Archived: Wombwell Hall Care Home

Wombwell Hall Care Home is a residential care home providing nursing and personal care for up to 120 people. Peoples’ needs were varied and included those living with dementia, people with physical needs and some requiring nursing in bed. The service was arranged on one level across four different units; each one can accommodate 30 people. At the time of our inspection there were 73 people living in the service and one unit was temporarily closed.

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

People told us they felt safe and were happy living in Wombwell Hall. One person said, “I’m very comfortable here because I’m confident that when I need help, they are here for me.” Another person said, “I’m very happy because the carers look after me well.” Relatives agreed that their loved ones were safe and happy. One relative said, “Oh, [relative] is so safe here. There is always someone to check [relative] is ok.” Another relative said, “[Relative] is safe here, I have no qualms.”

People received safe care and treatment from staff who knew them well. Medicines and infection control were both managed safely, and lessons were learned when things went wrong.

People were involved in decisions about their care and they received care which promoted their dignity and encouraged independence. Relatives told us they were involved in their relative’s care plans and were always kept up to date with any changes, either in the home or with their loved one’s condition. One relative said, “They did ring me and ask if I wanted anything updated in the care plan.”

People enjoyed the food and their dietary needs and preferences were met, for example vegetarian. People told us they had choices, but if they wanted something different, they only had to ask. One relative said, “[Relative] eats well and their weight is OK.” There was a range of activities offered, including group and individual activities and people could choose whether to attend.

Effective quality assurance processes were in place to monitor the service and regular audits were undertaken. Staff had received appropriate training. A new registered manager had been appointed since our last inspection and staff told us they found them approachable and supportive with an open-door policy.

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.

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 (published 17 June 2021).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a comprehensive inspection to review the five key questions of safe, effective, caring, responsive and well led. This enabled us to look at the concerns raised and review the previous ratings.

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.

The overall rating for the service remains good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wombwell Hall Care 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.

Wombwell Hall Care Home is residential care home providing nursing and personal care for up to 120 people. Peoples’ needs were varied and included those living with dementia, recovering from strokes and requiring nursing in bed. The service was arranged across four different units, each accommodating 30 people. At the time of our inspection there were 68 people living at the service and one unit was temporarily closed for refurbishment.

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

People told us they felt safe in the service and liked living there. One relative said, “I am 100% happy with the home. The staff are so kind to my wife and me and nothing is too much trouble for them.” People received safe care and treatment and there were enough staff to meet peoples’ needs. Medicines were managed safely, and lessons were learned when things went wrong.

People and their relatives were involved in decisions about their care and they received care which promoted their dignity and independence. Relatives told us they had been kept up to date with any changes during the COVID-19 pandemic when visiting was restricted. A relative said, “Yes, I do feel involved in decisions made about her care. When I go to the home, it’s like being at home for me too.”

Quality assurance processes were in place to monitor the service. The managers promoted an open-door policy and staff told us that they had a lot of confidence in the management team.

People told us they had choice about their meals and would always be offered an alternative if there was nothing on the menu they liked. A range of activities were planned throughout the service, but people could choose whether to attend, depending on their interests. One person said, “I don’t usually get involved in anything, I prefer to spend time in my room.”

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.

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 21 May 2019) and there were multiple breaches of regulation. We carried out a targeted inspection on 21 July 2020 to follow up on specific concerns which we had received but there was no change to the rating. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement 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 5/6 March 2019. 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 person centred care, consent, safe care and treatment, staffing, fit and proper persons and good governance.

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, effective, responsive and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions that were 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.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wombwell Hall Care 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.

We found the following examples of good practice.

¿ Due to the outbreak of COVID-19 the service was closed to visitors in accordance with Government guidelines. The provider had arranged for alternative ways for people to keep in touch with their relatives. Visitor pods had been purchased and were being installed to support safe visiting and to help protect people from infection.

¿ The service had an adequate supply of personal protective equipment (PPE) to meet current and future demand. Staff were using PPE correctly and in accordance with current guidance and disposal was safe.

¿ There were up to date infection prevention and control (IPC) policies and procedures, staff had received training and regular IPC audits were undertaken within the home and by regional quality teams. There were action plans to address any concerns raised.

