Wheathills House

Wheathills House is a residential care home that was providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The home is in a rural location with extensive grounds for people to use. People have single occupancy bedrooms and the home has been designed to enable people to move around independently. Due to the location of the home there is limited access to public transport or local amenities.

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

New governance systems including quality audits had been introduced to monitor the service and identify improvements. The provider recognised where further improvements could be made to ensure greater oversight of the service. Feedback from people, their relatives, staff and healthcare professionals were positive about the care in the home.

People felt safe and told us staff looked after them well. The staff worked well together and understood how to support people in accordance with their care plans and risk assessments. Relatives told us the registered manager and the staff team were very caring and responsive to people’s needs.

People’s safety and welfare was monitored. There was an overview of accidents and incidents and these were reviewed to help ensure there was not a reoccurrence. Medicines were stored and administered individually and were managed safely. Staffing levels had been reviewed to meet people’s needs and staff felt they could support people effectively and were available when people needed them.

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

Rating at last inspection

The last rating for this service was rated requires improvement (Published 12 December 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 5 October 2020 and a breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance in the home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wheathills House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wheathills House is a residential care home that can provide personal and nursing care to 30 people aged 65 or over. Twenty people were receiving a service in the home at the time of the inspection. The home is situation in a rural location with extensive grounds or people to use. People have single occupancy bedrooms and the home has been designed to enable people to move around independently. Due to the location of the home there is limited access to public transport or local amenities.

We found the following examples of good practice.

¿ The new manager had completed supervision for all staff during their first week in the service, to provide staff with assurances and guidance. Staff we spoke with felt supported.

¿ Additional personal protective equipment (PPE) had been ordered, to ensure there were adequate supplies to manage infection control and outbreaks of coronavirus.

¿ People were receiving care in their bedrooms and the new manager had reviewed the staffing within the home, to ensure people received the care they needed.

¿ Cleaning schedules and movement within the home had been reviewed to reduce the risks associated with the infection.

¿ The new manager was reviewing the infection control policy and practices to ensure these met current guidelines.

¿ Testing was completed in the home weekly for staff and monthly for people using the service. People using the service had consented to testing.

¿ People’s temperatures were checked four times throughout the day to monitor their well-being.

Further information is in the detailed findings below.

Wheathills House Residential Home is a residential care home that was providing personal and nursing care to 20 people aged 65 and over at the time of the inspection. The home is situation in a rural location with extensive grounds for people to use. People have single occupancy bedrooms and the home has been designed to enable people to move around independently. Due to the location of the home there is limited access to public transport or local amenities.

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

Quality audits were completed although these were not always effective to identify where improvements were needed.

Infection control procedures were in place and there had been no outbreaks of COVID 19 in the home. However, further improvements were needed to ensure PPE was worn safely and used to prevent transmission of infection. There was a designated area for relatives to visit people safely.

People’s care plans generally included information that gave staff information on how to support people. Further information was needed to support people with complex needs and to record care interventions.

Relatives felt people received the care and support they wanted. Staff hours were assessed in accordance with a dependency tool which calculated the number of hours of support people needed. Staffing will need to be kept under review to ensure people remain safe and people receive support when this is needed.

People’s medicines were managed safely, and audits were completed to ensure people received their medicines.

There were good communication systems to ensure relatives were kept informed about people’s well-being and current restrictions during the coronavirus pandemic. The provider worked in partnership with health care professionals to ensure people continued to receive the care they needed.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (Published July 2019) and there were multiple breaches of regulation. At this inspection we found improvements had been made although the provider was in breach of one regulation. The service remains rated required improvement.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wheathills House on our website at www.cqc.org.uk.

Wheathills House Residential Home is a residential care home that was providing personal care to 19 people aged 65 and over at the time of the inspection. The home is situation in a rural location with extensive grounds for people to use. People have single occupancy bedrooms and the home has been designed to enable people to move around independently. Due to the location of the home there is limited access to public transport or local amenities.

People’s experience of using this service:

Our previous inspections identified the provider needed to make improvements within the service. Good care is the minimum that people receiving services should expect and deserve to receive. On this inspection we found the provider had made sufficient improvements to be removed out of special measures; however, improvements were still needed.

