Archived: Weston Park Care Home

Weston Park Care Home is close to Macclesfield town centre. The home is a three storey building with accommodation for residents on the ground and first floors. The annexe (Silk Unit), and the ground floor of the home (Mulberry Unit), provide care and support for up to 64 older people with dementia. The first floor (Weaver Unit) provides nursing and support for up to 39 older people. The home had opened a fourth unit called the Tatton Unit, but at the time of the inspection the registered manager told us that they had taken the step to voluntarily closed this unit, due to difficulties in staffing the unit safely. At the time of our inspection there were 80 people living at the home. Weston park was last inspected on 26 February 2015 and was found to be compliant with all the areas inspected at that time.

There is a registered manager in place. 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.

We identified five breaches of the relevant legislation, in respect of staffing, safeguarding, consent, good governance and nutrition and hydration. You can see what action we told the provider to take at the back of the full version of the report.

We found that there wasn't always adequate staff to meet the needs of people. Staffing was affected by staff absences. The registered manager was recruiting new staff. Staff told us that the management team had made some improvements but we found that these had not been effective enough to ensure that staff sickness levels and other staff issues had been resolved.

Staff had received training in safeguarding and understood their responsibilities to protect people from harm and abuse. Staff knew how to report concerns, but some staff did not know where to report concerns to outside of their organisation. We found evidence that the service had not reported a safeguarding concern to the local authority, as required by the local Adult Safeguarding Policy and Procedures, therefore people could not be sure that they were fully protected from harm and abuse.

People’s medicines were administered safely. However, the storage of medicines was an issue because the home could not fully control the temperature of the treatment room, where medicines were stored. The provider was aware of the situation and told us that immediate steps would be taken to address this.

We found that most areas of the home were clean and well maintained. We noted some minor infection control issues. We saw that the registered manager was taking action to meet the requirements identified by the provider's fire risk assessment.

People's views of the food varied and some feedback was very negative about the quality and variety of food. We found that the dining experience was not a particular cheerful or sociable experience. We also unable to evidence from people's records and charts that they had always received adequate drinks.

Staff had received training in legislation such as the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They were aware of the need to gain consent when delivering care and support. Not all staff had an understanding of the MCA and we saw that mental capacity assessments had not always been completed appropriately.

Staff received an indication and a new induction programme was being launched, to meet the requirements of the Care Certificate. Staff received on-going training. Although some staff did not feel that the training delivery method of e-learning was always effective.

Where a person was being restricted or deprived of their liberty, applications had been made to the supervisory body under the Deprivation of Liberty Safeguards. However we found that there were also other people who needed to be assessed under these safeguards.

People told us that staff were kind and caring, although some people told us that some staff were more caring than others. We saw that people were treated with dignity and respect, but found that further improvements were required. The registered manager had already taken some steps to address this and had introduced dignity champions.

Care records were personalised and they reflected the support that people needed so that staff could understand how to care for the person appropriately. Daily charts were not always completed fully or at the time that the care was provided. We saw that staff responded to people’s changing needs and sought involvement from outside health professionals as required.

Social activities were offered for people to participate in and enjoy but these needed to be further considered for all people's social needs to be met.

A complaints procedure was in place for people and their relatives to raise their concerns or complaints if they had a need to.

The registered manager was supported by a wider team. She emphasised that work had been undertaken to make improvements coming into post. She told us that there were further areas for improvements which they were focused on. Staff told us that they felt supported by the registered manager, they found her to be approachable and felt able to raise any concerns. We found that the provider had not made sufficient improvement to ensure people received a high standard of care that was consistently provided and kept people safe.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and 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 we spoke with told us they felt safe and their rights and dignity were respected.

Staff had received up to date training with regard to DoLS and when spoken with were more knowledgeable about the processes in place to assist people who were unable to make their own decisions. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

There were appropriate procedures in place should anyone need to be subject to a Deprivation of Liberty Safeguard (DoLS) application or plan.

People's care records had improved to ensure that they received appropriate up to date care. Staff knew about risk management plans and gave us examples of how they had followed them.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents.

