We inspected Whetstone Grange on 14 March 2017. The visit was unannounced. This meant that the staff and provider did not know that we would be visiting.

At our last inspection on 29 and 30 November 2016 we asked the provider to take action to make improvements in two areas. We asked them to improve practice relating to assessing people’s capacity to consent to their care and support and with regard to good governance. At this inspection we checked to see if the provider had made the necessary improvements. We found that they had.

Whetstone Grange is located in Whetstone, Leicester. The service provides care and accommodation for up to 38 older people with age related needs, including dementia and physical disability. On the day of our inspection there were 25 people living at the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People told us they felt safe living at Whetstone Grange and felt safe with the care workers who supported them. The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew what to do if they suspected someone was being abused. This included reporting any issues of concern to the management team.

Risks associated with people's care and support had been assessed. These assessments provided the management team with the opportunity to reduce and manage the risks presented to both the people using the service and the staff team.

People had plans of care that reflected their care and support needs. These provided the staff team with the information they needed in order to properly support people using the service. Staff knew the people they were supporting including their preferences.

Appropriate checks had been carried out when new members of staff had started working at the service. This was to make sure that they were suitable and safe to work there. An induction into the service had been provided for all new staff members and ongoing training was being delivered. This enabled the staff team to provide the care and support that people needed.

People we spoke with felt there were currently a sufficient number staff on duty each day because their care and support needs were being met. Their relatives and members of the staff team we spoke with agreed with what they told us.

People were on the whole receiving their medicines as prescribed by their doctor. Medicines were being appropriately stored and the necessary records were being kept.

People told us the meals served at Whetstone Grange were good. Their nutritional and dietary requirements had been assessed and a balanced diet was being provided. For people who had been assessed to be at risk of not getting the food and drink they needed to keep them well, accurate records were kept showing their food and drink intake so that this could be monitored.

The staff team involved people in making day to day decisions about their care and support. Where people were unable to make their own decisions, we saw that decisions had been made for them in consultation with people who knew them well and in their best interest. The staff team were working in line with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

The staff team felt supported by the registered manager. They explained that they were given the opportunity to meet with them on a regular basis and felt able to speak with them if they had any concerns or suggestions of any kind.

People told us that the sta

This inspection took place on the 29 and 30 November 2016. The first day of our visit was unannounced.

At our last inspection on 11 and 12 November 2015 we asked the provider to take action to make improvements in two areas. We asked them to improve practice relating to assessing people’s capacity to consent to their care and support and with regard to good governance. At this inspection we found that the provider had not made the necessary improvements. We identified that the provider was in breach of two of the Regulations 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 this report.

Whetstone Grange provides accommodation for up to 38 people who require personal care and support. There were 28 people using the service at the time of our inspection including people living with dementia.

The service had a registered manager. 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.

Not all of the concerns raised at our last inspection had been addressed. These were around assessing people's capacity and the monitoring of the service.

When people were unable to make their own decisions, capacity assessments had not always been carried out and decisions had not always been made for them in consultation with people who knew them well. The staff team involved people in making day to day decisions about their care and support. Staff members we spoke with were aware of their responsibilities under the Mental Capacity Act 2005.

There were systems in place to monitor the service being provided. However, these had not always been effective in identifying shortfalls, particularly within people’s care records.

Not everyone we spoke with felt there were always enough staff on duty to meet the needs of the people using the service. Questions were raised as to whether two waking night staff were sufficient to support 28 people when four of those needed the assistance of the two night staff at any one time.

Risks associated with people’s care and support had not always been assessed.

People’s plans of care did not always reflect the care and support that people needed and staff members did not always follow the instructions contained within them.

People had received their medicines as prescribed. Systems were in place to regularly audit the medicines held and the appropriate records were being kept.

Appropriate checks had been carried out when new members of staff had started working at the service. This was to check that they were suitable and safe.

An induction into the service had been provided for all new staff members and ongoing training was being delivered. This enabled the staff team to provide the care and support that people needed.

People’s nutritional and dietary requirements had been assessed and a balanced diet was provided, with a choice of meal at each mealtime. Monitoring records used to monitor people’s food and fluid intake did not demonstrate that people received the food and fluids they needed to keep them well.

People were supported to access the healthcare services they needed such as GPs and community nurses.

People told us that the staff team were kind and caring and they treated people with respect. Whilst this was observed, the actions of some staff members meant that people were not always treated in a caring or respectful manner.

The staff members we spoke with felt supported by the registered manager. They explained that they had been provided with the opportunity to meet with them on a one to one basis to discuss their progress. They also told us that there was always someone available for supp

This inspection took place on 15 December 2014 and was unannounced.

At the last inspection on 11 September 2013 we found the service met all the regulations we looked at.

Whetstone Grange is a purpose built care home for up to 38 older people with age related needs including dementia and palliative care. On the day of our inspection there were 29 people living at the service.

Whetstone Grange is required to have 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 the time of the inspection a registered manager was in post.

People that used the service told us that they felt safe but we found that there was a lack of staff to meet people’s needs and keep them safe.

Staff were aware of their responsibilities with regard to people’s health and safety. We found people received their medication safely and as prescribed by their doctor.

Staff received induction and training opportunities but we found there were gaps in the training staff received. Staff had not always received appropriate training to meet the needs of people they cared for. We found staff received insufficient support and supervision to undertake their role and responsibilities effectively.

People’s human rights were not always protected because the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had not always been adhered to.

People’s nutritional and dietary needs were assessed. However, people did not always receive the support they required to ensure they had sufficient amounts to eat and drink. We saw examples where the service worked with health care professionals and support was provided for people to receive ongoing healthcare support by having access to health care services.

