All inspections: Wymeswold Court - Care Quality Commission

This inspection took place on the 9, 10 and 14 December 2015 and was unannounced.

At our last inspection carried out on 5, 6 and 9 February 2015 the provider was not meeting the requirements of the law in relation to the care and welfare of people who use services, the management of medicines and assessing and monitoring the quality of service provision. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make.

During this inspection we looked to see if these improvements had been made. We found that whilst some improvements had been made, some issues of concern remained.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of the full version of this report.

Wymeswold Court provides accommodation for up to 40 people who require personal care. There were 20 people using the service at the time of our inspection including people living with dementia.

The person managing the service was an acting manager. They were in the process of applying to be the registered manager. 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 and associated Regulations about how the service is run.

People told us they felt safe living at Wymeswold Court and their relatives agreed with them.

Although the staff team knew their responsibilities for keeping people safe from harm, safeguarding incidents had not always been passed to the acting manager for their attention or action.

People had not always received their medicines as prescribed by their doctor.

People’s needs were assessed prior to them moving into the service and plans of care were developed from this.

People had been involved in making day to day decisions about their care and support. However, where people lacked capacity to make decisions, there was little evidence to demonstrate that decisions had been made for them in their best interest or in consultation with others.

People felt there were currently enough members of staff on duty to meet their care and support needs. There were 20 people using the service at the time of our visit.

The majority of risks associated with people’s care and support had been assessed and actions had been taken to minimise such risks.

Whilst there were times when we observed people being treated in a kind and caring manner, there were other times when they were not.

Checks had been carried out when new members of staff had been employed. This was to check that they were suitable to work at the service. The staff team had received training relevant to their role within the service and ongoing support had been provided.

Staff meetings and meetings for the people using the service and their relatives were being held. This provided people with the opportunity to be involved in how the service was run.

The staff team felt supported by the acting manager and felt able to speak with them if they had a concern of any kind.

People’s nutritional and dietary requirements were assessed and a balanced diet was provided, with a choice of meal at each mealtime. Monitoring charts used to monitor people’s food and fluid intake were not always completed consistently. Whilst the majority of people had a good experience at meal times, We found that one person did not.

There were systems in place to monitor the service being provided, though these had not always been effective in identifying shortfalls, particularly within people’s care records.

An unannounced inspection took place on 5 February 2015 and we returned on 6 and 9 February 2015 in order to complete our inspection. Our previous inspection of 24 September 2014 found the provider was not meeting two regulations at that time. These were in relation to care and welfare of people who use services and assessing and monitoring the quality of service provision. Following that inspection the provider sent us an action plan to tell us about the improvements they were going to make. At this inspection we found that the necessary action had not been completed and there were continued breaches of these regulations. We also identified two additional breaches in relation to staff support and management of medicines.

Wymeswold Court provides care and support for up to 40 older adults with a variety of needs including people with dementia. The home has two floors with a number of communal areas and gardens available for people to use. There were 23 people using the service at the time of our inspection.

The previous registered manager had left in October 2014. 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 and associated Regulations about how the service is run. A new manager had been recruited and had been in post for weeks at the time of our inspection. We were considering their application to become a registered manager at the time of our inspection. The provider had also given responsibility for oversight of the home to a new area manager.

People using the service had mixed views about the home and the care and support they received. Some people were satisfied with their care and support and told us they were treated with kindness and respect. Other people told us they would have liked more activities or events and some described inadequacies in their care. Some people’s relatives were also happy with the home and the staff team. We were told that staff were considerate and helpful and had a good understanding of their family member’s needs. However, other relatives were not so confident in the care being provided and were concerned about their family member.

People’s likes, dislikes, preferences and individual needs had been recorded by the service but we found examples when people’s wishes had not been followed. There was limited evidence that people had been involved in making decisions about their care. People had the opportunity to express their views about the service being provided in residents meetings but it was not clear how their suggestions were put into practice by the provider.

On many occasions we observed care being provided to people appropriately by staff who were kind, patient and friendly. These staff offered people choices and were helpful and appropriate in their approaches and engagement. However, we also observed occasions where staff treated people with a lack of respect and consideration. Most staff promoted people’s dignity and communicated effectively but this was not consistent and there were occasions where people’s dignity was not respected. Most staff we spoke with had a good understanding of people’s needs and were committed to providing the best care they could.

Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. Staff had received training and support to assist them in their roles, however this was ineffective. We observed occasions where staff did not put their training into practice. For example, we observed the unsafe administration of medicines and unsafe moving and handling procedures. Health professionals we spoke with both before and during our inspection raised concerns about the competency of the staff team. We were told that staff did not put their learning into practice which had caused shortfalls in people’s care.

There were significant shortfalls in the planning and delivery of people’s care and people had been placed at risk as a result. People’s needs in relation to their behaviour had not always been responded to appropriately by staff at the service and there was confusion and inconsistency about this area of practice. People’s health needs had been responded to and monitored but advice from health professionals had not always been incorporated and acted on by the staff team.

People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided. People received the support they required in relation to eating and drinking but this was not always carried out in a dignified manner.

There were enough staff available to meet the needs of people who used the service but people were not always able to call for help when they required it because call bells were out of place or not available.

People’s care needs, particularly in relation to their personal care had not always been met adequately. Many people’s bedrooms were dirty and unhygienic and their bed linen was soiled, stained and worn. Procedures for the appropriate disposal of clinical waste were not being followed. The new management team took immediate action to address these issues and we noted an improvement on the subsequent days of our inspection.

Medicines were safely stored and but people had not always received their medicines as prescribed because the systems for re-ordering of medicines were inadequate. This meant that the service had run out of people’s medicines on a number of occasions. We also observed medicines being administered in a way that did not protect people from the associated risks.

Staff were aware of how to protect people from avoidable harm and were aware of safeguarding procedures to ensure that any allegations of abuse were reported and referred to the appropriate authority. The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008 were known and understood by the new management team but there was inconsistency in how they had been applied by previous managers.

Incidents, accidents and complaints had been reported but they had not always been robustly investigated and responded to appropriately. Learning from these issues was not evident.

There were systems in place to assess and monitor the quality of the service but these were ineffective as they had not identified the widespread and significant shortfalls in service provision. This had placed people at risk of receiving inappropriate or unsafe care. The new management team were committed to making the necessary improvements and have an action plan in place to help them achieve this.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were overall treated with respect and dignity by staff. We observed staff in communal areas and saw how they treated people with dignity and respect. All personal care was provided either in the person’s bedroom or in the bathroom. One person told us. “The staff are lovely. I have a choice when I get up and go to bed”. People told us they felt safe. However visiting professionals told us that they observed staff speaking disrespectfully to a person and had reported this to the registered manager, who dealt with their concerns.

People told us that they knew how they could raise concerns and felt confident about doing so without consequences. One person told us. “I would feel happy making a complaint to the staff. I feel they would listen to me.”

People received their medications at the right time. Following concerns where people did not receive their prescribed medication the provider had set up effective arrangements for the safe management of medicines.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. However policies were not always being followed and people with impaired capacity were not always being assessed for the type of support they needed. We have issued a compliance action regarding assessing people’s capacity.

The provider employed housekeeping staff who cleaned the home. We saw that people's bedrooms and communal areas were clean and tidy. One person who used the service told us their room was always "clean and tidy".

People's care needs were not always taken into account when developing support plans. Where people had complex needs as a result of their dementia staff were not always given the information or guidance they needed to meet people’s needs safely. We have issued a compliance action regarding meeting people’s individual needs.

Is the service effective?

People's health and care needs were assessed but they did not always include the person or their representative. Support plans did not always include sufficient detail of people's needs and information about how people were supported with those needs.

When we spoke with visitors, they told us they were confident that the service provided good care. One visitor told us, “I really like this home, the staff care.”

Is the service caring?

People told us they were supported by kind and caring staff. One person told us, "The staff are kind and lovely." Another person said, “The staff are lovely. I have a choice when I get up and go to bed”.

The service provided a range of communal and individual activities that people could participate in. One person told us, “We have entertainment and it is really good and we can go out.”

Is the service responsive?

People told us that staff supported them with their needs. People told us they were well looked after. The daily records we looked at showed that people had been supported with personal care and health needs. Staff contact the relevant healthcare professional when people need support.

