Archived: Whiteoak Court Nursing Home

Whiteoak Court Nursing Home provides personal and nursing care and support for up to 27 older people. The home is spread over two floors and is situated within a quiet residential area of Chislehurst in Kent. At the time of our inspection there were 22 people residing at the home.

People’s experience of using this service

People spoke positively about the service and said staff were very caring and supportive. Throughout our inspection we observed staff interacted positively with people and had formed good relationships with them and their relatives.

The service had safeguarding and whistleblowing policies and procedures in place and staff had a clear understanding of these procedures and how to keep people safe. People's needs, and preferences were assessed and risks were identified with plans in place to manage risks safely. Medicines were administered and managed safely and staff followed appropriate infection control practices to prevent the spread of infections. Robust recruitment checks were in place and there were sufficient staff available to meet people's needs promptly. Staff had the skills, knowledge and experience to support people appropriately. Staff were appropriately supported through induction, training and supervision.

People were supported to maintain a healthy balanced diet that met their cultural and dietary preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were involved in and consulted about their care and support needs. People had access to health and social care professionals as required. People were supported to participate in activities of their choosing that met their needs and interests. Staff worked with people to promote their rights and understood the Equality Act 2010 supporting people appropriately addressing any protected characteristics.

There were systems in place to assess and monitor the quality of the service. The service worked in partnership with health and social care professionals to plan and deliver an effective service. The service took people’s and staff’s views into account to help drive service improvements.

Rating at last inspection: Good (Published 15 May 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect the service sooner.

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

Whiteoak Court Nursing Home provides personal care and nursing support for up to 27 older people. The home is situated within a quiet residential area of Chislehurst, Kent. At the time of our inspection the home was providing support to 25 people. The home had 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.

At this inspection we found the previous concerns in relation to staff receiving regular supervision, support, appraisals and appropriate training had been addressed and significant improvements had been made.

Risks to the health and safety of people were assessed and reviewed to ensure people’s safety was maintained. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were appropriate numbers of staff to meet people’s needs.

Staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals to ensure best practice. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and their support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint and people using the service were provided with opportunities to share their views about the service. There were systems in place used to monitor the quality of the service on a regular basis.

Whiteoak Court Nursing Home provides personal care and nursing support for up to 27 older people. The home is situated within a quiet residential area of Chislehurst, Kent. At the time of our inspection the home was providing support to 21 people. The home had 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.

At this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The provider failed to support staff through regular supervision and appraisals of their practice and performance in line with the provider’s policy. Staff administering medicines had not received appropriate up to date training and competency assessments, however the registered manager took immediate action and sourced appropriate medicines training for all staff that administered medicines and implemented a formal medicines competency assessment process. We will check on the progress at our next inspection of the service.

There were safeguarding adult’s policies and procedures in place to protect people from harm and incidents and accidents were recorded and acted on appropriately. Assessments were conducted to assess levels of risk to people’s physical and mental health and care plans contained guidance for staff to ensure people were kept safe by minimising assessed risks.

There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work. There were appropriate levels of staff on duty and deployed throughout the home to meet people’s needs. There were arrangements in place to deal with foreseeable emergencies and there were systems in place to monitor the safety of the premises and equipment used within the home.

Staff demonstrated good knowledge and understanding of the MCA and the Deprivation of Liberty Safeguards (DoLS) including people’s right to make informed decisions independently but where necessary to act in someone’s best interests. People were supported to eat and drink suitable healthy foods and received sufficient amounts to meet their needs and ensure well-being. People had access to health and social care professionals when required.

Interactions between staff and people using the service were positive and staff had developed good relationships with people. Care plans demonstrated people’s involvement in their care. Staff were knowledgeable about people's needs with regards to their disability, race, religion, sexual orientation and gender and supported people appropriately to meet their identified needs and wishes. People received care and treatment in accordance with their identified needs and wishes. Detailed assessments of people’s needs were completed and reviewed in line with the provider’s policy. People were supported to engage in a range of activities that met their needs and reflected their interests.

People and their relatives told us they knew who to speak with if they had any concerns. There was a complaints policy and procedure in place and complaints were managed appropriately. The manager was knowledgeable about the requirements of being a registered manager and their responsibilities with regard to the Health and Social Care Act 2014. The provider took account of the views of people using the service and their relatives through annual residents and relative’s surveys.

We did not speak to people using the service at this inspection but spoke with them in June 2014 when we last visited the service. We gathered evidence of people's experiences of the service by observing care practices, speaking with staff and reviewing records related to the running of the home.

The manager and owner showed us the changes that had been made since our last inspection in June 2014. We saw the service had reviewed, updated and changed its record systems to gain further detailed information on people's needs and risks and reviews of care plans had been conducted and recorded. We saw evidence that people using the service and their families/representatives had been involved in the assessment and or review process and people's wishes and choices had been considered and respected. We noted that people's care plans contained a section that recorded visits from health and social care professionals. We reviewed the home's fire safety policies and procedures which were comprehensive and noted that people using the service had a Personal Emergency Evacuation Plan (PEEP) in place.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.

