Wimbledon Beaumont

Wimbledon Beaumont is a residential care home providing personal and nursing care for to up to 49 people in one adapted building. The service provides support to older people, including those with dementia and a physical disability. At the time of our inspection there were 44 people using the service.

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

Staffing levels at the home were not always consistent in meeting people’s needs. People, relatives and staff reported that they felt more staff were needed. We have made a recommendation for the provider to review their staffing levels.

Quality assurance checks required more details to ensure that findings were clear, so that issues could be identified to support developments and improvements.

People were supported by staff that were safely recruited. Staff working at the home knew how to report any potential signs of abuse. Potential risks to people were clearly assessed so that staff were able to mitigate risk occurrence. Medicines were administered to people at the times they needed them and in line with prescribing guidelines.

People were 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; the policies and systems in the service supported this practice.

Staff received relevant training and support to enable them to carry out their roles. People were well supported with meals of their choosing and to access healthcare professionals when needed. The premises were suitably designed to meet people’s needs.

People were well cared for by staff that established a good rapport. Staff treated people with dignity and respect, whilst supporting people to be as independent as they could be.

Activities were planned to help stimulate people. Care records were personalised and allowed people to be supported in ways that met their preferences. Where people expressed their end of life wishes they were supported to do so and their care records reflected this. Complaints and concerns were responded to in a timely manner.

The leadership was visible, and people, staff and relatives felt they were able to raise any concerns they may have. The provider worked alongside other agencies to support continuity of care. People, relatives and staff feedback was sought to help develop and improve 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 good (published 04 September 2019)

Why we inspected

The inspection was prompted in part due to concerns received about staffing, suitable stimulation for people and the working culture of the home. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were suitably robust measures in place to prevent or minimise the risk of relatives and friends, professionals and others who visited the care home from catching or spreading infections. Visitor numbers were limited to a family member or friend of individuals who were receiving end of life care. All visitors were required to have their temperature checked, wash their hands and wear a face covering on arrival at the care home. Easy to understand instructions explaining what visitors must do to minimise the spread of infection were prominently displayed throughout the care home, including in the entrance porch.

Alternative arrangements had also been developed to help people maintain social contact with their family members and friends. For example, people could still meet their visitors indoors in a specially adapted visitor’s room that had been partitioned in half using a transparent plastic wall and an intercom installed to allow people to communicate with their guests. There was an external door for visitors that lead straight into the garden, which meant they did not have to walk through any part of care home to meet their relative or friend in the designated visitors’ room. There was a booking system in place to stagger the times of these visits. The service also increased the use of video calls and socially distanced garden visits (weather permitting) to help people keep in touch with their family and friends.

There were suitable arrangements in place to ensure people admitted to the care home were tested for Covid-19 and had to self-isolate in their single occupancy bedroom for at least 14 days thereafter. People already living in the care home who were found to be symptomatic also had to self-isolate in their rooms for 14 days and were not permitted to enter any of the communal areas or share lavatories and bathrooms. People continued to be assessed twice daily for symptoms of Covid-19, including having their temperature checked.

Staff used personal protective equipment (PPE) in accordance with current infection prevention and control (IPC) guidance. We saw staff wearing PPE correctly in people’s bedrooms and the main communal areas. All staff had received up to date training in Covid-19 related IPC guidance and use of PPE. Staff demonstrated a good understanding of safe IPC practices and the correct use of PPE, including donning and doffing procedures (putting on and taking off PPE). Staffs competency to follow Covid-19 related IPC and PPE guidance had been assessed by managers and senior nursing staff working in the care home throughout October 2020. The service had adequate supplies of PPE.

The care home was kept clean. The housekeeping staff had recorded cleaning schedules, which they were required to complete and that included frequency of cleaning of high touch areas, such as light switches, grab rails and door handles. Housekeeping staff were required to clean these high touch areas at least twice daily, which we observed happen during our inspection. We also saw communal areas were kept uncluttered so cleaning could take place effectively. There were laundry processes in place, so clothes were not mixed and washed together, and the laundry room was subject to regular enhanced cleaning.

The provider had thoroughly assessed and mitigated infection risks to staff working at the care home, including staff in high risk groups, such as black, Asian and minority ethnic (BAME) members of staff. The registered manager told us she would take these identified risks into consideration and made reasonable adjustments if staff needed to be assigned staff to support people who were symptomatic and/or had tested positive for Covid-19.

