Archived: OSJCT Wyatt House

Updated 3 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17, 18 and 19 July 2018 and was unannounced. It was carried out by one inspector and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. In this case a person who has cared for a person who lives with dementia.

Prior to visiting the home, we reviewed the information we held about the home. This included notifications of events which have an impact on people and the home which the provider must legally send to us. We looked at information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually. This was submitted by the provider on 6 April 2018 and it gave some key information about the service, what the service does well and improvements they plan to make.

During our visit to the home we spoke with seven people who lived at Wyatt House and five relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed eight people’s care files which contained care plans, risk assessments and other relevant care documentation, including weight monitoring records. We also reviewed 15 people’s bathing records and relevant care plans. We reviewed records pertaining to the Mental Capacity Act and Deprivation of liberty Safeguards.

We spoke with 10 staff which included the registered manager, one of the provider’s operations directors, one nurse, one team leader, three care staff, the activities co-ordinator, a cook and an agency member of staff. We spoke with one health care professional about people’s care and sought their views on the services provided by the home. We reviewed two staff recruitment files and the staff duty roster.

We reviewed records relating to the management of the home. These included complaints records, quality monitoring audits and the home’s compliance improvement plan. We attended one staff handover and looked around the building.

We requested to be forwarded to us and received the home’s Statement of Purpose and staff training record.

Updated 3 October 2018

This inspection was unannounced and took place on 17, 18 and 19 July 2018.

Following our previous inspection on 21 and 22 March 2017 the service was rated ‘Requires Improvement’. We found the provider needed to make improvements to how the home was managed. It required consistent management by a manager who was registered with the Care Quality Commission (CQC), improvements were needed to people’s care plans so they accurately reflected people’s care needs and the provider’s quality monitoring processes needed to be more effective in making improvements which could be fully embedded and sustained.

At this inspection we found some improvements had been made. People had benefited from a consistent manager being in post who was registered with the CQC. Some care plans had been re-written but several still did not reflect people’s needs. Quality monitoring processes had taken place but these had not, identified the shortfalls in the management of people’s risks, identified during this inspection, or successfully achieved full improvement in people’s care plans, required following our previous inspection.

We requested that the provider send us an immediate action plan on how they were going to ensure people’s risks were fully assessed and safe and effective care was planned. An action plan was subsequently received which we will follow up in due course.

Following this inspection an overall rating of ‘Requires Improvement’ was awarded. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Wyatt House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can

accommodate 30 people in one adapted building. At the time of our inspection 29 people lived there. The home specialises in the care of people who live with dementia and who also require nursing care.

Wyatt House is a circular design with an inner, secure garden. People are accommodated across two floors. One floor provides accommodation for a small group of people who need less support and which promotes their independence. On the second floor people required all support with their daily needs which the design of the home and its fittings supported. The circular design is experienced on this floor, which allows people to walk freely, without interruption; but a seated area also provides a place to rest. People could access an outside seating area safely from this floor, but they were supported by staff to visit the whole of the garden. There was ample car parking in and around the home’s grounds and wheelchair access to the home.

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.

Although the provider had processes in place to assess people’s risks, these had not always been completed, in a timely manner, to ensure people would remain safe. Some people had been left with risks and areas of need, which had not been fully assessed or addressed through the planning of safe and effective care. A breach of regulation was identified in relation to this. Practices were not consistent as we saw that other risks had been well assessed and appropriate care planned and delivered to reduce these.

People’s care plans still did not always give accurate detail about the care people required. This was despite staff completing regular reviews of these. This had potential for people to receive unsafe or inappropriate care and a breach of regulation was identified in relation to this.

Since the last inspection and since the registered manager had been in post the provider had carried out quality monitoring checks of the home’s overall performance. There had however, been less consistent follow up following these checks to ensure necessary areas of improvement were completed. The system in place had not been sufficiently effective and a breach of regulation was identified in relation to this.

There were arrangements in place for complaints and areas of dissatisfaction to be raised, although, the action taken in response to issues raised about people’s laundry, had not led to these being resolved. We made a recommendation about the management of complaints.

People’s medicines were managed safely and people were supported to take their medicines. People lived in a clean home where infection control measures were in place. There were enough staff to meet people’s needs and staff had been safely recruited. There were arrangements in place for staff to receive appropriate training and support. Staff understood their responsibilities with regard to protecting people from abuse and poor practice.

People had access to health care professionals. People were supported to make decisions about their care and treatment and where necessary, people’s representatives were consulted. The principles of the Mental Capacity Act were followed to protect those who lacked mental capacity. 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.

People had a choice in what they ate and drank and in what activities they took part in. Staff were particularly kind and caring towards people and knew individual people well. This helped them to deliver people’s care, support people’s independence and promote people’s self-worth. Staff responded straight away to anyones distress. Family and friends were welcomed and kept informed about people’s progress, where appropriate. Activities were tailored to people’s abilities, likes and preferences; they were meaningful to people and some had a therapeutic value.

People’s end of life wishes were explored and they were supported to have a comfortable and dignified death. Staff supported people and others during times of loss and bereavement.

The registered manager had provided consistent leadership and was respected and liked by staff and relatives. There were arrangements in place which helped the registered manager to communicate effectively with all staff and relatives. We observed people, staff and relatives feeling comfortable enough to communicate with the registered manager when they needed to. The registered manager had made significant improvements to how the service operated and this was evidenced through past and present audits. The home was advertising for a deputy manager to help support staff further and to help embed and sustain the improvements already made.

We found two 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