Staff training had improved for staff to enable them to support and care for people with dementia. There were enough staff to meet people's needs and there were less agency staff being used.

The environment had been improved and there was still maintenance work ongoing.

We asked if medicines were handled safely. We found that people's individual medicines needs were not always met. Arrangements were not consistently in place to ensure that medicines were given at the right and best times in order that people would receive most benefit from their medicines. This included consideration of how people's medicines needs could be met when away from the home and the lack of records supporting the review and monitoring of the use of 'when required' medicines. Managers completed regular audits of medicines handling and described plans to bring about improvements.

Is the service effective?

The service worked well with other agencies and services to make sure people received care in a person centred way.

We found the information in each person's care plan was more detailed and reflected the individual person's needs.

Professionals spoken with said they felt the home had improved.

Is the service caring?

Feedback from people was positive, for example; "I am comfortable here staff are good.'

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

There was an improvement in staff training so that they were clear about their roles and responsibilities.

There was a complaints procedure in place and complaints were being investigated and followed through.

The service had responded to our enforcement actions and had improved the service for people who live there.

Is the service well-led?

The service had no registered manager in place at the time of our inspection. We were informed that a new manager had been recruited and would commence at the home in the near future. The interim management team had worked together with the staff to improve the service offered to people.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Shortfalls had been raised and concerns had been dealt with.

Staff spoken with said they felt better supported.

Records had improved and the actions from audits undertaken were completed and recorded.

In this report the name of a registered manager appears who was not in post and not managing the home at the time of our visit. Their name appears because they were still a registered manager on our register at the time of our inspection.

Following our inspection in October 2013 the provider sent to us an action plan.

Quality officers from the local authority's adult safeguarding unit visited the home and identified further inadequacies in the planning and provisioning of care. We also received information from people which told us that the home did not have enough staff on duty to met people's needs. We shared this information with local authority's adult safeguarding unit.

Visits had been made by the Infection Control team to ensure that the home was clean and free from infection

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care.

During the inspection we spoke with the provider, peripatetic managers, staff members, relatives and with people who lived in the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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

Is the service safe ?

We saw in two care plans there was very little guidance as to how to manage challenging behaviour. There was no recording of what if anything might trigger the behaviour so that staff could ensure, if possible, that some situations could be avoided or managed to support the people and to maintain the safety of people and staff at the home.

There was not enough staff to engage with people to help them with their reactions to the noises and behaviours exhibited. People with behaviour that challenged did not have adequate care plans in place to support and direct staff in how to manage their needs.

We saw some good interactions between staff and people in the home, however we could see that some staff needed further training and support to develop their skills in relation to caring for people with dementia.

No one engaged with any activities, staff said they did not have any activities for the service users and that they had no time to carry anything out.

Is the service effective ?

We looked at duty rotas and found that although there were increased numbers of staff on duty a high number of agency staff were being used due to the high level of staff vacancies. This meant that the skill mix of staff to ensure that there were enough knowledgeable, competent, experienced staff on duty to ensure that people were supported was not always in place.

We found that at least two, sometimes three staff members on each unit were agency staff on most days each week. This meant that almost fifty per cent of the staff on duty were agency staff. This meant that people living at the home would not receive consistent care that met their needs.

Staff spoken with said that the use of agency staff was affecting the people living at the service and staff themselves were finding it hard to support people as the agency staff did not know people's needs. We saw examples of care where it fell below the standard that met people's needs and was ineffective.

Is the service caring?

We visited all of the units and spoke with people living there, relatives and staff. One person living at the home said 'it's a nice place the staff are nice.'

Comments received from relatives we spoke with during our inspection were:-

'I am very happy that my relative's needs are met but they have never shown me his care plans or asked me to sign or agree anything. I do feel involved though, they keep me up to date and every time I come he is clean, well-presented, relaxed and content.' and 'they are wonderful, caring people who treat our relative with the utmost respect we really cannot speak too highly of them.'

