Our previous comprehensive inspection to the service was on 5 and 7 February 2018. The overall rating of the service at that time was judged to be ‘Requires Improvement’. A breach of regulation 17 [Good governance] with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was made. However, the service remained in ‘Special Measures’. We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in ‘Special Measures’.

Whittingham House provides accommodation and personal care for up to 70 older people and people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Whittingham House is a large detached building situated in a quiet residential area in Southend on Sea and close to all amenities. The premises is set out on two floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service on each floor. The service is separated into units and consists of Lemon and Lavender suites on the ground floor and Blossom and Bluebird suite on the first floor. At the time of this inspection Bluebird suite was not in use.

This inspection was completed on 27, 28 and 30 November 2018 and was unannounced. There were 44 people living at the service.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

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.

A registered manager was 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.

Quality assurance checks and audits were not robust, as they did not identify the issues we found during our inspection and had not recognised where people were placed at risk of harm and where their health and wellbeing was compromised. The management team of the service had not taken appropriate steps

At a previous unannounced comprehensive inspection of this service carried out on the 10, 11, 12, 13 and 14 July 2017, we found breaches with regulatory requirements relating to Regulation 9 [Person centred care], Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing]. As a result of our concerns the Care Quality Commission took action in response to our findings by rating the service as ‘Inadequate,’ placing the service into ‘Special Measures’ and amending the provider’s conditions of registration.

Whittingham House 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 care home accommodates up to 70 older people and people living with dementia.

Whittingham House is a large detached building situated in a quiet residential area in Southend on Sea and close to all amenities. The premises is set out on two floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service on each floor. The service is unitised and consists of Lemon and Lavender Suites on the ground floor and Blossom and Bluebird Suite on the first floor.

The Local Authority had placed a restriction on the service provision following our last inspection to the service in July 2017. This inspection was completed on the 5 and 7 February 2018 and was unannounced. At the time of this inspection there were 38 people living at the service.

Since our last inspection to the service in July 2017, a new manager had been appointed and had been in post at Whittingham House since the 14 August 2017. The manager was registered with us on 2 March 2018. 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 overall rating for this service is ‘Requires Improvement.’ However, the service remains in ‘Special Measures.’ We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Whilst a number of improvements were noted since our last inspection in relation to the registered provider’s arrangements for safeguarding, staffing levels, staff training, induction, supervision and some aspects of care provision, further improvements were still required. Quality assurance arrangements at both provider and service level were not as effective as they should be. Where issues were highlighted as part of the management teams auditing arrangements, information was not always available to show actions required had been addressed. The registered provider and manager had failed to monitor and evaluate this progress properly so as to assure themselves that sufficient improvements had been undertaken to their audit and governance arrangements and these were effective and any improvements made were sustained.

Not all risks to people were identified and improvements were required to record how these were to be mitigated so as to ensure people’s safety and wellbeing. Improvements were required to ensure that people’s care plan documentation reflected all of their care and support needs and how the care was to be delivered by staff.

Although people told us that staff cared for them in a kind and caring manner and whilst some aspects of care by staff was seen to be good, other arrangements w

Whittingham House provides accommodation and personal care for up to 70 older people including people living with dementia. However, the provider had placed a restriction on the service provision and there were 43 people living at the service on the day of inspection.

We carried out an unannounced comprehensive inspection of the service on the 10, 11, 12, 13 and 14 July 2017. Previously, the service had been inspected in November 2016 and received an overall rating of requires improvement.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. 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 time frame. If not enough improvement is made within this time frame 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 this registration.

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. The Care Quality Commission is now considering the appropriate regulatory response to resolve the problems we found during our inspection.

The service did not have a Registered manager. It is a requirement of the service’s registration with the Care Quality Commission that there is a registered manager in place. 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 no systems in place to ensure that staff were deployed in a way which met people’s changing needs and circumstances. This meant that staffing levels were not adequate to ensure that people’s needs were met and people were put at potential risk of harm.

Care records, plans, and assessments were very generic and did not take account of people’s individual needs effectively. Information had not always been recorded or assessed to demonstrate how the service was going to mitigate any risks to people’s safety. People were at risk as the processes in place to safeguard people from potential incidents remained inadequate.

Staff training had not been embedded in everyday practice. Staff training was out of date in some cases and their competency to perform their duties had not been reviewed. Staff did not receive regular supervision and support, which meant that staff lacked the skills and support to perform their roles effectively.

Improvements were required to the way in which the service assessed people’s capacity to make decisions and how they supported people to make choices. People’s dining experience was not always positive. The service needed to improve the way mealtimes were organised and how choices were offe

Whittingham House provides accommodation and personal care for up to 70 older people and older people living with dementia. However, the provider had placed a restriction on the provision of services. The manager confirmed that 57 was the maximum number of people they would provide a service to.

