About the service:

Whiston Hall provides accommodation for up to 44 older people, including people living with dementia in one adapted building. At the time of our visit there were 26 people using the service.

People’s experience of using this service:

After the last inspection of September 2018, the provider had sent us an action plan to tell us how they would address the areas we raised on inspection. At this inspection we found concerns regarding safe care and treatment, infection, prevention and control and staffing. Whilst the action plan had addressed some of our immediate concerns, it had not been fully effective in improving the service.

The service did not have a registered manager, their last day had been Monday 8 April 2019. The deputy manager was working nights due to staff shortages so there was no management. The nominated individual was at the service during our inspection. The nominated individual told us they had put in place management arrangements that the quality lead and themselves would be overseeing the service until a new manager was recruited. Since our inspection the provider has confirmed in writing the management arrangements to ensure improvements are sustained.

We completed a tour of the home with the nominated individual and found some areas, equipment and furniture were not clean, although audits had been completed they had not identified all the issues we found at inspection.

Risks associated with people's care, including moving and handling had been identified. However, we found the care plans and risk assessments in respect of moving and handling people to meet their needs were not followed. We also found they had not always been reviewed when there were changes to people’s needs. This put people at risk of harm.

We found people did not always receive care that was responsive to their needs. Care plans we looked at did not always contain the most up to date information or contained information that was contradictory. People were not always provided with opportunity for meaningful activity.

People we spoke with told us they felt there were not always enough staff, as they were not always available to provide care and support in a timely way. The nominated individual explained to us that they had a dependency tool and the hours required were maintained. However, the layout of the building was over three floors and the tool did not fully take this into consideration and the deployment of staff was not always effective.

People told us they generally felt safe. The provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in safeguarding and confirmed that they would take appropriate action if they suspected abuse. However, the unsafe moving and handling that we observed during the inspection was reported to the local authority safeguarding. This was because staff did not follow risk assessments or care plans to ensure peoples safety.

Recruitment procedures followed safe practices. Medicines were managed safely. Incidents and accidents had been recorded and analysed. However, the analysis was not always effective to ensure safe management of these to reduce occurrences. The provider improved these systems following our inspection.

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 supported this practice. The provider was adhering to the principles of the Mental Capacity Act (MCA). People who lacked capacity had decisions made in their best interests.

Peoples nutritional needs were met. People who required support with their diet had their needs met by staff that understood their dietary requirements. We observed the lunch time meal the food served was well presented, appetising and special dietary needs were met. However, we found the experience for people could be improved, people sat waiting for a long

The inspection took place on 27 September 2018 and was unannounced which meant the people living at Whiston Hall and the staff working there didn’t know we were visiting.

The service was previously inspected in November 2017, when we identified four breaches of regulations. The registered provider did not ensure care was person-centred, did not manage risks to ensure peoples safety, was not meeting the requirements of The Mental Capacity Act and there was ineffective deployment of staff. The service was rated Requires Improvement. At this inspection we found the service had deteriorated and we have rated it Inadequate and it is placed in special measures.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Whiston Hall’ on our website at www.cqc.org.uk.

At the time of our inspection there was not a registered manager in post. 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. A registered manager from another of the registered providers services was overseeing the service at the time of our inspection.

Whiston Hall 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. The service provides accommodation for up to 44 people in one adapted building. At the time of our visit there were 32 people using the service.

People were not protected as risks to their health and welfare were not effectively reviewed or managed. The risk assessments lacked detail, and were not always followed. We observed staff providing support to people and found that staff did not deliver the care and support in line with needs. This put people at risk of harm.

The home had a dependency tool in place to determine what staffing hours were required to meet people’s needs. However, this was not up to date and had not been completed since August 2018. We identified that there were insufficient staff on duty to meet the needs of people who used the service.

We found the service was predominantly meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found some people’s best interest decisions were clearly documented. However, we found others had not been considered and had no evidence in place to support the decisions made where people lacked capacity to make specific decisions.

We found there had been a lack of leadership and oversight and communication between all levels of staff had been poor. The registered manager had left and although the provider had acted to provide cover. We found the issues had not been identified in a timely way to ensure the service was improving following our inspection in November 2017.

Systems in place to monitor the service were not always followed and as a result the systems were not effective. People who used the service, their relatives and staff were not provided with forums where they could voice their opinions or be involved in the running of the service.

Systems were in place to manage medicines safely. People were provided with a nutritious balanced diet. However, we found people were not always supported with nutrition, which meant they did not always receive adequate nutrition and hydration.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action.