The registered manager confirmed the service did not currently use any temporary agency or bank staff. They were also aware of good practice in relation to care staff only working in one care setting to reduce the risk of spreading infection. Staff who did work in multiple care settings were told they were no longer permitted to do this and were asked to choose which care setting they wanted to permanently work in. We saw declarations had been signed by staff to confirm they understood and agreed to the principle of working in only one care setting to help control the spread of infection. To help staff maintain social distancing staff handovers at the end of each shift were done virtually, utilising electronic messaging apps. Only senior nurses in charge met in-person at appropriately safe distances to give a verbal shift handover.

A regular ‘whole home testing’ regime was in place at the care home. This ensured people living in the care home were rested at least monthly and staff were tested weekly. People were also tested without delay if they became symptomatic or if anyone in the household 'bubble' of a member of staff displayed symptoms. The registered manager knew how to apply for coronavirus testing kits for people living in the care home and for staff. They had no issues with the supply of Covid-19 home testing kits. People living in the care home had received the flu vaccination and staff were being encouraged to follow suit. Most staff had taken Covid-19 antibody tests.

There were a range of IPC policies and procedures which had been reviewed and updated since the start of the Covid-19 pandemic. These included contingency plans for managing adverse events, such as Covid-19 outbreaks and related staff shortages. Managers and senior nurses routinely monitored and audited compliance with IPC practices. This included daily walkabout tours of the building to check the premises were clean and that staff wore their PPE correctly. Managers also supported people and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely.

Further information is in the detailed findings below.

Wimbledon Beaumont is a care home providing personal and nursing care for 40 older people, at the time of the inspection. The service can support up to 49 people. The provider is Barchester Healthcare Homes Limited and the service is situated in the Wimbledon area of south west London.

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

People enjoyed living at Wimbledon Beaumont and staff working there. They thought the home was a safe place to live and work in. Risks to people were assessed, enabling them to live safely, whilst enjoying their lives, and taking acceptable risks. The home reported, investigated and recorded accidents and incidents and safeguarding concerns. There were suitable numbers of appropriately recruited staff. Medicines were safely administered.

Well-trained and supervised staff spoke to people in a clear way, that they could understand. People were encouraged, by staff, to discuss their health needs and had access to community-based health care professionals. Staff protected people from nutrition and hydration risks and people were encouraged to choose healthy and balanced diets that also met their likes, dislikes and preferences. The premises were adapted to meet people’s needs. Transition between services was based on people’s needs and best interests.

People were 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; the policies and systems in the service supported this practice.

The home had a warm, welcoming and friendly atmosphere with staff providing care and support in a way people enjoyed. People did not experience discrimination and had their equality and diversity needs met. The staff we met were caring and compassionate. Positive interactions took place between people, staff and each-other during our visit. Staff observed people’s privacy, dignity and confidentiality and encouraged and supported them to be independent. People had access to advocates.

People had their needs assessed and reviewed and received person centred care. They had choices, pursued their interests and hobbies and did not suffer social isolation. People were provided with information, to make decisions and end of life wishes were identified. Complaints were investigated and recorded.

The home had an open, positive and honest culture with transparent management and leadership. There was a clear organisational vision and values. Service quality was frequently reviewed, and areas of responsibility and accountability established. Audits were carried out and records kept up to date. Good community links and working partnerships were established. Registration requirements were met.

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

Rating at the last inspection and update

The last rating for this service was requires improvement (published 29 September 2018) and there were multiple breaches of regulations. 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

This was a planned inspection based on the 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.

Wimbledon Beaumont 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. Wimbledon Beaumont provides care for up to 49 people including people with dementia and is located in the Raynes Park area of west London.

This responsive inspection was prompted by concerns raised by relatives, health care professionals and current and former staff.

The home did not have a registered manager. 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 and associated Regulations about how the service is run.

The home was covered by the registered manager of another home within the organisation since mid-May 2018. Staff did not think the acting manager and organisation provided good support, that enabled them to do their jobs effectively. Many people and seven of eight relatives we spoke with said they did not find the acting manager approachable or responsive and they did not encourage negative feedback from people. People and their relatives said that they did not feel listened to. The registered manager who left in September 2017 had been in post for 11 years, since they left there had been inconsistent management and oversight of the service, with another manager leaving after only a very short period.

