Archived: Whitworth House

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

At this inspection we found the provider was still not taking adequate steps to protect people from the risk of unsafe care and treatment. Whilst staff told us they were verbally updated on people’s health and welfare needs, we found care records contained risk assessments that were often unclear, inaccurate and not in line with information contained in care plans. This was particularly in regards to risks associated with dehydration, choking and skin integrity.

The registered manager still continued to fail to ensure there was adequate governance and oversight of the service, and we saw concerns raised at our last inspection and through the local authority’s quality monitoring processes had not been addressed. The registered manager did not consistently adhere to the provider’s policies, including in relation to incidents management. Appropriate action was not taken in response to care records audits and we saw the audits completed did not identify or address the concerns we found during this inspection.

Since our last inspection the provider had taken steps to ensure a safe environment was provided. This included in relation to monitoring hot water temperatures, ensuring call bells were accessible and in good working order, and ensuring safe fire exits.

The provider adhered to infection prevention and control procedures and safe practices were in place regarding the donning and doffing of personal protective equipment.

The registered manager was now submitting statutory notifications to the CQC about key events that occurred at the service, and displaying their latest CQC rating, as required by their registration.

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 (Inspection November 2019, report published May 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether appropriate action had been taken since our last inspection in relation to the breaches of Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 20A (display of performance assessments) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 (notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009. The overall rating for the service has not changed following this targeted inspection and remains ‘Requires improvement’.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Whitworth House is a residential care home providing accommodation and personal care. The home accommodates up to nine people in one house. At the time of our inspection five older people, some of whom were living with dementia, were living at Whitworth House.

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

At our last inspection we found breaches relating to staff recruitment, safe care and treatment, consent, staff support, good governance and notifications. We served the provider warning notices in relation to safe care and treatment and good governance. At this inspection we found the provider had improved sufficiently and was no longer in breach of the regulation relating to staff support. However, the provider remained in breach of all other regulations and was also in breach of the regulation relating to displaying their CQC rating. We are taking enforcement action against the provider and will report on this as soon as our processes are complete.

A registered manager had been in post for over 20 years and was also the owner. The registered manager had not taken sufficient action to make the improvements that were needed. Their oversight of the service was inadequate. During our inspection the registered manager was unable to show us many key records including care plans, risk assessments, staff records and some health and safety records. This was because the registered manager did not have access to these key records. The registered manager did not provide us with the documents we requested in a timely manner after the inspection so we used our powers under section 64 of the Health and Social Care Act 2008 to require the provider give these to us. However, the registered manager did not provide us with all the requested documents by the given date.

The registered manager had a poor understanding of their responsibilities and had not submitted notifications relating to deprivation of liberty applications and their outcomes to CQC. The registered manager also had not ensured the most recent CQC rating was displayed in the service, as required by law, to ensure people were openly informed about quality and safety at the service.

The provider did not always assess risk to people's care to ensure they were doing everything possible to reduce the risks. The provider did not always ensure recruitment was robust so only suitable staff were employed. The provider had not carried out robust checks of the premises and equipment to ensure risks were identified and reduced. The service was sufficiently clean although some food hygiene practices required improvement. There were enough staff to support people safely. People received medicines safely.

The provider did not ensure staff training records were always in place and stored securely. Staff received supervision to support them sufficiently in their roles. The provider did not always follow the Mental Capacity Act (MCA) in ensuring best interests’ meetings were held to make decisions in people’s best interests when they were assessed to lack capacity. Most people enjoyed the food although one person would like more choice. People’s day to day healthcare needs were met.

A care plan was not in place for one person. For the other people care plans did not contain sufficient guidance for staff relating to oral health but were otherwise sufficient. People were cared for by staff who were kind and knew them well. Staff treated people with dignity and respect. People were provided with enough activities to occupy themselves. The provider had a suitable process in place to respond to any concerns or complaints.

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 (inspected May 2019, report published July 2019) and there were multiple breaches of regulation. The provider did not complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider remained in breach of regulations.

Why we inspected

This was a planned inspection to follow up on the actions we told the provider to take at our last inspection.

Enforcement

We have identified breaches in relation to staff recruitment, safe care and treatment, consent, good governance, displaying their rating and notifications at this inspection. We are mindful of the impact of COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We met with the provider to discuss how they will make changes to ensure they improve their rating to at least good. 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. We will work with the local authority to monitor progress.

Whitworth House is a residential care home that provides personal care for up to nine older people, some of whom are living with dementia. There were seven people using the service at the time of our visit.

People's experience of using this service

• We found breaches in relation to staff recruitment, safe care and treatment, consent, staff support and good governance. We served warning notices in relation to the repeat breaches of good governance and staff recruitment.

• The provider did not always ensure recruitment was robust so only suitable staff were employed.

• There were enough staff to support people safely and staff spent time sitting with people.

• The provider did not always assess risk to people’s care to ensure they were doing everything possible to reduce the risks.

• The provider had not carried out robust checks of the premises and equipment to ensure risks were identified and reduced. Some food hygiene practices required improvement.

