Wisteria House Residential Home - Somerset

Wisteria House Residential Home is a care home which is registered to provide personal care to 13 people. There were 13 older people living at the service at the time of inspection.

The home had a passenger lift, which makes access to the first floor easier. The house is an older style building set over two floors with some rooms less suitable for people with mobility difficulties. The management team considered the nature of the building when assessing people who wished to move in, to ensure their needs could be met.

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

The provider had improved oversight of the home since the last inspection. This included actions and procedures to reduce the risk of preventable harm, better protect people from the spread of infection and consistently robust checks when recruiting prospective staff.

Since our last inspection fire safety had improved and was well managed. There had also been significant improvements to the home environment and décor. This had improved safety and people’s quality of life.

People told us they felt safe living at Wisteria House Residential Home. This view was shared by relatives.

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.

People, relatives and staff praised the registered manager about the improvements they had made to the home and their passionate approach in providing good quality care.

Staff told us they enjoyed working at the home which had a supportive and homely feel. Staff told us they felt valued. They were encouraged and supported to develop their practice and progress professionally.

Surveys were undertaken which gave people, relatives and staff the opportunity to say what the home did well and what they could do to improve. Feedback from the July 2022 survey was unanimously positive.

The home had developed and maintained good working relationships with GPs, district nurses, social workers and the local authority care home in-reach team. The registered manager recognised how the home could benefit from and contribute to the local community.

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 17 June 2021).

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.

At our last inspection we recommended that the provider reviewed medicines management, staffing levels and the deployment of staff to ensure people's needs were met in a timely way. At this inspection we found medicines management had improved, staffing levels had increased and there was a full staff team to meet people’s needs.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We carried out an unannounced focused inspection of this service on 12 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and fit and proper person employed.

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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Wisteria House Residential Home - Somerset 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.

Wisteria House Residential Home is a care home which is registered to provide personal care to 13 people. The home offers care to older people. Since the last inspection the provider has installed a passenger lift, which makes access to some areas easier. However, the house is an older style building set over two floors and some rooms may not be suitable for people with mobility difficulties. The management team considered the nature of the building when assessing people who wished to move in, to ensure their needs could be met. There were 11 people living at the service at the time of inspection.

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

People and their relatives told us they felt the service was safe and people received a good standard of care. Comments included, “The care is very good, they look after us very well”; “We are looked after very well – almost as if we were family” and “The home runs very well and there is good communication between the home and the family”. However, we found several areas that required improvement.

Staff were not using personal protective equipment (PPE) as per the Government guidance, which put people at risk of infection.

We identified the provider had not ensured all aspects of the environment were safe. For example, fire safety risks had not been addressed. Recruitment practices were not carried out robustly to ensure potential employees were suitable to work at the service. Some aspects of medicines management were not safe.

People were supported by staff who knew them well, however, we have recommended the provider review the number and deployment of staff on duty to ensure individual needs are met.

The premises were in need of some redecoration and refurbishment to ensure it met people's diverse care and support needs, especially those living with dementia.

The service was not always person centred. There was a lack of social opportunity and engagement for people, especially people living with dementia.

The registered provider did not have effective governance systems in place to maintain and improve the quality and safety of the service. Analysis of accidents and incidents were brief in detail and did not show clear evidence patterns or trends were being identified.

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 09 July 2019).

Why we inspected

This inspection was prompted due to concerns received about moving and handling practice; the management of pressure ulcers and continence care; concerns that nutritional needs were not being met; people not having access to call bells and overall management of the service. A decision was made for us to inspect and examine those risks. We found evidence during this inspection that people were at risk of harm from some of these concerns.

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.

This report only covers our findings in relation to the key questions of safe and well-led which contain those requirements and concerns. Prior to the inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We found evidence the provider needs to make improvement.

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

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

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 monitor the service.

We have identified three breaches of regulation in relation to people's safety, infection control, recruitment and governance at this inspection.

We served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action in relation to infection prevention and control practice. We told the provider that we were considering whether to use our powers to urgently impose conditions on their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within four days that described how it was addressing the concerns. On receipt of the action plan we undertook a review and were assured by the actions the provider had taken.

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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wisteria House Residential Home is a care home which is registered to provide personal care to 13 people. The home specialises in the care of older people. The house is an older style building set over two floors and some rooms may not be suitable for people with mobility difficulties.

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

People felt safe at the home and with the staff who supported them. Risks of abuse to people were minimised because the provider carried out pre-employment checks on all new staff. People told us staff were always kind and we saw people were very relaxed and comfortable.

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. People said staff always asked for their consent before helping them.

People had their needs assessed and were supported by staff who had the skills and experience to meet their needs. Staff monitored people’s health and well-being and worked with other professionals to make sure they received the care and treatment they needed. People’s nutritional needs were met and everyone we spoke with was happy with the food and drinks provided.

People had good relationships with the staff and other people at the home. People were able to choose to socialise or spend time on their own. Where people chose to spend time in their rooms staff visited them regularly to make sure they were comfortable and did not feel isolated. Staff respected people’s privacy and independence.

Care was provided to people in a way which took account of their preferences, culture and lifestyle choices. People were able to express their personal wishes for the care they would like to receive on a day to day basis and at the end of their lives.

People were able to join in with activities or occupy themselves. People’s friends and family were always made welcome which helped them stay in touch with people who were important to them.

People lived in a home which was managed by a registered manager who was very visible and knew them well. People were able to discuss their care or raise concerns with staff or the registered manager. The registered manager had formal and informal ways to monitor the quality of care provided to people. People were consulted about their care and any changes in the home.

