Wimborne

Wimborne is a care home providing accommodation and personal care to older people and people living with dementia. The service can support up to 52 people. At the time of the inspection 41 people were living at the service.

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

The provider failed to ensure people were supported with medicines safely.

Assessments were not always conducted comprehensively and on occasions were incomplete.

We could not be assured people were consistently protected from the risk of harm. This is because incidents had not always been investigated in a timely manner. Notifications were not always submitted to the local authority and CQC as required by law.

Whilst the provider had governance systems in place, these arrangements were not consistently effective at driving improvement and maintaining safety.

The provider was in the process of recruiting additional staff for various job roles. We observed effective staff deployment and people received their care and support at the times they required it.

The provider demonstrated actions were taken when concerns were raised.

People enjoyed a variety of activities and staff engaged positively with people. Relatives and people were complimentary about the care and support people received.

The provider had appropriate arrangements in place for the management of infection control.

Management were open and honest with us during and after the inspection and had submitted 7 notifications retrospectively.

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 the service was good and published on 11 September 2019.

Why we inspected

We carried out a focused inspection because we received information of concern relating to risk management and leadership within the home. We undertook this focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well led key question sections of this report.

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

Enforcement and recommendations

We have identified 2 new breaches in relation to safe care and treatment and governance.

Follow up

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

Wimborne is a care home providing accommodation and personal care to older people and people living with dementia. The service can support up to 52 people. At the time of the inspection 45 people were living at the service in one adapted building all on ground floor level.

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

People were protected from the risk of potential abuse and risks to people were assessed and planned for. People told us they felt safe, medicines were stored safely and there were enough staff to meet people's needs.

People were supported by caring and passionate staff in a spacious environment with a large accessible central courtyard and garden area.

The service was clean, tidy and furnished thoughtfully to a good standard.

The service had a positive person-centred culture. Both people and staff told us the registered manager was approachable, the service worked in partnership with others and engaged people and staff. The service was displaying its current rating as required and had sent us notifications when necessary.

There was a wide variety of activities to engage people in.

Links had been developed to ensure the service was an active part of the local community.

People enjoyed the food provided by the service. There was a positive staff culture, and this reflected in a happy and friendly atmosphere.

People were supported with their health conditions and we received consistent positive feedback from health and social care professionals about the quality of care provided.

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.

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. Last report published (1st March 2017)

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.

Wimborne is registered to provided accommodation and support for up to 52 people. At the time of our inspection there were 45 people living at the home, some of whom live with dementia. Accommodation is all on one level with four communal areas, 47 single rooms and 5 double rooms.

At this inspection a registered manager was in place. 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.

Following our last inspection in September 2015 requirement notices were issued for breaches in Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person had not ensured person centred care, they had not ensured that all identified risks associated with people's care had been appropriately assessed and plans developed to mitigate such risks. Service user records were not always up to date and accurate. At this inspection improvements had been made and these were no longer a breach.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report any suspected signs of abuse. Medicines were managed safely and risks associated with people’s needs had been assessed with plans developed to mitigate such risks. People could be confident they were being cared for by staff appropriate to do so because the provider operated safe recruitment processes and ensured there were enough staff available to meet people’s needs.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately. They understood the importance of obtaining people's consent when supporting them with their daily living needs. Staff received training and support which enabled them to understand and meet the care needs of each person.

People were supported to have sufficient to eat and drink to maintain a balanced diet. Staff monitored people's health and well-being and ensured people had access to healthcare professionals when required.

People experienced caring relationships with the staff that provided good interaction by taking the

time to listen and understand what people needed. People's care was planned in a personalised way and delivered by staff that knew them well. Their support needs were monitored and reviewed to ensure that care was provided in the way that they needed.

A clear complaints policy was in place and people knew how to use this if they needed to. The registered manager responded appropriately to complaints and used committee meetings to engage and listen to people.

Records had improved and systems were in place to monitor the service and drive improvement. The registered manager was open and staff felt supported in their roles.

We set out to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

People's health and care needs were assessed before they moved into the home.

We found that there were enough experienced staff to meet people's needs. On the day of the inspection there were four care staff, ancillary staff and the manager on duty.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) - although no applications had needed to be made. Relevant staff had been trained to understand when an application should be made and in how to submit one. This meant that people were safeguarded as required.

Staff we spoke with demonstrated a good understanding of what constituted abuse and the different avenues available to them to report concerns. The training matrix demonstrated that all staff had received safeguarding training.

Is the service effective?

People who lived at Wimborne expressed their satisfaction about living at the home. One person told us "I am happy with everything that Wimborne has to offer me', another person said "staff are very attentive to my needs, I wouldn't change a thing".

All people had an individual care plan which set out their care needs. We looked at four individual care plans which we found to be detailed and comprehensive and clearly identified people's needs.

Is the service caring?

We made observations throughout the visit and saw people being offered choices as to what they wanted to eat or what activities they wanted to take part in during the day. For example we saw staff encouraging people to participate in singing and dancing with them.

Staff showed patience and gave encouragement when supporting people. They were aware of people's needs and the preferences of people they cared for in how people wanted care to be delivered. Our observations showed that people were addressed by staff in a respectful manner.

Is the service responsive?

People we spoke with told us they were listened to and staff respected their wishes.

The provider took account of complaints and comments to improve the service. We saw a record was maintained of any complaints made along with a record of any investigation and the findings as well as a record of the outcome of the complaint investigation.

Is the service well led?

There was a clear management structure with good lines of communication and accountability. Staff spoken with were clear about reporting arrangements.

All staff received regular supervision meetings. The manager told us that staff performance issues were addressed through these meetings and additional staff training was identified as necessary.

We saw that regular audits of the service were completed by the provider which ensured people who used the service benefit from a service that monitored the quality of care that people received.

There was no registered manager at the time of the inspection. The current manager was in the process of registration with the Commission.

During the early evening meal time we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We saw people had positive experiences. The mealtime was well organised. People were offered choices from a wide range of foods.

People said they were satisfied with the standard of care provided by the home. A relative told us, 'They have worked miracles with my relative.' This relative also said they visited the home at different times of the day on a regular basis and did not have any concerns about the care of people.

The home was found to be clean and free from any odours.

Recruitment checks were carried out before any new staff started work.

The home sought the views of people at the home, and, of their relatives regarding the standard of service provided. There were comprehensive audits and checks of the home's operation and performance.