Systems to monitor the service had been developed, however these needed to be embedded within the service to ensure these were effective in identifying the improvements that were still needed. Further training and support was still needed to ensure the provider recognised where improvements were needed, and the provider was accepting support from other agencies to address this.

People were not always protected from harm as risks had not always been identified and action to taken to mitigate these. Care plans were not sufficiently detailed to guide staff to provide people’s care needs. This meant people’s support was not always provided in line with current legislation and best practice guidelines.

There were limited activities on offer during our inspection and people were not supported to engage with activities that interested them. When dedicated activity staff were available, people were happy with how they were supported to engage with activities. However, the staffing was not sufficient to enable care staff to spend time with people unless they were providing support or personal care; people needed to alert staff when other people needed support as there were no staff present and people could not summon support themselves.

Infection control procedures were effective, and the home was maintained and cleaned to a good standard. The home enabled people to move around independently and there was a range of equipment to help people where this was needed. Further consideration was still needed to support the needs of people living with dementia. There was no signage to support people to orientate the building and encourage their independence.

Improvements had been made with how medicine systems were operated although further improvements were needed to ensure people received their prescribed medicines safely as this was not in accordance with good practice guidelines.

People could make everyday decisions. Where people lacked capacity, the provider had now completed assessments to demonstrate how capacity was assessed and decisions made in their best interests. This meant some people were now supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

People were treated with respect and dignity and people were relaxed and comfortable with staff and the management team. Relatives told us the staff team were pleasant, kind and caring and took good care of people. People told us that they thought the management team were responsive and they dealt with any concerns promptly.

Staff had now received further training to gain the skills they needed to support people and further training was planned to continue with staff development. Staff now understood how to identify potential abuse and knew how to make alerts to ensure people’s safety. We had received notifications of significant events. Staff were recruited safely to ensure they were suitable to work with people who used the service.

People enjoyed the meals and felt they had a choice of what to eat and drink. People had good health care support from health professionals. Staff identified when people were unwell and prompt care was given.

Rating at last inspection: The last rating for this service was Inadequate (Published February 2019) and there were multiple breaches of regulation. The provider completed monthly action plans to show improvements they were making. At this inspection, we found some improvements had been made although the provider was still in breach our regulations.

Why we inspected:

On our previous inspection, we rated the service as inadequate and placed the service is in ‘special measures’. This service has been in Special Measures since March 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Enforcement:

We have identified breaches in relation to how risk is managed and how staffing is organised to ensure people receive safe care. Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during our inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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

Wheathills House is a residential care home for 31 older people, some of whom were living with dementia. At the time of our inspection there were 20 people using the service. 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 overall rating for this service remains ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider is also the registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Within the report we refer to them as ‘the provider’.

The provider had failed to ensure improvements had been made, to ensure people received safe care. Where people may have been harmed, they had not identified incidents as potential safeguarding concerns, and not reported these to the local authority or sent this information to us.

People’s health care needs had not always been fully assessed when they moved into the home to ensure their needs could be met; the staff did not know how new people needed to be supported to receive their care to keep well. Necessary checks had not been made with health professionals prior to admission to ensure their care could be provided safely and to obtain details of any prescribed medicines.

Improvements were needed with how medicines were managed to ensure there were safe systems for people to receive medicines as prescribed. Improvements were needed with how medicines were audited and stored.

The provider had failed to ensure that they had received effective training along with the staff team, to understand how to provide necessary care for people. The staff had received training, but the provider had not recognised this was not effective.

People were not always supported to have maximum choice and control of their lives and staff did not always supported them in the least restrictive way possible; the policies and systems in the service did not support this practice. Where people lacked capacity, the provider and staff had not understood how to assess this and to ensure decisions were made in their best interests. Where restrictions were in place, such as monitors and CCTV, the provider had not sought people’s consent to ensure the rights and freedom was not restricted. There were no clear systems in place to identify how information was used, retained or stored. Where restrictions were in place, the provider had not identified these and applications had not been sought to ensure these were lawful.

Quality monitoring systems were not effective and had not assessed all areas of care to ensure improvements could be identified; these systems were not used to drive improvements. The provider did not have a clear overview of the service provided or actions that were necessary to improve the quality of the service. The provider had not worked in partnership with other agencies to understand best practice care or how to make the necessary improvements.

