We carried out a review of the data available to us about Wrottesley Park House Care 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 Wrottesley Park House Care Home, you can give feedback on this service.
Wrottesley Park House Care Home is a residential care home providing personal and nursing care to 46 people at the time of the inspection. The service can support up to 63 adults with physical and learning disabilities. The home accommodates 63 people across four separate wings, each of which has separate adapted facilities. Three wings on the ground floor were occupied at the time of the inspection, the fourth wing, which was not in use, was located on the first floor of the home and accessed via a passenger lift.
People’s experience of using this service and what we found
We found staff had not always followed the provider’s own processes with regards to recording of medicines administration. Improvements were also needed to the way people’s medicines were stored.
We have made a recommendation about the management of some medicines.
People’s night time needs were not always met in a timely way, by sufficient numbers of staff.
People told us they felt safe. Staff had received training in protecting people from harm and knew how to escalate concerns for people’s safety. Risks were assessed and managed to reduce the risk of avoidable harm. Where incident had occurred, or things had gone wrong, learning and taken place to reduce the likelihood of reoccurrence.
People’s needs were assessed prior to them moving in to the home. Staff received training relevant to their role and had the skills and knowledge required to support people. People received enough to eat and drink and people’s individual dietary needs were met. People were supported to access healthcare services as required.
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 spoke positively about the care they received from staff. People were supported to make their own decisions where possible. The staff used their knowledge of people’s life histories and preferences, to ensure care provided with dignity and respect.
Improvements had been made to the range of activities available to people, and some people received positive one to one support. The provider acknowledged further improvements were required to ensure people’s well-being was promoted, as some people’s experience of meaningful occupation was, at times, limited. These improvements were underway at the time of the inspection.
People were now involved in the planning and review of their care. People’s communication needs were met and information was provided in a format people could understand. End of life care plans were in place which contained people’s wishes and preferences.
Improvements had been made since the last inspection. The registered manager and provider were open about their plans for the service and where improvements were needed. People, relatives and staff were asked for their feedback and this was used to drive improvements. The staff and management team now worked in partnership with other agencies and were open to learning from other providers and healthcare professionals.
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 15 February 2019) and there was a breach of regulation. We issued the provider with a warning notice which required them to make improvements within a specified timescale. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
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.
people including people with physical and learning disabilities. On the day of the inspection there were 35 people living at the home.
The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We found that the service did not promote these values. We have recommended that the service is developed in line with this guidance and values.
There had not been a registered manager in post since April 2018. 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 2008 and associated Regulations about how the service is run.
At our last inspection on 06 June 2017, we rated the provider as ‘requires improvement’. This was because systems used to ensure safe recording of medicines required improvement, staff missed opportunities to engage with people, improvements were required to ensure people had opportunities to take part in activities and hobbies that interested them and the audits completed had not identified the shortfalls that we did. At this inspection we found some of these issues still required improvement.
There were sufficient numbers of staff to support people. However, we received mixed views from people, relatives and staff about this due the deployment of them and agency usage. Most people told us they received their medication as prescribed. However, Medication Administration Records (MARs) showed that some people had not been receiving some of their medication as prescribed. A staff member had not recognised an incident between two service users as meeting the criteria for reporting and therefore the correct process had not been followed.
People told us staff had the skills to meet their needs. Staff had received what the provider considered to be mandatory training which they applied in practice. However, staff had not received specialist training in relation to some people’s health conditions. Staff had a good understanding of the Mental Capacity Act 2005. However, in practice they did not always seek consent prior to supporting people.
People told us staff were kind and caring. However, some people raised concerns that not all staff were as kind to them and we observed that staff missed opportunities to engage with people and sometimes appeared to have a task focused approach.
We found improvements were required in relation to the stimulation and activities available for people. People’s care plans were reflective of their current needs and had been updated on a regular basis. However, care records did not show that a review had been completed with the involvement of the person and their relatives.
The systems and audits in place to monitor the quality of care provided had not identified the issues that we did during our inspection. There were inconsistencies with people’s care plans and information was difficult to find. Improvement was required in relation to the information regarding people’s medication. The process to handover information and issues highlighted was not effective. There had been inconsistencies with the management team and therefore some people did not know who the current manager was.
People told us they felt safe. Individual risks to people were assessed and staff knew how to minimise them. The provider had systems in place to ensure staff employed at the home were safe to work with vulnerable people. Lessons were learnt when things went wrong.
People were happy with the food and drink provided and people’s nutritional needs were met. People had access to healthcare professionals when required.
People were given choices and involved in their day to day decisions. People were supported to remain as independent as possible. People told us and we observed that people’s privacy and dignity was respected. Visitors were able to visit with restrictions and people were supported to maintain relationships.
