Archived: Whitchurch Care Home

Updated 15 February 2019

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.

The inspection was prompted in part by a notification of a serious incident. This inspection did not examine the circumstances of this incident but did examine associated risks.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

This inspection took place on 17 and 24 January 2019 and was unannounced. The inspection was carried out over the course of two days by five inspectors and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. Three inspectors attended the first day and two on the second.

Prior to the inspection, we reviewed information we held about the service including statutory notifications. Statutory notifications are information about specific important events the service is legally required to send to us.

As part of our inspection, we spoke with eight people, the manager and other senior management staff, five relatives and eight members of staff. We tracked the care and support provided to people and reviewed six care plans relating to this. We examined eight people’s medicines records. We looked at records relating to the management of the home, such as the staffing rota, policies, recruitment records, training records, meeting minutes and audit reports. We also made observations of the care that people received.

Updated 15 February 2019

Whitchurch Care Home provides accommodation and nursing care for up to 50 older people. At the time of the inspection there were 25 people in residence. Each person had their own en-suite bedroom. The home was spread over two floors with a lounge on each floor and a main dining room on the ground floor.

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.

The inspection took place on the 17 and 24 January 2019 and both days were unannounced. The last inspection of the service took place in October 2017 and the service was rated Good.

At the time of this inspection the service was in a whole service safeguarding process and the provider had put in place a self imposed embargo on admissions. This meant the local authority safeguarding team were monitoring and working with the service to ensure people were protected from abuse and their rights safeguarded. A recent incident where a person had suffered a significant injury was being looked into by the statutory agencies.

At this inspection we found nine breaches of regulations. These include areas relating to safe care and treatment, safeguarding, treating people with dignity and respect, person centred care, staffing, complaints, statutory notifications and good governance. We will be asking the provider to send us a report of the improvements they will make.

The overall rating for the service is 'Inadequate' it will therefore be placed into special measures. The commission is now considering the appropriate regulatory response to resolve the problems we found.

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.

There were widespread and systemic failings identified during the inspection. The quality and safety monitoring systems used by the provider were not fully effective. They did not ensure that there were the right resources in place to ensure the quality of service provision and mitigate risks to people.

The provider had failed to make appropriate statutory notifications; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

The provider had failed to report and take prompt action as required regarding adverse safeguarding incidents appropriately.

There were not enough skilled and competent staff to meet peoples' needs. The staff team was unstable. The resulting high usage of agency staff had caused a lack of leadership for staff and confusion about who was responsible for people’s wellbeing and care needs.

Staff had not received regular meaningful supervision; the provider had not ensured that staff performance and progress was monitored effectively and that staff had an opportunity to voice their individual views. Staff training did not meet staff or peoples' needs. Staff recruitment procedures were not always followed appropriately.

Care plans were not consistently person centred. The guidance within peoples' risk assessments were not always followed by staff and records used to monitor peoples' health were not always completed. This exposed people to risks of neglect and unsafe or inappropriate care or treatment.

People had access to healthcare professionals however we were not assured that staff always identified when referrals were required. People did not always receive their prescribed medicines as required.

We received some positive feedback about the care staff and their approach with people using the service; however we observed occasions when people's dignity had been compromised.

The provider had a complaints procedure however not all complaints had been recorded as such or investigated following the procedure.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.