• Records were not always stored securely. The provider struggled to locate documentation we requested throughout our inspection. In addition, we found confidential documentation accessible to visitors in a communal room.

• Staff did not receive supervision to support them sufficiently in their roles. However, staff received the training they need to understand people’s needs.

• The provider did not always follow the Mental Capacity Act (MCA) in assessing people’s capacity to make their own decisions. This meant the provider may have unfairly determined a person lacked capacity.

• The provider lacked sufficient good governance and had not identified and responded to the concerns we found.

• Some people were unable to express their views due to their advanced dementia, so we carried out observations to understand their experiences better. Most people we spoke with, and both relatives, were positive about the care they received. Everyone we spoke with told us staff and the management were kind and caring.

• The provider supported people to access activities including a local social club. However, some people and relatives felt there were not enough activities to occupy people.

• People received medicines safely.

• We received mixed feedback regarding the food, although most people enjoyed this.

• Staff supported people to see the health and social care professionals they needed to maintain their health and wellbeing.

• A registered manager had been in post for over 20 years and was also the owner. They managed the service alongside two close family members who were deputy managers.

• People and relatives knew how to complain and had confidence the management team would respond appropriately to any issues they raised.

We found the service met the characteristics of a "requires improvement" rating overall.

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

Rating at last inspection: At the last inspection the service was rated as Good [report published on 9 November 2016].

Why we inspected: This was a planned inspection based on the rating at the last inspection. The rating has declined to “requires improvement” overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

At the previous unannounced inspection in January 2016 breaches of legal requirements were found. This was because recruitment procedures were unsafe. People were not protected from the risks associated with fire, emergency evacuation plans were not developed for people using the service. The provider did not have an effective system for assessing and monitoring the quality of service provision, and did not make proper provision for identifying and addressing shortfalls in the service. After the comprehensive inspection in January 2016, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. During the comprehensive inspection on the 18 August and 27 September 2016 we found that the provider had followed their plan and legal requirements had been met.

Whitworth House is a small residential care home situated within a residential area of Croydon. The premises are an adapted family house, and do not offer en-suite facilities. People share communal bathrooms and toilets. The home can accommodate up to nine older people. Accommodation is provided over three floors and is accessed by a passenger lift. There are communal areas that offer a small lounge and dining room. At the rear of the premises is a small back garden.

There is a registered manager who has been in post over 20 years. ‘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.

Improvements were made to promoting safety in the service. Individual risks associated with care and welfare were assessed and care arrangements were in place to ensure these were managed safely. We found that people had personal emergency evacuation plans (PEEP’s) in place. This meant that in the event of an emergency situation people may be evacuated effectively.

People told us they felt safe and well cared for by the staff in this homely environment. Staff undertook safeguarding training and knew the correct procedures for responding to and reporting any suspicion of abuse. Recruitment procedures had improved and were satisfactory and relevant checks had been carried out to make sure staff were suitable to work in the home.

Staff were attentive to people with high levels of engagement observed. This created a friendly, suitably stimulating environment with a ‘family’ feel. Staff consistently sought people’s agreement before assisting them with activities of daily living. This meant that people were empowered to express their wishes and their rights were respected.

Staff knew and understood people’s care needs well and the small team were able to easily share information. The care documentation was handwritten and totally person centred; it supported staff with clear guidelines and reference to people’s choices and preferences. This helped staff respond to people on an individual basis.

Staff understood the requirements under the Mental Capacity Act 2005 and about people’s capacity to make decisions. A number of people were restricted lawfully under Deprivation of Liberty Safeguards, the service had the required authorisation to do so. People who did not have capacity to make decisions due to illness had their capacity assessed; best interest discussions took place. People were not restricted without the service having the required authorisation to do so.

The small family style environment met the needs of people living there in a homely manner. Regular staff were employed, three were family members. Staff had developed meaningful relationships with people and demonstrated a caring approach. People said, tenderness and kindness were the qualities displayed by staff. People said they liked living at the home, because it was non-clinical and they said it felt "Like home." Staff were knowledgeable about the individuals; they approached people in a kind and caring way.

Staff were up to date in all mandatory training and participated in training provided by the provider and the local authority care home support team. People’s healthcare needs were promoted, and referrals were made to specialist services as appropriate. People were encouraged to have a healthy diet. The provider served home cooked food which people enjoyed. Staff knew people’s likes and dislikes and the menu was planned around these. People enjoyed meals and found they met their dietary and cultural needs.

There were arrangements in place for the on-going maintenance and repair of the building. The layout of the premises was not adapted to support people living with dementia, but relatives reported the small scale environment compensated for the environment.

The registered manager worked hard at providing the care to people. The provider and the manager were very accessible to visitors, enabling minor issues that arose to be discussed and resolved immediately, Relatives and people using the service told us that they had received information about the home as part of the admission procedure, including how to make a complaint. They said that staff worked collaboratively with them and professionals. This ensured the health and wellbeing of their relative and their satisfaction with services.