Visitors we spoke with told us that they knew how to raise concerns and were confident they would be listened to. We saw that a relative's complaints had been investigated and resolved.

All visitors we spoke with told us that the service had kept them informed about their relative’s wellbeing if they became unwell. “If my relative becomes unwell they will call a GP.”

People who used the service and relatives had participated in a satisfaction survey. The results of the survey showed that people were satisfied with their care. Relatives told us that their views had been acted on.

Visiting professionals raised concerns that the service did not always learn from incidents but told us that the new registered manager had accepted training for the staff on how to prevent pressure care ulcers.

Is the service well-led?

The service had a system for monitoring the quality of service. This included checks of documentation and records.

The provider had carried out a survey of people who used the service. The survey gave people an opportunity to comment on their experience of the service.

You can see our judgements on the front page of this report.

We carried out this inspection following information of concern. We spoke with eight people using the service and four care staff on duty as well as visitors to the home.

We wanted to know if people were receiving the care they were assessed for and if they thought there was enough staff on to meet their needs. People told us that they thought staff were "wonderful" and very caring but at times it was very busy, particularly in the morning. Relatives thought there were less staff at the weekends but we were told that this was not the case by the quality area manager. There are housekeeping and kitchen staff as well the activity organiser. The acting manage and deputy manager carry out spot checks out of normal working hours. We observed staff and although busy they were able to answer people's call bell in good time. We saw that people were receiving regular position changes to minimise risk of pressure ulcers developing and fluid charts were being completed. The acting manager was carrying out spot checks to ensure that records reflected the care given.

We looked at care plans and we saw that they lacked detail particularly where a person had complex needs and communication issues.

The service has been without a registered manager for nearly a year and this has had an impact on the consistency of care and support staff are receiving. The provider must ensure that a registered manager is in post as soon as possible.

We spoke with people using the service and their relatives. They told us that they felt the home had improved over the last few months. "The staff know what they are doing, they seem more confident."

We saw that care plans had been improved, they contained better information about people's needs and were kept up to date.

People using the service also told us that home was kept clean and tidy and staff told us that they received infection control training and that the manager checked their understanding of this training. "My room is always clean." "There is never any nasty smell here."

We saw that staff used personal protective equipment when they needed to and they received the training they needed to minimise the risk of cross contamination.

We spoke with four visitors they gave a mixed view of the home. Generally they were happy with the care their loved one received, although there were some exceptions particularly when it came to issues around medication. We found that although staff worked hard, they struggled to manage the number of people using the service due to the level of needs and minimum staffing levels.

We saw that people had care plans in place that described care needs. However the new care plans were not being created with the same level of information and staff did not routinely read care plans to keep up to date with people's needs.

Staff did not receive the training and support they needed to work safely and although the acting manager and new manager were putting training in place staff did not feel supported.

The medication system although good still had potential for people not to receive prescribed medication and this was a concern for a relative who's loved one had experienced this problem.

Staff worked hard in the home and were observed them being kind and gentle with people. However we also observed staff being disrespectful, for eaxample by telling people using the service to 'sit down' when they got up to walk around rather than support them whilst walking.

We also observed poor hygiene practice that could promote cross infection and a relative told us they had noted faeces at the side of their relatives chair that had not been removed from the previous week.

We spoke with two people using the service and three relatives, they told us that they were happy with the care they received.

"The staff are all really lovely, they are kind and patient."

"They are kind they can't do enough for me."

"I feel confident when I leave here that the staff will look after my ( relative) well and will be kind to them."

"Staff bring me my medication when I need it."

"They have Relative Meetings here and we are encouraged to attend and be involved with what is happening in the home."

"If I needed to make a complaint I know I could go to the manager and she would deal with it."

Archived: Wymeswold Court

All Inspections

9, 10 and 14 December 2015

During a routine inspection

5, 6 & 9 February 2015

During a routine inspection

24 September 2014

During an inspection in response to concerns

16 October 2013

During an inspection in response to concerns

7 August 2013

During an inspection looking at part of the service

3 April 2013

During a routine inspection

20 June 2012

During a routine inspection