Archived: Sedbury Park

The main part of the house is a grade II listed building plus an extension. Parts of this building were in a poor state of repair but there was a refurbishment plan in place. There was also two purpose built units called Marlings and the Wye Unit. The three units could accommodate 28, 21 and 25 people respectively. There were 60 people in residence at the time of our inspection. All private bedrooms have en-suite facilities.

There was no registered manager in post but the provider had appointed an interim manager to oversee the running of the 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. The interim manager will be making application to CQC to be the registered manager until a permanent manager can be appointed.

Whilst we found the premises to be clean on this inspection, the service did not have measures in place to ensure that infection control and prevention procedures were adequate. No infection control audits had been completed and there were no records of checks of equipment to ensure it was clean. However, a hand-washing audit had been completed in March 2016.

People’s rights may not be protected because staff did not act in accordance with the Mental Capacity Act 2005. Applications to deprive a person of their liberty in their best interests had been submitted but this had not been completed in all appropriate cases. Whilst the staff team understood the need to obtain consent from people regarding day to day decisions, their knowledge of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) was limited. Staff were not clear who had an authorised DOLS in place.

Care planning documentation had improved since the last inspection however on Wye unit particularly the reviewing of care plans and risk assessments was not consistent. Further improvements were required to ensure that for each person, there was an accurate and detailed care plan stating how their care and support need were to be met. Despite this, people said they received the care and support that met their specific needs.

All staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if bad practice was witnessed, alleged or suspected and would take the appropriate actions. The manager was fully aware of reporting procedures and had reported a number of events promptly to the local authority and CQC. The appropriate steps were in place to protect people from being harmed. There were safe recruitment procedures in place to ensure unsuitable staff were not employed.

The arrangements in place to ensure the premises were safe had been improved. Contractual arrangements were in place for the servicing and maintenance of equipment and there was a programme of environmental checks completed on a weekly or monthly basis. A range of risk assessments were completed for each person and appropriate management plans were in place. Medicines were well managed.

Staffing numbers were based upon the care and support needs of each person in residence, although the manager did not use any formulae to determine safe staffing levels. The service were in the process of reviewing staffing levels in Wye unit based on feedback from the staff team and relatives.

New staff were expected to complete an induction training programme but this had been hit and miss prior to the new manager starting. For all staff there was a programme of essential training to enable them to carry out their roles and responsibilities but the records of who had done what was out of date. The manager was already aware of this shortfall and had already taken action to rectify this. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People were provided with sufficient food and drink. Their specific dietary requirements were catered for and there were measures in place to reduce or eliminate the risk of malnutrition or dehydration. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to.

The staff team were described as kind and friendly and had good caring relationships with the people they were looking after. People were able to participate in a range of different activities and external entertainers regularly visited the home. People were encouraged to be as independent as they were able and were involved in having a say about how they wanted to be looked after.

The staff team were responsive to people’ individual needs and the care planning processes were on the whole sufficient. Improvements were required with the care planning documentation in Wye unit. Many of the plans had not been transferred to the new documentation and the reviews had not consistently been carried out.

Regular staff meetings were now scheduled as a means to provide good leadership and management of the service. This ensured the staff team were kept up to date with any changes and developments in the service and knew what was expected of them. The provider had a regular programme of audits to complete to check on the quality and safety of the service. Some of the checks were completed on a daily basis, others on a weekly or monthly basis.

We found a number of 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 this report.

During this inspection we reviewed what action the provider had taken. We looked at the care records for two people with pressure ulcers / wounds and talked to staff. We did not speak to people who used the service during this inspection because this visit was to follow up on the actions taken since our previous visit. The provider had increased training for staff and had been seeking support from the home support team at the local authority.

We looked at the care files for two people who used the service. One of these people had been identified as having a pressure ulcer and the other person had the beginnings of a wound. In both cases we saw that care plans had been put in place together with photographs of the wounds and regular wound assessments. Staff had sought advice from specialist tissue viability nurses in a timely way.

We found no issues with two of the three care records we looked at. However, we had concerns about the care one person had received. This person had developed severe pressure ulcers on their hand. Advice offered by the provider's own physiotherapist had not been followed and dressings used by staff were not in line with locally agreed treatment options. A delay in seeking specialist advice meant the person had not been protected against the risk of receiving unsafe or inadequate care. This meant that the provider had not protected each person using the service against the risk of receiving unsafe or inadequate care.

The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We looked at the training records for staff and saw that staff had been offered information about how to recognise abuse and informed of their responsibilities when reporting safeguarding issues.

The provider had made arrangements to ensure that a sufficient number of qualified, skilled and experienced staff were on duty each day to meet the needs of people living in the home.

We spoke with a number of people living in the dementia units. They commented, regarding staff, that 'they are friendly and helpful' and 'they are marvellous, they know what I like', 'they are kind to me', and 'they are very good here.'

The care planning documentation across the home now follows the same format. The improvements, in the quality of care provided, had been assisted by the decision of the home to only accept a limited number of new admissions, and to reduce the overall numbers of people living in the main house. As a consequence of this decision, staffing ratios were higher and had benefitted people living at the home. Staff had also been able to access regular health and safety and specialist training. A number of staff were able to provide training in moving and handling. These staff also regularly observed moving and handling practice and the competence of staff. The quality and frequency of auditing had also improved.

We found that the provider was and is continuing to investing considerable resources at Sedbury Park. This included additional management support, training and starting the process of reviewing all of the care records at the home.

Care plans had, or were in the process, of being updated. Whilst this process is underway however, there is a mix of old and new documentation and archiving of recent care documents.

We reviewed the care planning records for two people, for whom concerns had been raised, regarding their care. We found that the records were in some areas incomplete. Of greater concern was the failure to assess and mange wound care. Staff had failed to adequately assess pressure ulcers or manage wound care effectively. Records failures to monitor and turn people with existing wounds. Staff had also failed to provide, following their own assessments, sufficient food and drink to people. We did not have the opportunity to speak with people living at the home.

Whilst the investment in the home is welcomed, this inspection found that fundamental basic standards of care were not being met at the time of the inspection.