Cullum Welch Court Care Home

Cullum Welch Court Care Home is a care home providing personal and nursing care to up to 60 people across three separate units over two floors, each of which have separate adapted facilities including dining rooms and sitting areas. At the time of our inspection, there were 32 people were using the service some of whom had dementia and nursing needs.

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

Staff were not supported and supervised to be effective in their roles. People were supported with their needs. However, care plans did not always explore best possible ways to meet people’s individual needs. Staff did not get the leadership they needed as there was inconsistency in management. There was high turnover of staff and managers which had affected the quality of the service and staff performance.

Risks to people were managed to reduce harm to them. There were management plans in place that provided guidance to staff to reduce risks to people. People were safeguarded from the risk of abuse. Staff had received safeguarding training and knew actions to take to report abuse.

Incidents and accidents were reviewed, analysed and actions taken to ensure learning from them. People’s medicines were administered and managed safely. There were enough staff available to support people. Staff were trained in infection control and followed procedures to reduce risks of infection.

People’s needs were assessed in line with best practice guidance. People’s nutritional needs were met. People were supported to eat a balanced diet and drink enough to keep hydrated. Staff had an induction when they started their jobs; and had received training in their roles. People had access to the healthcare services they needed to maintain good health; and staff liaised effectively with other services.

People 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. People’s consent was sought for the care and support they received.

The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

People’s end-of-life wishes were documented in their care plans and followed when required. People were supported and encouraged to participate in activities they enjoyed.

People and their relatives knew how to raise complaints about the service. Complaints were appropriately addressed in line with the provider’s procedure. The provider worked in partnership with other organisations and services to develop and improve the service. The service had effective systems to monitor the quality and safety of the service.

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 26 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service, staffing, poor care, safeguarding concerns and medicine management. A decision was made for us to inspect and examine those risks. We carried out a comprehensive inspection looking at all five domains.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

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.

When we inspected Cullum Welch Court in March 2017, we found two breaches of regulations relating to the management of medicines and quality assurance systems.

We then undertook a focused inspection on 16 August 2017 in relation to the breaches of regulation we identified at the March 2017 inspection. We found that the service had followed their action plan and had met statutory requirements.

At this inspection the service continued to meet the regulations and we have therefore rated the service as Good overall.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

People told us they were safe at the service. People knew how to report any concern or abuse. Staff also had knowledge and understanding of the various types of abuse. They knew how to report any concerns and felt confident that any concerns they raised will be thoroughly investigated and addressed.

Risks to people were managed in a way that promoted their health and well-being. Staff knew the risks associated with people and actions to reduce such risks. Incidents, accidents and near misses were reported, investigated and actions put in place to prevent them from happening again. The home was well maintained, clean and free from unpleasant odour. Health and safety checks were conducted regularly to ensure the home complied with health and safety regulations.

People received their medicines as prescribed. Only trained and competent staff administered medicines to people. Medicines administrations records were correctly completed. Medicines were stored safely.

People received support from sufficient number of staff with suitable skills and experience to meet their needs. Appropriate recruitment procedures were followed to recruit staff to ensure only suitable applicants worked with people.

People’s needs were thoroughly assessed and planned for. People received care from staff who were effectively trained, supported, supervised and appraised in their role. Staff had completed a range of training to do their jobs.

People 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. People gave consent to the care and support they received.

People’s care was delivered in line with the requirements of the Mental Capacity Act 2005 (MCA). People were asked for their consent before care was provided and staff respected their decisions. Relatives and healthcare professionals were involved in the best interest process to support people who were unable to make decisions about their care. People’s rights were safeguarded under the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations were in place and valid where required.

People had access to a range of healthcare services and to maintain their well-being and good health. The service ensured people’s care was well arranged when they moved between services. There were suitable facilities and adaptations for people to use. The facilities available within the service include bedrooms with en-suite wet rooms, communal living areas including sitting rooms, dining rooms, a chapel, a sensory room, a hair dressing saloon and a well-maintained garden.

People enjoyed the food provided at the service. People’s nutritional and dietary requirements were met. Staff supported people who required support with eating and drinking. Dietitians were involved where required to maintain people’s nutritional needs.

People, and their relatives told us that staff were kind, compassionate and caring. People told us they felt comfortable with staff. We saw positive interaction existed between people and staff. People were involved in their day to day decisions. Staff understood the importance of respecting people’s dignity and privacy.

People received care personalised to their needs. Care plans reflected people’s needs. Staff knew people well and understood their needs, likes, dislikes and preferences. People were engaged in activities they enjoyed. Activities were of a wide range and tailored to reflect people’s interests.

