CQC report explained · a residential care home
What the CQC found at Whittingham House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, July 2023
Rated Inadequate and placed in special measures; inspectors found people at risk of harm because safety, consent, nutrition and management systems were not reliable.
This was an unannounced focused inspection after concerns about safeguarding, staffing and poor care. Inspectors visited on 6 and 7 June 2023, reviewed records and medicines, observed care, and spoke with people, staff and relatives.
The home was rated Inadequate for Safe and Well-led, and Requires Improvement for Effective. Inspectors found risks from unsafe moving and handling, unlocked chemical and medicine storage, missed safeguarding reports, poor follow-up after injuries, and incomplete care records.
People were not always supported in line with the Mental Capacity Act. Some legal conditions were not followed. Inspectors also found gaps in food and fluid monitoring and examples of people not being supported sensitively to eat.
The overall rating fell from Good at the previous inspection to Inadequate. The home was placed in special measures, and CQC said it would monitor progress and normally re-inspect within six months.
Some people felt safe
Most people and relatives inspectors spoke with said they felt safe. Some relatives were also satisfied with how staff dealt with falls and contacted them.
“Most people and relatives told us they felt safe.” from the report
Medicines were administered
Although medicines were not securely stored and recording needed improvement, inspectors found that administration records were completed and the medicines checked matched the records.
“Medicines administration records (MAR's) were completed, and a sample of medicines we checked reconciled.” from the report
Some positive staff feedback
Some relatives described staff as caring and hardworking, and some staff said they felt supported by local managers.
“Staff are very good, and they work hard. They're always smiley and greet me like a friend.” from the report
People were at risk of avoidable harm
seriousInspectors saw unsafe moving and handling and found that risks from falls, injuries, distressed reactions and eating and drinking were not consistently managed.
“This meant people were not safe and were at risk of avoidable harm.” from the report
Safeguarding reports were missed
seriousSome accidents and injuries had not been reported to the local safeguarding team or CQC when required. Some were only reported after the inspection.
“We found a further two incidents where injuries had occurred that had not been reported to either the safeguarding authorities or CQC.” from the report
Consent and legal conditions
seriousSome Deprivation of Liberty conditions were not met. Mental capacity assessments and best-interest decisions were also missing for some restrictions.
“The principles of the MCA were not always followed.” from the report
Food and fluid support
seriousFood intake was not always recorded, fluid records did not always meet care-plan targets, and inspectors saw people being supported to eat in an unsuitable way.
“People were not always supported with their nutritional needs effectively.” from the report
Weak management checks
seriousThe home's audits did not identify the problems inspectors found. There was also no effective provider-level oversight.
“Robust and effective governance systems to monitor the safety and quality of people's care and welfare were not effective.” from the report
Limited meaningful activities
needs fixingInspectors saw few activities of interest. People were often asleep or disengaged, and no other meaningful activities were observed during the inspection.
“We did not observe any other meaningful activities taking place during our inspection.” from the report
- 01What immediate changes have been made to manage falls, moving and handling, injuries, distressed reactions and eating and drinking risks?
- 02How are medicine keys, controlled drugs cupboard keys and chemical storage now kept secure?
- 03How do you make sure every safeguarding concern and serious injury is reported promptly to the local authority and CQC?
- 04Which people now have completed mental capacity assessments and best-interest decisions, and how are Deprivation of Liberty conditions checked?
- 05How are food and fluid records reviewed each day, and what action is taken when a person does not meet their care-plan target?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings were used when calculating the overall rating. This explanation was written from the published report of 14 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, June 2021
Rated Good; inspectors found safe, caring and well-managed support, with clear improvements since the previous Requires Improvement rating.
This was an unannounced inspection on 10 May 2021. Two inspectors spoke with 12 people, staff and others, and reviewed care records, medicine records, staff files and management checks.
The home was rated Good overall. Safe, Effective, Responsive and Well-led were rated Good. The report does not give a separate Caring rating.
Inspectors found that people felt safe and were happy living at the home. Staff were trained, medicines were managed safely, care plans had improved, and people were supported with food, activities, healthcare and end-of-life care.
The previous inspection had rated the home Requires Improvement and found several breaches. This inspection found that improvements had been made and that the home was no longer in breach of regulations.
Improved risk management
Risk assessments and care plans had been improved and gave staff clear instructions. Personal evacuation plans and regular maintenance checks were also in place.
“Risks assessments were up to date and regularly reviewed. We saw these were person centred and provided guidance to staff to mitigate risks to people.” from the report
Safe medicines and infection control
Staff were trained and checked as competent to give medicines. Inspectors were assured that the home had suitable infection prevention and control arrangements, including for visits.
“Medicine records we reviewed were in good order. There were suitable systems in place for the storage, ordering, administering, monitoring and disposal of medicines.” from the report
Personalised care and activities
Care plans reflected people's preferences and needs. Staff supported people with activities, communication, cultural needs and spiritual support.
“Care plans were person centred and supported people as individuals to meet their preferences, over the care they received.” from the report
Stronger management and oversight
The manager had introduced new systems to monitor quality and learn from incidents. The report says the home was no longer in breach of the regulations found previously.
“New systems had been put in place to provide oversight of the service to the manager and provider.” from the report
Some records were still being transferred
minorThe new electronic care planning system was in use, but some records were still paper based and were still being uploaded. Ask how the home prevents important information being missed during this change.
“Some records were still paper based, but these were in the process of being uploaded to the system.” from the report
Manager registration was pending
minorThe manager had applied to be registered with the CQC, but the report does not say that registration had been completed. Ask about the current position.
“They had applied to be registered with the commission to make them the responsible registered manager for the service.” from the report
- 01Have all care records now been transferred from paper to the electronic system, and how do you check that no information is missed?
- 02What is the current position on the manager's application to become registered with the CQC?
- 03How do you make sure activities continue to match each person's interests, culture and communication needs?
- 04How do you monitor risks, accidents and incidents now, and how are lessons shared with staff?
- 05How will you support my relative's specific dietary, hydration and healthcare needs?
This was a planned inspection based on the previous rating and covered Safe, Effective, Responsive and Well-led; the report does not give a separate Caring rating. This explanation was written from the published report of 5 June 2021 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 Whittingham House
8 rated inspections over 7 years: the service has slipped, from Requires improvement to Inadequate.
- July 2023Inadequatecurrent ratingdown from GoodSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Inadequate
- June 2021Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- February 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- August 2019Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2019Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- December 2017Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- December 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
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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