We carried out a review of the data available to us about Wessex Lodge Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Wessex Lodge Nursing Home, you can give feedback on this service.
Wessex Lodge Nursing Home is a residential care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 40 people.
People’s experience of using this service and what we found
People told us they felt safe, and the provider had made improvements in areas we found needed improvement at the last inspection. The provider had completed actions to comply with their independent fire risk assessment. The service had maintained standards in other areas such as the management of medicines and protecting people from abuse. We were somewhat assured that the provider used PPE safely and effectively, and we were assured by the provider’s practice in other areas of infection prevention and control we looked at.
Staff told us they had seen improvements in how the service was managed. The provider had completed actions to make improvements identified at their last inspection. There was a new management team which was supported by a newly appointed director of clinical governance. A system of audits, checks and processes was in place to embed improvements already made and drive further improvements.
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 2 April 2020). We found one breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 29 January 2020. We found a breach of legal requirements. The provider completed an action plan after the last inspection to show what they would do and by when to improve in the area of good governance.
We undertook this focused inspection to check the provider 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.
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 coronavirus and other infection outbreaks effectively.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 Wessex Lodge Nursing Home on our website at www.cqc.org.uk.
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.
Wessex Lodge Nursing Home is a residential care home providing nursing and personal care to 31 people at the time of the inspection. The service is registered to support up to 40 older people who may be living with dementia. It accommodates people in a single purpose-built building. There was a garden with shelters for people to sit out.
People’s experience of using this service and what we found
The service had not been well led in the absence of a registered manager and other senior staff members. Staff had continued to meet people’s needs but management and quality systems had not been operated effectively. Actions to sustain the quality of service had not been followed up.
The provider had not addressed findings in an external fire risk assessment in a timely fashion. People were protected from other risks to their health and welfare, including the risk of avoidable harm and abuse. There were enough numbers of staff deployed to support people safely and promptly. People had their medicines as prescribed and according to their preferences.
People’s care and support was effective and based on detailed assessments and care plans which reflected their physical, mental and social needs. 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 supported people to eat a healthy, varied diet.
There were caring relationships between people and staff. Staff respected and promoted people’s privacy and dignity, and encouraged people to be as independent as possible. Although people were involved in day to day decisions about their care and support, most people had not been supported to take part in reviews of their care plans.
People’s care and support met their needs and reflected their preferences. People could take part in activities inside and outside the home which were designed to prevent social isolation.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.
Rating at last inspection
The last rating for this service was good (report published 7 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach in relation to operating effective management and quality systems at this inspection. Please see the action we have told the provider to take at the end of this report.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Wessex Lodge is a modern purpose-built nursing home for up to 40 service users, some of whom may be living with dementia and physical health conditions such as Parkinson’s disease, epilepsy and diabetes. At the time of the inspection 32 people were living at the home. People had their own singularly accommodated bedrooms with ensuite washrooms with shared communal living spaces. There were gardens and a shelter for people to enjoy the outside space.
Rating at last inspection
At the last inspection, the service was rated Good
Rating at this inspection
At this inspection we found the service remained Good.
Why the service is rated good.
The provider had arrangements in place to protect people from risks to their safety and wellbeing, including the risks of avoidable harm and abuse. Staffing levels and recruitment processes were appropriate to support people safely. Processes and procedures were in place to receive, record, store, administer and dispose of medicines safely.
People were cared for by staff who had received appropriate training, support and supervision to maintain and develop their skills and knowledge to support people in accordance with their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice. People were encouraged and supported to eat and drink sufficiently in order to meet their needs and were able to make choices about what they would enjoy. Staff supported people to promptly see a range of healthcare professionals in order to maintain good health.
People told us that care was delivered by kind and caring staff who sought to meet their needs and ensure they were happy. They were actively supported by staff to be involved in day to day decisions about their care. Staff ensured people's privacy and dignity was upheld.
People received care and support which was based on individual assessments of their care needs and took into account each person’s ability, need and preferences. People were encouraged to participate in a range of activities which reflected their interests. People were aware of how to make a complaint and spoke positively of the registered manager’s ability to address any concerns.
The home promoted a warm, friendly and relaxed environment where people were placed at the heart of care delivery. Systems were in place to make sure the service was managed effectively and to monitor and assess the quality of the service provided. People, relatives and staff reported the service was run by a knowledgeable, approachable and responsive registered manager. Staff applied the provider's values during the course of their work with people. People's views about their care were sought and acted upon to improve their experience of the care provided.
The inspection took place on 4 and 5 March 2015 and was unannounced.
