Inwood House

Inwood House is a residential care home providing accommodation and personal care to older people and people living with dementia. At the time of this inspection 28 people were living at the home. The service can support up to 55 people.

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

Safe recruitment procedures made sure staff were of suitable character and background. There were enough staff employed to help people keep safe. However, staff could have been deployed more effectively during busier times of the day. There were systems in place to recognise and respond to any allegations of abuse. Medicines were stored safely and securely. There were effective systems in place to ensure people received their medicines as prescribed.

Staff were provided with an effective induction and relevant training to make sure they had the right skills and knowledge for their role. People enjoyed the food served at Inwood House and were supported to eat and drink to maintain a balanced diet. People were supported to maintain good health and have access to health and social care services as required.

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. There were effective systems in place to monitor and improve the quality of the service provided. The service had policies and procedures which reflected current legislation and good practice guidance.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 December 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we 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.

We carried out an unannounced focused inspection of this service on 31 August 2021. Breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Inwood House on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Inwood House is a residential care home providing personal care to older people. At the time of this inspection 33 people were living at the home. The service can support up to 55 people.

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

Medicines were not administered safely. People and staff all told us there was not enough staff.

We have made a recommendation about staff consistency and deployment.

Action was not always taken to mitigate against those risks. There was little evidence lessons learnt, following analysis, had been shared with staff People told us they felt safe. Infection prevention and control was in place.

The governance framework was sporadic and did not identify the issues found during our inspection visit. The actions identified following this inspection had not improved the safety or quality of the service. Provider oversight was limited to telephone calls and reports; there was no evidence the provider had undertaking any checks or audits.

Not all staff had received training in-line with the provider’s policy. We observed staff were caring and gave people choice. People told us the food was good. 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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 August 2021) and there were two breaches of regulation. The service remains requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective 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 Inwood House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines management and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inwood House is a 'care home' that provides personal and nursing care to older people. At the time of this inspection 45 people were using the service. The service can support up to 55 people.

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

The provider had systems in place to ensure all risks were identified, however, these were not always managed effectively, and medicines were not always managed safely. People told us they felt safe and staff were recruited safely.

There had been some improvements in the systems to monitor and assess the service provided, such as falls analysis. However, the governance systems in place were not robust enough to identify the shortfalls we found during this inspection. There was inconsistent management in the service. This had a destabilising effect on the staffing, morale and improvements being made and sustained.

Training was up to date. People were supported to eat and drink and had a good choice of food. People’s weight was monitored; however, actions were not always evidenced around action taken to manage weight loss. Staff ensured people received appropriate healthcare, when needed. People’s rooms were personalised and appropriate signage to support people living with dementia was in place. 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.

Staff were caring and supported people with dignity. Staff encouraged people to make choices and supported them to maintain their independence. People’s privacy was respected.

The home was responsive to people’s needs and choices.

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

Rating at last inspection (and update)

The last rating for this service was inspected but not rated (published January 2021)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and governance.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Inwood House is a ‘care home’ that provides personal and nursing care to older people. At the time of this inspection 46 people were using the service. The service can support up to 55 people.

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

People told us they felt safe and relatives told us they thought their relations were safe in the home. Not all areas of risk associated with people’s care was assessed appropriately. Staff were recruited safely. Medicines were not always managed safely. Accident and incidents were analysed to check for themes and reduce the risk of reoccurrence.

Information in people’s nutritional care plans needed more detail to ensure people’s needs were met.

A new provider had taken over the home since our last inspection. They had a clear vision and strategy for the home. Staff told us they felt confident they would now be listened to. There was a clear governance framework; however, it had not identified all the concerns we found. The provider completed surveys of people, relatives and staff views and opinions of the care provision. Meetings with people and staff took place. The provider worked closely with local partners.

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

Rating at last inspection

This service was registered with us on 9 April 2019 and this was the first inspection. The last rating for the service under the previous provider was good (published 8 June 2016).

Why we inspected

This was a planned inspection in line with our inspection programme. We have made changes to the way we work due to the COVID-19 pandemic. This is to avoid putting pressure on services that are caring for people. We completed a focussed inspection. During this inspection we looked at the key questions of 'is the service safe?' and 'is the service well-led?'. We also looked at elements of the key question 'is the service effective?' following some concerns we received. We do not look at all of the five key questions during a focussed inspection. Therefore, the service was not given an overall rating.

We looked at infection prevention and control measures under the key question of 'is the service safe?'. 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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to safe care and treatment, good governance and staffing at this inspection.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.