Wimbledon House Residential Care Home

Wimbledon House Residential Care Home is a residential care home providing personal care to 29 people with mental health needs at the time of the inspection. Wimbledon House accommodates up to 34 people in one adapted building.

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

The registered manager did not ensure auditing systems and process were established and operated effectively. There was a lack of oversight by the registered manager over the day to day running of the service. There was no effective system to record and analyse accidents and incidents to ensure any patterns or trends could be monitored, identified and acted on.

Risk assessments, such as the risk of choking, were not sufficiently detailed. For example, there was no guidance for staff about what to do should a person begin to choke, in line with good practice. Whilst staff, who knew people well, had been trained in first aid, the service was using agency staff and recruiting new staff. This meant there was a risk staff who were unfamiliar would not know what action to take.

When people were at risk of constipation, there was insufficient guidance for staff about when the medication should be given or when to seek advice from a health care professional. Other risk, such as a possible deterioration in mental health were in place.

People were protected from the risks of abuse, and discrimination. Staff understood how to report concerns. People were supported by a consistent staff team who had been recruited safely.

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 told us they felt safe and happy living at the service. Equality and diversity were promoted by staff who treated people equally as individuals. People were encouraged to make suggestions about the day to day running of the service and their ideas were listened to and acted on.

People were supported to see health care professionals when needed. Staff worked closely with community psychiatric nurses, community nurses and GPs to make sure people received the support they needed.

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 March 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Enforcement and Recommendations

We have identified breaches in relation to good governance. 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.

We found the following examples of good practice.

Visitors to the service were provided with clear guidance on the process they needed to follow during visits to Wimbledon House Residential Care Home. Checks were completed on all visitors to the home to ensure they had a negative Covid-19 test result and where required had been vaccinated against Covid-19. Staff followed the latest guidance and people were able to receive visitors without restrictions.

People were supported to safely go out and about with their family, friends and staff.

People and staff followed the current Covid-19 testing programme to quickly identify any infections.

Wimbledon House is a residential care home providing personal care to 25 people with mental health needs at the time of the inspection. Wimbledon House accommodates up to 34 people in one adapted building.

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

People felt safe at Wimbledon House. They were treated with dignity and respect and their lifestyle and equality needs and choices were understood and respected. People had privacy.

People were supported to protect themselves from the risks of harm and abuse. Staff knew how to identify concerns. Any concerns raised had been listened to and acted on. Risks had been assessed with people and ways to keep them safe, while remaining independent, had been agreed.

Staff supported people to remain physically and mentally well. People were offered a balanced diet which met their needs. People’s medicines were managed safely. The building was clean and people were protected from the risk of infection.

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 had planned their care with staff and were supported to live their lives in the way they wanted. They were supported to take part in a range of activities they enjoyed. People had been invited to share their end of life preferences.

The registered manager had oversight of the service. Regular checks were completed on the quality of care people received. Any shortfalls were addressed and action was taken to prevent them happening again.

People, their relatives and staff were asked for their views of the service. These were listened to and acted on to improve the service.

The registered manager understood their legal responsibilities and had shared information with us and others when they needed to.

There were enough staff to support people when they needed. Staff had the skills they required to care for people and were supported by the management team. Staff were recruited safely.

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 19 February 2019). 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

This was a planned inspection based on the previous rating.

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.

At the last inspection we found that the Wimbledon House Residential Care Home was 'Good' in all domains. However, we found the service is now rated requires improvement.

Wimbledon House Residential Care 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.

Wimbledon House Residential Care Home provides accommodation and support for up to 34 people living with mental health issues. At the time of inspection there were 28 people living at the service. The care home is located close to the centre of Herne Bay and a short walk to the sea front.

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.

Risks to people were not always fully assessed and mitigated. Management did not learn from incidents which may have prevented harm. In addition, management failed to assess people's mental capacity when their mental and physical health fluctuated.

People were not always given medicine safely. Audits identified continued medicine administration errors, which persisted despite being raised in staff meetings and through staff notices. In addition, protocols around 'as needed' medicines (PRN), such as; cold medicine or sedatives were not specific to each person. Therefore, there was a risk that people could be given antipsychotic PRN medicine without less restrictive options considered first. We discussed this with the management who took action to rectify the concerns, by changing the medicine administration process and by seeking advice from a local pharmacist.

