Weatherstones House Nursing Home

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

There were sufficient care staff on duty to meet people’s needs. However, improvements were needed to make sure staff files contained all the required information before staff started work.

Domestic staff vacancies meant there was not always enough staff available to undertake deep cleaning. The provider was trying to recruit to the posts and had rearranged tasks so that more cleaning could be undertaken at night.

Improvements had been made to the governance and oversight of the service, however, these needed to be further developed and become embedded into day to day practice.

We made a recommendation about the governance of the service.

Improvements had been made to the arrangements for the management of risk of COVIDovid-19 and record keeping. Risk assessments had been completed and care plans had been brought up to date. Medication was safely managed, and systems were in place to identify and report events that could place people at risk of harm.

People and their relatives spoke highly of the caring nature of the staff and had confidence in the managers' ability to lead the staff team and manage the service.

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 inadequate published 9 July 2021 and there were multiple breaches of regulation. 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.

This service has been in Special Measures since 8 July 2021 . 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.

Why we inspected

This was a planned inspection based on the previous 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 Inadequate to 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 Weatherstones House Nursing Home on our website at www.cqc.org.uk.

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The governance and oversight of the service was inadequate. Insufficient arrangements had been put in place by the provider to ensure safe and effective oversight of the quality and safety of the service people received. This placed people at risk of harm and of not receiving care to meet their needs.

Quality assurance systems were not robust and had not identified areas that needed improvement. Records relating to people's care, staff training and the overall management of the service were not all up to date and had not always been accurately completed. Systems in place to check the completion of medication administration records (MAR) were also not effective. There were no systems to routinely analyse accidents and incidents for themes and trends or to check that documentation relating to fire safety was up to date and accurate. These failures increased the risk that the support people received would not meet their needs.

The provider had not fully implemented COVID-19 guidance to reduce the risk of infection. People were not consistently monitored for signs and symptoms of COVID-19; Personal Protective Equipment (PPE) was not always disposed of appropriately. Although visiting was taking place, there were no cleaning schedules for the ‘visiting pod’ or high touch points and deep cleaning schedules were not being followed. Visitors were not screened for signs of COVID-19 or asked to produce evidence of a negative test and the provider had no records to demonstrate staff were completing COVID-19 rapid result tests, in line with government guidance.

We raised our concerns with the provider and sought assurances they would address these issues. On the second day of the inspection we found improvements had been made however the issues relating to cleaning schedules had not been addressed. This placed people at increased risk of infection.

People were not always protected from harm. The management of ‘as required medicines’ (PRN) and topical creams was ineffective, and records did not demonstrate they were administered as prescribed and intended. Care plans did not always contain up to date and appropriate risk assessments and guidance for staff to follow. Accidents, incidents had not been reviewed and associated risks minimised. Documentation relating to fire safety including fire risk assessments and peoples’ personal evacuation plans (PEEPS) were not up to date. This placed people at increased risk of harm in the event of a fire.

The recruitment of staff was safe. Relevant identity and security checks had been completed before staff were employed and staff were deployed in sufficient numbers to meet people’s needs. Staff knew people well. People told us staff were kind.

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 good (published 29 November 2018).

Why we inspected

We undertook a targeted inspection as part of CQC’s response to the COVID-19 pandemic to look at the infection control and prevention measures the provider had in place.

We inspected and found there was a concern with the overall management of the service and the lack of provider oversight so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safety and governance of the service.

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 inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Weatherstones Nursing Home is a large sandstone detached property in two acres of grounds. It is situated on the A540 close to the village of Willaston and the town of Neston. The home has 24 bedrooms, 15 of which have en-suite facilities. There are two floors with a passenger lift and staircase.

The service had a registered manager who was registered with us in 2014. 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 manager was present during the days of our visit.

On our last visit, we rated the service as good. This inspection found that overall the service remains good.

Staff understood the types of abuse that could occur and measures were in place to ensure that people who used the service were protected.

Staffing levels were appropriate to meet people’s needs.

Medication management was robust with medicines appropriately stored and accounted for, however improvements were needed to make medication administration more person-centred. These steps have subsequently been taken.

Recruitment procedures included checks on new staff to ensure that they were suitable to support vulnerable people.

The premises were well maintained and all checks on equipment such as portable hoists or electrical equipment had been made.

Staff received the training and supervision they required to perform their role. A structured induction process was in place for new staff.

The registered provider had demonstrated a clear process for determining people’s capacity in line with the principles of the Mental Capacity Act 2005.

Signage had been put into place for one person living with dementia. This assisted in orientating this person around the building.

The nutritional needs of people were met. People were referred to other health professionals in order to promote their wellbeing.

People were supported in a kind and patient manner. Staff ensured that people’s privacy and dignity was upheld at all times. People were enabled to be as independent as possible and have their wishes respected.

Care plans were in place. These were reviewed and include key information about each person. Care plans included reference to the preference, likes and dislikes people had and how they wished to pursue daily routines.

Activities were provided and subsequent action has been taken to ensure that this was person centred.

A complaints procedure was in place. No complaints had been received but people felt confident that their views would be listened to.

People commented that the service was “home-like” and staff considered the culture of the registered manager to be supportive and approachable.

People had the opportunity to express their views about the support they received and these were positive.

Audits were in place to measure the quality of the service provided.

We found that care plans demonstrated people's weight was monitored on a regular basis. We saw that nutritional assessments to identify if people were at risk from malnutrition also formed part of people's care plans. Where a risk had been identified additional care plans were in place.

We found that fire alarms were tested weekly. Discussions with staff demonstrated they were knowledgeable of the fire safety procedures the service had in place and knew what to do in the event of an emergency.

We looked at five staff files. They contained copies of the relevant qualifications for each staff member in line with the role they were undertaking within the service. This showed that the people who used the service are supported by staff that had the right skills and competencies.

We found that no concerns were raised in the survey's that had been completed by people who used the service and/or their representatives.

We found that staff understood their responsibilities so that records were kept accurate and fit for purpose.

We revisited the home and found training was now current for all core areas. Audits were now in for place health and safety, training, complaints, medicines management and the management of finances for people living at the home. However, the provider did not have an effective system to regularly assess and monitor the quality of service that people received. The service still did not have a manager that was registered with us.

We spoke with five people who used the service. Comments from them included 'I'm very happy here. The staff are very kind and nice', 'I couldn't be better. They(the staff) really look after you."