Wensley House Residential Home

We found the following examples of good practice.

• The registered manager had followed the government's guidance on whole home testing for people and staff until the outbreak of COVID-19 at the service in January 2021. In line with government guidelines testing for people using the service and staff is due to recommence from 27 March 2021.

• People's well-being was supported by telephone calls to relatives and window visits. An internal visiting pod had been built within the service and this enables people to see their relatives.

• Arrangements were in place for relatives to visit family members who were judged to be at the end of their life. Suitable measures were in place such as temperature checks, Personal Protective Equipment [PPE] and separate entrances to the building to keep infection risks to a minimum.

• Most staff employed at the service had received training on infection prevention and the correct use of Personal Protective Equipment (PPE). There was clear guidance and signage in the service to help promote staff to safely work whilst minimising the risk of spreading infection including effective hand washing.

• Appropriate infection prevention control practices were observed, such as the wearing of masks, gloves, aprons and also included good hygiene practices.

• The environment was visibly clean. Cleaning schedules evidenced the frequency of cleaning undertaken, including regular deep cleaning of the service.

• People living in the service were encouraged and supported to maintain social distancing in communal areas, such as the lounge and dining room.

Wensley House is a residential care home providing personal and nursing care to 27 people aged 65 and over at the time of the inspection. The service can support up to 48 people. Wensley House accommodates people in one adapted building across three floors.

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

People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. Risks to people were identified and assessed to keep them safe. Sufficient numbers of staff were available to support people living at Wensley House and to meet their needs. Recruitment practices were robust to make sure the right staff were recruited. Medication practices were safe, and people received their medicines as prescribed. People were protected by the prevention and control of infection. Findings from this inspection showed lessons were being learned and improvements made when things go wrong.

Improvements were required to ensure enough members of staff were appropriately trained relating to first aid and medication. The latter specifically related to night staff. Improvements were also required to make sure all staff received regular formal supervision. The dining experience for people using the service was not always as positive as it should be, however this improved on the second day of inspection. People received enough food and drink to meet their needs. People were supported to access healthcare services and receive ongoing healthcare support. The service worked with other organisations to enable people to receive effective care and support.

People were in general supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

People and those acting on their behalf told us they were treated with care, kindness, respect and dignity. Staff had a good rapport and relationship with the people they supported, and observations demonstrated what people told us.

Though each person had a plan of care detailing their care needs and how these were to be met by staff, shortfalls were identified with some of the information recorded. People were supported with ‘in-house’ social activities, but improvements were required to enable people to access the local community, particularly as the service’s proximity to Epping town centre and Epping Forest is close. The service is not fully compliant with the Accessible Information Standard to ensure it meets people’s communication needs. People and those acting on their behalf were confident to raise issues and concerns and felt listened to. At the time of this inspection, no-one was requiring end of life care support. The management team knew how to seek support from the local palliative care team.

Governance arrangements were much improved, but progress was still required to make sure improvements made were sustained in the longer term.

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

The last rating for this service was ‘Requires Improvement’ (published February 2019) and there were three breaches of regulation. Enforcement action was completed whereby the Care Quality Commission imposed conditions on the provider’s registration. The provider completed an action plan after the last inspection in December 2018 to show what they would do and by when to improve.

The service remains rated requires improvement, but the Commission acknowledges significant improvements have been made. This service has been rated requires improvement for the last three consecutive inspections. At this inspection we found improvements had been made and the provider was no longer in breach of regulations, but some improvements were still required.

Why we inspected

This was a planned inspection based on the service’s previous rating.

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.

Wensley House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Wensley House Residential Home provides accommodation and personal care for up to 48 older people. Some people also have dementia related needs.

The inspection was completed on the 3 and 4 December 2018 and was unannounced. At the time of the inspection, there were 32 people living at Wensley House Residential Home.

The service did not have a registered manager in post. The service was being managed by a deputy manager and 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.

Quality assurance checks and audits were not robust, they did not identify the issues we found during our inspection and had not recognised where people were placed at risk of harm and where their health and wellbeing was compromised. The registered provider was unable to demonstrate overall responsibility and scrutiny of what was happening within the service to make the required improvements. The lack of managerial oversight had impacted on people, staff and the quality of care provided. Therefore, they were unable to demonstrate where improvements to the service were needed, how these were to be made and had been addressed; and lessons learned to ensure compliance with regulatory requirements and the fundamental standards.