The inspection was completed on 22 and 24 November 2016 and was unannounced. There were 53 people living at the service when we inspected.

The service is required to have 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. A registered manager had not been in post since November 2015. However a new home manager had been appointed in October 2016.

Arrangements to manage and mitigate against risk, so as to ensure people’s safety and wellbeing, required improvements to make robustness certain. Risk assessments had not been developed and documented appropriately for all areas of identified risk such as; pressure ulcers, diabetes and people’s behaviours that challenged care workers. Improvements were required to ensure that the care plans for people were detailed accurately to ensure staff had adequate information to support people. Improvements with regard to the recording of care and treatment provided had been considered by the provider and plans were in place to introduce computerised systems to increase efficiency of care workers.

The service needed to improve their quality assurance systems. Systems were in the process of being developed by the newly appointed home manager to embed robust quality monitoring of the service. Although systems were in place to make sure that people’s views were gathered, feedback from people and relatives had not been acted upon to drive improvements within the service. There had been a lack of oversight by the provider with regards to ensuring leadership was present and high quality care was consistently delivered.

Improvements were needed in the way the service and staff supported people to lead meaningful lives and participate in social activities of their choice and ability. The provider advised us this had been addressed and a new activity co-ordinator had been recruited.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient members of staff enabled peoples individual needs to be met adequately. Qualified staff dispensed medications and monitored people’s medication needs satisfactorily.

The manager was making developments within the service. A new workforce was being created and effective teamwork was being promoted. Care workers were being supported to obtain further skills and knowledge and were supervised effectively to ensure consistent best practice. The service worked well with other professionals to ensure that people's health needs were met. Where appropriate, support and guidance were sought from health care professionals, including Community District Nurses and social workers.

Assessments had been carried out where people living at the service were not able to make decisions for themselves. Care workers understood the importance of consent and ensured that people were given choice. Although care workers knowledge of Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) was variable the manager had arranged for external training to increase staff confidence around the subjects. ‘Best interest’ meetings were being held to ensure that people’s decisions were protected and respected.

Staff understood people's needs and treated people with dignity and respect. Positive relationships had been created between people and care workers. Advocacy services were provided where needed to ensure pe

Below is a summary of what we found during our inspection. The summary is based on our observations during the inspection. During the inspection we spoke with and spent time with people using the service. We spoke with staff supporting people and the manager of the service. We also spoke with five people's relatives.

We looked at five people's care records. Other records viewed included staff training records and rotas, health and safety checks and staff and resident meeting minutes.

If you want to see evidence supporting our summary please read our full report.

We considered our inspection findings to answer 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?

Is the service safe?

When we arrived at the service our identification was checked and we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

The Care Quality Commission, (CQC,) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate actions had been taken to safeguard people's rights. Relevant staff had been trained to understand when an application should be made and how to submit one.

We saw appropriate arrangements were in place in relation to the management of people's medicines. People could therefore be confident that they were protected from the unsafe use and management of medicines.

We saw records which showed that health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

The service was kept clean and staff practice ensured that people were protected as far as possible from the risk of infection. People were happy with how the service was kept with one relative telling us that, "The place is kept spotless, you can't fault it."

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People made comments such as, "I am quite content here, the staff are kind and the food is good," "I can't fault it so far," and, "The carers are helpful and considerate."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Staff who worked in the service were supported through induction, on-going training and supervision to offer people care and support to meet their needs. Staff were positive about their role and felt that teamwork in the service was good.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect.

Staff had a knowledge and understanding of people's care and support needs, including recognising and supporting them as individuals. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People’s preferences, interests, aspirations and diverse needs had generally been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken in to account and listened to.

We saw that staff were responsive to people's changing wishes and needs and supported them well.

People told us that they felt able to raise any issues they might have and felt that the service would act upon their concerns.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

Leadership in the service had improved. A registered manager was in post supported by a deputy manager. Management cover was being provided across the week and at weekends to ensure good support and consistency of approach to managing the service.

People's care was organised through adequate care planning and recording which was kept under review and monitored. Staff allocation systems ensured that staff were accountable and that practice could be monitored. Staff also had lead areas to monitor practice in aspects such as health and safety and infection control. The provider had arrangements in place to regularly assess and monitor the quality of the service provided. Audits were undertaken to assess all aspects of the service and actions were taken where shortfalls were identified. This showed us that the provider sought to provide a good and consistent service.

People had the opportunity to express their views about the service through meetings and one to one discussions.