Staff recruitment procedures were not thorough and the provider had not ensured all necessary recruitment checks had been completed prior to staff working in the service. People felt there was enough staff to keep them safe, although the provider did not review this against people’s dependency levels to ensure this continued to meet people’s needs.

People's care plans had been developed to guide staff to provide their individual care needs. Further improvements were still needed to ensure these reflected people’s views about care towards the end of their life.

Where people became ill, the staff were responsive and ensured additional health care was sought to help people keep well. Risks to people were now assessed to ensure where people had identified risks such as a risk of choking or risks with movement. Information was available to guide staff about how to mitigate these risks. Accidents or incidents were now recorded and used to identify any trends to improve the safety of people. The environment was suitable to promote people’s safety and the necessary fire precautions had been actioned.

People felt the staff were kind and considerate and they were happy with the level of activities provided and felt these interested them. The provider had a complaints policy and procedure, however, no complaints had been received. Relatives and people who used the service knew the provider by name and felt that they were approachable if they had any problems or concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service was last inspected in 7 September 2016. There were two breaches of regulation at that inspection. At this inspection the provider continued to be in breach of these regulations as they had not taken action to respond to the breaches.

On the first day of our inspection 28 people were using the service and this was reduced to 26 on the 5 April 2018. The service is required to have a registered manager. 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. The provider is the registered manager.

During this inspection we found the service was unsafe as there were no systems in place to manage the service, identify and mitigate risk and therefore ensure people’s safety.

People were not 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 do not support this practice

There were no systems in place to deploy staff to ensure people were supervised at all times. The provider was unable to show the staff had trained in and understood how to protect people’s rights under the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS).

Not everybody had a care plan that detailed their care needs and wishes. The care plans that existed were not inclusive and the information was inaccurate or was out of date. Some care plans consisted of data from various agencies. This information was not analysed and a plan of care written. There was no assessment process in place to re-admit people who had been in hospital. Daily notes were written in diary form. They were not referred to nor were they filed in a manner that supported the care of people.

On the first inspection visit the provider was unable to show us care plans for seven people who were using the service. Risk was not effectively assessed and put in an up to date care plan for staff to follow. Some accidents and incidents were recorded, however they were not reviewed to ensure the cause of accidents was recognised and, where appropriate, acted upon to prevent other accidents happening.

There was no process in place to identify people who were at risk of choking. People were left alone during breakfast without means of communication or calling for assistance.

There were not enough staff to meet people’s needs in a timely manner. People were left unattended for long periods of time. Staff were not up to date on the training the provider considered necessary to care for people safely and effectively.

Some medicine was stored and administered as prescribed. There were no systems in place to store medicines for people who were using the service for respite care.

There were no communication systems in place to ensure all staff were aware of the current needs and welfare of people. The provider was unaware of the number and gravity of the falls people had and was unable to supply us with accurate and up to date information when asked for.

Staff were not supported, trained or supervised. There were no systems in place to recognise and put best practice in place.

Menus were planned in advance taking in people needs wants and wishes.

There were no systems in place to recognise signs that the service may no longer be able to meet people’s needs.

People were not always referred for health assistance in a timely manner.

People’s dignity was not always promoted. People were not involved in the planning or delivery of their care. Staff were kind in their interactions with people. However they did not always knock before they entered a person’s room. Independence was not always promoted.

Care was not person centred and reviews did not reflect the condition of people. People were not supported to pursue their hobbies and interests. They were bored. Choice was not promoted.

There was no easily assessable complaints process in place. People did not have the opportunity to join in community based activities. There was an activity co-ordinator in place but they didn’t have a budget to arrange entertainment or activities.

The provider did not ensure the service was managed effectively and in the best interests of people. There were no systems in place to review the quality of the service. The provider did not ensure there was a system in place to inform CQC of incidents. Therefore there were incidents we were not informed about. Record keeping was poor and ineffective. There was no system in place to keep staff updated on people’s changing needs and wishes. Some records were missing and others were not dated appropriately.

Staff were not recruited in a manner that promoted the safety of people.