People knew how to raise concerns if they needed to and felt happy doing so. There was a system in place to manage complaints and ensure they were dealt with appropriately. People’s cultural and religious needs were met.
People’s feedback was gained via residents meeting and we saw actions had been implemented as a result. Staff told us they felt supported and we saw most staff had received recent supervision. The provider had links with the local community and professionals.
We found the provider was not meeting the regulation regarding the overall governance of the service. You can see what action we told the provider to take at the back of the full version of the report.
Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
We undertook this unannounced comprehensive inspection on 06 June 2017 to check that the required improvements had been made. You can read the report from our previous inspections, by selecting the 'all reports' link for Wrottesley Park House Care Home on our website at www.cqc.org.uk. At this inspection, we found some of the required improvements had been made and the provider was no longer in breach of the regulations. However, further improvements were still required.
Wrottesley Park House Care Home is registered to provide accommodation with personal care for up to 63 people including people with physical and learning disabilities. On the day of the inspection there were 38 people living at the home. There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People received their medicines as prescribed, however systems used to ensure the safe recording of medicines required improvement. People told us they felt safe living at the home and improvements to the home environment had been made and were still ongoing at the time of the inspection. People were now protected from the risk of harm presented by the home environment and equipment used to support people with their mobility was safe. There were sufficient numbers of staff to support people; however people sometimes experienced delays in response to call bells due to staff deployment. The provider had systems in place to ensure staff employed at the home were safe to work with vulnerable people.
People told us they felt staff had the skills, knowledge and experience to meet their care and support needs. Staff had received training, which they applied to ensure people received safe and effective care. People were asked for their consent before care and treatment was provided and where people’s rights were restricted this had been done lawfully. People were happy with the food and drink provided and received support from healthcare professionals when required.
People told us staff were friendly and caring toward them, however some people raised concerns, and we also observed staff missed opportunities to engage with people so that people felt valued and cared for. People were involved in day to day decisions about their care and support and staff communicated with people using their preferred communication systems. Visitors were able to visit at any time and were welcomed by staff who knew them by name.
Improvements were required to ensure people had the opportunity to take part in pastimes and hobbies that interested them Some people spent long periods of their day with very little stimulation. People were involved in the planning and review of their care and staff were aware of people’s preferences. People and relatives knew who to raise concerns with if they were unhappy about the service they received and there was a system in place to ensure complaints were managed effectively and complainants provided with a response they were happy with.
There were systems in place to monitor the quality of care provided, however these had not always been effective at identifying the concerns found at our inspection. The registered manager acknowledged that further improvements were required in relation to the monitoring of the service carried out by the management team. People and staff recognised there had been significant improvements made to the environment and told us they were happy with the changes. People and relatives were now being offered opportunities to give feedback about the service and staff felt involved in the on-going improvements and future plans for the home. The registered manager and the new manager demonstrated a good understanding of the requirements of their role and had notified us of events required by law.
Wrottesley Park House Care Home is registered to provide accommodation and personal care for up to 63 people with physical and learning disabilities as well as complex health needs. On the day of the inspection there were 46 people living at the home.
There were two registered managers in post. One of the registered managers was the area manager for the provider, and the other had been appointed in August 2016 and 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 (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 2008 and associated Regulations about how the service is run.
People were placed at risk of harm from the environment of the home. Equipment used to lift people had not been serviced in accordance with the legal requirements. Individual risks had been assessed; however these assessments had not given consideration to the condition of the building. Not all staff were aware of how to report concerns to people’s safety and well-being. There were not always enough staff available to meet people’s needs. People received their medicines as prescribed, although some improvements were required to the way prescribed creams were stored. Recruitment checks were carried out to reduce the risk of unsuitable staff being employed.
People did not always receive support from staff who had up to date knowledge and skills. Staff did not always feel they were supported in their role. People were asked for their consent before care and support was provided. People's capacity had been assessed and recorded so that staff knew how to support people when making choices and decisions. People had access to external healthcare professionals when required and people's health needs were monitored by staff.
People were not always supported in way that upheld their dignity. People expressed concerns about not being supported to maintain their independence, where possible. Most people felt involved in decisions about their day to day care and support. People described staff as kind and staff responded to people’s need in a compassionate and caring way.
Although some activities were available people were not always supported to participate in activities that interested them. People and relatives knew how to complain, however were not always satisfied with how their concerns had been dealt with by the registered manager. People were involved in the assessment and planning of their care and staff were aware of people’s individual preferences.
