Welby Croft Residential Home

About the service

Welby Croft is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

The home is set across two floors, with bedrooms on both levels. There are communal spaces including a dining room. The garden offers a secure space with seating and there is a conservatory with views of the local area.

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

The provider used a range of audits and systems to monitor the service; however, these had not always identified areas which required improvement. Staff had received training in many areas, however recent training in relation to COVID-19 had not been done or training in relation to specific health conditions.

Risk assessment had not always been completed to cover all aspects of people’s care. These had not been reviewed or monitored to consider changes in the risk or how to reduce it.

People felt supported by kind and caring staff who had information to enable them to share their daily needs or life history. The care plans had been completed, however the provider told us they were making developments in this area to make these more person- centred. This was with the introduction of electronic care planning system.

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

There was a relaxed atmosphere in the home and people enjoyed the lunchtime experience. Assistance was provided if required and there were many choices to promote people’s dietary needs.

People and relatives were consulted on aspects relating to the home and the care people received. The staff worked in partnership with health and social care professionals to support peoples ongoing needs.

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

Rating at last inspection The last rating for this service was Good (published 12 January 2019)

Why we inspected

The inspection was prompted in part due to concerns received about infection control and managing risks. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and welled sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. 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 Welby Croft Residential home on our website at www.cqc.org.uk.

People’s experience of using this service:

The service met the characteristics of good in all areas.

People continued to receive safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and received their prescribed medicines safely. Lessons were learnt when mistakes happened.

The care that people received continued to be effective. They 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. Staff received training and support to be able to care for people well. They ensured that people were supported to maintain good health and nutrition; including partnerships with other organisations when needed. The environment was adapted to meet people’s needs.

People continued to have positive relationships with the staff who were caring and treated people with respect and kindness. They were able to get involved in activities and pursue their interests. Staff knew them well and understood how to care for them in a personalised way. There were plans in place which detailed people’s likes and dislikes and these were regularly reviewed. People knew how to raise a concern or make a complaint and the registered manager managed any complaints in line with the provider’s procedure.

The registered manager was approachable and there were systems in place which encouraged people to give their feedback. There were quality structures in place which were effective in continually developing the quality of the care that was provided to them.

More information is in the full report.

Rating at last inspection: Good: report published on 16 July 2016

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

At our last inspection on 25 April 2014 shortfalls were identified regarding assessing and monitoring the quality of service provision and action was required. At this inspection we found the necessary improvements had been made, all regulations were met and no concerns were identified.

A registered manager was in post and present on the day of the inspection. 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.

People were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained, competent and confident to meet their individual needs. People were able to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were opportunities for additional staff training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

Up to date policies and procedures were in place to assist staff regarding how to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There were thorough quality assurance audits – improved, as required, since the previous inspection - and a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

Is the service safe?

People who used the service and relatives we spoke with told us people were treated with consideration and respect. Some relatives told us they visited the home several times during the week and had never seen staff behave inappropriately towards the people who used the service. The care staff we spoke with were knowledgeable about the systems in place to protect people who used the service from abuse or neglect.

Primary care services were provided to everyone at the home by one GP practice, who visited once or twice a week. We spoke with a healthcare professional who had come to see people on the day of our visit. They told us staff from the practice worked closely with the home's staff. We were informed that the calls they received to visit the home were always appropriate and they had not seen anything which gave them any cause for concern about the quality of care. This meant the service ensured people's welfare and safety. We found people who used the service were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines which were followed by care staff. The care staff we spoke with who had responsibility for supporting people with medicines were knowledgeable about the procedures they should follow and had received training in the safe administration of medicines.

The deputy manager told us some people were not always able to fully understand decisions relating to their care, for example because of their dementia. We found examples of decisions which had been made in people's best interest recorded in care plans which meant arrangements were in place to meet the requirements of the Mental Capacity Act 2005 (MCA). This is a law that provides a system of assessment and decision making to protect people who do not have capacity to make decisions for themselves. No one using the service was subject to an authorised deprivation of liberty. People's rights were protected and decisions were made in their best interests

Is the service effective?

We found peoples' needs had been assessed prior to them using the service. Their needs had been reviewed when they arrived at the home and regularly whilst they continued to use the service. The care plans we reviewed contained an accurate assessment of peoples' needs and included important information to ensure people were protected from the risk of receiving inappropriate care.

Care staff we spoke with told us the provider encouraged them to study for qualifications in health and social care to ensure they fully understood how to provide people with good quality care.

One person who used the service told us 'I like my meals in fact I have had to cut back a bit on what I was eating, there is fresh fruit to eat and drinks in the lounge and in my room if I need them'. They said ' No one wants to live in a home but I have everything here that I need'.

Is the service caring?

We spoke with a relative of someone using the service. They told us 'We are really pleased with the care provided, staff are very kind and very nice'. One person who used the service said 'I still haven't come to terms with being cared for in a home but I am very comfortable here". We observed care staff providing care and saw they were considerate, patient and encouraging.

Is the service responsive?

Several relatives told us care staff contacted them if their relative had fallen or become ill. One relative said 'They are quick to act if someone needs help'. They told us staff had contacted the paramedics when their relative was unwell. They said they lived close by and that the ambulance was already there when they arrived and they had been able to accompany their relative to hospital. One person who used the service told us they had woken up that day with an unusual swelling. They said 'I am surprised and pleased the GP has been able to visit me today and reassure me'.

Is the service well-led?

We spoke with care staff and the care home managers who were experienced in providing care. We saw from training records care staff had the appropriate qualifications to provide an effective service. A director of the company who was not involved in the homes day to day management visited people every month to see how they were and discuss their experience of the service. The record of their visits showed they spoke to everyone using the service.

The provider had conducted survey's over several years to obtain the views of people who used the service about what could be improved. They had also surveyed care staffs' opinions about the quality of the service and invited suggestions about areas for improvement. It was not clear however how the provider used the results of the surveys to improve the quality of the service.

We found the premises were safe, comfortable and accessible, including for people with mobility difficulties. We saw that sufficient equipment was available to provide people's care. The provider had ensured equipment was safe for people to use.

We saw that people's consent was obtained for their care, and that proper procedures were used if they could not make their own decisions, for example due to dementia.

We saw that plans were in place describing how people should be cared for and any risks that could affect them were assessed. This included guidance for staff to ensure they were aware of people's health conditions or disabilities including signs of deterioration and what to do if there was an emergency. This meant that people received consistent, safe and appropriate care that met their needs and ensured their welfare.

We checked the staffing levels at the home and found that suitable numbers of skilled and experienced staff were provided to deliver people's care.

We saw that care planning included assessment of people's needs, and that some risks that could affect people were assessed and managed. Some aspects of people's care were not assessed, however, including their health needs. This meant that although staff were generally knowledgeable, that people received might not always receive safe, appropriate care.

We found that staff were recruited using appropriate procedures, and that they received training in the areas necessary to meet people's needs. Staff said that they felt supported by the managers.

We saw that staff were trained to recognise and report any concerns about abuse or neglect, and people told us that they felt safe at the home.

The home had systems in place to assess the quality of their service, including recording and dealing with complaints or concerns. People were able to attend residents' meetings to talk about the service, and also had individual meetings to ensure that their views were known.