¿ A head housekeeper took responsibility for monitoring compliance with cleaning regimes. When we visited, Wombwell Hall was clean and cleaning schedules had been completed.

Further information is in the detailed findings below.

Wombwell Hall Care Home is a residential care home providing personal and nursing care to up to 120 older people. People’s needs included those living with dementia, recovering from a stroke and requiring nursing in bed. There were 97 people living at the service at the time of inspection. The service was divided into four separate units, each accommodating up to 30 people.

People’s experience of using this service

People and their relatives told us that permanent staff were kind and caring and knew people well. One relative told us, "Staff are very kind and helpful although they do have to work very hard".

The overall deployment of staff was not effective as there was a lack of oversight in one unit. This was because there was no manager or permanent nursing staff to lead the staff team.

Quality assurance processes were not always effective in identifying and addressing shortfalls in the service .

Potential risks to people were not always acted on to ensure people’s safety .

Records of people’s care and treatment were not always accurate.

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 Requires Improvement (published 21 May 2019).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question .

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the management of the service, staffing levels and responding to risks. A decision was made for us to inspect and examine those risks.

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

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 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.

For more details, see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

¿ Although the registered manager used a dependency tool to calculate the numbers of staff needed and felt assured their staffing levels were sufficient, most people we spoke with were clear there were not enough staff as they were often kept waiting to have their needs met. There were a number of agency staff used, particularly at night and people had concerns about this.

¿ People were not always supported to maintain their basic rights when they lacked capacity to make particular decisions, and were deprived of their liberty.

¿ Meaningful occupation through the day was not available to everyone, particularly those who were nursed in bed or chose to stay in their rooms.

¿ People did not always receive their medicines as prescribed as sometimes they did not receive the correct amounts of tablets.

¿ New staff were not always recruited in a safe way to make sure they were suitable to work with people living in the service.

¿ We found one area needing to improve: consideration to providing a more dementia friendly environment.

¿ Apart from the concerns about staffing, people and their relatives thought the staff were caring, friendly and worked hard.

¿ The food was described as good and people could order something different if they were not happy with what was on the menu. Qualified nurses took care of people’s health needs and referred them to other healthcare professionals when needed.

¿ Staff were well trained and supported by a clear management structure.

¿ A registered manager was in post who knew people well.

Rating at last inspection: Requires Improvement (Report published 16 March 2018). Insufficient improvements had been made to raise standards since the last inspection. This service has been rated Requires Improvement at the last two inspections.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of this report.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Requires Improvement.

Wombwell Hall Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service comprises of four separate houses, Pickwick House, Weller House, Copperfield House and Micawber House, together with a main administration building. Each house provides residential and nursing care for up to 30 people making a total of 120 people when the service is full. There were 114 people living in Wombwell Hall Care Home at the time of our visit.

The service was run by a registered manager and they were present on the days of our visit. 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.

This is the first time the service has been rated since the change in ownership in December 2017.

People and their relatives told us staff were kind and caring and made people feel safe. They said staff had the necessary skills to respond to people’s needs, monitored their health and that people enjoyed their meals. However, we found inconsistency in care practices across the service which meant that people did not always receive the level of care expected.

Systems to monitor the quality of care were not always effective. Potential risks were not always accurately monitored and recorded and records were not always legible, accurate and up to date which could result in people receiving inappropriate staff support.

There was evidence to show that there were at times insufficient numbers of staff on duty to meet people’s needs.

Shortfalls had been identified in staff training and plans were not in place on the first day of the inspection visit, to ensure staff received relevant refresher training for their role. Not all staff felt well supported both informally and through formal processes such as staff meetings and supervisions.

Recruitment practices were robust in ensuring only suitable staff were employed at the service.

People’s needs were assessed and a plan of care was developed which included their choices and preferences. Guidance was in place for staff to follow to meet people’s needs. However the care plans were not always legible, accurate and up to date to ensure that people’s needs were met.

People’s health needs were assessed and monitored and the service worked in partnership with healthcare professionals to ensure people received appropriate care and treatment. However, there were examples where the provider had not effectively managed and responded to risk.

Medicines were on the whole managed safely and people received them as prescribed.

The views of people and their relatives were sought through meetings and an annual survey.

Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order.

Management systems were in use to minimise the risks from the spread of infection and keep the service clean, although records did not always support this.

We found four 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.