Quality assurance processes had improved and shortfalls were identified and addressed, but there was scope for further improvement to the processes to drive improvements. People felt able to raise any issues with the management and were confident these were addressed appropriately. The service had a complaint's procedure but this contained inaccurate information about the regulator.

Whitworth House is a small residential care home situated within a residential area of Croydon. The premises are an adapted family house, and do not offer ensuite facilities. People share communal bathrooms and toilets.The home can accommodate up to nine older people. Accommodation is provided over three floors and is accessed by a passenger lift. There are communal areas that offer a small lounge and dining room. At the rear of the premises is a small back garden.

There is a registered manager and she has been in post over 20 years. ‘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.

During this inspection we identified the quality assurance process had not been sufficiently developed and there was a lack of good governance. Breaches were also found in areas relating to fit and proper persons employed, personal evacuation plans, people being restricted without the service having the required authorisation to do so, completion of Mental Capacity Assessments and best interest decisions.

We also made recommendations about making appropriate adaptations to the environment to support people living with dementia.

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Individual risks associated with care and welfare were assessed and arrangements were in place to ensure these were managed safely. We found that people did not have Personal Emergency Evacuation Plans (PEEP’s) in place. This meant that in the event of an emergency situation people may not be evacuated effectively.

People told us they felt they were safe and well cared for by the staff. Staff undertook safeguarding training and knew the correct procedures for responding to and reporting any suspicion of abuse. Recruitment procedures were not satisfactory and relevant checks had not been carried out before staff started working in the home. This was a breach of regulation and placed people at risk of being cared for by people who may be unsuitable for the role.

Staff knew and understood people’s care needs well and there were systems in place for all staff to share information. The care documentation supported staff with clear guidelines and reference to people’s choices and preferences. This helped staff respond to people on an individual basis.

Although staff had completed training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) in practice staff demonstrated limited knowledge of the principles associated with the legislation and in promoting people’s rights. Staff were not consistently applying the principles of the Mental Capacity Act 2005. People who did not have capacity to make decisions due to illness did not have their capacity assessed; best interest discussions did not take place. People were restricted without the service having the required authorisation to do so. This was a breach of regulations.

People’s healthcare needs were promoted, and referrals were made to specialist services as appropriate. People were encouraged to have a healthy diet. Staff knew people’s likes and dislikes and the menu was planned around these. People enjoyed meals and found they met their dietary and cultural needs. Some people needed a soft diet and extra fluids due to their condition and staff made sure people had the nutrition and fluids they needed.

There were arrangements in place for the on-going maintenance and repair of the building. However these were poorly planned and have been on-going for 18 months. The impact for people was that the dining area was not available for meals while refurbishment took place and the communal lounge offered limited space for dining. There was a lack of signage and adaptations to support people living with dementia.

Each person had an individual care plan; care needs were reviewed and updated on a regular monthly basis.

People felt able to raise any issues with the management and were confident these were addressed appropriately. The service had a complaint's procedure but this contained inaccurate information about the regulator.

People told us they found the staff were caring and said they liked living at the home. Staff were knowledgeable about the individuals; they approached people in a kind and caring way. Regular staff were employed who developed positive relationships with people.

The service did not invest in a staff training and development programme, but staff were up to date in all mandatory training as they participated in training provided by the local authority care home support team.

The registered manager worked hard at providing the care to people, but they lacked essential knowledge and leadership and had not kept up to date with legislation. The shortfalls in the service were not identified and addressed. The registered manager had not informed the Care Quality Commission of notifiable incidents in line with legislation.

On the day of our inspection we met with all six people who used the service and observed how staff supported and cared for individuals. We saw that the registered manager and staff respected people's privacy and dignity, and took account of what people expressed and said in relation to the way their care and support was provided.

People who were able to communicate with us said they were happy in the home. One person told us, 'I like it here, the manager is very nice'. Another person told us 'The food is great. I like hot and spicy food which the manager makes for me'. We saw that people were supported to undertake a range of activities in the community and had varied and individual routines. During our inspection several people attended a local club with support from staff.

We spoke with family members and representatives of people who use the service. One person told us 'I am very happy with the care and support that is provided. I like the home because it is small and homely and the manager and staff are very friendly and welcoming'.

People had consented to their care and treatment. Where people did not have the capacity to consent, decisions would be made in their best interest and with people's families or representatives fully involved. People we spoke with said they had choice and control over the support they received.

There were two people using the service at the time of our visit and we met with both of them. People said they felt well cared for and that the staff were kind and helpful. They spoke positively about the care and support they received. Comments included, 'we're very well looked after" and one person described the registered manager as, 'she's like a mother to us, smashing!'

Since our last inspection, we found that the manager and staff had taken action to address the compliance actions. The registered owners had also been working with Croydon local authority to make required improvements. Following our visit we asked for written feedback from the council's Care Support Team. Their report stated, 'On visits to the home we have observed that the management and care staff had treated people with dignity and respect.' They also wrote, 'We have found the proprietor and the manager very committed to the training session delivered by the team or London Borough of Croydon. They have attended all the training sessions and given valuable feedback.'