At the last inspection in June 2017 the key questions of effective, responsive, caring and well-led were rated "Good" and safe "Requires improvement". The safe key question required improvement because staff were not following corporate policy in using separate slings for people who required the use of lifting equipment to transfer. The overall rating was "Good". At this inspection staff were following the corporate policy.

Some people and their relatives that we spoke with said they were happy with the care and support provided by the home and way it was delivered, whilst others told us it was not of the quality they expected. All the people said that the staff were caring and did their best, however they felt there were too few staff to safely meet people’s needs. There was also a high turnover of key staffing and management roles over the previous two months. Some relatives told us they felt staff did not have the experience, training or received the managerial support to carry out senior roles competently. A new experienced deputy manager was recently appointed.

Medicine was not safely administered and medicine records were not complete and up to date.

Other records such as activity care plans were not fully completed.

The Mental Capacity Act and DoLS required the provider to submit applications to a ‘Supervisory body’ for authority. Not all appropriate applications had been submitted by the provider or applications under DoLS been authorised, and the provider was not complying with the conditions applied to the authorisation. They were aware of this and endeavouring to complete the required outstanding applications.

The home’s quality assurance system failed to identify short-comings in the service provided in a timely manner and did not consistently monitor and assess the quality of the service provided. The acting manager had picked up some of the areas in which the home was not performing well and was addressing them.

People and their relatives were encouraged to discuss health needs and they had access to community based health professionals as well as nursing and care staff. People had balanced diets that also met their likes, dislikes and preferences and protected them from nutrition and hydration associated risks. People and their relatives told us the meals provided were of excellent quality and plenty of choice was provided. Staff supported people to eat their meals and drink as required whilst enabling them to eat at their own pace and enjoy their meals.

The home was clean, well-furnished and maintained. The front entrance door did not provide a safe environment for people to live in. This was attended to during the inspection.

Staff were knowledgeable about the people they supported and had the appropriate basic skills and training to meet people’s needs competently on a day to day basis. They focussed on providing people with individualised care and support and this was provided in a professional, friendly and supportive manner.

Staff were aware of their responsibility to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences.

We found four 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.

Wimbledon Beaumont provides accommodation for up to 49 people who require nursing and personal care. People using the service had a wide range of healthcare and medical needs. The home specialises in caring for older people with dementia and physical disabilities. They also provided care to people with end of life care needs. At the time of our inspection there were 38 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the service continued to be rated ‘Good’.

Risks to people and the premises were generally managed well. However, staff were not following corporate policy in using separate slings for individuals during hoist transfers. This meant people were at increased risk of falls and the provider was not always managing risks relating to infection control well.

Access to the home was unmonitored for short times such as when there were no staff on reception and the front door was unlocked. However, the provider was aware of this and was actively considering solutions to increase the security of the building to reduce risks to people as soon as possible.

People felt safe and staff understood how to keep people safe from abuse. Staff were recruited through robust procedures and there were enough staff to care for people appropriately. Medicines management was safe.

Staff received the right support to care for people with training, support, supervision and appraisal. People were supported to have maximum 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.

Staff were kind and caring and treated people with dignity and respect. Staff knew the people they cared for well and involved them in their care, giving information and explanations when required. The provider supported people to plan how they would like to be cared for at the end of their lives.

People were provided with a range of activities they were interested in. People’s care plans were current and staff generally followed them in providing care. People were involved in their care reviews. The provider investigated and responded to complaints appropriately.

The service was well led with visible leadership and people were supported by staff who enjoyed and felt motivated in their work. The provider encouraged open communication with people, their relatives and staff. A range of suitable audits were in place to assess and monitor the quality of service delivery.

Further information is in the detailed findings section of the report.

We saw evidence staff were given guidance and instructions on the importance of gaining people’s consent before carrying out any care or support. People’s records showed their care and support needs had been assessed and plans were in place to meet these needs. Risks to their health and wellbeing had been identified and plans were in place to manage these to keep them safe. Where people were unable to make decisions about their care, their families and representatives had been involved in planning and developing their care and support needs. We noted information about people was reviewed and updated regularly so staff had up to date information about people’s current care and support needs.

Records we looked at showed medicines were administered appropriately and stored safely in the home.

There were effective procedures in place to recruit and appoint staff and appropriate checks were made about their suitability to work for the service. The competency of new staff was assessed to ensure they had the appropriate skills and knowledge to care for and support people using the service.