People we spoke said they were happy with the way their medicines were managed. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the storage and recording of medicines.

People we spoke with seemed generally content living in Whittingham House, and felt that they were given choices about when they went to bed.

As at our previous recent visits to the service we found that care records and practice needed improvement to show that people were receiving the care that they needed.

From discussions and records viewed at this and previous visits it was clear that Whittingham House was going through a period of change. This had led to a high turnover of staff and had on occasions had an impact on the levels of staff provided.

We found that staff were caring in their approach, and had an understanding of people's needs. The new management team at the service were working hard to ensure that all staff were properly trained and supervised on a regular basis.

People told us that they felt comfortable living in Whittingham House. One person said that they were, “Quite comfortable, with good food, good staff and good beds.” People told us that they could follow their own routines, were offered choices about their care, and that staff treated them kindly. Staff spoken with had an adequate understanding of individual people's needs. People were treated respectfully and their individuality understood.

We found that people's needs were assessed and planned for to ensure that their individual needs would be met. New care planning and recording systems had been put in place which made it easier to understand peoples' needs and to follow their progress.

People felt that there was a lack of opportunity for activity and occupation in the service. We saw that the provider was trying to address this.

People told us that the staff who worked at the service were good. One person said, "The staff are lovely." We found that staff were now supported through better levels of training to have the skills and knowledge needed to carry out their role effectively.

People told us that they were happy with the quality of the service provided. We found that the provider now had more robust processes in place to monitor the quality and safety of the service.

People told us that they felt comfortable living in Whittingham House. They told us that they could follow their own routines, were offered choices about their care, and that staff treated them kindly. Staff spoken with had a good understanding of individual people's needs. People were treated respectfully and their individuality understood.

We found that people's needs were better assessed and planned for to ensure that their individual needs would be met. People however felt that there was a lack of opportunity for activity and occupation. The provider told us that they were trying to address this.

People told us that the staff who worked at the service were good. One person said, "I get on well with all the staff." We found that staff were now supported through regular supervision but that levels of staff training still needed to be improved to ensure that staff had sufficient and up to date knowledge and skills.

People told us that they were happy with the quality of the service provided. We found that the provider was now consulting with people more to seek their views. Although the provider was undertaking more monitoring of the service to ensure that standards of quality and safety would be maintained, development was still needed to make sure that quality and safety is established and maintained on an ongoing basis.

People using the service told us that they were happy living at Whittingham House and that they felt satisfied with the care and support they were offered.

People said that they liked the food provided and told us they were offered choice about what they ate.

People told us that the staff were friendly and caring.

People said that they felt safe and secure living in Whittingham House.

People told us that they were comfortable living in Whittingham House. They told us that the staff were kind and approachable. People told us that they always had plenty to eat and drink and enjoyed the food. Some people however told us that they would like it if breakfast was served earlier.

People told us that they were generally content living at Whittingham House and that staff were kind and friendly.

People using the service told us that they were happy living at Whittingham house, and that they felt satisfied with the care and support they were offered.

People said that they liked the food provided and told us they were offered choice about what they ate.

People told us that the staff were friendly and caring.

People living in Whittingham House told us that they were happy there. They said that the care and support they received met their needs. They told us that staff and the manager at the home were good and that they felt at ease with them. Comments such as, “I have been very pleased with things here,” and, “The staff are good” were made.

People told us that they liked the food at the home and were happy with their rooms.

Relatives told us that, although there was still work to do, the service had improved a good deal in recent times. They felt that staff were better and spent more time with people using the service.

People told us that they felt comfortable living in Whittingham House. One person said, “I am content, I like my room and am happy with the food.” People told us that they liked the staff. One person said, "They are all friendly and kind."

Staff spoken with had an adequate understanding of individual people's needs. We found that staff were caring and responsive to people's needs. People were treated respectfully, and staff interacted well with them. We also found that staff sometimes needed to give attention to detail to ensure that people always received good and consistent care.

We found that people's needs were assessed and planned for to ensure that their individual needs would be met. We found that improvements were needed to make sure that care plans were always detailed and person centred.

The premises appeared to be satisfactorily clean and people were happy with the level of cleanliness maintained. However, improvements were needed to make sure that staff at the service followed the correct guidelines and the providers own procedures to ensure adequate levels of hygiene and infection control.

There was sufficient equipment provided to meet people's individual needs. Equipment was generally maintained in a safe and satisfactory condition.

We found that there were significant issues with the way that staff are initially trained and supported on an on-going basis through training and supervision. It was recognised that the new management team in the service were working hard to address this and other issues identified to ensure an effective and well led service.