Although people told us they were safe, the service’s previous manager had failed to notify the Local Authority and Care Quality Commission of two safeguarding incidents and internal investigations were poorly completed and provided insufficient evidence to back-up the findings and outcome.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered, and risk assessments had not been developed for all areas of identified risk. Care records were not maintained to ensure staff were provided with clear up to date information which reflected people’s current care needs. Where people were judged to be at the end of their life, information relating to their end of life care needs were not recorded. Improvements were required to the service’s medication arrangements as discrepancies relating to staff’s practice and medication records were found.

The management team had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people using the service, others were not respectful or caring and failed to ensure people received the care they required. People were not supported to participate in meaningful social activities. Improvements were also required to people’s overall dining experience as the support provided was not always provided in a respectful and dignified manner.

People’s capacity to make day-to-day decisions had been considered and assessed. Nonetheless, improvements were required to ensure staff had a better understanding of the main principles of the Mental Capacity Act and best interest assessments completed for all areas.

Not all staff had received a comprehensive robust induction and the role of senior members of staff was not effective in monitoring staff’s practice and providing sufficient guidance and support. Most staff had attained up-to-date training but improvements were required to ensure this was embedded in their everyday practice.

The service worked with other organisations to enable collaborative joined-up care and ensure people’s healthcare needs were met. The registered provider’s arrangements for the prevention and control of infection at the service was satisfactory. Safe recruitment practices and procedures were in place.

Wensley House 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 care home accommodates up to 48 people over three floors in an adapted building. There is a passenger lift to provide access to people who have mobility issues and the garden is also accessible. 45 people were living in the service at the time of this inspection, two of whom were in hospital.

A registered manager was not in post. 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 had inconsistent management since the last inspection and the provider managed the service when no manager was in post. An experienced manager was now in post and who had made application to register with CQC as required.

We rated the service as Good at our last inspection on 5 January 2017. We received information of concern in November 2017 that insufficient staff were available in the service. Concerns also related to people’s care, communication, fire safety, medicines and the failure of the provider and manager to deal with these effectively. We shared the information with the local authority who visited and were supporting the service to improve. We also received information that recruitment procedures in the service needed improvement.

This inspection was unannounced and completed by two inspectors on 16 and 17 January 2018. We found three breaches of regulation and other areas of practice that needed to improve.

People’s individual risk management plans did not support people's safety. Equipment was not safely used. Medicines were not safely managed to ensure people's wellbeing. People’s care needs were not planned for in a way that gave staff clear guidance on how to meet these safely and well. This included people’s nutritional and social care requirements.

The lack of consistent competent leadership in the service had affected the quality and safety of the care people received. The provider’s quality assurance processes were not sufficiently robust as they had not identified the failings in the service so that corrective action could be promptly taken.

Discussion with staff and review records showed that information was not always shared or acted upon so that learning could take place to safeguard people. Records also showed that checks of prospective staff needed to be more thorough and ensure that references obtained were always from the most appropriate people.

Staff support systems had faltered. Staff had not received continuous training, support and competence assessment to ensure they provided people with safe and effective care. The manager had recently recommenced the provider’s systems to supervise staff, monitor their performance and to plan a staff training programme.

While staff generally sought people’s consent, improvement was needed to records and staff understanding to show that up to date guidance about protecting people's rights in decision-making was followed.

People told us they enjoyed the meals and drinks served overall although sometimes food was not hot enough. Staff approach to supporting people to have a positive mealtime experience needed to improve in some areas. People told us that staff were kind and caring overall and treated them with respect. We noted occasions where staff did not make efforts to interact and engage people. Visitors felt welcome.

Enough staff were deployed to meet people’s needs. Systems were in place to monitor staffing levels in line with people’s changing needs and these were positively supported by the provider. Arrangements were in place to support people to gain access to health professionals and services.

Wensley House offered people a clean and comfortable environment that was well-maintained.

People felt able to raise any complaints and felt that the manager and provider would listen to them. Information to help them to make a complaint was readily available. People knew the manager and provider and found them to be friendly and regularly available in the home.

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

Wensley House provides accommodation and personal care to up to 48 people. People living in the service may have care needs associated with dementia or mental disorder. There were 39 people living at the service on the day of our inspection.

A registered manager was in post. 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.

At this inspection we found a number of improvements had been achieved across the service. The service was led by an experienced manager who had worked with the support of the provider to stabilise the service and demonstrate sustained improvements. Staff morale was high and staff worked as a team to provide care in a friendly and homely environment.

Medicines were safely managed to ensure people received their prescribed medicines to meet their needs. Risk management plans were in place to support people and keep them safe. There were also processes in place to manage any risks in relation to the running of the home. Care records included better detail of people’s care needs and staff had information on how best to meet people’s needs. Quality assurance systems were better established and effective in support safe, quality care.

