The Worthies

We found the following examples of good practice.

Staff greeted visitors at the entrance to the home and took their temperature and ensured they were wearing the correct Personal Protective Equipment (PPE). Arrangements for visiting were displayed clearly so health and social care professionals, friends and family knew what was expected of them to keep people safe.

Visitors had to leave their contact details as part of a track and trace and complete a health declaration and show a negative lateral flow test. Vaccination status was checked for all contractors and health and social care professionals in line with legislation that had come into effect in November 2021.

There were separate zoned areas for putting on and removing PPE, and suitable arrangements for their disposal. There was hand sanitizer, gloves and aprons placed in different areas of the home for ease of access.

The environment had been adapted by moving furniture to enable social distancing. The home had two double bedrooms. The registered manager and the regional manager told us these had not been used during the pandemic and were single occupancy only. Daily activities were organised for people to help with their wellbeing. People looked well cared for and expressed satisfaction about their care and support.

People were supported to see friends and family in accordance with government guidance. People and their relatives had been asked who their named visitors would be. Essential Care Givers (named relative) were supported to visit during the recent outbreak and where people were end of life relatives were also supported to spend time with their loved one. There was also a garden visitors’ pod to enable visits as some relatives preferred not to come into the home. Relatives we contacted were satisfied on how the staff and management had managed the pandemic and kept their loved ones safe and the communication that was in place. They said this had improved since the new registered manager had commenced in post.

The provider and registered manager had ensured that staff had up to date information to keep people and staff safe. The registered manager demonstrated a good understanding of the guidance to minimise risks in respect of the pandemic.

All staff had received additional infection prevention and control training, and this had been updated in the last four weeks as the provider had introduced a new training provider. Checks were completed to ensure staff were wearing the correct person protective equipment (gloves, aprons) in accordance with the government guidance. This included hand washing.

There were clear policies, procedures, quality assurance checks and contingency plans in place in respect of managing the pandemic and keeping people and staff safe.

The registered manager told us before the inspection that the lift was being replaced and this would take up to three weeks. Contingency plans were in place. Staffing was being increased at peak times such as mealtimes. We were told this was being increased from three care staff to four care staff to ensure people received safe and effective care. A bedroom had been made into a lounge area on the top floor to prevent isolation of people in this area.

The registered manager and the regional manager said they had not experienced workforce pressure and contingency plans were in place to ensure suitable numbers of staff were working in the home.

The Worthies is a 'care home'. People in care homes receive accommodation 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 Worthies provides personal care and accommodation for up to 26 older people. At the time of our inspection there were 23 people living at the home.

There was a registered manager in post. They were also responsible for another registered home, which was in close proximity to The Worthies. A registered manager is a person who has registered with the CQC 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.’

The provider had made improvements in respect of the breaches found at the inspection in September 2107. What they told us they would do in their action plan they had completed. Further action plans had been developed in conjunction with the local safeguarding team and these were being implemented with assistance from the additional management support. The additional management support was from registered managers employed by the provider who worked at other services owned by the provider.

People were receiving care that was effective and responsive to their changing needs. Care plans were in place that described how the person would like to be supported and these were kept under review. People’s medicines were managed safely and improvements had been made since our last inspection. This included regular checks, which provided the provider with assurances and addressed any shortfalls promptly.

People had access to healthcare professionals when they became unwell or required specialist help. People were encouraged to be independent and were encouraged to participate in activities in the home and the local community.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. People confirmed their involvement in decisions about their care. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected. This was done by involving relatives or other professionals in the decision making process.

Staff were knowledgeable about the people they were supporting and spoke about them in a caring way. Staff had received suitable training enabling them to deliver safe and effective care. Further training was being organised in May 2018 to provide staff with updates. People were protected because staff went through a thorough recruitment process. Regular staff meetings were taking place. Staff were supervised on a one to one basis. This had recently improved with staff receiving these every two months instead of three monthly.

Sufficient staff supported people living at The Worthies and this was kept under review. People’s views were sought about the service. Surveys were also completed by relatives and staff.

The quality of the service was regularly reviewed by the provider/registered manager and staff. The registered manager was aware of the areas that required improvement with an action plan in place.

This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. This inspection took place on the 20 and 21 September 2017. This inspection was brought forward because we had received concerns from a whistle blower. The concerns related to how people were being cared for, the culture of the home and some environmental concerns. Some of the concerns were substantiated. However, it was evident that the provider and registered manager had taken action and had addressed some of these concerns prior to the inspection.

A registered manager was in post at the time of our 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 home is run.

