Wishingwell Residential Care Home

Wishingwell Residential Care Home provides accommodation and personal care for up to 4 older people who may be living with dementia. Accommodation is provided in an adapted house over 2 floors. At the time of our inspection there were 4 people using the service.

People’s experience of using this service and what we found

People had a very positive experience of using the service and consistently praised the care and support they received. However, there were wider risks and issues with how the service was managed which put them at increased risk of harm. Staff had not been safely recruited and they had not always completed appropriate and relevant training. Risks had not been thoroughly assessed and managed. This included risks in relation to fire safety, people’s mobility and use of the stairs, and the safe management and administration of medicines. The provider had not completed audits or checks so issues that put people at risk of harm had not been identified and addressed.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

We made a recommendation around monitoring people’s weight to ensure any issues around malnutrition could be identified and addressed in a timely way.

Despite these concerns people felt safe and well cared for. People praised how staff supported them, and relatives felt there was excellent communication, and that they were involved in all aspects of people’s care.

The home environment was clean and welcoming. Staff were friendly, kind and respectful.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 9 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wishingwell Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We identified breaches in relation to the safety of the care, the recruitment of staff, consent and the provider’s oversight and governance arrangements at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wishingwell Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates four older people living with dementia in one adapted building.

There was no requirement to have a registered manager at this service as the registered provider ran the service. 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.

There were sufficient staff on duty who had been trained and had the skills and knowledge to meet people's needs. Staff recruitment was carried out safely with checks of people's background.

Maintenance of equipment was carried out and was up to date. There were now regular checks of fire safety equipment and drills. There was an emergency plan in place so that staff knew what to do in the event of an emergency situation.

People's social needs had been met and activities were part of their everyday life. Staff were respectful to people and preserved their dignity. They had a caring and compassionate approach to people.

There was a complaints policy in place but no complaints had been received by the service. People's records were stored securely.

The service was a family home and that was reflected in the way people were relaxed and happy taking part in domestic and other activities.

People's nutritional needs had been met. Food was home cooked and people's likes and dislikes were noted by staff.

Care plans were person centred and enable staff to provide care people needed.

The service had clear information in care plans about people's communication needs. They also used aids to assist in orientating people. This went some way to meeting the requirements of the Accessible Information Standard.

Audits and checks were carried out to monitor the quality of the service. There were not always written action plans which would help the manager when making sure actions were completed.

The inspection took place on the 7 September 2017. The inspection was announced. We told the provider the day before our inspection that we would be visiting because it is a small service and we needed to be sure that there would be a member of staff available to assist us with the inspection. During our last inspection of the home, in July 2015, the provider was rated Good overall and Good in each of the five key questions. At this inspection the service was rated Requires Improvement overall.

The service does not have a registered manager as it is managed and run by the registered provider. 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. Throughout this report we have referred to the registered provider as ‘the provider’.

People told us they felt safe living at Wishingwell Residential Care Home and we observed that people appeared comfortable and relaxed in the home and with staff.

There were a range of safety systems and checks in place, such as gas safety checks, a fire alarm and emergency lighting and regular servicing of equipment. However, improvement was required in relation to the systems for ensuring electrical and fire safety. Action was taken shortly after the inspection to address these issues.

Recruitment checks were in place to ensure that people were supported by staff who were safe to work with vulnerable people. However, some improvement was required to ensure that all appropriate checks and documentation were retained and we have made a recommendation about this in our report.

Quality assurance systems in place were informal. The provider regularly sought people’s views about the quality of the service and acted on these. They also took action when they identified any issues in relation to the environment or people’s care. However, the quality system in place had not been effective in identifying and addressing the issue with electrical and fire safety systems or recruitment records. Some policies did not reflect up to date legislation and guidance. There were also some minor issues identified at our last inspection which had not all been addressed. Whilst there was no evidence of any negative impact to people as a result of this, it showed that quality assurance systems could be improved to ensure they were consistently effective in driving continual improvement. We have made a recommendation about this in our report.

