CQC report explained · a residential care home
What the CQC found at Whitchurch Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough skilled staff, suitable safeguarding procedures, up-to-date risk assessments and safe systems for medicines. They were also assured about infection prevention and control.
- Effective?
- Good
- People's needs were assessed and care plans were reviewed with families and staff. Staff had relevant training, people were supported with eating and drinking, and the home worked with health and social care professionals.
- Caring?
- Good
- Are people treated with kindness and dignity?
- Responsive?
- Good
- Is care built around the person? Care plans, activities, complaints.
- Well-led?
- Good
- Inspectors found active management, regular checks on quality and safety, and a culture of learning when things went wrong. People, relatives and staff gave positive feedback about how the home was run.
What inspectors found, July 2023
Whitchurch Lodge was rated Good; inspectors found safe, effective and well-managed care.
This was an unannounced focused inspection. The inspection activity took place from 23 to 26 June 2023, with visits on both dates. One inspector and an Expert by Experience spoke with people, relatives, staff and managers, and reviewed care files, medicines records, staff files, policies and audits.
The home was rated Good overall and for Safe, Effective and Well-led. Inspectors found enough trained staff, safe medicines systems, suitable risk assessments and good infection control. The home was clean, well maintained and people had access to healthcare and support with food and drink.
The inspection found that managers monitored the quality of care, investigated incidents and acted on learning. The rating was unchanged from the previous Good rating published in January 2020.
This inspection only looked at Safe, Effective and Well-led. Caring and Responsive were not inspected, so this report does not provide new findings or ratings for those areas.
Enough trained staff
Inspectors found enough staff with the skills, experience and knowledge to meet people's needs and keep them safe.
“The provider had recruited enough skilled staff to meet people's needs and keep people safe.” from the report
Safe medicines
The home had systems for prescribing, giving, recording and storing medicines. Monthly audits were used to identify and deal with errors.
“People were supported by staff who followed systems and processes to prescribe, administer, record and store medicines safely.” from the report
Good partnership working
The home worked with health and social care professionals, and guidance from them was included in people's care plans.
“Staff worked in partnership with health and social care professionals to plan and deliver positive outcomes for people.” from the report
Active management and monitoring
Managers used audits, meetings and feedback to monitor the service and identify improvements. Inspectors found a culture of learning after incidents.
“There were systems in place to monitor the quality and safety of the service on a regular basis.” from the report
Inspectors raised no specific concerns in this report.
- 01How will you make sure my relative's risk assessments and care plans are updated when their needs change?
- 02How will you support my relative to choose meals and manage any eating or drinking needs?
- 03How often will you review my relative's medicines and explain any changes to the family?
- 04How will you involve my relative and our family in care plan reviews and feedback about the service?
- 05As Caring and Responsive were not inspected in this visit, how do you support personal preferences, activities and changing needs?
This was an unannounced focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected in this visit. This explanation was written from the published report of 19 July 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2020
Rated Good; inspectors found kind, safe and personalised care, with a few records and follow-up tasks still needing attention.
This was an unannounced inspection on 27 and 28 November 2019. The inspector spoke with people living in the home, relatives, staff and visiting professionals. They also observed care and checked care records, staff files, medicines, maintenance and quality checks.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and were treated with respect. Inspectors saw caring interactions, suitable staffing, safe medicines practice, personalised care and a range of activities.
Inspectors found some minor gaps. The names of staff taking part in fire drills were not recorded. Guidance about preventing accidents from happening again was not written in the accident book. The home did not yet have a policy for accessible information, and the analysis of a satisfaction survey was unfinished.
The previous overall rating was also Good, published on 26 April 2017. Safe had improved from Requires Improvement to Good, while the other four areas remained Good.
People felt safe
People and relatives said they felt safe, and inspectors found risk assessments, safeguarding procedures and suitable emergency arrangements.
“People told us that they were safe in the home.” from the report
Kind and respectful staff
Inspectors saw staff spending time with people and speaking to them in a friendly and respectful way. People and relatives also described staff positively.
“We observed positive interaction between people and staff.” from the report
Personalised support
Care plans covered people's individual routines, health, cultural and religious needs. Staff knew how to support people with these needs.
“People received personalised care and support.” from the report
Safe medicines and staffing
The records checked showed that people received their prescribed medicines. Inspectors also found appropriate recruitment checks and enough staff to meet people's needs.
“Medicines administration records (MAR) examined indicated that people received their medicines as prescribed.” from the report
Activities and inclusion
People could take part in arts and crafts, entertainment, visits and outings. Staff also supported religious and cultural observances.
“The home had a an activities organiser and a varied programme of social and therapeutic activities” from the report
Fire drill records
minorThe home carried out fire drills, but did not record which staff took part. This made it harder to show that all staff had participated.
“We however, noted that the names of staff who participated in the drills had not been recorded.” from the report
Recording learning from accidents
needs fixingAccidents were recorded, but the accident book did not include the guidance and action intended to prevent them happening again. The manager said this information was in people's care records.
“Guidance and action to prevent re-occurrence was not recorded in the accident book.” from the report
Accessible information policy
needs fixingThe home did not have a policy explaining how it would meet the Accessible Information Standard. The manager said one would be provided and that some documents were already available in large print or could be translated.
“The home did not have a policy for meeting this standard.” from the report
Survey follow-up
minorA satisfaction survey had been carried out, but its analysis and report were not yet complete. The manager said this would be done soon.
“The analysis of this had not been completed.” from the report
- 01Have you now recorded which staff take part in fire drills, and how do you make sure all staff practise emergency procedures?
- 02How do you record and review what has been learned after an accident?
- 03Has the promised Accessible Information Standard policy been completed, and how would you provide information in large print, another language or another suitable format?
- 04What did the annual satisfaction survey show, and what improvements followed from it?
- 05How are people's cultural, religious, dietary and activity preferences reflected in their current care plans?
This was an unannounced planned inspection of the care home, covering both the premises and the care provided, with ratings given for all five key questions. This explanation was written from the published report of 10 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Whitchurch Lodge
4 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- July 2023Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2020Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- April 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 14 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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