Whitstable House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We identified a breach of regulation as people’s dignity was not always maintained. People’s needs were not always met in a timely way. People were not always given choices and were dressed in clothes which were not their own. Staff explained how they maintained people’s dignity, but this was not always people’s experience. Some staff did not always engage with people, only responding when people became distressed.

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us about occasions when they had witnessed staff not treating other people with kindness. One person told us, “A lot of the carers just ignore the ladies that want the toilet. They don’t like it if you go to find them to get someone to help, when there are no staff around, which happens a lot. I’ve seen carers walk past those shouting 'help me, help me'. Sometimes the staff speak their own language around you, so you don’t know what they’re saying. I think it’s rude.” Another person told us they had clothing go missing, “I have a problem with my things going missing. My clothes are tagged to my room number but I’m sitting here in clothes that don’t belong to me.” The person had told us they felt they were being ignored as there had been no action to find their clothes.

Staff explained how they promoted people’s dignity. Staff told us, “I introduce myself from their door, I ask for their consent to support them, explain why I am there, cover them with towels, close the curtains, keep the door shut and give them privacy when they use the toilet.”

Professionals told us, they did not always feel the staff were as open as they could be during their visits about people's care needs. There was also concern that staff did not always follow their guidance, this could place people at risk of not receiving the support they required or their condition improving.

During the assessment we observed staff had neutral engagement with people, for example, offering a drink without necessarily a choice of drink, or only responding to someone when they were becoming agitated, not pre-empting the situation to avoid or reduce likelihood of the person becoming agitated. Staff did not treat people as individuals and did not recognise triggers for people's change in mood.

People told us they did not feel they were always treated as individuals. People commented, “Sometimes there’s activities, but you’re stuck on your own a lot of the time. I’ve made two friends here. Sometimes someone comes and throws a ball to you, and you’re supposed to throw it back.” Another person told us, “I get a bed-bath between 7 and 7.30 [am] and I’m ok with that, but I’d like to have my breakfast later, about 10.30 [am] but they don’t do it like that.” Another person told us they felt they were treated as a ‘patient’ only receiving a quick wash. They told us they had only had one shower since coming to the service, though this would be their preference, each day.

Staff told us they supported people in line with their choices and preferences. One staff member told us, “When people join us, we ask them all about their preferences for care, their hobbies and interests, and if they can’t tell us very much, perhaps because they have dementia, we speak with their families and friends.” However, this was not always people’s experience, people had not been supported in the way they preferred.

There was a lack of activities within the service and these were not linked to people's interests or to be productive and engaged. We spent time in the communal lounges, there were some activities taking place such as a quiz or throwing a ball. There were no planned activities which had been suggested by people. There were a few people taking part in the quiz but most people were watching the television.

The systems in place had not been effective in recording people’s choices, preferences and individual health needs. People’s care plans did not always include specific information for staff to follow to make sure people were treated as individuals. There was little information about people's interests and what they would like to do to keep themselves occupied.

One person told us, “If I ask to see a GP, I see one, but why do they use Tunbridge Wells, not the surgery next door? They told me (the provider) use Tunbridge Wells.” Another person told us, “The staff only come in to give my medicines, personal care, drop off food. They don’t come in for a chat, no.” They told us, “I have my medicines at 8[am], 12 and 4[pm]. I have capacity and I can do them myself, but they’re kept in a locked cupboard up there [on the wall above the kitchen sink area]. I can’t reach them, and they have the keys, so I must wait for the staff. All my choices are restricted by the availability of staff for when I want my medicines, to get up, to have a wash… you could use the call bell, but you can’t hear whether it has gone through. Response time are around 15minutes.”

Staff described how they supported people to make decisions. One staff member told us, “We ask people how they like to be supported and what they want to do, where they want to sit, what they want to eat and drink.” Another told us, “I give people choices by offering options with their clothes and shoes and meals/drinks and what activities they want to do.” However, this was not always people’s experience.

We observed people at lunch time being given meals and drinks they had not chosen. People had to ask staff for a different meal as staff did not always offer them a choice, people vocalised their disappointment at the meals. People confirmed they had not been offered a choice before the meal and were unaware what the meal was. We observed people who enjoyed a vegetarian or vegan diet were most affected by a lack of choice, there was not specific meals for them to choose from. They were not assured they would receive the diet they preferred.

The processes in place were not effective in recording people’s choices and capacity to make decisions. There was no oversight by the management team to make sure people’s choices were being respected. When changes had been made to people’s support reasons had not been recorded and discussions had not been had with people for the reasons.

People’s experience of staff responding to their needs was not always positive. One person told us, “Some of the staff are ok. The good ones listen, and they communicate well, they’re gracious. It makes them popular, so they’re run off their feet. But in general, the staff aren’t kind or caring and I feel like I’m in the way, that I’m a pain. Some of the staff are belligerent.” Another person told us, “One morning I had no pad change until after 11 [am]. I was in the same pad through the night. I wanted a wash and get up and the carer said they would come back but he didn’t. After 2 hours I asked what the problem was, but he didn’t say. This happens all the time. If someone uses the call button, the carers don’t turn up.”

Staff described how they responded to people ‘s needs and requests. However, this was not always people’s experience, staff were unaware people were not happy with the care and support they provided. The management team and staff were not aware of the impact this had on people.

We observed people having to wait for staff when they used the call bell. People were waiting for long periods of time and for some people this had caused distress as they were waiting for assistance to use the bathroom. Staff had not opened people's curtains, people were still waiting to have their curtains open when we spoke to them in the middle of the morning.

Staff told us the management team were supportive. One staff member said, “The managers are very supportive, they check us to see how we are handling the patients, do spot checks and they are available. The duty manager is the first port of call.” However, staff told us there were areas such as oversight and support for staff with the medicines where they thought more could be done. We were told, “To some extent. I would like to see a more proactive oversight of medicine’s stock take, for example. I am not sure we are doing all we can.”

The provider had processes in place to supervise, train and mentor staff, however, the management team had not followed these. The management team had not had effective oversight of the staff team. Staff did not always have the skills to undertake their role and support people safely. The management team had not identified the poor culture within the service and the shortfalls within the staff team and how they interacted with people. Following the assessment the provider told us an induction manager will be based at the service to complete another induction with staff. We will review this at our next assessment.