People and visitors spoke highly about the provider and were very satisfied with the quality of care provided at the service. They told us the provider was approachable and very responsive to people’s needs and wishes. The provider promoted a positive and person centred culture. People were cared for in a family environment and there was a friendly and relaxed atmosphere. Throughout our inspection it was very evident that people were at the forefront of everything staff did and that support was tailored around people’s individual needs, wishes and strengths.

There was a small staff team who knew people well and understood their preferences. Staff interactions with people were warm, supportive and caring. Staff respected people’s choices and opinions. People told us that staff respected their privacy and maintained their dignity at all times.

Medication systems were generally managed safely although there were some minor issues identified at our last inspection which had reoccurred.

People were complimentary about the quality and choice of meals available at the home and staff provided appropriate support to ensure people’s nutritional needs were met. People were able to access the support of relevant healthcare professionals where required, in order to maintain their health. Staff were also proactive in seeking ways to promote people’s emotional well-being.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service was meeting the requirements of the Deprivation of Liberty Safeguards. Staff had additional training booked to improve their knowledge in relation to the Mental Capacity Act (2005).

Staff received an induction, training and regular support in order to provide them with the knowledge and skills to provide an effective service.

Care records were in place for each person, and these included information about people’s preferences. This meant staff had information about how to support people. Staff also responded appropriately to changes in people’s needs and any risks in relation to this.

People had access to activities and social opportunities and these were tailored around people’s individual interests and hobbies. People were also supported to access the local community. The home was furnished to provide a stimulating environment for people.

The home had not received any complaints since our last inspection but there was a complaints procedure in place should people wish to raise any concerns. People and relatives were very confident that any issues they raised would be dealt with.

Is the service safe?

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes. People told us that they were consulted about their care. Comments included, "I can choose what I want to do and how I spend my time. I am well cared for." The home had risk assessments in place. This helped to reduce the risks to people.

Is the service effective?

The home had informal arrangements in place for gaining people's consent. People's health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. People told us they were very happy living at Wishingwell residential care home.

Is the service caring?

People were supported by the providers. They lived as part of a family. We observed warm and caring interactions between the providers and those living at the home. The people living at the home had done so for a while so they knew each other well. People's preferences, interests, aspirations and diverse needs had been recorded and care and support was being provided in accordance with people's wishes.

Is the service responsive?

People told us that they felt able to raise any issues and that they did this informally. People also attended an annual review meeting so that their care needs could be discussed. People were confident that if any issues were raised these would be responded to by the providers. The provider may like to consider reviewing their systems to reflect more formally the way in which they consulted with people.

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Is the service well-led?

The home was run by the providers and people lived as part of a family. Some of the policies and procedures in place would benefit from review as were not based on up to date legislation or guidance. The service worked well with other agencies and services to make sure people received their care in a joined up way. All of the people we spoke with said that they felt able to raise any concerns and were confident that these would be addressed.

We saw that people had individualised care records and risk assessments in place and were looked after by the provider of the service and two other staff. This ensured that the staff knew people's needs in detail. This provided excellent support and continuity of care for people. Everyone we spoke with told us they were very happy with the care and support they received. One person said "It is another world. You have a 'real' home here.' Another said "It could not be better. I am well looked after'.

People were asked at each mealtime what they would like to eat and drink and they could have anything they liked. There was always drinks and snacks available at any time. A person said "The food is always very nice I can choose what I like." People's dietary needs were being met.

During our visit we saw there was enough skilled and experienced staff to meet people's needs. This was confirmed by people we spoke with. A person said "I am well looked after." The manager said I always get the best staff. I interview and work with them so I know their standards of care are good."

There were systems in place to deal with any complaints. However, no complaints had been received. People we spoke with at the home had no complaints at all about any aspect of the service they received.