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 peop

We carried out a comprehensive inspection on 24 October 2017. The previous comprehensive inspection was undertaken in February 2017. At this inspection the provider had breached three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These breaches related to: safe care and treatment; good Governance and person-centred care. The service was rated as ‘Requires Improvement’. Following the previous inspection in February 2017 the provider has been sending monthly reports regarding their medicines management, records and auditing systems. At this inspection we checked whether improvements had been made and the service was no longer acting in breach of the regulations.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Whitchurch Care Home, on our website at www.cqc.org.uk

Whitchurch Care Home is registered to provide accommodation for persons who require personal or nursing care for up to 50 people. The service cares for older people, some of whom are living with dementia. At the time of our inspection there were 35 people living in the service.

There was no register 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 current manager has submitted their registered manager’s application to the Commission for consideration.

At our last inspection in February 2017 we found that improvements were needed to make sure medicines were managed safely. Although areas of this work required further development sufficient improvements had been made.

At our previous inspection the provider had not consistently protected people against the risk of poor or inappropriate care as accurate records were not being maintained. The provider has been sending monthly progress reports on this issue of concern. At this inspection we found sufficient progress had been made.

At our previous inspection we found that care plans were not sufficiently detailed to help staff provide personalised care based on current needs. They were not consistently written in conjunction with people or their representative. At this inspection we found improvements had been made but this area of their work required further development.

At our previous inspection the provider did not have effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. At this inspection we found sufficient improvements had been made.

A range of recruitment checks had been carried out on staff to determine their suitability for work. Staffing levels were maintained in accordance with the assessed dependency needs of the people who used the service. Staff were supported through a training supervision programme.

People were cared for in a safe and clean environment. Regular maintenance and equipment audits were undertaken. Where actions were required they are taken forward within a reasonable timescale and recorded in the maintenance log book.

People's rights were upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

People told us that they thought the staff were caring and they were treated with dignity and respect. Staff were knowledgeable about people and understood their needs and preferences.

Advanced care plans were in place. Staff had documented their conversations with people and their relatives about people’s choices in relation to the care they wanted to receive towards the end of their lives.

Staff told us there had been “a lot of changes” recently, but in the main spoke positively about the new manager. Following the

We carried out a comprehensive inspection on 20 July 2016. Following this inspection, we served a Warning Notice regarding the breach of Regulation 17 of the Health and Social Care Act 2008, relating to good governance. The provider did not have effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. The provider had not consistently protected people against the risk of poor or inappropriate care as accurate records were not being maintained. The provider also breached Regulation 12 of the Health and Social Care Act 2008. The service did not consistently prevent avoidable harm or risk of harm to people. Medicines were not managed safely. Best practice had not been consistently followed in relation to infection control. The service was rated as ‘Requires Improvement.’

We undertook an inspection on 1 and 15 February 2017 to check the provider was meeting the legal requirement of the regulations they had breached and had complied with the Warning Notice.

Whitchurch Care Home is registered to provide accommodation for persons who require personal or nursing care for up to 50 people. The service cares for older people, some of whom are living with dementia. At the time of our inspection there were 40 people living in the service.

There was a registered manager in place on the day 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.

In July 2016 we found that medicines were not managed safely. The provider sent us an action plan telling us what they were going to do to meet the regulations. During this inspection we found insufficient improvements had been made. This is the fourth inspection where we have found that the service has not managed medicines safely.

We served a Warning Notice relating to the breach of Regulation 17 [Good governance] of the Health and Social Care Act 2008. The warning notice required the provider be compliant by 13 December 2016. At this inspection we found that records were not consistently completed accurately to manage and ensure that people’s on-going needs were met. Systems were not being operated consistently effectively to assess and monitor the quality and safety of the service provided. This resulted in continued unsafe practice in some areas of the service.This is the fourth inspection there continues to be a breach of Regulation 17.

Staff were not consistently supported through a regular supervision programme. Supervision is where staff meet one to one with their line manager.

Care plans were not sufficiently detailed to help staff provide personalised care based on current needs. They were not consistently written in conjunction with people or their representative. People we spoke with had little or no knowledge of the content of their care plan.

Staffing levels were assessed by following the Care Home Equation for Safe Staffing (CHESS) dependency tool. Staffing rotas viewed demonstrated that staffing levels were in the main maintained in accordance with the assessed dependency needs of the people who used the service. There were mixed comments from staff and people and relatives about the levels of staff. The registered manager told us that at times when staff call in sick at late notice it has not always been possible to cover their absence with existing or agency staff.