At the time of our inspection there were twenty four people using the service. We used different methods to help us understand the experiences of people who use the service. We used our Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care provided which helps us to understand the experiences of people who were unable to talk with us.

Is the service caring?

People using the service we spoke with told us they were treated with respect and dignity by staff and that staff checked with them and confirmed their choices and wishes with regards to the delivery of their care. Staff addressed people respectfully when talking with them and people using the service were spoken to by their preferred names. We heard members of staff speak politely with people and consult them about their choice of meals and the support they were offered with mobilising around the home or which activities to engage in. People using the service who we spoke with told us they were very much a part of the planning of their care and had been given choices about their support and how it was delivered. One person told us 'Staff are respectful to me at all times and I am always asked for my views and choices'.

Is the service responsive?

During our inspection we spoke with several people using the service and visiting relatives. They all spoke positively about the service. One person using the service told us 'It's like the Dorchester here; I am treated very well and have never known such a homely and warm place to be. Staff have nothing but compassion and respect.' Another person said 'I am very well looked after, the staff are gentle and kind, on the whole it is very good.' A relative visiting the service told us 'I am seriously impressed, the staff are terrific.

We found that following an initial assessment process relatives were not involved with any on-going formal review process of the care provided or the risk assessments that had been conducted. These were undertaken by staff members alone. We were told that people who used the service were regularly consulted as part of the review process which was conducted every three months; however this was not evident from records seen. There was no recorded evidence of discussions with people using the service and records were only signed by members of staff. This meant that people's care plans were potentially not reflective of their current needs or wishes.

We saw from records when someone using the service had fallen or an injury had occurred this was recorded on a body map tool within people's care plans. Medical assistance was sought and a doctor or an ambulance was called as appropriate. However records within peoples care plans were not reflective of this and did not allow for the recording of visiting health and social care professionals involvement. This meant that staff may not be aware of peoples care and treatment needs if someone had suffered a fall or had been taken to hospital to receive medical treatment.

Is the service safe?

People we spoke with using the service told us that they felt safe in the home and well supported by staff. Observations during our inspection showed there was a relaxed friendly atmosphere within the home environment and people chatted freely and openly with each other, the staff and management.

The service had clear procedures on safeguarding vulnerable adults from the risk of abuse including how to recognise types of abuse and what action to take. The owner showed us the homes safeguarding adults from abuse procedure and told us this procedure was used in line with the "London Multi Agencies Procedures on Safeguarding Adults from Abuse" (PAN London). They also showed us the local authority's procedure for reporting abuse and the contact information they had with details of who to contact within the local authority should they have any concerns.

Is the service effective?

In discussions we had with staff they were able to explain how they monitored people's nutritional intake and the action they took if people were losing or gaining weight. This included monitoring people's weight on a regular basis and making referrals to the GP for dietician involvement if required.

During lunchtime we carried out a SOFI (Short Observational Framework for Inspection) in the dining room of the home. We used our SOFI tool which helps us to see what people's experiences at mealtimes were. We found that people had positive experiences. We saw that people were assisted to the dining room and supported with their choice of meal and drink. Staff members supporting people with their lunch knew what support they needed and respected their wishes if they wanted to manage on their own. We saw that people were offered a good size portion and people seemed to enjoy their food. Where relevant, people were provided with suitable adapted crockery to help them feed themselves and staff monitored discreetly where needed to ensure people had enough to eat. We saw that food was pureed for those who had possible choking or swallowing difficulties and concerns. We observed that for people not well enough to come to the dining room they were supported by staff members to eat their meals in their rooms. We saw that people were spoken to and assisted respectfully.

Is the service well-led?

During our inspection we observed that there were sufficient numbers of staff on duty to attend to people's needs and nobody was left alone for any length of time. We looked at the records for staffing arrangements within the home and found there were enough qualified, skilled and experienced staff to meet people's needs. We spoke with the owner and several members of staff who told us that the home had a stable team of staff. The owner explained to us that most members of staff had been employed by the home for many years and that the home did not use agency staff to cover staffing shortages. We were told that the home operated its own bank of staff who could be contacted if required.

The home had a system in place for the recording and monitoring of accidents and incidents. The owner told us that all accidents and incidents were monitored on an annual basis. We were given examples of how this monitoring helped to improve service delivery. For example they told us how statistics showed the level of falls within the home and how these could be minimised and addressed for people using the service. They also told us of the various audits they undertook on a frequent basis. Audits included; medication, equipment, the homes environment, water and refrigeration temperature checks and electrical and gas appliances safety checks. Records we looked at confirm this. This meant the provider had effective systems in place to regularly assess the risks and benefits to people that used the service.

When we inspected the home we found that people were asked verbally to consent to care and treatment and people's end of life wishes were recorded appropriately in most cases. People's care was delivered in line with their individual needs. Staff were aware of how to respond to any allegation of abuse in a way that safeguarded vulnerable adults and the provider had effective recruitment procedures in place. The provider took steps to monitor the quality of the service and take action where required.