Waltham House Care Home

Waltham House Care Home is a residential care home providing personal care to up to 33 older people, including people living with dementia in 1 adapted building. At the time of our inspection there were 23 people using the service.

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

Quality monitoring systems were in place which helped to check various areas of the home. Any actions identified were carried out to make sure the service was continually improving. However, some improvements in relation to monitoring records were required.

People were happy with the care they received, they felt safe and well looked after.

People had support from staff who had been safely recruited. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. People and staff spoke positively about the management of the service. Staff received guidance and support from management regularly and when required.

Staff followed care plans and risk assessments which were in place for known risk, up to date, and regularly reviewed. People were supported to take their medicines safely as prescribed.

People were regularly asked their views on the service provided and action had been taken when suggestions were made.

People were supported to have access to healthcare services to monitor and maintain their health and well-being. People were encouraged to maintain a healthy diet, where people had specific dietary requirements, these were catered for.

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.

The home was clean and tidy. Staff had access to and followed clear policies and procedures on infection, prevention and control that met current and relevant national guidance.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 30 March 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this 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.

This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Waltham House Care Home on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation in relation to information recording systems.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Waltham House Care Home is a residential care service providing accommodation to a maximum of 33 older people, some of whom are living with dementia. At the time of this inspection there were 24 people using the service.

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

Since the last inspection, the provider improved the quality of care records in relation to people’s safety. Care records contained information about people’s needs and risks. People’s preferences and choices were considered and reflected within records. Fire safety issues had been addressed and regular fire drills carried out to ensure people’s care needs were identified in the event of an emergency situation. Staffing levels had improved at night to meet people’s individual needs.

People and relatives said they felt the service was safe and that people were well supported and received good quality care.

People received safe, person centred care. Good systems were in place to protect people from abuse. The service had recently implemented a full electronic recording system which had improved recording and oversight of care such as checks for skin integrity and medicines.

Medicines were managed safely. Staff received training and competency checks in relation to medicines. Staff also received training on the new electronic system used to record medicines.

Staff demonstrated a good level of understanding in relation to safeguarding. Appropriate referrals to the local safeguarding team had been made. People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed. However, some relatives highlighted concerns regarding lack of communication at times.

Staff knew people well and were knowledgeable about when to refer to other health professionals for advice and support. 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 enjoyed the food provided and were supported to make sure they had enough to eat and drink.

The registered manager and provider were responsive to feedback and committed to improving the service.

Staff were recruited safely and received the training and support they needed to undertake their role. Staff spoke positively about the support they received from the management team.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published 10 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider reviewed their staffing levels in line with people’s individual support needs. At this inspection we found improvements had been made to staffing levels.

This service has been in Special Measures since 10 June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

The provider has taken action to effectively mitigate the risks identified in the previous inspection.

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

Waltham House Care Home is a residential care service providing personal care to a maximum of 33 older people, some of whom are living with dementia. At the time of this inspection there were 25 people using the service.

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

People at Waltham House Care Home did not receive a safe, effective and well led service. We identified concerns relating to people’s safety which included poor oversight of fire safety issues by the provider. A lack of guidance for staff on how to support people in the event of a fire emergency situation put people at significant risk of harm.

Staffing levels at night did not meet the individual needs of people using the service. We have made a recommendation about this.

People did not always receive person-centred care and care records did not fully reflect their needs. Staff lacked guidance and had failed to seek professional advice and make appropriate referrals in relation to people’s poor skin integrity.

The provider had no oversight of the safety and quality of the service. Quality assurance systems were not robust and operated effectively to ensure compliance with regulations.

Medicines were not managed safely. Staff did not always have guidance to ensure they administered ‘as and when required’ medicines to people safely. The provider’s policies and protocols were not being followed by staff and management.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; policies and systems in the service did not support this practice.

Systems were in place to recruit staff safely.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 22 February 2020) at this inspection the service is rated inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about pressure care and the organisation and leadership of the service. A decision was made for us to inspect and examine those risks.

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 has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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.