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 (Report published November 2016)

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.

The service is also registered to provide personal care to people in their own homes in the community. This part of the service had been expanding rapidly and 60 people were now receiving care and support. The service was run from an office in the grounds of the home.

There is a registered manager in post. The registered manager was responsible for the day to day running of the home. 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 registered provider was responsible for the quality assurance and standards of the whole service. They supported the registered manager in relation to the running of the home and were closely involved in the day to day running of the domiciliary service.

The provider and the registered manager were open and approachable and supported people receiving a service and staff well.

People told us staff were kind and caring and always respected their privacy and dignity. People were very positive about the care and support they received both in the home and in the community.

One person living in the home said “I don’t know where else I could be happier. I have friends here amongst the staff. It is amazing but I am ever so happy.” One person receiving support in the community said ““They are a lovely care company. Very caring. There are no complaints at all.”

Care was responsive to people’s needs and personalised to their wishes and preferences. People were able to make choices about all aspects of their day to day lives.

Staff knew the importance of learning about people’s preferred ways of daily living and supporting them to continue to be independent when possible.

People were offered care they had been involved in planning themselves. People were involved in discussions about the care and support they received and were made aware of any risks. The staff responded to changes in people’s needs and adjusted care accordingly.

Staff were aware of how to assist people to make decisions if they lacked the mental capacity to make decisions for themselves.

People enjoyed the food in the home. They had a choice of food and staff catered for people with specific dietary needs and preferences when required. Food was plentiful and the size of people’s meals varied according to their appetite and preferences.

People in the community were offered support with their diets in a variety of ways that met that their needs.

In the home people were seen by doctors, nurses, chiropodists, opticians and were supported to attend hospital appointments where needed.

In the community people’s health needs were assessed and plans were in place to reduce the risk of them becoming ill. The service supported people with complex needs by working in partnership with other professionals

All staff had access to on-going training which ensured they had the skills and knowledge to safely and effectively support people.

There was a recruitment procedure which minimised the risks of abuse to people. There were sufficient staff to ensure people received appropriate, unhurried care.

Staff had received training in recognising and reporting abuse and were confident that any concerns would be fully investigated to make sure people were protected.

People knew how to make a complaint and everyone told us they would be comfortable to do so. All were confident they would be listened to and action would be taken to address any shortfalls.

Across the service there were robust systems to monitor the quality of the service offered to people.

Is the service safe?

People told us they felt safe. Staff were trained in safeguarding and understood their role in preventing and reporting abuse. The service worked well with other agencies to help keep people safe. The house was clean and there were infection control measures in place.

Is the service effective?

People told us that they were satisfied with the care they received. From our observations and speaking with people and staff we saw that care plans were up to date and changes were noticed and acted upon. The service cooperated with other agencies to ensure changing needs were met. One person told us, 'they know what to do but most importantly, they listen to what I've got to say because we are all different and we are different each day."

There was enough equipment in place to meet people's needs. We found where people were unable to give their consent to care, the provider worked with family or other advocates, and relevant professionals to determine people's best interests.

Staff told us they received regular supervision and training, and felt supported working as part of a team.

Is the service caring?

We found that care plans were up to date and that staff worked with people, offering choice and support. One person told us, 'I find the carers excellent; I've never had anyone rude or discourteous." Members of staff we spoke with demonstrated respect for people, most of whom had complex long term conditions including physical and mental health needs.

Is the service responsive?

We found people's needs had been assessed and reviewed and that care plans contained simple clear guidance for staff about people's preferences and specific care and support needs. One member of staff told us, 'my carer knows exactly what to do and how to handle my care needs." A member of staff told us they found it easy to contact the manager or supervisor to discuss someone's care or to report changes. One member of staff told us," the managers are very open to considering new ways of doing something, as people's needs change all the time."

Is the service well-led?

The service benefitted from an additional registered manager since the last inspection and additional supervisory staff. We found care plans had been reviewed and updated. There were checks for making sure these remained up to date. We found there were checks on the environment of the house and we saw improvement plans in progress. Checks on risk were made in response to people's care needs and in response to the environment in the house. Monitoring of quality was being developed in areas related to the experience and wellbeing of people who use the service. A new system of visits monitoring was helping to provide information about the effectiveness of the domiciliary care service.

This inspection was to look at the progress made in achieving compliance since our last inspection in March 2013. We spoke with seven people who live in the home, six people who use the domiciliary care service, and seven members of staff. People spoke highly of the staff. One person told us 'They are all very kind and caring'.

The staff working in the home were kind, but they were not always respectful in their interactions with people. People appeared comfortable and relaxed with the staff who supported them, and activities were taking place. However, in some instances we saw that care plans were not being followed.

The home was not clean and we found that hot water was not working properly in the upstairs sinks. Equipment was serviced but necessary work was not always arranged.

Staff had received training around safeguarding however, there was a lack of clarity about who decides when, and if, an alert should be raised.

The home had started to undertake quality assurance audits , however these systems had not identified the majority of the concerns outlined in this report.

Although people spoke positively about the care they received, we found that their needs were not properly assessed and their files contained limited or no information. As a result, care and treatment was not planned in a way that ensured their safety and welfare.

People were not protected from the risk of abuse. We found that there were two separate incidents of alleged abuse that had not been notified to the CQC according to the provider's registration responsibilities and the local authority had been made aware of only one of these incidents.

Staff were supported to carry out their role. We found that staff had access to a wide range of relevant training and that they were supported through regular supervision.

The provider generally had systems in place to monitor the quality of service that people received. However, this was not the case with people's care files which had not been audited and which contained limited and poor quality information.