People were supported by staff who knew them well and were available in sufficient numbers to meet people's needs effectively. Recruitment procedures were thorough. Staff knew about identifying abuse and how to report it to safeguard people.

People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences. Arrangements were in place to support people to gain access to health professionals and services.

People were well cared for by kind and caring staff. People’s dignity and privacy were respected. Visitors were welcomed and relationships were supported. People’s care was planned and reviewed with them or the person acting on their behalf. People were supported to participate in social activities that met their needs.

People felt able to raise any complaints and felt that the provider would listen to them. Information to help them to make a complaint was readily available. The provider had listened to people’s views and ensured that people were satisfied with the actions taken.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

We undertook a focused inspection on 17 and 18 December 2015 to check on those warning notices. We found that additional time was needed to further improve the service and establish the delivery of safe care to people living there. Further warning notices were issued that had to be met by 18 February 2016.

This inspection took place on 16 and 17 March 2016. We found that while further progression was still needed in some areas, sufficient improvements had been made and sustained to the safety and quality of the service and the legal requirements of the warning notices were met.

Wensley House is registered to provide accommodation with personal care to up to 46 older people. People living in the service may have care needs associated with dementia. There were 20 people receiving a service on the day of our inspection.

A manager was in post who had made application to the Care Quality Commission to be registered. 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.

At this inspection of 16 and 17 March 2016, improvements were noted in all areas from the previous inspections, further minor improvements were needed in regards to aspects of how people’s individual care needs and risks were assessed and planned for and one area of medicines management.

Improvements were needed to ensure that all the people using the service were given sufficient choice and information to enable consistently good nutritional intake and participation at mealtimes. The manager took immediate action to address shortfalls in staff practice and ensure a good mealtime experience for all the people using the service.

Although in place, social activities were not always suitable for all of the people living in the service so as to reflect their personal interests and abilities. Work was needed to ensure people’s voice was heard in all instances and that people were addressed by their own name so as to respect them as individuals. The provider’s quality assurance system, although improved needed further development to ensure that all aspects of shortfalls in the service was captured and addressed on an ongoing and sustained basis. The manager was aware of the areas that still required some improved and we felt assured that improvements would continue to enhance people’s wellbeing and safety.

Improvements were noted to the management of risks to the environment and the running of the business so as to ensure people’s safety. This included the safety of the water system. Equipment such as that relating to fire or moving and handling equipment had been tested and checked to ensure it was safe and in good working order.

Where people lacked capacity to give consent, assessments had been carried out to ensure their rights were protected. Staff were knowledgeable about identifying abuse and how to report it to safeguard people.

People were supported by staff who were clearer on their roles and responsibility. The recruitment of additional permanent staff meant there was less use of agency staff, so people were cared for by staff who were familiar to them. Staff training and support systems had been established and implemented effectively.

Care records were regularly reviewed and showed that the person had been involved in the planning of their care. Staff knew people’s needs and people told us that they received the care they required.

People knew the manager and found them to be approachable and available in the home. People told us they had noted many positive improvements to the way the service was now being run. People living and working in the service had the opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response.

We considered our inspection findings to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found based on our observations during the inspection, where we looked at written records and spoke with seven people who used the service. We also spoke at length with the manager, the owner and three members of care staff.

If you want to see the evidence supporting our summary, please read the full report.

Is the service caring?

We spoke with seven people who used the service. One person said to us, "I am very happy here, I have no complaints. Everyone is very kind." Another person said, "The staff are very friendly; we often have a good laugh with them." We observed the care and attention people received from staff. All interactions we saw were appropriate, respectful and friendly and there was a relaxed atmosphere throughout the home.

Is the service responsive?

We saw that care plans and risk assessments were informative, up to date and regularly reviewed. The manager responded in an open, thorough and timely manner to complaints. Therefore people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the home.

Is the service safe?

The home was undergoing refurbishment at the time of inspection to improve the facilities at the home. People had been properly consulted about this and risk assessments were in place to ensure the ongoing safe operation of the home. People's bedrooms were personalised to them. People were protected by effective staff recruitment systems. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines.

Is the service effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with generally positive feedback from people reported in the provider's own annual quality assurance survey. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

All staff had been trained in the Mental Capacity Act. With the knowledge they had of people they were caring for, meant they knew what assistance an individual would require to make a decision or give consent.

People told us they enjoyed the food at Wensley House. One person said, "They spoil me, I've never had a bad meal."

We found there were appropriate arrangements in place for the management of people's medicines.

We saw there was a complaints policy and procedure in place and on display in the communal entrance hall. The procedure was clear and informed people how to complain and when they could expect their complaint to be dealt with. All complaints or concerns, no matter how minor, were reported and had been acted on appropriately.