We had received complaints about verbal abuse prior to our visit which had been referred to the local authority following safeguarding procedures. Concerns about staff being verbally inappropriate are being investigated by the provider.

We observed staff speaking loudly in communal lounges to each other about the personal care being given to people and giving instructions to each other. For example 'We need to change pads now' and 'X needs to be taken to the toilet '. Staff had no concept of how they were breaching people's confidentiality and they lacked dignity and respect in routinely discussing care openly in front of other people at the service.

Staff spoken with told us that they received supervision or support but that training had not been updated.

Is the service responsive ?

We saw a care plan had been completed for one person who had been prescribed a drug which may help calm them on an as needed basis (PRN). There was no information for staff as to when was the best time to give this drug to assist to calm the person. Not only should there be a clear and legible directive as to when PRN should be administered there should also be guidance on care post administration of the drug. This was not in place. This meant there was a risk that staff would be unable to appropriately administer this person's medication in a way that met their needs and protected their rights.

We looked at a further 12 care plans throughout the home and found these had improved since our last visit. Issues that had been raised by the Cheshire East social services with regard to care plans had been addressed.

We looked at training records for the staff working at the home and found that only 69% of mandatory training had been completed by staff. We observed that staff lacked competencies in meeting people's needs in dementia and with behaviour that challenges and dignity and respect.

The home has two units which are primarily for people with dementia and the staff had not received dementia training for some time. Staff spoken with confirmed that they had not received any training in dementia care or behaviour that challenges for some time.

Is the service well led ?

The home does not have a registered manager in place. It is being managed by peripatetic managers who are supported by the regional manager.

This inspection identified continued non -compliance with the regulations in a number of areas which had not been identified by the quality assurance processes carried out by managers and staff. This indicated that the provider's quality assurance arrangements were not being implemented effectively.

There was no evidence that learning from incidents/investigations had taken place and that appropriate changes had been implemented.

We were informed by the staff and the peripatetic manager that staff meetings had not taken place for some months. Staff spoken with and staff surveys seen stated that 'no-one speaks to us' and 'we are not told anything that is going on.'

Staff told us and we observed that there was inadequate crockery and cutlery to ensure everyone had a clean cup when drinks were given out and adequate cutlery at mealtimes. Staff told us that they had to wait for people to finish their drink and wash cups and spoons.

We received an action plan following our inspection from the regional manager addressing some of these issues.

In this report the name of a registered manager appears who was not in post and not managing the home at the time of our visit. Their name appears because they were still a registered manager on our register at the time of our inspection.

During the inspection we spoke with eight relatives of people who used the service. They told us that overall, they were happy with the care at the home.

We saw that staff were responsive to people's needs. However, the majority of the staff we spoke with expressed concerns about the number of staff available to meet people's needs.

We saw that in some areas the home required cleaning and, although some improvements had been made with quality assurance systems, the infection control audit that had been carried out was ineffective.

During the inspection we saw that people were provided with freshly cooked, nutritious meals and were offered drinks and snacks throughout the day.

We looked at seven care records and saw that some care plans needed further information to reflect people's needs. We also saw that some of the records relating to the care and welfare of people who lived at the home were being completed inaccurately

We spoke to three people who used the service. They were complimentary of the staff at the home. Comments we received included; 'All the staff here are my friends' and 'The staff here treat me very gently when they help me.'

During this visit we concentrated our time on Weaver Unit. We spoke with the registered manager, the regional manager and members of staff.

We spoke with a family member whose relative used the service. They told us that the home consulted with them on a regular basis.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs. We also spoke with three people who lived in the home and they all told us that considered themselves to be well cared for and supported.

We looked at a selection of care records. We had concerns regarding the documentation we saw.

We saw that the home had effective recruitment procedures in place and there were systems to safeguard people from the risk of harm and abuse.

We found although the service had some quality assurance systems in place identified actions were not always completed.

We viewed the training and supervision provided to staff and saw that staff were supported to attend training and development activities.

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We saw that some records were incomplete and there was confusion regarding the completion of some documentation within the home.