Whitstone House

Updated 18 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors, 1 of whom was a medicines inspector.

Service and service type

Whitstone house is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Whitstone House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed all the information we had received about the service since the last inspection. We sought feedback from the local authority who had inspected recently to monitor the service progress against their action plan. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During our inspection we observed the care and support provided to people and spoke briefly to people as they prepared for the day, most were going out. We looked at 3 care plans and associated care records and looked at other records in relation to the safe running of the service including recruitment, training, and fire safety. We spoke with 9 staff including a senior member of staff, the care coordinator, care staff, the registered manager, the operational manager, the finance director, and a trustee. Following the inspection, we continued to seek validation from the provider and spoke with 4 relatives.

Updated 18 May 2023

About the service

Whitstone House is a residential care home providing personal and nursing care to up to 10 people with a learning disability, and autistic people, with mental and/or physical healthcare support needs. At the time of our inspection there were 8 people using the service. The service provider is Autism Anglia, and the building is owned by a housing association.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support:

We identified continued breaches of regulation as part of this inspection. This meant the provider did not assure us that people’s safety could be upheld, as not all risks associated with people’s care and their environment had been assessed and rectified. For example, risks from poor infection control, risks from falls from height and risks from broken or poorly maintained equipment placed people at increased risks of avoidable harm.

People were mostly 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 did not always document this practice.

We were still not confident that people were appropriately supported to make more complex decisions in regards to their health care needs in line with the principles of The Mental Capacity Act 2015.

Best interest decisions did not clearly demonstrate how and why decisions had been made.

Relatives spoken with were not confident that people who staff supported were receiving good outcomes of care. They told us communication could be poor and staff did not always inform them how people spent their day. Relatives said they were advised of anything of an urgent nature but would like to know how people were supported with their needs. They described activities as mundane and not in line with people’s needs and experiences of what they used to enjoy.

We identified a positive culture in the service with people going out often, but less so at the weekend due to staffing fluctuations. Continuity of care and support was important to both people and their relatives, and we still had concerns about staff vacancy rates and the regular use of agency staff which potentially limited people’s opportunities.

Staff were supported in their role by the registered manager, through a recognised national induction and were assessed to ensure they had the right competencies and skills. Some staff training had lapsed, and role specific training had not been fully rolled out which meant potential gaps in staff’s knowledge, some who were new to their roles.

People’s care plans had improved and the ones we looked at were up to date. We reminded the provider to ensure records were cross referenced and to make sure all staff were aware of the records they must adhere to when providing people with care and support. We also recommended that care plans and risk assessments were updated by staff following an incident to ensure risks and actions were clearly documented.

We found medicines were administered to people in line with their needs and monitored to ensure they were necessary and correctly given in line with prescriber’s instruction. We have made 3 recommendations about medicines management in the service. They are around ensuring people understand why they are taking medicines and what the side effects are. Monitoring medicines and where possible reducing them and thinking about a more person-centred approach to medicine administration.

Right Care: Some progress had been made since the last inspection and a new organisational structure and management team meant further improvements had been identified and planned. Relatives were aware of some of the changes but were not aware of how their feedback was acted upon or how they could influence the service. People using the service were encouraged to make choices by staff supporting them, but information should be readily available to them to help them understand more complex aspects of their support such as medicine administration.

At the last inspection we noted notifications were not being submitted in a correct, timely way to CQC in line with the provider’s regulatory responsibilities to provide safe care and support. We were confident the provider now understood their regulatory responsibilities and were submitting notifications in a timely way.

Right Culture:

The provider had learnt lessons and was developing the service to consider people’s immediate needs and how their needs might change in the future. Staff had not received training in end-of-life care. The provider advised us forward planning documents were going to be put in place.

Effective auditing was still not in place and risks identified as part of our inspection had not been identified by the provider. Whilst we were assured that people were going out and received good outcomes of care, we were less assured by the progressiveness of the service and how they ensured people were living their best lives with measurable outcomes of care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 November 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of 4 regulations. The provider had not ensured the premises were safe and fit for purpose. We had concerns about how staff sought consent from people for more complex decisions and the governance and oversight was improving but had failed to identify some of the areas we did as part of our inspection.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed and remains requires improvement.

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.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.