Archived: Ward House Nursing Home

Ward House Nursing Home is a residential care home providing accommodation, nursing and personal care for up to 23 older people in one adapted building. At the time of this inspection there were 17 people living at the home.

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

Quality assurance systems had not been used effectively to either identify areas for improvement and/or to bring about effective improvement.

Individual risks to people had not all been assessed, recorded and updated when people's needs changed. This included risks resulting from people's known health and care needs.

Appropriate recruitment procedures had not been followed meaning that all necessary checks had not been completed prior to staff commencing employment.

Whilst there were appropriate numbers of care and ancillary staff (housekeeping, catering, maintenance) the service did not have enough registered nurses to ensure one was provided at all times. Agency and bank nursing staff were employed to fill registered nursing shifts however, there were occasions when these staff were not available meaning no UK registered nurse had been in the service for periods of up to 12 hours.

Safe systems to manage medicines had not always been followed meaning people had not always received their medicines safely as prescribed.

There were appropriate policies and systems in place to protect people from the risk of abuse and the registered manager and staff understood the actions they should take to keep people safe.

Infection prevention and control measures were in place and followed government guidance.

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 and their family members all gave us positive feedback about the home and told us that staff were kind and caring. We observed positive interactions between staff and people.

People, their family members and external professionals said the registered manager was approachable and supportive. Staff were also positive about the registered manager.

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 4 July 2019).

Why we inspected

This inspection was prompted by recent safeguarding concerns and the length of time since the service was inspected.

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.

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 changed from Good to Requires Improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to staff recruitment, medicines management, risk assessment and quality assurance procedures at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Ward House Nursing Home provides suitable communal areas and access to an enclosed rear patio garden. Some bedrooms can be used for shared occupancy however, at the time of the inspection only one room was used for as shared occupancy.

We found the following examples of good practice.

The provider had decided to use shared rooms for only one person. This reduced risks of infection from people sharing bedrooms.

There were procedures in place to support safe visiting by family members or professionals following relevant national guidelines. Staff undertook screening of all visitors. Rapid response lateral flow tests (LFT) were undertaken for visitors before they entered the home. Visitors were provided with Personal Protective Equipment (PPE) and guided to its safe use.

People and staff were regularly tested for COVID-19. Staff had LFT testing three times a week as well as standard Polymerase Chain Reaction (PCR) tests weekly. The manager understood the actions they needed to take should any tests return a positive result.

The service had a good supply of PPE to meet current and future demand. Staff were using this correctly and in accordance with current guidance and disposal was safe at the time of this inspection.

The manager was aware of actions they should take for all new admissions including people who were returning from a hospital admission.

The home was kept clean. Staff kept records of their cleaning schedules, which included a rolling programme of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles.

Ward House Nursing Home is a residential nursing home that provides accommodation, nursing and personal care to 23 people. Accommodation is provided over three floors with single and shared bedrooms, ensuite facilities and communal areas on the ground floor. Ward House provides a service for people living with dementia and or a physical disability who require nursing care.

People’s experience of using this service

People and their visitors were happy with the service they received. They felt staff were available when they needed them and responded promptly to their requests for support. Systems were in place to investigate and respond to complaints. When required, people received all necessary end of life care to ensure they remained comfortable and any symptoms were managed.

Systems were in place to seek the views of people, visitors and staff about the service. Quality auditing systems were in place to monitor the service people received.

Rating at last inspection

The service was rated as Good at the last full comprehensive inspection, the report for which was published in February 2019.

Why we inspected

This inspection was prompted in part due to a concern we received about the standard of care people received at the weekends. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

Prior to the inspection 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 remained the same, although the rating for the Well-led section has improved to Good. This is based on the findings at this inspection.

Please see the Effective and Well-led sections of this full report.

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.

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

Ward House Nursing Home 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 is registered to provide accommodation and personal care for up to 23 people and there were 21 people living at the home at the time of the inspection. Ward House is a detached older property which has been extended and adapted. There is a passenger lift so people can access the upper floors where most of the bedrooms are situated. Bedrooms were a mixture of single rooms and some shared by two people. Communal areas included a lounge dining room divided into several separate areas and a quiet room which could be used for small meetings or activities. An enclosed rear garden was fully accessible for people.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Quality assurance process had not identified areas for improvement found during this inspection in relation to documentation and the recording of care. The registered manager responded promptly when we identified areas for improvement.

Where people were unable to make some or all decisions about their care the decision-making processes had not followed all the Mental Capacity Act 2005 (MCA) steps. Staff were aware of the need to gain people's consent to their care and support. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

There were gaps in the recording of some care such as repositioning and food and drinks people had been provided with. The service had introduced a new computerised care planning and recording system which staff acknowledged had been hard to adjust to.

The provider had arrangements in place to protect people from risks to their safety and welfare. Arrangements were also in place to store medicines safely and to administer them according to people's needs and preferences.

