Whitgift House provides accommodation with nursing and personal care for up to 36 older people. Accommodation is provided over two floors with two modern lifts enabling access around the building. There were two communal lounges on each floor and a large lounge with a conservatory on the ground floor that was also used to provide day care during the week. The dining room was large and well presented with room for those using the service and those people attending the day centre. The garden was well maintained and easily accessible for people with several seating areas.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff knew how to keep people safe and the staff members we spoke with demonstrated a good knowledge of how to recognise abuse and how to report any concerns.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care while still encouraging people to be independent.

There were systems in place for the safe storage, administration and recording of medicines. Each person's medicine was stored securely and registered nurses administered people’s medicines.

Staff had been recruited safely with appropriate checks on their backgrounds completed. All staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were kept up to date.

All areas of the service were clean and well maintained. Cleaning schedules were in place and staff had access to personal protective equipment when required.

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.

People were supported to keep healthy and well. People were supported to have sufficient amounts to eat and drink and risks associated to people’s diet had been identified. People had access to healthcare professionals when they needed to.

Staff supported people in a way which was kind, caring, and respectful. People were encouraged to participate in a wide range of activities.

When people needed end of life care, the service was able to provide care in line with peoples wishes. The service was an accredited Gold Standard Framework (GSF) nursing home.

There were a number of audits and quality assurance systems to help the provider understand the quality of the care and support people received and look at ways to continually improve the service.

Further information is in the detailed findings below.

We visited Whitgift House on 24, 29 and 30 March 2016. The inspection was unannounced.

The service provides residential and nursing care for up to 36 older people.

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 at the service felt safe and secure. Staff knew how to recognise and respond to abuse and had completed safeguarding of vulnerable adults training. They knew how to report safeguarding incidents and escalate concerns if necessary. The service provided a safe environment for people, visitors and staff. People’s needs were assessed and corresponding risk assessments were developed. There were sufficient numbers of staff to meet people’s needs. Staff recruitment was subject to robust systems to ensure the service employed suitable staff. The management and administration of medicines was safe. The service provided care and treatment in a clean and hygienic environment.

Staff were supported with regular supervision and comprehensive training. The service was working within the principles of the MCA. We saw evidence of completed mental capacity assessments, best interests meetings and DoLS in care plans and care records. Staff had completed MCA and DoLS training. People were supported to have a healthy diet and to maintain good health.

People were consistently positive in their comments about staff. We observed numerous examples of positive interactions. People and their representatives were supported to express their views and were involved in making decisions about their care and treatment. Keyworkers provided additional support for people. There were meetings for people where they could express their views and opinions about the day to day running of the home. Staff respected people’s privacy and dignity. People’s preferences for end of life care had been considered with them and family and recorded in line with their wishes. The service was an accredited Gold Standards Framework (GSF) nursing home.

People received personalised care, support and treatment that focussed on their needs, goals and preferences. People were involved in the development of their care and treatment. Care plans and associated risk assessments reflected their needs and preferences. People were encouraged to take part in activities which reduced the risks of them becoming lonely, bored and isolated. There were regular meetings for people using the service to feed back their experiences of the service and suggest improvements or changes. People were confident that they could raise concerns with staff and those concerns would be addressed.

Staff spoke positively about the management team and said they were approachable. Staff meetings were held regularly giving staff the opportunity to feedback their thoughts about the service. There was a system of reviews, checks and audits to assess and monitor the quality of service provided and identify any risks to the health safety and welfare of people using the service, staff and visitors. Records relating to the provision of care were fit for purpose.

Our inspection team comprised an inspector and a pharmacist. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:-

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, looking at records and speaking with people using the service, their relatives, and members of staff.

Please read the full report for evidence that supports our summary.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. One person told us, “It’s lovely and clean and they do look after us.”

We found that staff were supported with regular training and supervision to provide safe and appropriate care. One person told us, “The staff are very special, they are very caring.” A visitor commented, “When I leave here I have no concerns. I know he will be looked after.” Members of staff treated people with respect and dignity.

We looked at a random selection of care plans for people using the service. We saw they were person centred and reflected the individual needs of each person. They covered a comprehensive range of care and healthcare needs including individual risk assessments. We saw care plans were regularly reviewed and up to date which supported staff to deliver safe and appropriate care.

We found there were procedures in place to deal with foreseeable emergencies. For example, people had a personal emergency evacuation plan. In addition to the trained nurses that were on duty each shift some members of staff were first aid trained. All staff had fire safety training once a year.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. There was a safeguarding incident in 2013 which was raised by the service in relation to the administration of medication. On completion of the investigation improvements in procedures were introduced.

The Care Quality Commission monitors operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted at the time of the inspection appropriate policies and procedures were in place.

Is the service effective?

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We were told that an assessment of people’s needs was carried out by the matron or the deputy matron before people came to the home.

We were told there was an activity coordinator for the service most days. We observed a group activity taking place in the communal room. People using the service spoke positively about the activities provided. We saw a timetable of activities displayed. Staff told us that lots of relatives were involved in the regular social events that took place. One person told us, “They are very good here. There’s always a lot going on, a lot of entertainment.”

Staff received appropriate professional development. We found that the service employed a permanent trainer. We were provided with information and records to show that staff received regular training. Staff were able, from time to time, to obtain further relevant qualifications

Is the service caring?

We observed staff interactions throughout our inspection. We were told by staff they had the time to sit and talk with people and were encouraged to do so. One person said, “The staff are very special, they are very caring.” Another person said, “The staff are really wonderful, all of them. I am so glad there was a place here.”

Is the service responsive?

People expressed their views and were involved in making decisions about their care and treatment. We saw that care plans were person centred and recorded how people preferred their care and treatment to be delivered.

People’s care and treatment reflected relevant research and guidance. For example, the service achieved ‘Beacon’ status in the Gold Standard Framework for end of life care when they were reaccredited last year.

Is the service well led?

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We spoke with people using the service, visitors and members of staff who told us the matron and deputy operated an ‘open door’ policy and were approachable. One member of staff told us, “Brilliant manager, really approachable.”

There was a combination of meetings, audits, policies and approachability that demonstrated the provider had systems in place to assess and monitor service provision.

Whitgift House was registered to accommodate up to 36 people who had nursing needs. On the day of our inspection, 32 people were living at the home and we were able to talk at length to seven people, we also had informal chats with many others. The general view from people who used the service was positive, we received comments such as “staff are caring and compassionate especially when they hoist me” and “I’m comfortable and they look after me.”

We saw that the staff that were on duty at the time of our inspection had knowledge of individuals needs and were able to respond appropriately. There was a great deal of warmth and understanding displayed by the staff. People who used the service were also appreciative of the quality of the food and the range of activities provided and organised by the full time activities co-ordinator.

We were able to speak to seven of the thirty-four people living at the home. In general, all were positive about the care and support they were getting particularly from the staff. Comments we received included, ‘staff are a nice bunch’ and ‘staff are generally good, it’s the details that annoy you’.

People also told us that they felt safe living in the home and that any concerns or issues that they had would be listened to and acted upon.