About the service:

Whorlton Grange Residential Home is a residential care home that provided personal care for up to 51 people. At the time of the inspection, 47 people were living at the service.

People’s experience of using this service:

Medicines were not always administered in a safe way or in line with what had been prescribed.

Various systems and processes were in place and were monitored by the manager. However, audits and checks needed to be reviewed in light of our finding, in particular regarding medicines.

The provider had not met their legal requirement by sending the Care Quality Commission (CQC) all incidents which were notifiable.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in their care plans. The care plans were being developed to provide more information about people and their care needs.

People said they were safe living at the service. They were safeguarded from abuse by staff who had been trained in this area. Any accidents or incidents were monitored and any lessons learnt were acted upon.

Bedrooms had been personalised and made to feel homely. The service was clean and tidy.

Safe recruitment procedures were in place to ensure suitable staff were employed. We have recommended the provider review staffing levels and night time procedures to ensure they are still appropriate. Staff said they felt supported, however, yearly appraisals had not been completed, some for over three years.

Various tailored activities were available at the service, including regular entertainers and involvement in community events.

There was a manager in place who was in the process of registering with the CQC but before the inspection was completed, we were informed they had resigned. The previous manager’s (who was now the regional manager) registration was still in place and they were going to maintain an overview of the service until a replacement was found.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in connection with medicines, staffing and governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection:

Good (Report published on 22 June 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

The service is now rated overall as requires improvement. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This was an unannounced inspection which took place over three days on 24 and 25 February and 2 March 2016. The service was last inspected in April 2014 and was meeting the regulations in force at the time.

Whorlton Grange is registered to provide accommodation for people who need personal care. It provides a service primarily for older people, including people with dementia. Nursing care is not provided. The service had 51 beds, and there were 46 people living there at the time of this inspection.

There was a registered manager who had been registered since 2010. 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 home was warm, clean and had comfortable communal areas. There were sufficient staff, with different skills to meet the needs of the people living there.

People told us they felt safe, being cared for by staff who knew them well. Staff told us they knew how to raise concerns and had confidence action would be taken if they had any issues. Relatives told us they felt their families were safe at Whorlton Grange and the home was welcoming and had a happy atmosphere.

Risks to people, such as malnutrition and skin integrity, were assessed and care plans were in place to protect people from harm. Where people’s needs changed, referrals were made to health care services and advice from professionals was integrated quickly into the care plans and acted upon.

Staff were trained so that they could work flexibly with different people and were deployed so that at peak times there was sufficient staffing. Staff were effectively deployed throughout the day to meet the needs of people. For example ensuring support for people at mealtimes.

People’s medicines were managed safely; stock control and ordering were managed by trained staff with checks to ensure that the risk of errors were minimised. Audits were carried out regularly to ensure that staff were competent and that any errors would be quickly identified.

Care was effective and people received care based on best practice and the advice of external professionals. Care plans were detailed and personalised. People’s consent was sought, where this was possible. Where people could not consent, their care was delivered in their best interests after consultation with family and professionals.

There were a number of people subject to Deprivation of Liberty Safeguards (DoLS) and these had been managed well by the service with referrals for local authority authorisation being made appropriately. The service had a system in place to ensure that renewals were requested promptly.

Staff were recruited robustly and received training based on the needs of people using the service including dementia awareness. Staff had undergone an induction period and their mandatory training was up to date.

People were supported to eat and drink and maintain a balanced diet. Staff supported people at mealtimes in a dignified way. The service monitored people’s weights and took further action if needed. Visiting health care professionals told us the care and support offered was effective.

Care interactions observed were positive and there were good relationships between people and staff. All staff we spoke with knew people’s needs well and spoke about them in a positive manner. A relative told us, “All the staff know you and always ask how you are”. People and their families were encouraged to express their views and be actively involved in making decisions about their care and support. There was evidence of people’s involvement in their admission assessments and reviews of care, as well as house meetings and feedback surveys.

People’s choices and rights were respected. Staff knocked on doors before enteri

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?

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe with staff who provided their care and support. Relatives we spoke with told us they were confident that their family members were safe at the home. We found safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, “I’m happy here – safe, secure and comfortable.”

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. The building was clean, well maintained and secure and other appropriate measures were in place to ensure the security of the premises. One relative told us, "The care and treatment is absolutely wonderful; it’s a lovely place this. I’m very happy she’s so well looked after here." Another relative said, "I think they do a brilliant job. She can be difficult and stubborn at times, but they are patient and caring, and handle her very well. They have built up an excellent relationship and rapport with her."

We found the provider undertook appropriate checks before staff began work and effective recruitment and selection processes were in place.

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home. One relative told us, “She is well looked after and all her needs are met.” Another relative commented, “The staff seem very confident and competent in what they do.”

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, “They always ask me if I want help with anything.” One relative commented, "I’m in here every day to visit; you couldn’t get any better care and it has a lovely atmosphere.” Another relative said, "I’d definitely recommend this home. It’s safe and caring and nothing’s ever a bother.”

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed every six months to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

People and their relatives knew how to make a complaint if they were unhappy. We saw that three complaints had been recorded, investigated and resolved to the satisfaction of the complainant within the last 12 months.

We saw the service had policies and procedures in place in relation to the safeguarding of adults and Deprivation of Liberty Safeguards. We noted the registered manager had recently made a Deprivation of Liberty safeguard application to the local authority and reported two safeguarding incidents to the local authority safeguarding team. This meant that people were safeguarded as required and the provider responded appropriately to any potential allegations of abuse.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People and their relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We used a number of methods to help us understand the experiences of people who used the service. This included observing care, speaking with people who used the service, reviewing comments and surveys and speaking with staff.

We discussed the home with people who used the service and also their relatives. They told us that the home was ‘always clean’, ‘nice’ and they had ‘every confidence in the staff and the home’. We received comments that staff were ‘excellent, a great help and flexible’, as well as ‘respectful’ to people who used the service.

Relatives also commented that all issues are dealt with ‘immediately, there is good, proactive communication’. We were told that there were a variety of activities in the home and one person ‘had changed his outlook since coming into the home’.

We checked on the safety and suitability of the accommodation and environment. We saw the shared areas were clean and tidy and bedrooms were well decorated and personalised by individuals who used the service.

People and their relatives spoken to had access to their care plan and we were told that any changes in their care had been discussed with them.

Throughout our inspection we saw people were treated with consideration and respect. We reviewed four care records and saw that people's preferences and care needs had been well documented.

We spoke to staff, who were knowledgeable about people's care needs and what they should do to support them.

We observed the care given to people who used the service and spoke to their families. They told us they were ‘very happy’ with the care provided by staff and they commented that the staff were ‘very good’, ‘spoke to them well and with respect’ and they ‘really like it here’.

People who used the service and family members had also made comments that the home had ‘given devoted care over many years’ and staff were ‘kind and helpful and it is more than just a job’.

We spent time observing how people were treated and saw that staff spoke with people who used the service in a polite, respectful manner that encouraged decision making and independence. We asked people if they had any complaints but although they said they knew who to talk to they said they did not have any. People who used the service also told us they had enough to do.

People who used the service and also family members spoken to, said they had seen care plans, that they were consulted about changes to care and the home included them in reviews of care plans.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

The people who we spoke with said staff always respected their privacy and dignity. They thought the staff were very caring and helpful. They said the food was very good and they were always given a choice. People said the atmosphere was always friendly and there were plenty of activities taking place. They told us the manager was very approachable and they felt confident any concerns or complaints would be taken seriously.