The provider had not always notified of us of events and incidents as required by law. People told us they did not feel involved in the running of the home and had not been consulted about planned changes. Staff did not always feel involved in decisions made about the home and some staff had not received regular supervision or support from senior staff. The provider had not responded to the recommendations of recent health and safety audits. There were systems in place to monitor the quality of care people recede, however these had not always been effective at identifying areas of concern or driving improvement. People continued to be placed at risk of harm as the provider had not taken action to address the condition of the home environment. Staff told us they felt supported by the colleagues and felt able to approach the registered manager if they had any concerns.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
During the inspection we found 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.
Wrottesley Park House Care Home is registered to provide accommodation with nursing and personal care for up to 63 people, including people with physical and learning disabilities. At the time of the inspection there were 40 people living at the home. There were four units within the home; three on the ground floor, accessed via a central reception area and a fourth unit upstairs. The fourth unit was not in use at the time of the inspection.
The home had a registered manager in post. 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.
People did not always receive their pain relieving medicines when required. Some people and staff told us there were not always sufficient numbers of staff to meet people’s needs. People were protected from harm by staff who understood their responsibilities in identifying and reporting possible abuse. Improvements had been made to the way that risks were managed and the provider followed safe practices in the recruitment of staff.
Staff received training relevant to their role. Staff sought people’s consent before providing them with care and support, and had received training to enable them to support people in a non-restrictive way. People had access to sufficient amounts of food and drink, and were supported to access healthcare when they required it.
People were supported by staff who cared for them and were warm and friendly in their approach. People’s dignity was upheld by staff, and their privacy was respected.
People were unhappy about the quality of activities that were offered to them. Staff were aware when people’s needs changed and their care was updated accordingly. People and relatives knew who to contact if they were unhappy about the service they received. Some people and relatives felt that although staff listened to their concerns, they did not always respond in a way that met their expectations.
People had not been asked to give feedback about their experience of living at the home. Management of the home had not always been effective. People, relatives and staff expressed confidence in the registered manager. Checks were carried out to monitor the quality of service provided.
The inspection started on 6 January 2015 and was unannounced. We completed the inspection on 12 January 2015.
The home can provide accommodation and nursing care for up to 63 people with physical disabilities, learning disabilities and autistic spectrum disorders. At the time of the inspection there were 47 people living in the home. There were four units in the home; three on the ground floor leading from the central reception area. A fourth unit was upstairs and could be accessed by a passenger lift.
There were two people registered to manage this service. 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.
One of the managers of the service told us at this inspection that they had submitted their resignation and at the time were still in day to day control of the home. The other registered manager who was working in a more senior position was providing part time support to the home.
At the last inspection in October 2013 the service had become compliant with regulations. At this inspection we found that some legal requirements were not being met.
At our inspection we found concerns relating to the management of medications. The Clinical Commissioning Group (CCG) for Wolverhampton had visited the home in October 2014 and found that people were not receiving the health care and support that they needed. They had raised safeguarding concerns about two specific people's care and advised about their concerns including: people being restricted in movement, medication administration, pressure area care, people's nutrition, staff training and care planning. At our inspection we found that these concerns that had been raised by the CCG in respect of medication management remained and actions that had been taken had not fully addressed the issues. During our inspection some action was taken to address some of the immediate concerns.
We found that medication administration was not timely or in line with prescriber's instructions putting some people at risk. Medication management arrangements in the home were not robust or safe. Checks on the administration of medicines had been undertaken but these had not shown the concerns identified at the inspection so they were ineffective. You can see what action we asked the provider to take at the back of the full version of this report.
In addition to changes in the registered management of the services there had been some changes in roles and responsibilities of nurses within the home. There were vacancies amongst the permanent staff group and the provider had engaged agency nurses who were working to support the staffing rota on most day and night shifts.
There were inadequate systems in place to identify, monitor and plan for the risks to people's health and wellbeing in the home. People's health and care needs were not consistently met. Communication between staff was not effective and had failed to ensure that changes in health or care needs were appropriately shared. People were placed at risk that their health and wellbeing would not be protected or promoted.
The systems in place for reviewing and learning from people who used the service and their relatives together with reviews of trends identified through concerns or complaints were not robust. People told us they were unhappy with responses they received from staff when they had raised concerns or complaints.
The systems in place for assessing and monitoring the quality of the service and for responding to risks were not effective. Issues identified during the inspection had in some instances been known by the service but action to address the concerns not been timely and in some instances were incomplete. Action to address issues that had been noted by the CCG in October 2014 were still outstanding or incomplete at the time of the inspection in January 2015. Issues raised were related to the healthcare needs of people using the service. You can see what action we told the provider to take at the back of the full version of the report.