People were supported to maintain relationships which mattered to them. People’s cultural, social and religious needs were maintained and respected. People were given the end of life care they wanted. Staff cared for people well at the end of their lives. They ensured people were comfortable and their pain was managed as much as possible.

People knew how to make a complaint. Complaints were resolved in line with the provider’s procedures. People’s feedbacks were obtained and used to plan and improve the service.

People, relatives, staff and professionals told us the service was managed well. There was an open and transparent culture at the service. The registered manager was visible and approachable. Staff told us they received the leadership and direction they needed.

Regular checks and audits of the quality of care were carried out to improve on service delivery. The service had close partnership with other healthcare professionals and with external agencies.

Cullum Welch Court Care Home is owned by the charity Morden College and is within the grounds of Morden College and part of its community. The home provides residential, nursing and dementia care for up to 60 older people and respite care to members of its community and the wider local community. On the day of the inspection there were 50 people living in the home.

There was an established registered manager in post who had worked at the home for several years. 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. They were aware of their responsibilities as registered manager.

At this inspection we found considerable improvements had been made. The provider had reviewed their quality monitoring systems and added to them to oversee quality improvements and communication across the charity. The previous concerns in relation to medicine storage and administration had been addressed, the clinical rooms had been refurbished and reorganised. The auditing process strengthened. Medicines were safely managed across the service.

At the last inspection in March 2017 we had found that, although there were some health and safety checks in place, they were not comprehensive to cover all areas of equipment and the premises in order to reduce risk. At this inspection we found the provider had appointed a new maintenance staff member with responsibility for premises and equipment checks. There was a full range of equipment and premises checks completed and where issues were identified these were rectified. An audit of staff files had been completed and action taken in relation to any missing records. There were systems to ensure that new staff records were kept up to date.

The home has a structure to keep an effective overview of risks and safety and there was a culture of learning from mistakes.

In view of the improvements found and that there were no other issues noted at the comprehensive inspection of March 2017 we have changed the rating of the key questions safe and well led to good and this has changed the overall rating to good, in line with our characteristics for providing ratings.

Cullum Welch Court Care Home is owned by the charity Morden College and is within the grounds of Morden College and part of its community. The home provides residential, nursing and dementia care for up to 60 older people and respite care to members of its community and the wider local community. On the day of the inspection there were 53 people living in the home.

There was 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.

At this inspection we found the previous concerns about staff supervision had been addressed. However there were other breaches of regulations as medicines were not always administered or disposed of safely. The system for monitoring the quality and safety of the service had not identified the need for an audit of staff recruitment records or checks on the safety of some aspects of the premises. The checks had not always been sufficiently robustly operated. You can see the action we have asked the provider to take at the back of the full version of this report.

We discussed the issues we found with the provider and registered manager and immediate action was taken to address them. However we were not able to judge the effectiveness of the improvements made at the inspection.

People told us they felt safe and well looked after living at Cullum Welch Court. Staff knew how to identify and respond to any safeguarding concerns. There were enough staff to meet people’s needs and we observed that staff were able to spend some time talking with people during the day.

Possible risks to people were identified and monitored to reduce risk of the occurring.

There was a strong emphasis on staff training and development. Staff told us they received training on a wide range of areas to help them develop their skills. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s dietary needs were met and a range of health professionals including physiotherapists and a mental health nurse were available at the home to support their health needs. The home was committed to delivering dignified end of life care.

People spoke with a sense of community and belonging. There was a person centred culture at the home; care was provided with sensitivity and kindness. Staff spoke with enthusiasm about their work. They spoke with people respectfully and were aware of people’s needs and preferences. The management team worked to ensure the nursing home was part of the Morden College community. The home also had links with the local community and people were active inside and outside of the home. There was a strong focus on delivering a range of personalised activities for people and for people to remain as independent as possible.

Some aspects of the home were very well-led. The home was proactive in looking for ways to improve the care provided. Developments included a falls awareness group whose work was aimed to reduce the incidents of falls and increased knowledge for staff about how to support people living with dementia through involvement in a research project. The home also made use of consultancy to drive improvements for example increasing awareness of signs of sepsis. There was a range of meetings to support communication across the home. People were consulted for their views about the service through residents meetings, surveys and involvement in a food committee.

We found that people who used the service were happy living at the home and had various choices available to them. Each person had a care and treatment plan with relevant risk assessments which was reviewed monthly to meet people's changing needs. We found that staff knew what constituted abuse and their responsibility to protect people from abuse. Staff were supported through induction, training and supervision to deliver care that was safe and to an appropriate standard. The provider used regular surveys, audits and complaints from people, their relatives and staff to monitor the quality of the service provided