We observed staff interacting with people and found they were kind and caring, but identified people had to wait for assistance and some staff interactions wer

We carried out this inspection on 21 November 2017. The inspection was unannounced, which meant the people living at Whiston Hall and the staff working there didn’t know we were visiting. The service was previously inspected in January 2017 and was meeting all the fundamental standards. However, we had received concerns regarding this service so we bought this inspection forward.We identified the service had declined at this inspection. However, the manager had left and there had been a period without a manager, the provider had identified the concerns and was taking action to ensure improvements were made.

The service did not have a registered manager. However, the provider had appointed a new permanent manager who had been in post three weeks at the time of our inspection and they had commenced the process to register with CQC. 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.

Whiston Hall is a care home which providers accommodation for up to 48 people. The home is within easy reach of the local amenities such as the shops, village hall and public transport. There were 35 people using the service at the time of our inspection.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. However, issues we identified during the day did not support this and we submitted a safeguarding referral to the local authority.

We found there was a dependency tool to determine staffing levels. However this was not reviewed when there were changes and it was not clear from talking to staff and people who used the service if there were sufficient staff on duty to meet people’s needs in a timely way.

Risks to people had not always been identified and if they were identified we found these were not always followed. Systems were in place for safe management of medicines. However, we identified some areas of documentation could be improved.

People were not always protected by the prevention and control of infection procedures. We found some areas of the service were not kept clean or hygienic to ensure people were protected from acquired infections.

We found procedures were followed for the recruitment of staff. Staff supervision took place although staff told us this was not effective. However, staff told us they felt supported by the new manager. Staff received training that ensured they had the competencies and skills to meet the needs of people who used the service.

We found the service did not always meet the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Most staff we spoke with did not have a satisfactory understanding and knowledge of this, and people who used the service had not been assessed to determine if a DoLS application was required. We also found people’s best interest decisions were not always considered.

People were offered a well-balanced diet; however, we saw people were not always supported to maintain a balanced diet. People accessed health care services when required. Referrals were made quickly to health care professionals when people’s needs changed.

People and their relatives we spoke with all said the staff were kind and caring. People also said staff respected them and maintained their dignity. However, staff did not always recognise when people required support as the call system could not be heard throughout the building.

Care plans identified people’s needs and had good detail of how to manage people’s needs. However, we identified that some documentation did not always reflect peoples current or changing needs.

People told us they were l

The inspection took place on 24 January, 2017 and was unannounced. The home was previously

inspected in January 2015 and the service was meeting the regulations we looked at.

Whiston Hall is a care home which provides accommodation for up to 48 people. The home is within easy reach of local amenities such as shops, village hall and public transport.

At the time of our inspection the service did not 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. The provider had appointed a manger who had commenced the registration process. A new manager had been appointed and had been in post for two weeks at the time we visited the service. They were in the process of registering with the Care Quality Commission.

We spoke with staff about safeguarding people from abuse and they were very knowledgeable about this. They told us they attended training and they had learned about the different types of abuse and how to recognise and report it.

We looked at three recruitment files and found the provider had a safe and effective system in place for employing new staff.

We looked at systems in place to manage medicines and found that they were safe. Medicines were stored and administered safely.

Care plans we looked at identified any risks associated with people’s care. For example, risk assessments were in place for falls, pressure area care and nutritional needs.

We spoke with staff who said they received appropriate training which gave them the skills and confidence to carry out their responsibilities. Training included moving and handling, first aid, health and safety, fire prevention, safeguarding, and food hygiene.

Through our observations and from talking with staff and the registered manager we found the service to be meeting the requirements of the DoLS. Staff confirmed they had received training in this subject.

People were offered a choice of food at each meal and drinks and snacks were provided throughout the day in line with their preferences and dietary requirements.

We looked at peoples care plans and found that relevant healthcare professionals were involved in their care when required. For example, district nurse and speech and language therapist.

We observed staff supporting people and found they were respectful and caring in nature. Care plans we saw included information about people’s likes and dislikes.

We looked at care records belonging to four people and found they were informative and reflected the care and support being given. However, a new process was being introduced and some information from previous documentation had not been carried over to the new document. This was being looked at by the manager.

The service employed an activity co-ordinator who was available 30 hours a week. People we spoke with were happy with the activities provided.

The provider had a complaints procedure and people felt able to raise concerns if they needed to. The manager kept a log of concerns received and addressed them effectively.

People told us the manager was supportive and there was a good leadership structure in place. People felt able to approach the manager and felt she listened to them and acted on what they told her.

We saw regular audits took place to check the quality of service provision. Action plans were devised to follow up any issues.

People were involved in the service and their views were sought. We saw evidence that people were involved in residents and relatives meetings and were able to comment about the service.

The inspection took place on 21 January 2015 and was unannounced. Our last scheduled inspection at this service took place in November 2013 and we found the service compliant.

Whiston Hall is a care home which providers accommodation for up to 48 people. Some people who used the service were living with dementia. The service is situated in Whiston. At the time of our inspection there were 36 people using the service.

