.

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

People were happy and content living at the home and we received only positive comments about people’s experience at the home. There was a positive culture in the home with the registered manager and staff putting people at the centre of everything they did. People were encouraged to be involved in the running of the home and to voice their opinions on the care they received.

People were supported to make decisions for themselves and were offered choices about the food they ate and how they spent their time. Where people were unable to make a decision about if they wished to live at the home their rights had been protected under the Mental Capacity Act 2005.

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 were supported by staff who received the training and support necessary to provide safe care. People told us staff were kind and caring. There were enough staff to ensure people received their care in a timely manner. Staff had received training in how to keep people safe from abuse and raised concerns appropriately.

Risks to people had been identified and care plans contained all the information staff would need to provide safe individualised care to people. Care plans has been reviewed and updated when people’s needs had altered.

The environment had been designed to support the independence of people living with dementia. Signage was available in picture as well as text format. It was well maintained and supported people’s well-being.

The provider’s policies and procedures reflect best practice guidance and staff worked in like with the policies. Medicines were safely managed and effective infection control processes were in place.

The provider had effective systems in place to monitor the quality of care provided. They had built strong ties to the local community. The provider had engaged with research organisations to investigate the current guidance of the needs of people living in a care home.

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 requires improvement (published 13 July 2018).

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 the previous inspection in May 2017, we identified some improvements were required in two key areas we inspected; ‘Safe’ and 'Well-led'. This resulted in the service having an overall rating of 'Requires Improvement'. One breach of regulation was found, this was with regard to the Care Quality Commission (Registration) Regulations 2009, the registered provider had not notified us of information they were required to inform us about. The registered provider sent us information on how they intended to improve the rating to at least ‘good’. At this inspection we found some improvements had been made however some improvements were still required.

OSJCT Whitefriars is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

OSJCT Whitefriars can accommodate up to 57 older people and people living with dementia. On the day of our inspection, 45 people were living at the service. The accommodation is a purpose built, single storey property. It is divided into five self-contained units or 'households' each of which has its own communal facilities and bedrooms. The households are called Fern, Poppy, Lavender and Primrose in each of which nine people can live. The other household is called Jasmine where 20 people can live. All of the households are intended to accommodate people who live with dementia, with Primrose and Jasmine being reserved for people who need the most support.

The service had a registered manager at the time of our inspection who had been in post since March 2018. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered provider had safeguarding policies and procedures and staff were aware of their responsibility to protect people from avoidable harm and abuse. However, a concern was identified in how the management team had responded to a recent allegation of abuse. Risks associated with people’s needs had been assessed. Whilst staff were aware of people’s needs, recorded information to instruct and guide staff of how to manage risks, lacked detail or was out of date. Risks associated with the environment and premises had been assessed and were monitored regularly.

Safe staff recruitment checks were completed before staff commenced employment. The registered provider used a dependency tool to assess people’s needs and staffing levels required. However, the deployment of staff required reviewing to ensure this was effective in meeting people’s needs.

Some shortfalls were identified in the management of some medicines and with some of the infection control measures in place.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service were not always followed. Where people lacked mental capacity to consent to their care and support, assessments to ensure decisions were made in their best interest had not always been consistently or fully completed. Where people had a Deprivation of Liberty Safeguards (DoLS) authorisation, staff were aware of this and the person was cared for effectively.

People’s nutritional needs had been assessed, but information to guide and instruct staff either lacked detail or was out of date. People received a choice of meals and drinks and support to eat and drink where required.

The registered provider had policies and procedures that were based on current legislation and best practice guidance. Staff received an induction, ongoing training and support.

People were supported to access health care services and staff worked with external healthcare professionals in the management of their health care needs.

Staff were aware of people’s needs, routines and what was important to them. Staff were kind, caring, and they supported people ensuring their privacy, dignity and respect was met. Independence was encouraged and supported. Information about independent advocacy services was available.

