Archived: Whitewaves Care Home

Updated 20 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on the 16 and 18 January 2018 in response to social services concerns raised about the quality and safety of the service. We reviewed the breach of regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that we identified at the previous focused inspection. A warning notice was served for this breach. This inspection visit was unannounced, which meant the provider and staff did not know we were coming. Two inspectors and an Expert by Experience undertook this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service and of people living with dementia.

Before our inspection we reviewed the information we held about the home, including previous inspection reports and the provider's information return (PIR). We attended a professionals meeting with health and social care colleagues to review the quality and safety of the service. We considered the information which had been shared with us and looked at safeguarding alerts and complaints which had been made and statutory notifications which had been submitted to us by the provider. A statutory notification is information about important events which the provider is required to tell us about by law.

We spoke with seven people, four care staff, and the administrator who deputised for the registered manager. We spoke with the registered manager who was also the registered provider for this service. We observed care in the communal areas using a Soft Observational Framework for Inspection (SOFI). SOFI is an observational tool used to help us collect evidence about the experience of people who use services, especially where people may not be able to fully describe this for themselves because of cognitive or other problems. Records were reviewed for three staff and three people and other records relating to the management of the home, such as policies and procedures, complaints and accident / incident recording and audit reports.

We also spoke with seven healthcare professionals visiting the service during the inspection process.

Updated 20 July 2018

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

Whitewaves Care Home provides support and accommodation for up to19 older people, some of whom were living with dementia. The care home provides accommodation for older people with a passenger lift and stair lift available to access all floors. At the time of our inspection there were eight people living at the home. The service also offered respite care.

We previously inspected the service on the 22 October 2017, following concerns about people’s safety which were raised by social services The inspection was focused and looked at the ‘key questions’ of ‘safe’ and ‘well-led.’ At this inspection the service was rated as ‘requires improvement’ with a breach of regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a warning notice for this breach. At this inspection we found the required improvements had not been made.

This was an unannounced comprehensive inspection which took place on 16 and 18 January 2018.

There was a registered manager when we completed this inspection. 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.

A lack of robust systems and processes, poor management and leadership and ineffective staff training meant that people were not always safeguarded from abuse and avoidable risks to them. Safeguarding concerns had been identified by social services, but these concerns had not been reported to us. Staff at the home had not raised concerns outside of the organisation demonstrating that they did not understand the processes for whistleblowing when care and treatment for people was unsafe or resulted in harm for people.

Risks to people’s safety were not always assessed or managed properly. People were not kept safe by suitably skilled or competent staff and training for staff was not always effective. For example, people were not always supported with their mobility needs in a safe way because staff were not adequately trained or aware of managing risks to people in their bets interests.

People did not always experience care and treatment that was in their best interests, because staff did not have a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). An example of this was seen for a person who was assessed that they lacked the mental capacity to consent to their care and treatment. This person suffered a serious injury to their leg due to staff not making appropriate best interests decisions to keep them safe. People and appropriate others, which included advocates and named relatives who may hold relevant legal decision making powers, such as Lasting Power of Attorney (LPoA), were not always involved in the design and review of care plans and risk assessments. This meant that care and treatment decisions were not always provided in line with peoples own preferences or in their best interests when they may lack the mental capacity to consent for themselves.

Although people were supported to take their medicines in a safe way, there was a lack of detailed ‘As required’ (PRN) protocols for pain relief for people. People did not always receive their pain control medicine when they needed it, which resulted in a person experiencing pain while being supported to move by staff.

People did not have their nutrition and hydration needs met. There was not enough food for people to eat, and meals were decided on a daily basis rather than being planned in advance. People had limited choice about the food they did eat. The management of the home did not follow national nutritional guidance regarding appropriate foods for people living with dementia despite this being advised by social services. People did not always receive the nutritional supplements that had had been prescribed for them which placed them at risk of malnutrition. People’s health and wellbeing was put at risk because they were not supported to eat well.

People were not always protected by safe recruitment systems. The registered manager had not obtained a DBS (Disclosure and Barring Service) check or employment references for one member of staff. This meant that they could not be assured that they were of good character. Staff were not always suitably trained or skilled to provide safe or appropriate care and treatment to people which had resulted in a lack of staff understanding regarding appropriate action to take for people. Delayed contact with appropriate health and social care professionals when people’s health had deteriorated was seen. Staff meetings had taken place, although these meetings did not focus upon the serious safeguarding or service quality concerns raised by social services which meant that staff were not informed of the seriousness of concerns about the service provided at Whitewaves Care Home. This left staff feeling confused about the reasons why social services had taken significant action. Social services suspended any new placements to the home and terminated placements for people at the home due to these concerns for people’s safety and wellbeing. Lessons had not been learned by the provider when things had gone wrong regarding the quality and safety of the service provided. Appropriate adjustments were not made and the registered manager did not accept the concerns identified by social services, community healthcare professionals or the Care quality Commission (CQC). Staff had received some supervisions and annual appraisals, although the concerns that surrounded the home were not noted in these which meant that staff did not collectively contribute to the improvements required at the home.

People were not protected by effective infection control systems and processes at the home. We observed that toilet facilities were unclean and cleaning schedules were not established. A staff member was allocated to clean the home but was not at the service with the required frequency to keep the service clean. The staff rota confirmed this. We observed overflowing bins and unclean toilets and scaled shower heads during the inspection which placed people at risk of infection. Areas of the home were also observed by visiting professionals to be damp and dusty. A number of people had experienced serious chest infections whilst at the service. There had been unexpected deaths for people with serious chest infections.

Records for people were not always up to date to reflect their current needs and risks to them. Records were not held securely for people in line with legislative requirements which meant that people could not be assured of the confidentiality of information held about them. We saw end of life care plans that did not reflect that DNAPCR (Do Not Resuscitate) instruction were agreed for people. This meant that people may receive care and treatment at the end of their lives that is not appropriate to meet their wishes or in their best interests. People were not always identified by staff as being at the end of their lives which resulted in people not always receiving timely care and treatment from appropriate healthcare professionals. Staff weren’t always clear about which people had DNACPR’s in place. Nutrition and mobility records and risk assessments weren’t up to date for one person. The staff were seen to be kind and caring towards this person, but did not know how to care for them safely or appropriately. This meant that the person experienced pain and discomfort when being moved inappropriately by staff and were moved urgently by community healthcare professionals to an alternative place of residence where their needs and risks to them could be met safely.

People were not always supported to take part in stimulating activities that were important to them. An identifiable group of people were observed to be engaged with staff in nail care activities with although another group of people who were not supported to take part in any stimulating activities or engagement with staff. This group of people looked disinterested whilst sat in the lounge area of the home and were seen sleeping for long periods during the inspection.

The provider had not made sure there was a robust quality assurance system in place and had not identified the significant concerns we found at this inspection. Social services terminated the care contracts for three people at the home due to the on-going lack of engagement from the registered manager and lack of improvements made to the service in the required timescales. People were not asked for their views of the service they received in any formalised way. Complaints had not been captured. However, complaints had been received about the service from social services. This indicated that the provider was not monitoring or handling complaints appropriately.

Due to the seriousness of our concerns and the lack of engagement from the registered manager and provider we served an urgent Notice of Decision (NoD) to prevent new people from being admitted or people being readmitted to the service. We also served a Notice of Proposal (NoP) to cancel the registration of this service to prevent regulated activities being provided at this location. We received confirmation from the provider that they were not appealing this proposal notice. We then issued a further Notice of Decision (NoD) to cancel the registration of this service in line with our civil action procedures.

During this inspection we found breaches of the Heal