Some staff were caring and attentive to people’s needs. However, we observed many examples where the care practice was poor. People were not always treated with compassion, respect and dignity.

People raised concerns about the lack of opportunities with social activities, interests and hobbies. People were not always consulted about their preferences this showed care was not always personalised.

People had access to information about the provider’s complaints procedure and independent advocacy services.

The quality and assurance systems in place had failed to identify and respond to areas that required improvement.

We found the service was in breach of four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations 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.

We spoke with four people who used the service and with two relatives who were visiting. All the people we spoke with were happy with the service. One person who lived in the home told us “it’s good here. The food is good and we get more than enough to eat. I get up early as I’ve always done. I choose where I eat my lunch and usually have a rest in my room after it”.

We looked at records for three people who used the service. The care records had a care and support plan in place which identified risks and how these could be managed. There were regular reviews.

We found that staff supported people appropriately and spoke to them in a friendly and respectful manner. Staff understood peoples’ needs and preferences and respected their choices.

Staff were trained and supported and delivered care which met peoples’ needs. Staff we spoke with had a good understanding of the different types of abuse and could explain what they would do if they suspected someone was being abused. They knew who they would report this to both within the service and to external agencies.

We found that the provider had adequate quality assurance processes to ensure the comfort and safety of the people they cared for was maintained.

We spoke with six people living in the service. They all confirmed they were satisfied with the care provided by staff in the service.

We spoke with two relatives. They were all happy with the support their relatives received. One relative told us the staff were “friendly and caring. I am kept informed if my mother is not well".

We received comments from people, their relatives and staff that that there were no trips out for people. The manager said that she would look into this. She later sent us information stating that a pub trip had been arranged for people.

We also received one comment from a relative that there did not appear to be the staff numbers available to be able to take her mother out for a daily walk, as contained in her care plan. The manager again said that she would look into this provision. Management may wish to know that in order to fully meet the individual needs of people, an increase in staffing cover may be needed to provide people with proper stimulation.

We visited the home unannounced on Monday 1st August 2011 at 8.30 in the morning. The inspector saw breakfast being served to around twenty five people with a range of hot and cold food provided. Staff were seen sensitively assisting individuals to eat and drink.

We saw people being assisted and encouraged to walk by two staff. Staff were observed being polite and caring in their manner when supporting people who use services.

People told us,

“Staff deal with people’s behaviour very well.”

“Good food here. Can’t do anything here. ”

“Would like to sit in the garden don’t know how to do this. “

People also told us they wanted more recreational activities to be provided.

We identified areas for service improvement:-To focus on person centred thinking and planning and delivery of care; to provide regular and improved staff supervision and appraisals; identify and provide staff training around safeguarding from abuse and other key areas of learning; and to provide robust quality monitoring systems.

This inspection took place on the 11 and 12 November 2015 and was unannounced.

At our last inspection carried out on 15 December 2014 the provider was not meeting the requirements of the law in relation to respecting and involving people who use services, assessing and monitoring the quality of service provision, consent to care and treatment and staffing. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make.

During this inspection we looked to see if these improvements had been made. We found that whilst improvements had been made in relation to respecting and involving people who use services and staffing, concerns remained with regard to consent to care and treatment and monitoring the quality of service provision. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of the full version of this report.

Whetstone Grange provides accommodation for up to 38 people who require personal care. There were 24 people using the service at the time of our inspection including people living with dementia.

The service had a registered manager. 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.

People had been involved in making day to day decisions about their care and support. However, there was no evidence in people’s plans of care to demonstrate that their consent to their care or support had been obtained. Where people lacked capacity to make decisions, there was little evidence to demonstrate that decisions had been made for them in their best interest or in consultation with others.

There were systems in place to monitor the service being provided. These had not always been effective in identifying shortfalls, particularly within people’s care records.

The majority of the staff team we spoke with told us that there were currently enough staff members on each shift to meet the care and support needs of those they were supporting. One staff member disagreed. People using the service and their relatives felt there were enough members of staff to support them properly. We observed people’s care and support needs being met, however, we found there was little time left for the staff team to spend any quality time with people.

Recruitment processes were not always robust. Gaps in people’s employment had not always been investigated and information received within the checks carried out had not always been followed up.

Risks associated with peoples care and support had not always been assessed. Where risk assessments had been completed these had not always been kept up to date.

People felt safe at Whetstone Grange and the staff team were aware of what to do if they felt people were being treated badly.

We raised some concerns around fire safety within the service because we found a fire exit to be cluttered and a fire door to be dead locked. Other issues including the suitability of the fire procedure were also raised.

People had received their medicines as prescribed, though there were some inconsistencies within people’s medication administration records. Protocols for medicines given ‘as required’ were well detailed.

The staff team had been provided with a number of training courses which were relevant to their role however, training for specific health related conditions including diabetes, had not always been offered.

People’s nutritional and dietary requirements had been assessed and a balanced diet was provided with a choice of meal at each mealtime. Monitoring charts used to monitor people’s food and fluid intake had not always been completed consistently.

People’s plans of care did not always accurately reflect the care and support they were receiving.

People told us they were treated with respect and the staff team were kind and considerate. Relatives on the whole agreed.

There was no dedicated person employed to provide activities or assist people to enjoy interests or hobbies that were important to them. People spent large amounts of time on their own and without meaningful interactions.

The staff team felt supported by the registered manager and team meetings and supervisions had been reintroduced.

People knew how to raise a concern and they were confident that things raised would be dealt with appropriately however, complaints that had been received by the provider had not always been concluded.