Staff had information to support them to understand people’s needs, preferences and diverse needs. However, this information lacked detail in places or was out of date. People received opportunities to participate in meaningful activities. The provider’s complaint policy and procedure had been made available to people who used the service, relatives and visitors. People and their relatives received opportunities to review the care and support provided. Consideration to people’s advance decisions in relation to their future care needs had been made.

The registered provider had met the Accessible Information Standard because they had considered and assessed people’s communication and sensory needs.

The service had a new and experienced management team and people, relatives and staff were positive about their leadership and improvements made. Systems and processes were in place to monitor and improve the quality and safety of the service. An action plan was in place to drive forward continued improvements. People who used the service and their relatives received opportunities to share their experience about the service.

OSJCT Whitefriars can provide accommodation and personal care for 57 older people and people who live with dementia. There were 51 people living in the service at the time of our inspection. The accommodation is a purpose built, single storey property. It is divided into five self-contained units or ‘households’ each of which has its own communal facilities and bedrooms. The households are called Fern, Poppy, Lavender and Primrose in each of which nine people can live. The other household is called Jasmine where 20 people can live. All of the households are intended to accommodate people who live with dementia, with Primrose and Jasmine being reserved for people who need the most support and reassurance.

The service was run by a company who was the registered provider. At this inspection the company was represented by an assistant operations director. There was a registered manager in post. 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. In this report when we speak both about the company (as represented by the assistant operations director) and the registered manager we refer to them as being, ‘the registered persons’.

At our last inspection on 26 January 2015 we found that a number of improvements needed to be made to ensure that the service was well led so that people reliably received safe care. The improvements included making sure that medicines that had not been given were recorded correctly, other care records were accurate, people were promptly assisted to dine and robust security checks of the accommodation were completed. At this inspection we found that each of these particular concerns had been addressed.

However, at this inspection we also found that other shortfalls needed to be addressed. One of these was a breach of the Care Quality Commission (Registration) Regulations 2009. This was because the registered persons had not promptly informed us about a number of significant events that had occurred in the service. You can see what action we told the registered persons to take in relation to this breach of the regulations at the back of the full version of this report.

We also found that parts of the accommodation were not clean and that full background checks had not always been completed before new staff were employed. In addition, medicines had not always been managed safely. Furthermore, the registered persons had not always ensured that there were enough care staff on duty. However, people had been helped to avoid preventable accidents and care staff knew how to safeguard people from situations in which they might experience abuse.

Although some care staff had not received all of the training the registered persons considered to be necessary, in practice they had the knowledge and skills they needed. People were supported to eat and drink enough and care staff ensured that people received all of the healthcare they needed.

The registered persons had ensured that whenever possible people were helped to make decisions for themselves. When people lacked mental capacity the registered persons had ensured that decisions were taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had ensured that people only received lawful care.

Care staff were kind and compassionate. People’s right to privacy was promoted and confidential information was kept private.

People had been consulted about the care they wanted to receive and were given all of the practical assistance they needed. Care staff promoted positive outcomes for people who lived with dementia and people were supported to pursue their hobbies and interests. There were arrangements to quickly resolve complaints.

Although quality checks had not always effectively resolved problems in the running of the service, people had been consulted about the development of their home. Care staff considered that the service was run in an open and inclusive way so that they were able to speak out if they had any concerns.

We looked at the care records of six people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights. Before people were provided with care, they were asked for their consent. We found that the service worked with other professionals involved in people's care which ensured that they were provided with a consistent service that met their needs.

We looked around the service and found that people were provided with a clean and hygienic environment to live in. Equipment used in the service was regularly checked and serviced to ensure that it was fit for purpose and safe to use.

We looked at four staff personnel records which showed that staff were trained and supported to meet the needs of the people who used the service. We saw that the appropriate checks were made on staff before they started to work in the service to ensure that they were able to work with vulnerable people.

Records seen, including people's care records and staff records were accurate and up to date.