The quality of information recorded about people varied. Some care plans were thorough and contained information on people's likes, dislikes and preferences, whilst others were very basic local authority care plans that had not been reviewed. People had reviews to ensure that people could discuss how they wanted to be supported by staff. However, reviews did not always take place when accidents and incidents occurred or when people's needs changed.

Systems to monitor and assess the quality of the service were not always effective. Although the provider and registered manager undertook regular audits, shortfalls idenitifed were not always addressed, and areas of concern were not always recognised.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC requirements.

People felt safe living at Wimbledon House Residential Care Home. People told us that they would feel confident raising concerns and complaints with the managers. They also felt confident raising issues in resident's meetings and when talking to their keyworker. People told us that staff cared for them and respected their views and beliefs. Some people went to church and church services took place at the service which people attended. Staff supported people to take part in activities that interested them. However, some people felt activities at Wimbledon House Residential Care Home could be improved. This had been raised to management and they had recently hired an activities coordinator.

Staff knew what to do if they witnessed or suspected abuse and there was a safeguarding and whistleblowing policy that staff were aware of. Staff also attended annual safeguarding training. Environmental risks were assessed, and staff knew what action to take in the event of an emergency. There were enough staff to support people and a robust recruitment process ensured that staff were safe to work alone with people. New members of staff underwent a thorough induction programme and existing staff had regular face to face training that they found helpful to their roles. However, training was not always effective as shortfalls continued to be identified.

Staff were aware of people’s mental health needs and physical needs, as well as their hydration and dietary requirements. People had access to a range of different meals and alternatives were always offered. The chef talked to people about options and those with specialist dietary requirements were catered for. Staff worked closely with professionals to enable people to live as healthy life as possible. Staff knew when people were unwell, and we saw that appropriate referrals to health professionals had been made. People were supported to attend medical appointments and a weekly GP clinic was held at the premises. When people visited other services, information about the person was taken to promote consistency in care.

The premises met people's needs. Communal areas were decorated in a homely way and each person could decide how their room was decorated. There were different areas for people to socialise or relax in and environmental changes were made to accommodate people when their physical needs changed.

Staff respected people's privacy and dignity and understood principles of consent. Staff attended mental capacity and deprivation of liberty training, as well as equality and diversity. People were encouraged to be as independent as possible. We saw people were offered choices and their decisions were respected.

Staff felt comfortable raising concerns in supervisions, appraisals and in staff meetings and felt supported by the management. Each year the management asked for feedback from people, staff, relatives and health professionals. Comments were collected and analysed by the provider to develop the quality of the service provided to people.

The registered manager attended local forums for registered managers, to learn about the latest and best practice. This information was passed to staff through staff meetings and notices. Management liaised appropriately with local agencies, such as; professionals and the local authority.

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

Wimbledon House can provide accommodation and personal care for 34 people who have mental health conditions. The accommodation is on two floors. There were communal lounges, a dining room, smoking room and well maintained gardens. A stair lift was available to help people who had mobility difficulties and one bathroom was fitted with a bath hoist. The service had its own vehicle to make sure people were able to access facilities in the local area and pursue a variety of activities.

Rating at last inspection

At the last inspection, the service was rated good and requires improvement in the ‘safe’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 April 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wimbledon House Residential Care Home on our website at www.cqc.org.uk

At this inspection we found the service remained good and is now rated good in the ‘safe’ domain.

Why the service is rated Good

The service had improved since the last inspection. Potential risks to people were now identified and there was guidance on how to safely manage the risks. People received the interventions they needed to keep them as safe as possible. Risk assessments were designed to keep risks to minimum without restricting their activities or their life styles and promoting their independence, privacy and dignity.

Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

Safeguarding procedures were in place to keep people safe from harm. These procedures had been followed by the registered manager when necessary. Staff had been trained in safeguarding adults and they knew what action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the registered manager, or outside agencies.

Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

There was enough staff on duty to keep people safe and give them the care and support that they needed.

People received their medicines safely and when they needed them.

At the time of the inspection there were 33 people living at the service. The care and support needs of the people varied greatly.

There was a registered manager working at the service. 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. The registered manager, deputy manager and staff supported us throughout the inspection.

The registered manager provided leadership to the staff and had oversight of all areas of the service. There was a culture of continuous improvement, so that people would feel increasingly well cared for. Staff were motivated and felt supported by the registered manager and senior staff.