We have identified breaches in relation to safety of the service, need for consent and the provider's oversight and governance arrangements.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

• Sanitising hand gel, disposable masks, aprons and shoe sanitiser were provided for visitors at all entrances of the service.

• The service communicated well with relatives to promote people’s wellbeing.

• Staff were wearing PPE in line with government guidance and designated areas were set up within the service for staff to remove and apply PPE.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Waltham House on our website at www.cqc.org.uk.

Waltham House Care Home is a residential care service providing personal care to a maximum of 33 older people, some of whom are living with dementia. At the time of this inspection there were 23 people using the service.

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

People received safe, person-centred care. Since the last inspection, there had been improvements in risk management and the safety and cleanliness of the environment. The quality of care records in relation to people’s safety had improved and recruitment records contained appropriate checks.

Improved consent records demonstrated 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 provider’s quality monitoring system had been developed and new monitoring systems introduced, but some recent improvements needed to be embedded and sustained. For example, the recording of the application of topical medicines and some care records. More robust audits and effective monitoring were needed to drive improvements around odour management.

People were supported to access the wider community. The staff team had made efforts to improve the range of social activities, but many people remained reluctant to participate. We made a recommendation around changing the culture and approach to activities.

The registered manager and provider were responsive to feedback and committed to continually improve the service. They promoted a very person-centred culture which respected people’s diversity. Meetings were held with people, relatives and staff to exchange information and gather feedback.

People were treated with dignity and respect and their independence was promoted. Staff worked together to effectively meet people’s needs. Enough staff were deployed to support people in a patient and caring way. Staff received training and supervision to help with their development and confidence when supporting people’s needs.

Staff knew people well and were knowledgeable about when to refer to other health professionals for advice and support. Communication care plans were in place to support people’s communication preferences. People enjoyed the food provided and were supported to make sure they had enough to eat and drink.

The provider had a system for the management of complaints, and people felt able to raise concerns knowing they would be addressed.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Waltham House 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.

Waltham House accommodates up to 33 older people, some of whom may be living with dementia, in one building over two floors.

A registered manager was 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.

Risks had been identified and personalised risk assessments formulated, so that steps could be taken to mitigate risk where possible. However, we found one incident where risk had been identified and systems in place to minimise the risk had not been followed. Further risk had been identified, but action had not been taken. This meant there had been a delay in one person receiving medical intervention for a pressure sore.

The home was generally clean and tidy, however we found some shortfalls including one bedroom and some toilets requiring a more thorough clean. There were some issues with the safety and maintenance of the environment including a potentially hazardous unused shower area; there was a risk people with dementia may have accessed this. The registered manager confirmed this was secured following the inspection.

Medicines were not always administered as prescribed. We found one person had missed medication when they were asleep and two people had missed eye drops when they were asleep. One person’s cream chart had not been completed, which meant staff were missing guidance about where to apply the cream as prescribed, and guidance for one ‘as and when required’ medicines (also known as PRN) required additional details so staff could administer this safely.

Some systems were in place to assess and monitor the quality and safety of the service, but these were not always effective. This meant the opportunity to drive improvement had been lost and risk had not always been minimised. This had led to some safety issues in the environment and shortfalls in record keeping for the application of the Mental Capacity Act 2005 (MCA). We have made a recommendation about this.

Systems were in place to recruit staff safely. They were supported through on-going supervision and accessed training relevant to people's needs, to ensure these could be met. There were sufficient numbers of staff available to meet people’s needs.

Staff protected people from avoidable harm, were knowledgeable about safeguarding and able to raise concerns. They supported people to meet their health needs. A nutritional diet was offered and choices were available. We received some mixed feedback about the food.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We found staff were aware of the MCA and supported people to make their own decisions wherever possible.

Staff were caring and friendly. We observed positive interactions from staff. They supported people to maintain their independence and treated them with dignity and respect.

There was a lack of meaningful activities provided for people. The registered manager told us they were in the process of recruiting a new activities coordinator to address this.

Care plans reflected people’s individual needs and circumstances, which enabled staff to provide person-centred care as a result.