At the previous inspection, in September 2014, we judged the service to be in breach of four regulations, relating to supporting people’s care and welfare, staffing levels, meeting people’s nutritional needs and records management. The provider sent us an action plan showing how they would achieve compliance.
This inspection, in March 2015, showed the provider had made improvements in all areas where we had previously found breaches in legal requirements.
Wessex Lodge Nursing Home provides personal and nursing care to up to 40 older people and people living with dementia. When we visited there were 38 people living at the home. The home is purpose built, with accommodation over three floors and people have their own rooms with en-suite facilities. Two ground floor rooms have been combined to create an open plan room for sitting, dining and activities. This room opens onto a sheltered patio area and the home is set in a large garden.
The service is required to have a registered manager as a condition of its registration. 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The manager at Wessex Lodge started in September 2014 and became registered with the CQC in October 2014.
The provider had ensured the quality of care had improved since our previous inspection. The new registered manager had created a strong staff team, committed to providing personalised care, in line with people’s needs and preferences. People living at the home, their visitors and visiting health care professionals were complimentary about the quality of care.
People told us they felt safe and staff were friendly, kind and compassionate, treating them with respect and dignity. People’s safety was promoted through individualised risk assessments and safe medicines management. Arrangements were in place to check safe care and treatment procedures were undertaken and to improve the quality of care provision.
Staff recruitment processes were robust. There were sufficient staff deployed to provide care and treatment and staff understood their roles and responsibilities to provide care in the way people wished. They were responsive to people’s specific needs and tailored care for each individual. Staff worked well as a team and were supported to develop their skills and acquire further qualifications.
Staff helped people to maintain their health and wellbeing by providing practical support. Staff were trained to deliver effective care, and followed advice from specialists and other professionals. This included training in caring for people with specific health conditions.
People’s health needs were looked after, and medical advice and treatment was sought promptly. Any concerns about people’s health were escalated appropriately to health care professionals for advice and guidance.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when a DoLS application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The home aimed to enable people to maintain their independence and socialise as much as possible. People were cared for without restrictions on their movement. Staff supported people to make decisions and to have as much control over their lives as possible.
The registered manager promoted a culture of openness and had made changes at the home to improve the morale of staff and to promote a culture where people came first. There was a clear management structure and systems were in place to deliver improvements in care.
In September 2014 our inspection team was made up of an inspector and an expert by experience. The inspection findings helped answer aspects of our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with 14 people using the service and their relatives, seven staff members and the newly appointed home manager. We looked at records for six people using the service.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People were not always safe as there were not always enough staff with the appropriate skills and experience to care for people. Staff were sometimes rushed and did not have time to spend time with people, engaging with them in a kind and friendly way.
Appropriate actions and decisions had been made under the Mental Capacity Act's Deprivation of Liberty Safeguards (DoLS).
Is the service effective?
People's health and care needs had been assessed, with their involvement or that of their relatives where appropriate. Their summary 'snapshots' of care was clear and up to date and reflected people's needs and preferences.
People's care records had not been reviewed in full since our last inspection and contained information that was out of date and could lead to confusion about the person's current needs.
People were not always supported to have a diet of their choice, with healthy options and snacks. People told us they did not like the food and it was sometimes cold.
Is the service caring?
People were mostly supported by kind staff. Some staff showed patience and gave encouragement when supporting people, but some did not engage with people in a friendly way.
We found that people's preferences and requests were not always respected, for example to be cared for by staff of a specific gender or to have showers when they wanted them.
Is the service responsive?
Activities were offered that people liked but staff were sometimes unable to respond to people in a timely way.
Is the service well-led?
A new manager had been appointed since our last inspection and some improvements had been made but these were in the early stages of being implemented and embedded.
A more positive culture was being promoted at the home, to encourage person centred care and staff said they felt supported.
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
At the time of this inspection the home was accommodating 38 people. We spoke with four people who use the service and two relatives. We also spoke with the manager and deputy manager and five members of staff. We looked at care and treatment records for five people. This is a summary of what we found '
Is the service safe?
We found that not all of the systems in place ensured people's safety. Care and treatment was assessed and planned to meet people's needs. The delivery of care did not always follow guidance given in care plans and may present a risk of inappropriate care to people using the service. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.
Risks to the health, safety and welfare of people using the service and others were not always monitored effectively. During the inspection a commode chair was left blocking a fire exit with a keep clear sign for a short period in the morning. We observed that some doors were propped open with chairs. This meant that the doors would not close in the event of a fire. We spoke with the manager who assured us that they would take action to address the issue.
