Background to this inspection
Updated
6 December 2016
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.
The inspection took place on 19, 20 and 21 of October 2016 and was unannounced. The inspection team consisted of three inspectors and a pharmacist. At our last inspection on 14 July 2014 the service was rated as requires improvement. We issued seven requirement notices in relation to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Prior to the inspection, we gathered and reviewed information we held about the service. This included notifications from the service and information shared with us by the local authority. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We spoke to 13 people who lived at the service, three relatives, seven care staff, five nurses, two activities coordinators, an NVQ assessor, deputy manager, registered manager and regional director. We looked at people's bedrooms, with permission, and all facilities at the service. We made observations of staff interactions and the general cleanliness and safety of the home. We observed people with higher support needs in a communal area to help us see how their needs were met. We looked at 14 care plans, three staff files, staff training records and quality assurance documentation.
Updated
6 December 2016
We inspected Wombwell Hall Nursing Home on 19, 20 and 21 October 2016. The inspection was unannounced. Wombwell Hall Nursing Home is a residential care home providing nursing support and accommodation for up to 120 older people. At the time of our inspection there were 116 people living at the service. Wombwell Hall Nursing Home is split into 4 units each being able to accommodate up to 30 people. Each unit had its own food service area, communal area, dining area, medicine room and staff room. There was also an additional building which contained a kitchen, laundrette, manager’s office, meeting room and staff rooms.
There was a registered manager in post who was registered with the CQC. 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.
At our last inspection on 14 July 2014, we found 7 breaches of the Health and social Care Act 2008 (Regulated Activities). These breaches were in relation to not being fully compliant with the Mental Capacity Act 2005 (MCA), not enough staff on duty, medicines not being stored or administered safely, poor infection control practice, people receiving treatment during lunch service, people being left in wheelchairs for long periods of time and poor quality auditing systems. The provider sent us an action plan stating that they would address all of these concerns by June 2015.
At this inspection, we found that the provider had taken action on all these areas and was fully meeting the regulations where breaches were found.
People were protected against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns.
Medicines were stored securely and administered safely. Staff had received training on medicines handling and administration, and checks had been undertaken to ensure staff were competent to administer medicines safely. However, we found that some people’s medicine records had not been updated and that some required further details. We have made a recommendation about this in our report.
The provider had ensured that the home was well maintained. Up to date safety checks had been carried out on electrical and gas installations. Equipment, such as hoists, were being checked and serviced. However, we found a back up syringe driver that had not been serviced since 2014.
The service appeared clean and tidy and there were cleaning rotas in place to ensure that all areas were cleaned. The provider had ensured that the premises were safe for use and had up to date safety certificates.
There were sufficient staff to provide care to people throughout the day and night. The registered manager used a dependency tool to identify the amount of hours required to provide support. When staff were recruited they were subject to checks to ensure they were safe to work in the care sector.
People’s needs had been assessed and detailed care plans had been developed. Care plans had appropriate risk assessments that were specific to people’s needs.
The principles of the Mental Capacity Act 2005 (MCA) were adhered to. People were being assessed appropriately and best interests meetings took place to identify the least restrictive methods of keeping people safe. Staff had training on MCA and had good knowledge. The provider had recently introduced new MCA forms that ensured that records were being completed appropriately.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.
People were supported to have a healthy and nutritious diet. Staff could identify when people required further support with eating and appropriate referrals were made to health professionals and staff were seen to be following the guidance provided.
People told us they were happy with the care staff and the support they provided. Staff communicated with people in ways that were understood when giving support. Staff and the manager had got to know people well. Staff could build positive relationships with people to fully understand their needs.
People and their relatives told us they were involved in the planning of their care. Records also confirmed people’s involvement. Care plans and risk assessments were being reviewed on a monthly basis by staff and at any time when it was required.
Staff respected people’s privacy and dignity at all the times. The provider had ensured that people’s personal information was stored securely and access only given to those that needed it. People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people’s decisions.
People at the service had access to a range of activities that were personalised to their needs. People told us they were happy with the activities on offer but would like to go on more visits outside of the home.
The provider had ensured that there were effective processes in place to fully investigate any complaints. Outcomes of the investigations were communicated to relevant people.
Staff were not always consistently updating people’s records. Some people’s care plans had gaps in their records. Staff could tell us why there were gaps but this information was not being recorded. We have made a recommendation about this in our report.
The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately. The registered manager was open, transparent and responded positively to any concerns or suggestions made about the service. The provider carried out surveys to identify shortfalls within the service.