People told us they felt able to raise any issues or concerns. The provider had systems in place to manage and respond to any complaints.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 01 and 02 June 2016. The service was last inspected on 05 February 2014 when the service was found to be compliant with the regulations inspected.

Waltham House is situated on the outskirts of Grimsby in a rural location. The home provides accommodation and personal care for up to 32 people. The service predominately provides care for older people some of whom may be living with dementia. At the time of our inspection there were 25 people using the service.

There was an acting manager in post who had applied and submitted an application to have their competencies and skills to be formally assessed by the Care Quality Commission and was currently awaiting an interview for this. 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.

Assessments were carried out to enable staff to support people who used the service to take positive risks whilst keeping them safe from harm. Training had been provided to ensure staff knew how to protect people from potential abuse and checks had been carried out to ensure staff were safe to work with people who used the service. Staffing levels were monitored to ensure there were sufficient numbers available to meet people’s needs. People received their medicines from staff who had been trained on the safe handling and administration of medication. Checks were carried out to ensure the building provided people with an environment that was safe.

Staff were provided with a range of training and development opportunities to enable them to effectively carry out their roles and help them develop their careers. Staff involved people in decisions about their support and obtained their consent before carrying out interventions. People’s legal rights were protected and their best interests were upheld when people lacked the capacity to make important decisions for themselves. People received a good range of nourishing home cooked meals which they said they enjoyed. Community based health care professionals advised they had a good working relationship with the service.

Staff demonstrated courtesy and consideration for people’s needs and upheld their dignity and respected their wishes for privacy. People and their relatives were involved in the planning of their support which was reviewed on a regular basis. Information about people was maintained in a confidential manner.

People were provided with a range of opportunities for social interaction to ensure their wellbeing was promoted. A complaints policy was in place to ensure people could raise any concerns and have these addressed when this was required.

Management feedback was provided to staff in a constructive way and meetings took place to ensure staff were aware of their professional roles and responsibilities. A range of audits were regularly carried out to enable the quality of the service to be monitored and enable it to learn and continually improve. People and their relatives were consulted to ensure they could contribute their views to help the service to develop, however service’s without a registered manager cannot be rated higher than requires improvement in the well led domain.

Just prior to the visit we received concerns from a whistleblower. We took account of these concerns as part of the inspection.

The manager told us that of the 26 people who used the service approximately 70% of people had been diagnosed with dementia. We found there was a clear focus on dementia care in the home. The manager and staff were aware of good practice guidelines and these were incorporated into the care provided at the home. Sufficient and suitably trained staff were provided to ensure people with dementia received all the care and support they required.

A detailed assessment of people's needs was completed prior to admission to the home and personalised care plans were developed using this information. This meant staff had all the information they required to provide individualised care for people with dementia. It also enabled staff to be able to recognise any changes in the person's presentation or behaviours.

The staff worked well with other agencies and were proactive in ensuring that people received all the care and support they required from the appropriate agency. People were supported if they required hospital admission and information was provided to hospital staff to assist them to care for the person with dementia.

The manager had good systems in place to monitor the quality of the care provided and to ensure that people who lived in the home had their views heard.

The environment had been developed in line with some of the best practice guidance for people with dementia. For example, toilets were easily distinguishable as doors were painted a bright colour and signs had been used in picture format.

We found that the planning and delivery of care had improved and the care plans had been reviewed and rewritten to ensure that they reflected people's needs.

We found that staff had received the training required to enable them to understand and meet people's needs safely.

We observed very positive interactions between staff and people living in the home. We saw that staff offered people choices in how care was to be delivered and that they took their time to explain care tasks to people. We observed that staff were proactive in ensuring that people's privacy and dignity were maintained.

We found that people were consulted about the service provided through regular meetings and questionnaires. The records of meetings showed that meals and activities provided were discussed and that people also had the opportunity to raise any concerns or suggestions that they may have.

We found that the planning and delivery of care did not always reflect people's needs and this put their health, safety and welfare at risk. However visitors told us that their relative's health and mobility had improved during their stay at the home.

We found that staff had not always had the training required to enable them to meet people's needs safely.