Records showed that a range of checks had been carried out on staff to determine their suitability for work. This included obtaining references and undertaking a Disclosure and Barring Service (DBS) check. The DBS helps employers to make safer recruitment decisions by providing information about a person's criminal background and whether

This inspection took place on 20 July 2016 and was unannounced. The last inspection took place on 2, 3 and 8 December 2014. We found two breaches of the regulations of the Health and Social Care Act 2008 relating to the management of medicines and consent to care and treatment. These breaches were followed up as part of our inspection

Whitchurch Care Home is registered to provide accommodation for persons who require personal or nursing care for up to 50 people. The service cares for older people, some of whom are living with dementia. At the time of our inspection there were 46 people living in the service.

There was a registered manager in place on the day 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.

In December 2014 we found that medicines were not managed safely. At this inspection the provider had not made sufficient improvements. This is the third inspection where we have found that the service has not managed medicines safely.

In December 2014 we found that people’s rights were not being upheld in line with the Mental Capacity Act 2005. We found sufficient improvements had been made.

The provider had not consistently protected people against the risk of poor of inappropriate care as accurate records were not being maintained.

The provider did not have effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service.

The provider had not ensured that people were protected from the risk of cross infection.

Staff were not consistently supported through an effective supervision programme.

Staff demonstrated kind and compassionate behaviour towards the people they were caring for. We received positive feedback about the staff and people thought they were caring.

Care records that we viewed showed people had access to healthcare professionals according to their specific needs.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

We found two breaches 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.

During our inspection on 22 and 23 June 2013 we found that people’s personal records were not always completed, were not accurate or fit for purpose. For example, sections such as social information, personal preferences and schedule of personal effects had not been completed.

The provider sent us an action plan outlining what actions they would take to ensure that they would meet this essential standard. During this inspection we checked the actions that the provider had taken and judged that they were now meeting this essential standard.

We did not speak to people during this inspection as we were checking on required improvements in the area of record keeping.

We found that the record keeping at the home had improved and records maintained were now accurate, complete and fit for purpose.

We saw that the provider had implemented procedures to monitor the quality of records and put actions in place to remedy any shortfalls.

We spoke with 29 people living at the home to find out their views. We spoke with the manager, the senior nurse, two nurses, and four care workers. We also met a number of visitors during our visit.

The majority of people we met had positive views about life at Whitchurch care home Examples of comments we were told included, “everyone of the staff is kind”. “The food is quite good”. “We have lots of activities". “Not one of them is unpleasant there is always something to do”. “The food is lovely”. “They will do anything for you”.

Care plans partially showed how to meet people’s needs. However some people were being cared for without a fully complete and up to date care plan to guide staff on how to effectively meet their needs.

People told us they felt safe at the home. They were cared for by staff who were trained to understand the signs of abuse and knew how to report concerns if they witnessed any wrong doing.

There were enough staff to support people with their physical care needs. Staff were caring in manner to people who used the service. However staff levels failed to meet people’s full range of needs in a person centred way, which took account of the needs and preferences of each individual.

People were supported to make complaints about the service. People also benefited because complaints were properly investigated and learning took place to improve the service when necessary.

The inspection took place on December the 2, 3 and 8 2014. This inspection was unannounced. During our last inspection in May 2014 we found the provider was in breach of Regulations relating to respecting and involving people, care and welfare, cleanliness and infection control, medicines, staffing and quality monitoring. The provider wrote to us with an action plan of improvements that would be made.

Whitchurch Care Home based in Bristol provides personal and nursing care for up to 50 older people. At the time of our inspection 32 people resided at the home.

During this inspection we found the majority of people were protected from risks associated with their care because staff followed appropriate guidance and procedures. Care plans were in place; however there were some discrepancies in the plans which meant people may not always receive the care and support they needed. The home was clean and hygienic. The majority of people felt the staff were responsive to their needs. Staff were knowledgeable about the care needs of the people they were supporting.

People had access to food and drink throughout the day and staff supported them when required. However people’s dining experience was differant for those people having their meals in their bedrooms and those having meals in communal areas. For example, people in the dining room were supported by staff who were engaging in conversation. Of the staff we observed providing support to people in their bedrooms, there was very little verbal interaction or encouragement to eat.

Opinions regarding whether or not relatives felt their concerns would be listened to and appropriate action taken where required differed. We saw records to show formal complaints had been dealt with effectively.

We found that some improvements had been made to the arrangements for managing medines, however some further improvement was needed to make sure people’s medicines were managed safely. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 12 (f) & (g) 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 end of this report.

CQC is required by law to monitor the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS require providers to submit applications to a ‘Supervisory Body’, the appropriate local authority, for authority to do so. We found the provider was not submitting the necessary DoLS applications. This meant the requirements of the Mental Capacity Act were not always followed by the provider when reaching a best interest decision on behalf a person who lacked capacity. This is a breach of Regulation 18 of the Health and Social care act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 11 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 end of this report.

The home has 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.