People were supported to access healthcare services, such as GPs. At the end of their lives people received the care they required to remain comfortable and pain free.

Care and support were based on plans which considered people's needs and conditions, as well as their abilities and preferences. Care plans were adapted as people's needs changed, and were reviewed regularly.

People were supported to eat and drink enough to maintain their health and welfare. They could make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only workers who were suitable to work in a care setting were employed. New staff received appropriate training and arrangements were in place to ensure other staff completed required update training. Staff felt supported by the management team.

People and visitors found staff to be kind and caring. Staff respected people's individuality, privacy, dignity and independence. The home had an open, friendly atmosphere in which people, visitors and staff were encouraged to make their views and opinions known.

People could take part in activities which reflected their interests and provided mental and physical stimulation. Group and individual activities were available if people wished to take part.

There was a registered manager at the home. 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 and external health professionals were positive about the service people received. Medicines were managed safely and people received these as prescribed. People were positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care involving people were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

The registered manager and provider were aware of key strengths and areas for development of the service. Quality assurance systems were in place using formal audits and through regular contact by the provider and registered manager with people, relatives and staff.

Is the service safe?

We spoke with four of the 17 people at the home. They all told us they were very happy with the service they received. They said they had consistent care staff who knew what support they required. We also spoke with four relatives. They were also all very positive about the service and said they felt their relatives were safe. Staff had completed safeguarding and other essential training and were able to tell us what they would do if they had any concerns about people's safety or welfare.

Risks to people's health and safety had been assessed and management plans were in place to reduce these risks. We saw specific equipment identified in people's care plans was in place to reduce risks and keep people safe. This included equipment such as pressure mattresses and movement sensor alert systems. Staff told us they had received training to use the equipment in use. Systems were in place to ensure the home was clean and infection control risks were appropriately managed. There were also systems in place to ensure only suitable people with appropriate skills and knowledge were employed.

Is the service effective?

Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills necessary to care for people. The registered manager was aware of who to contact for specialist advice and when this may be required. For example, they had sought guidance about an infection control concern.

Systems were in place to monitor the care people received to ensure if continued to meet their needs. We heard during a staff handover, that the nurse had identified a person may have a new health need and had promptly sought medical advice and treatment from their GP. We spoke with two external healthcare professionals who had regular contact with the home. They told us they felt the home met people's needs in a safe and effective way.

Is the service caring?

People were supported by kind and attentive staff. People also told us the staff were kind and helpful and they were happy with the way they were cared for. One person told us 'you won't find any problems here, I would recommend the place'. We spoke with four visitors. They were also all very satisfied with the care their relatives received. They commented that staff knew their relatives needs and kept them informed about any changes in their care needs.

Staff said they had time to meet people's identified needs and could provide care at times people wanted it. Staff were aware of people's rights to refuse care and stated they would respect this. Records of care provided showed people had received care as detailed in their care plans.

Is the service responsive?

The service could be flexible and responsive to people's changing and urgent needs. For example, staff told us when a specific piece of moving and handling equipment had been required for a person this had been promptly provided. This meant the person's needs could continue to be safely met. One person we spoke with told us they had decided to stay in bed on the day of our inspection and staff had supported this decision. They told us if they did not want care at a particular time they could tell staff and they 'would come back later'. We saw one person who was unable to use a standard call bell system had been provided with an easy to see and use nurse call button. They told us 'staff usually come quickly when I use it'. They demonstrated this and a care staff arrived within two minutes. This showed staff were able to respond to people's requests and provide care at times suitable for people.

Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. A comprehensive contingency plan was in place which covered all possible emergencies. The registered manager described how they had used this when there had been a short interruption in the water supplies to the home in 2013.

Is the service well-led?

People and their relative's views were sought and a monthly care plan review was completed by the person's key nurse. Formal six monthly care reviews to which relatives were invited were also completed. There were procedures in place to monitor the quality of service provided including formal reviews with people and relatives and audits such as monthly infection control audits. A representative of the provider visited the home monthly and completed an audit of the service provided. Systems were in place to ensure accidents and incidents were managed correctly to safeguard people from repeat incidents. People and relatives had information about how to complain and there were systems to ensure complaints would be investigated by the registered manager or provider.

We spoke with nursing and care staff. Staff were aware of people's individual likes and dislikes and the help they required. Staff stated they had sufficient time to meet people's needs. Staff also told us they had attended relevant training and had all the necessary equipment to safely care for people.

We also spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's views. The care we observed corresponded with care plans and risk assessments viewed. We found medication was stored and administered appropriately. There were sufficient staff available to meet people's needs. Staff were receiving training and support. A range of quality monitoring procedures were in place.

We spoke with two health professional involved in the care of people. They were complimentary about the way the service met people's needs. We were told that the home contacted them appropriately and followed guidance and suggestions.

We observed that staff were courteous and respectful of people's views and opinions and that dignity was respected. We saw that people were offered choices about where they sat and activities.