CQC report explained · a residential care home
What the CQC found at Whitestones Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- There were enough staff and people were protected from abuse and infection. However, medicines taken when needed were not always supported by clear instructions or complete records.
- Effective?
- Good
- People's needs were assessed, staff were trained, and people received suitable food, drinks and health support. The provider worked within the Mental Capacity Act.
- Caring?
- Good
- People and relatives described staff as kind and caring. Staff knew people's preferences, respected their beliefs and supported privacy, dignity and independence.
- Responsive?
- Requires improvement
- People received person-centred care and enjoyed activities. However, end-of-life care wishes were not always recorded, and some complaints were not investigated or used for learning.
- Well-led?
- Requires improvement
- Management systems did not reliably identify and correct problems with medicines, care records, complaints or end-of-life planning. Some staff supervision and training records were also incomplete.
What inspectors found, January 2023
Rated Requires Improvement; inspectors found kind and effective care, but unsafe medicines management and weak oversight remained.
This was an unannounced follow-up inspection on 2 December 2022. Inspectors spoke with people living in the home, relatives and staff. They reviewed care, medicines, staff records and management documents.
The home had enough staff, protected people from abuse and infection, and allowed visitors. Care was effective and kind. People received suitable food, health support and activities, and staff respected their choices, privacy and dignity.
There were important shortfalls. Instructions and records for medicines taken when needed were not always safe. End-of-life wishes were not fully recorded, some complaints were not properly reviewed, and management checks had not found or fixed these issues.
The overall rating was Requires Improvement. Safe, responsive and well-led were rated Requires Improvement, while effective and caring were rated Good. The home had the same overall rating as at the previous inspection and remained in breach of Regulation 17.
Enough staff
Inspectors found enough staff to meet people's needs, and people did not have to wait for support. Recruitment checks were also completed.
“There were enough staff on duty to meet people's needs. People did not wait for staff to support them.” from the report
Kind and respectful care
Staff knew people well, used their preferred names and respected their privacy, dignity, beliefs and choices.
“People and relatives told us staff were kind and caring.” from the report
Skilled staff
Staff had training, induction and refresher learning relevant to the needs of people living in the home.
“Staff were trained effectively to meet the needs of people in the home. Staff had the skills and knowledge they needed to support people.” from the report
Activities and visits
People took part in activities they enjoyed, and relatives and friends could visit without restriction.
“People took part in activities which they enjoyed.” from the report
Medicines taken when needed
seriousThere was not always clear guidance for staff about when or why to give these medicines. The reasons for giving them were not always recorded, which could make it harder to review people's health.
“Where people received medicines as and when required (PRN) there was no guidance for staff to know how and when to support people to take these medicines.” from the report
End-of-life planning
needs fixingCare plans focused more on people's wishes after death than on how they wanted to be cared for before death. This issue had also been identified at the previous inspection.
“People were not always supported to express how they would like to be cared for if they were to approach the end of their life.” from the report
Complaints and learning
needs fixingSome complaints were not investigated or answered according to the provider's policy. The home did not record learning from a complaint upheld by the local government ombudsman.
“Complaints had not always been investigated or responded to in line with the providers policy.” from the report
Weak management checks
seriousAudits did not identify unsafe medicines practice. Reviews of daily care records were informal, and some staff supervision and training records were missing.
“Governance processes were not always operated effectively to identify where improvements may be required.” from the report
- 01What clear instructions are now in place for medicines taken when needed, and how do you record why each dose is given?
- 02How are each person's wishes for care before the end of life recorded and reviewed?
- 03How do you investigate complaints and record the lessons or changes that follow?
- 04How do managers check daily care records and medicines records so problems are found quickly?
- 05Are all staff, including those who transferred from another home, fully trained and receiving supervision?
This was an unannounced follow-up inspection after the previous inspection, covering the care and premises of the home, rather than a new comprehensive inspection. This explanation was written from the published report of 20 January 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, February 2020
Rated Requires Improvement; inspectors found kind and responsive care, but staffing, safety and management systems did not always protect people.