Safeguarding concerns about staff behaviour had resulted in some action by the managers with individual staff concerned. However managers were also aware of concerns about the night staffing in the home in November 2014. At our inspection some people we spoke with expressed concerns related to the same issue. Whilst we found there were enough staff on duty, at times the deployment of staff meant that people did not receive any opportunities for individual time with staff. Comments from people about staff varied but most people commented that staff had little time available to spend with them in any social way. Staff were seen to be kind in how they did support people. The privacy and dignity of people was protected by staff. You can see what action we told the provider to take at the back of the full version of the report.
The understanding of staff in respect of people's legal rights was good. This ensured that, where people did not have the capacity to make decisions that affected their safety or treatment, applications were appropriately made to the local authority to consider whether they should deprive the person of their liberty. People were not being deprived of their liberty and staff understood what action to take should this be considered necessary.
This inspection was carried out at 7.30pm to establish the staffing levels during the night time and to see if people's needs were being met. During this inspection we spoke with four people who used the service, the registered manager, the nurse in charge and one care staff.
We saw that care records contained detailed information about people's care needs and how to meet them. One person who used the service said, 'It's alright here, they take me out to the cinema now and then.'
We found that adequate staffing levels were provided to ensure people were provided with the relevant support. One person said, 'The staff do come quickly when I ring the call bell.'
We looked at three care plans that provided staff with information about people's care needs and the support they required to retire to bed.
We found that there were insufficient staffing levels during the night time to ensure people received appropriate support, care and treatment. However, the people we spoke with confirmed their satisfaction with the service they it depends on what is going on.'received. One person said, 'The night staff are all very nice. Sometimes when I use the nurse call alarm I have to wait a while but this doesn't happen very often.' Another person told us, 'The staff are fine and they come quickly,
We found that care plans and risk assessments provided staff with sufficient information about people's needs and how to support them. One person said, 'I was involved in my care planning and I'm very happy with the support provided.'
Care records showed that people had access to other healthcare services to monitor their physical and mental health needs.
Quality assurance systems were in place to monitor the management of medicines. We found some shortfalls with practices and these were identified to the registered manager.
We looked at the service's staff recruitment practices and found that appropriate safety checks were carried out to ensure the suitability of staff to work with vulnerable people.
Discussions with people who lived there, staff and the manager confirmed there were sufficient staffing levels to meet people's assessed needs. One person said, 'When I activate my nurse call alarm the response is pretty good.'
People had access to the home's complaints policy. The people we spoke with confirmed their awareness of this policy and said they felt confident to share any concerns with staff or the manager.
A manager has recently been appointed and we were informed that the necessary actions are being taken to register the manager with us.
Care plans are currently in the process of being reviewed to provide more information to support staff's understanding of people's care needs.
One person who uses the service said, 'The staff are alright and the food is good.'
Another person told us, 'I'm happy living here; the staff are very kind and talk to me nicely.'
The service provider has taken the necessary action to ensure sufficient heating and hot water supplies. One person who lives there said, 'The home is always warm and there is always plenty of hot water for a shower or bath.'
Sufficient staffing levels were provided to meet people's needs. One person who uses the service said, 'When I press the buzzer (nurse call alarm), the staff come quickly.'
Efforts had now been made to ensure staff receive safeguarding training to ensure they have the skills to recognise potential abuse and to protect people from this.
Efforts had been made to improve the management of people's prescribed medicines.
One person who uses the service said they receive their medicines when they need them and they were happy with the support they receive.
Another person told us, 'The staff do ask me how I would like to be cared for.'
One person said, 'I'm happy with the care given to me.'
Two people confirmed having access to relevant healthcare professionals when needed.
We observed that staff were always nearby to assist people when needed.
We saw staff participating in pastimes with people.
Relevant information on how to safeguard people from abuse were in place but not all staff have received safeguarding training to ensure they have the skills to recognise abuse and protect people.
There are insufficient records in place to tell staff how to best manage behaviours that challenge the service.
We saw that work was still in progress to ensure people have access to sufficent heating and hot water supplies.
People we spoke with did not say anything about infection control within the location. Two people did make the following comments about the cleanliness, 'Nice clean room, they always keep it nice'. 'It's ok. Never smells and is clean'.
"I have a lie down in the afternoon which is good." "Yes they encourage me to have meat and milk. I like the food it is good". "Yes have not had this one long.' (which related to a new cushion the person was supposed to have).
'The heating has been broken, its warm enough today but it was cold the other day'.
"The staff are very nice. They really do look after me. They are kind and make us laugh". "All staff are nice, friendly and kind".