There was no quality assurance process in place. No audits were completed, which meant the provider could not be assured they knew how the service was recognising and meeting people’s needs and wishes. It also meant there was no process to learn from mistakes to ensure they were not repeated.

We identified the provider was in breach of eight of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 7 and 13 September 2016; the first day was unannounced.

Wheathills House is a care home which provides accommodation and personal care for up to 30 older people in rural Derbyshire. At the time of our inspection there were 23 people using the service which provides accommodation with personal care and assistance.

The service had a registered manager who was also the provider of 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.

The service was last inspected on 14 May 2015, when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to assess, monitor and evaluate the quality of services and mitigate risks relating to health and safety. In addition, the provider did not ensure staff received the appropriate support, training and supervision. We asked the provider to send us an action plan to demonstrate how they would make improvements to meet the regulations. The provider did not send us their action plan. At this inspection, we found some improvements had been made. However, we identified several areas where improvements needed to be made to the quality of care on this inspection.

Staff recruitment procedures were now robust and the provider had carried out the correct checks to ensure staff were of the right character to work with vulnerable people.

People were involved in the decisions about their care however, staff had not received any training, supervision and support, and they were unaware of their roles in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw no evidence of how staff supported people to make decisions relating to their care.

The provider did not understand the need to inform the Care Quality Commission of any accidents, incidents or events at the service, as they are required to do.

Care plans provided information on how to assist and support staff to meet people’s needs. Care plans were in a pre-printed format; they were reviewed by the senior care staff, thorough analysis did not take place. People and relatives told us they had not been included in completing or reviewing care plans.

People were not consistently kept safe from the risk of avoidable harm. Risk assessments did not identify what actions or control measures staff should take to minimise the likelihood of harm.

Medicines management and procedures meant people received their medicines as prescribed. People felt happy and safe living at the service; there were sufficient numbers of staff employed and they were deployed effectively on a day-to-day basis.

Staff knew how to protect people from the risk of abuse and had a good understanding of people’s individual needs and preferences.

People using the service were very complimentary about the service and care they received. Staff were caring, kind and compassionate towards people. Staff ensured people were supported in a manner which promoted and respected their privacy, dignity and self-esteem.

People were supported to have food and drinks to meet their dietary needs and personal choices. People were supported by staff to have access health care professionals when it was required. Relationships with friends and relatives were encouraged.

The provider had implemented a system of checking the environment by carrying out audits to assess and review the quality of service.

We found one of breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (registration) Regulations 2009 (part 4). You can see what action we took at the end of this report.

Is the service safe?

People who lived at the home were at risk because their medicines were not managed safely.

The arrangements in place for the storage of controlled medications did not comply with the requirements set out within the Misuse of Drugs Regulations (2001).

Robust recruitment procedures were not in place. This meant that people were at risk of being cared for by staff who were not suitable to work at the care home.

Is the service effective?

Staff had not been trained or assessed as competent in the management and administration of medications.

Is the service caring?

People we spoke with told us that they were happy with the way staff managed their medications.

Is the service responsive?

People we spoke with told us that they received their medicines on time.

Is the service well-led?

The concerns relating to the management of medications and standards of recruitment following our last inspection had not been acted upon.

Medications and pharmacy audits had not been carried out.

Robust recruitment procedures were not in place. This meant that people were at risk of being cared for by staff who were not of good character, and who may not have the skills and experience necessary to provide a high standard of care.

People told us they were happy with the care and service they received, and felt that their needs were being met. One person told us 'the home provides high standards; I cannot fault the service.' Another person told us ''the staff are lovely and look after us really well.'

People said that they felt that they get the help they needed as there was usually enough staff on duty.

People said they enjoyed their meals, which included a choice of home cooked foods. People were supported to have a well balanced diet and sufficient fluids throughout the day.

People's medicines were handled safely and they received them at the times they needed them. Although we found that some arrangements for handling and safe keeping of medicines required strengthening to ensure they are managed appropriately.

Relatives and people we spoke with felt that the service employed reliable and trustworthy staff. We found that the provider's recruitment procedures required strengthening in line with the regulations to ensure that staff are suitable to carry out their work.

People said they felt listened to and able to express their views or raise any concerns with staff if they were unhappy.

Required records were not kept to show that concerns were listened to, acted on and resolved, where possible.