This was an unannounced, planned inspection on 20 January 2020. Inspectors spoke with 10 people, six relatives and eight staff. They reviewed care plans, medicines records, staff files and management records.
The home was not always safe. Staff were not always available when people became distressed, and people sometimes relied on each other for reassurance. The home also did not always provide enough choice at mealtimes or drinks and snacks during the day.
There were positive findings. Staff were kind in the interactions inspectors saw, knew people well and supported activities, independence and end-of-life care. The home followed mental capacity requirements, and its infection control was managed well.
The overall rating was Requires Improvement. Safe, Effective, Caring and Well-led were all rated Requires Improvement. Responsive was rated Good. Safe and Effective had fallen from Good since the previous inspection, while Well-led remained Requires Improvement.
Kind interactions
Inspectors saw staff treating people with kindness, dignity and respect. People, relatives and visitors also spoke positively about staff.
“People were treated with kindness, dignity and respect during all the interactions with staff that we saw.” from the report
Personalised support
Staff knew people's life histories, preferences and what mattered to them. Care plans included detailed information to help staff provide individual support.
“Staff knew people well and understood people's life history and what was important to them.” from the report
Activities and relationships
People could take part in group and one-to-one activities. Visitors were welcomed without restrictions on visiting times.
“People were supported to take part in a variety of activities.” from the report
Clean home
The home was clean and staff followed infection control practices. Staff had and used suitable protective equipment.
“The control and prevention of the spread of infection was managed well.” from the report
Supportive manager
People, relatives and staff spoke highly of the registered manager. Staff said they felt valued and respected.
“Without exception, people, relatives and staff spoke highly of the registered manager.” from the report
Staff availability and safety
seriousStaff were sometimes unavailable when people became distressed. People were relied on to reassure one another, and incidents included verbal and attempted physical abuse.
“Staff were not always deployed effectively to support some people to stay safe.” from the report
Missed safeguarding information
seriousThe manager did not know about one recorded incident involving abuse and had not investigated or referred it to safeguarding professionals.
“The registered manager was not aware of the other incident and therefore had not investigated or referred the incident to the safeguarding team.” from the report
Food and drink choice
needs fixingPeople did not always receive a choice at lunchtime. Everyone was offered the same type of drink, and access to drinks and snacks was not always available throughout the day.
“People did not always have choice at mealtimes or access to drinks and snacks throughout the day.” from the report
Behaviour support records
seriousBehaviour support plans and records were not always updated, accurate or used effectively. This could mean staff and outside professionals did not have a clear picture of what had happened.
“The provider had failed to effectively implement positive behaviour support plans for people who displayed behaviour that challenged.” from the report
Weak management checks
seriousThe manager did not reliably review or audit records about behaviour that might challenge others. Care plans were reviewed monthly but were not always updated effectively when needs changed.
“Governance and performance management were not always reliable or effective.” from the report
End-of-life planning
needs fixingThe home supported people to have a dignified death, but records did not explain how people wanted to be cared for if they became seriously unwell or approached the end of life.
“There was no information about how people would like to be cared for if they became seriously unwell or were approaching the end of their life.” from the report
- 01What staffing changes were made after the inspection, including the designated well-being staff member in the communal room?
- 02How do you now identify, record, investigate and refer incidents involving abuse or challenging behaviour?
- 03How are behaviour support plans kept up to date when a person's needs change?
- 04What choices are now offered at each meal, and how can residents get drinks and snacks throughout the day?
- 05How are residents' wishes about care if they become seriously unwell or approach the end of life recorded?
This was an unannounced inspection covering all five key questions; Safe and Effective had deteriorated from Good, Responsive remained Good, and Well-led remained Requires Improvement since the previous inspection. This explanation was written from the published report of 20 February 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 Whitestones Care Home
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- January 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- July 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2014
Report published without a new overall rating.
- July 2014Inspected but not rated
- November 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 6 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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