At the last inspection in October 2016, the service was rated good overall, with improvements needed to ensure people were safe. This was because we did find some recording omissions and inaccuracies in regards to people's medicines. There were no breaches of regulation.

During this inspection, we found people’s medicines were still not managed safely, in respect of the administration and the disposal of pain patches. We also found that a person that was at risk of choking was not being provided with a suitable textured diet and thickened drinks to reduce these risks. We also brought to the provider’s attention some environmental issues in respect of hot water, which could pose a scalding risk to people, a loose handrail leading down some stairs and a slight odour in parts of the home. There was also a lack of signage where there was low headroom leading down from the stairs. Whilst action had been taken to address these concerns, the provider’s own checks had not identified these shortfalls with prompt action being taken.

People were receiving care that was effective and responsive to their changing needs. Care plans were in place that described how the person would like to be supported and these were kept under review.

People had access to healthcare professionals when they became unwell or required specialist help. People were encouraged to be independent and were encouraged to participate in activities in the home and the local community.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. People confirmed their involvement in decisions about their care. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected. This was done by involving relatives or other professionals in the decision making process.

Staff were knowledgeable about the people they were supporting and spoke about them in a caring way. Staff had received suitable training enabling them to deliver safe and effective care. People were protected because staff went through a thorough recruitment process.

Staff confirmed they received support and guidance from the management of the service. Sufficient staff supported people living at The Worthies and this was kept under review. People’s views were sought about the service. There was a programme of change, which included refurbishment of the environment and developing the skills of the staff to improve the way they supported people living with dementia. They were supported by the Dementia Wellbeing Service in introducing these changes.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The Worthies provides personal care and accommodation for up to 26 older people. At the time of our inspection there were 22 people living at the home.

A registered manager was in post at the time of our 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 home is run. The registered manager was on long term planned leave at the time of our inspection. The home had notified the Commission of this absence and had suitable managerial arrangements in place.

At the last inspection in April 2015 we found that suitable arrangements for the management of people’s medicines and cleanliness and infection control were not being met. At this inspection we found improvements had been made in both areas to meet the regulations. However, we did find some recording omissions and inaccuracies in regards to people’s medicines which we brought to the attention of senior staff.

People had assessments in place to minimise risk and there was suitable guidance for staff in risk management. Staffing levels were safe. People and relatives told us there was enough staff to deliver care and support effectively. The home ensured people were safe by having thorough recruitment procedures. This was followed by an effective induction, supervision and training programme to ensure staff were skilled and well supported in their role.

Senior staff were aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. The home kept clear records of how conditions attached to a DoLS authorisation were being met. People’s capacity had been considered and documented in care records. When a best interest decision was needed, this was fully documented with the involvement of family and health or social care professionals. Staff were confident in their knowledge of DoLS and the Mental Capacity Act 2005.

We observed good relationships between people and staff. Staff knew people well and ensured there was a happy and positive atmosphere within the home. Positive comments were made by people and relatives about staff’s kind and caring approach.

Staff were responsive to people’s care and support needs. Care records were person centred, showing people’s personal preferences. Staff supported people to be involved in a range of activities both within the home and in the community. People were involved with decisions made at the home.

At our last inspection in April 2015 we found that systems to monitor the quality of the home were not effective. We saw that the home had reviewed and implemented changes to their systems as detailed in the action plan they sent us. We received positive feedback about how the home was led and run. Regular staff meetings were arranged and there were effective communication systems in place. Feedback was sought from people, staff and relatives. Any areas that required further follow up were thoroughly completed.

Some people living in the home remembered us from previous visits and we were welcomed by everyone. We spoke with people individually and we participated in an activity in the afternoon. This gave us the opportunity to get to know people and their views about the home.

People shared with us their experiences about living in the home and we spoke with three people at length. Everyone expressed positive comments. People told us, "I couldn't wish for a better place' and "The manager is good as gold, very helpful and very thorough' and 'I can honestly say the staff are so very kind. We all live together happily like a family".

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the care, attention and support that people received. There was a constant interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company. It was a positive inspection and the provider was compliant in all five outcomes that we looked at.

People were positive about their experiences. Comments from people included, 'I am very happy here and the manager and staff have been lovely', 'Things have really improved since your last visit and I have settled in well' and 'All the staff are very kind and we are all good friends here'.

Staff we spoke with us told us, 'Moral has greatly improved and there is a great team of staff', 'Communication has improved and the manager welcomes any ideas and suggestions we may have' and 'The training has really helped us improve our knowledge and skills'.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at the home received.

There was constant interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company. We were introduced to people throughout the day and they welcomed us to their home. They talked freely with staff in front of us and people were confident and comfortable in their surroundings.