There were enough qualified, skilled and experienced staff to meet people's basic care needs. However, feedback we received was mixed in relation to staffing levels. During the inspection care staff were still supporting people to get up at 12.15 and were again busy helping people with personal care in the afternoon. This meant that people were left unsupervised in the main lounge.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the delivery of care and providing sufficient numbers of staffing to monitor the safety and welfare of people.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.
Is the service effective?
The service was not always effective, because some of the care practices and records we saw did not promote people's dignity. For example, in one person's room, items such as toilet rolls and unused continence pads were left on the armchair. We saw another person sat on a continence pad in the lounge, with a monitoring chart propped against the chair where they were sitting. We spoke with the manager who assured us that she would take action to address these issues.
The service was in the process of updating the procedures for obtaining people's consent to care, which included further training for staff in relation to the Mental Capacity Act 2005. This would help to ensure that, where people did not have the capacity to consent, the provider acted in accordance with legal requirements.
Is the service caring?
People who use the service confirmed that staff were caring. We observed and heard care staff interacting with people who use the service in a cheerful and friendly manner, while providing care and support. One person told us they received the support and personal care that they required. Another person said they were 'Looked after very well'. A relative told us 'The care staff are all terrific. They keep a smile on their faces. We can all have off days, but they never take it out on the residents'. They said their relative had 'Come on leaps and bounds since coming here'.
We saw staff assisting a person to transfer in the lounge. This was carried out with care and with regard to the person's safety, with staff providing reassurance.
Is the service responsive?
We saw evidence that the delivery of care was responsive to people's changing health needs, which were monitored and referred to health professionals appropriately. The records showed that any identified concerns were followed up and appropriate action was taken.
The service was currently recruiting in response to care staff vacancies. The manager had a detailed recruitment action plan to address the current shortfalls in permanent care staff. The plan included managing absence and utilising staff across sites.
Is the service well led?
We saw evidence that the service was well led, including records of residents and relatives meetings, staff meetings and quality assurance surveys. We read some responses to a recent quality survey the service had carried out. The responses from four external health and social care professionals rated the service as 'good' and 'excellent' across all areas of service delivery. One commented 'Always kept informed about issues with allocated clients'. Another remarked 'A very well run and caring home'.
The provider was taking action to improve the systems in place to regularly assess and monitor the quality of service that people receive. The minutes of a staff meeting showed that nurses were reminded about their responsibilities. For example, checking food and fluid charts, bowel charts and pressure area care and continuing with care plan updates. A member of staff told us that the deputy manager was 'Really hot on things' such as records being completed, and was 'Really turning the place around'.
There were adequate levels of staff on duty on the days of our inspection. Some people we spoke with told us that they sometimes had to wait longer in the afternoon, evening and at weekends for support with personal care and going to bed at a time that suited them.
Staff were supported through training, supervision and appraisal. We reviewed staff files and found records to demonstrate that staff had received recent training in dementia, wound care and the mental capacity act.
There was an appropriate complaints system in place. The provider responded to complaints in accordance with their policy.
People's care plans, risk assessments and reviews were up to date and comprehensive. The provider had made improvements to the care plans and we found them to be person centred with personal histories and likes and dislikes recorded.
Observation of practices during our inspection showed that people were receiving effective, safe and appropriate care, which was designed to meet their specific needs. One person told us 'The staff are good to me and I am extremely happy with my care'.
People who lived at Berehill and Wessex Lodge were protected from the risk of abuse. This was because staff had received appropriate training. The people we spoke with told us that they felt safe living at the home.
Generally there were enough staff to support people's needs. One person living in the home told us that they always received help when they needed it. A few people told us that they sometimes had to wait longer for staff to help them in the afternoons and evenings.
We found that staff had not always received suitable supervision, appraisals and training. There were plans in place for staff to receive appropriate training and support by December 2013.
People, their representatives and staff were asked for their views about care and treatment. Feedback surveys were undertaken in 2011 and planned again for 2013.
We reviewed the care plans of people. We found that the plans were not always person centred and did not include information about people's history, likes and dislikes.
We found that people had person centred care plans in place that reflected their assessed needs and people were encouraged by the care staff to maintain their independence.
People told us they enjoyed the food and the activities that were organised.
We found that the home had a appropriate recruitment procedures in place for staff and that people were correctly vetted and checked before they started their employment.
We saw that the home undertook regular checks and audits of the service to promote safety and identify potential risks.
We found that the provider has been developing and improving the structure of the service since it has been changed from two separate registrations into one nursing home.