Wellesley Road Care Home

Wellesley Road Care Home is a residential care home providing personal and nursing care to 57 people aged 65 and over at the time of the inspection. The service can support up to 60 people in one purpose-built property which is divided into six units, each with separate communal facilities.

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

People and family members told us they felt the home was safe. The home had procedures in place to ensure people were safe from abuse or harm. Staff members understood their roles and responsibilities in ensuring people were safe.

People’s medicines were stored and administered safely. Staff administering medicines had received appropriate training and assessments of their competency.

The home had carried out regular risk assessments of people, premises and care practice. These had been regularly reviewed and updated when there was any change. The home followed current best practice guidance in ensuring people were safe from the risk of infection.

Staff were recruited in a safe way. Appropriate checks, including checks of references and criminal records had been carried out prior to appointment.

The home’s policies and procedures were regularly updated and reflected best practice and current guidance for care homes. Regular quality assurance monitoring had been carried out and actions had been taken to address any concerns. Although there were some gaps in weekly medicines monitoring records, daily monitoring of medicines ensured errors were immediately identified and acted upon,

People and their family members had been asked for their opinions about the care provided at the home. Regular staff meetings had taken place. Staff spoke positively about their roles in supporting people. Staff were generally supportive of the management, but some felt that team work and information could be improved.

The provider acted immediately to address issues raised at inspection.

The registered manager had worked in partnership with other professionals to ensure people received the care and support they required.

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 27 January 2018).

Why we inspected

This was a focused inspection carried out due to the length of time since the previous comprehensive inspection of the 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.

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 last inspection was carried out in May 2016. The overall rating for the service was Requires Improvement. During our comprehensive inspection in September 2017 the service demonstrated to us that improvements had been made.

Wellesley Road Care Home is part of the Shaw Healthcare (Group) Limited. It provides accommodation, nursing and personal care for a maximum of 60 older people, most of whom have dementia. On the day of inspection there were 56 people using the service.

At the previous inspection in May 2016, the home did not have a registered manager. At this inspection we found a registered manager was now 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.

At our last inspection in May 2016, there were concerns around the amount of agency staff that were being used at the home. At this inspection we saw that the service had reduced the amount of agency staff. There was a continuous recruitment programme in place to employ more permanent staff. At the time of this inspection, the service had employed 34 permanent staff. There were three more vacancies to be filled. We saw that people’s needs were being met.

A safe recruitment and selection process was in place. This ensured staff had the right skills and experience to support people. The provider carried out necessary checks prior to new staff commencing employment.

There were systems in place for the safe management of medicines. People received their medicines as prescribed. All prescribed medicines were available at the home and were stored securely. People told us they received their medicines when they needed.

We found that the registered provider had made improvements in their quality monitoring systems. The home had developed a range of ways to monitor the quality of the service in order to make improvements. A range of audits were carried out, including medicines, environmental, infection control and care plan audits. Where improvements had been recommended we saw that action had been taken.

Risks to people had been identified, assessed and reviewed. People receiving care told us they felt safe living at the home. There was a range of risk assessments, which covered the following areas: falls; skin integrity; and weight loss. There were control measures in place, which described how to keep people safe. The service had taken swift action to address issues we had identified with pressure mattresses.

The service met the legal requirements of the Mental Capacity Act 2005 in supporting people. We saw that staff sought and obtained people's consent before they offered help. People's mental capacity was assessed for particular decisions. Best interest meetings had been held with relatives and relevant health and care professionals where necessary.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw evidence that appropriate applications to restrict people's freedom had been submitted and the least restrictive options had been considered.

People were supported to meet their nutritional needs. They were able to make choices about the meals and drinks they wanted. We saw that alternative meals were provided.

People were supported to meet their health care needs and had access to a range of external health and care professionals. Healthcare professionals told us that people were referred to them in a timely manner so that people’s needs were met.

People’s privacy and dignity were respected. Staff cared for people in ways which recognised people's rights to make their own decisions.

At the last inspection of this service on 25, 26 and 31 May 2016 we found that some aspects of medicines management were not safe and there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to the serious nature of the breach we took enforcement action against the registered provider.

At the time of this focused inspection, there was 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.

We undertook this unannounced focused inspection on 13 February 2017 to check that the most significant breach of legal requirements in relation to Regulation 12, concerning medicines, which had resulted in enforcement action, had been addressed. During this inspection we found that the medicines were being managed safely and the breaches of the regulations identified in the warning notice had been met.

This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Wellesley Road Care Home on our website at www.cqc.org.uk.

We will undertake another unannounced inspection to check on all other outstanding legal breaches identified for this service.

Wellesley Road is registered to provide accommodation, nursing and personal care for a maximum of 60 older people, most of whom have dementia. On the day of inspection there were 56 people using the service.

The home had a registered manager who is also registered for another 60 bedded care home which is located nearby and run by the same provider. The registered manager spends most of her time at the other care home. The provider had employed a manager, as of February 2016, who is working full time at Wellesley Road and has applied to be registered for this 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 home completed some audits of people’s medicines. However, there were not enough people’s medicines checked to ensure a robust auditing system and identify medicines errors.

Stock control of medicines was not always checked or documented. Some people received covert medicines; there was no documented Mental Capacity Act (MCA) assessment for people around providing covert medicines.

Staff did not always receive regular documented supervision and support. The home did not provide adequate support and guidance for staff or identify individuals learning and development needs.

The home was compliant with applications for the Deprivation of Liberty Safeguards (DoLS). However, management failed to notify the Care Quality commission (CQC) when an application had been granted.

There were concerns raised by staff and relatives around the amount of agency staff that were being used in the home. The home completed 48 hour diaries, documenting the amount of care required, when a person’s needs changed. This was discussed with the local authority and staffing allocated according to identified need.

Food looked and smelt appetising. People told us that the food provided by the home was good. People were asked what they would like to eat the day before so that the kitchen could prepare the meals. This included alternative meals. However, on the day, people were not consulted as to whether this was still the meal that they wanted and an alternative was not offered. Some people were unable to remember what they had chosen the day before.

People told us that they felt safe within the home and were well supported by staff. Relatives also said that they felt their family members were safe within the home. We saw positive and friendly interactions between staff and people.

Staff understood people’s individual needs in relation to their care. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report abuse to if people were at risk of harm.

Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Where people were not able to have input in to making decisions affecting their care, there were records of MCA assessments and best interests meetings.

Care plans were person centred and reflected individual’s preferences. Care plans had been signed by people. Where people were unable to sign, they had been signed by relatives.

People were supported to maintain a healthy lifestyle and had healthcare appointments that met their needs. There was good joint working with healthcare professionals and we received positive comments from the healthcare professional the home worked with.

There was a dedicated activities coordinator and a weekly activities schedule that showed activities were provided seven days a week. We observed people engaging with activities and smiling and laughing.

Staff training was updated regularly and monitored by the manager.

People were supported to have enough to eat and drink. Where people had specialist diets, they had been assessed by Speech and Language therapists (SALT). Staff understood individual needs around food and hydration.

There was a complaints procedure as well as an accident and incident reporting. Where the need for improvements was identified, the manager used this as an opportunity for learning and to improve care practices where necessary.

There were regular health and safety audits. These allowed the provider to ensure that issues were identified and addressed. A recent service user survey had been completed and the service was in the process of collating these results.

There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance.

There was an improved and open atmosphere within the home. The management encouraged a culture of learning and staff development.

Overall, we found breaches in regulations, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We identified breaches of regulations relating to medicines, supervision, medicines auditing and notifications. You can see what action we have asked the provider to take at the back of the full version of this report.