The service had a registered manager in post at the time of our 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.

The registered provider had systems in place to ensure people were safe. A safeguarding vulnerable adult’s policies and procedures were available and there was a clear guide for staff to follow if required. We spoke with staff who were knowledgeable about recognising abuse and how to respond and report abuse.

The service had a procedure to follow to ensure safe recruitment practices were followed. Pre-employment checks were obtained prior to people commencing employment.

People’s medicines were managed safely. We observed two senior staff administering medicines during the morning. Staff were patient and explained what the medicine was for. Staff waited with people and supported them to take their medicines as they wished. Staff who administered medicines had completed a safe handling of medicines course.

We looked at care plans belonging to four people and found people had risk assessments to monitor and manage risks associated with their care. Risk assessments stated factors which needed to be considered and what action to take to minimise the risk.

Staff we spoke with felt they were trained to carry out their role and responsibilities effectively. Staff told us training provided was of a good quality and valuable. We looked at the training matrix and found that training was planned and delivered.

Staff had an awareness of the Mental Capacity Act 2005 and had received training in this area. Staff were clear that when people had the mental capacity to make their own decisions, this would be respected.

People who used the service were supported to have sufficient to eat and drink and to maintain a balanced diet.

We found that some people who used the service were living with dementia. The environment was not particularly dementia friendly. We discussed this with the registered manager and we asked him to consider best practice for people living with dementia.

People developed relationships within the service and enjoyed spending time with friends. The service operated a key worker system. A key worker is a member of staff working alongside a person and supporting them on an individual basis.

We saw evidence in care plans where people and their relatives had been involved in their care. People had signed to say they agreed with their care plan.

People we spoke with enjoyed the range of activities on offer and said they were involved in choosing them. We observed activities taking place which were led by the activity co-ordinator.

The service had a complaints procedure and responded, in a timely manner, to concerns raised.

Through observations and talking with people we found the registered manager spent time with staff and people who used the service to find out the quality of the service provided. Staff and people who used the service felt included in the running of the service.

We carried out this inspection because when we visited the service on the 16 September 2013, we found that people were not cared for in a clean, hygienic environment. We wrote to the provider and asked them to take action. The provider sent us an action plan which stated they would be compliant by 17 October 2013.

We inspected the service on 14 November 2013 and found the provider to be compliant.

People were protected from the risk of infection because appropriate guidance had been followed. People we spoke with felt the home was kept clean.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People we spoke with told us that there was always something to do. One person said, “I love the library visits and enjoy selecting my books, staff are very helpful too.” Another person said, “I enjoy knitting it keeps me occupied.”

We saw that the main living areas of the home were clean, but some areas such as the bathroom and laundry needed attention.

We found systems protected people who used the service against the risks associated with the unsafe use and management of medication. We spoke with people who used the service and they told us that they receive their medicines on time.

There were effective recruitment and selection processes in place. Staff told us that they had appropriate pre-employment checks before they commenced work with the provider.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

People told us that they had been consulted about the care package they received and that care plans were discussed with them. One person said. “I have signed my care plan in agreement.” People who used the service told us that they had been given written information about the service.

People who used the service had a care plan which was relevant to their individual needs. People were able to participate in appropriate activities throughout the day. People were happy living at the home and one person said “We have been on a barge trip and it was lovely and restful.”

We found that the home worked well with other professionals. People who used the service were supported to access other professionals when required. One person said, “If I am ill the staff call the doctor.” Another person said “I have the optician visit me here.”

There was enough equipment to support people appropriately. Some people used the hoist, others used walking aids. The manager told us that all equipment was assessed for the individual using it.

We found that there were enough staff to meet people’s needs. Staff were knowledgeable about their role and felt that the training they attended was good.

People knew how to complain if they needed to. The complaints procedure was available. One person said, “When I have complained things have been sorted out for me.”

We carried out a compliance review visit of this service in October 2011. This was a follow up inspection to check the progress made by Whiston Hall with regards to the compliance actions we imposed following the inspection.

We spoke with people with regards to these areas.

People were very positive about the care and support they received at Whiston Hall.

These were some of the comments.

“I like it here. Staff are very helpful. I feel comfortable here.”

“I have no worries. I feel safe and the staff are very caring.”

“My family have been to several places and they said that this was the best place they had seen. I tended to agree with it. It is smashing here.”

“Food is very good, I can have cooked breakfast if I want and I get three good meals. I can have drinks anytime I want all I have to do is ask. I can go and get drinks if I want.”

We spoke to people who lived at the home and the visitors. The general view was that it was a lovely and homely place to live and the care workers were caring and helpful. Two relatives said that it was like a five star hotel and they were happy that they found this home for their loved ones. Two people living at the home said that the manager came round and spoke with them most days and he was accessible if they needed anything.