The staff understood the vision and values of the service, such as person centred care, treating people with respect and maintaining their privacy and dignity. Staff told us the registered manager was approachable and they were confident they would not hesitate to raise any issues if they had any concerns. Safeguarding procedures were in place to keep people safe from harm. On one occasion these procedures had not been followed by the registered manager. They had not consulted with the local authority safeguarding team when the incident had occurred, which they should have done as part of those procedures. Staff had been trained in safeguarding adults and they knew what action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the registered manager, or outside agencies if necessary.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure they would be able to offer them the care that they needed. The care and support needs of each person were different and each person had a care plan which was personal to them. Some care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. However, some parts of the care plans did not accurately record the information needed. People had regular reviews of their care and support when they were able to discuss any concerns or aspirations and goals they wanted to achieve.

Potential risks to people were identified but guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. On the whole, there was guidance in place for staff on how to care for people effectively and safely. Risk assessments were designed to keep most risks to minimum without restricting their activities or their life styles and promoting their independence, privacy and dignity.

People had an allocated keyworker who was involved in their assessments and reviews. A key worker was a member of staff who takes a key role in co-ordinating a person’s care and support and promotes continuity. Throughout the inspection people were treated with kindness and respect. Staff were attentive and the atmosphere in the service was calm, and people were comfortable in their surroundings. People were involved in activities which they enjoyed. Contact with people’s family and friends who were important to them was supported by staff.

The staff knew people well and were familiar with their lifestyle wishes and preferences. This continuity of care and support resulted in building people’s confidence to enable them to make more choices and decisions themselves and become more independent. People’s individual religious preferences were respected. People’s health was closely monitored and people had regular contact with their doctor and specialist services.

People said that they enjoyed their food and it was always of a good standard. They said there was plenty of choice and the portions at meal times were good. They told us they had involvement in the menu to ensure they had their favourite foods.

People received their medicines safely and when they needed them. They were monitored for any side effects. Some people received medicines ‘when required’, like medicines to help people remain calm. There was some guidance for staff to tell them when they should give these medicines, but it did not contain a lot of detail to make sure people received the medicine consistently and safely. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. Some special medicines required storage in a special cabinet. The cabinet used by the service did not meet the required legal specifications for storing these medicines.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these are agreed by the local authority as being required to protect the person from harm. No DoLs applications had been made to the relevant supervisory body in line with guidance, as no-one required one.

There were adequate numbers of staff on duty during the days to meet people’s needs. However, the optimum staffing levels of six care staff per day was not being achieved due to staff vacancies. There was an ongoing recruitment drive to recruit new staff. There were robust staff recruitment procedures to ensure staff were suitable for their job roles.

Staff had the knowledge and skills to meet people’s needs. They received the training they needed to do their jobs effectively and safely. Staff received regular one to one meetings with the registered manager and an annual appraisal to discuss their training and development needs. Staff were supported by the registered manager and felt able to raise any concerns they had or suggestions to improve the service.

Records showed that there were safety and maintenance checks of services, to keep people safe. Tests and checks of fire equipment and the alarm were conducted regularly, to ensure equipment was in working order. Fire drills were held regularly to ensure staff were familiar with actions in the event of an emergency, however some people did not have a personal emergency evacuation plan (PEEPS). The registered manager told us most of the people living at the service were capable of leaving the building but some people refused to leave therefore assessments would be completed for each person. This was an area for improvement.

The complaints procedure was available and accessible. People knew how to complain and felt confident their complaints would be listened to and acted on. People had opportunities to provide feedback about the service provided both informally and formally.

Regular audits and checks were undertaken at the service to make sure it was safe and running effectively, however the action plan as a result of the last quality assurance check had not been completed. This was an area for improvement.

We found one 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 the report.

The service checked the suitabilty of staff before allowing them to provide direct care to people that used the service. Staff had been supported to gain qualifications, skills and experience in line with meeting the needs of these people.

We spoke to eight people that used the service. One of them told us, "They are brilliant here. I would not know what to do without them". Others said that the staff were, "marvellous", "wonderful", and that the home was a good place to live. We spoke to three health care professionals that were involved in the lives of people who used the service. "One of the best", was a term used by one of these people.

People said that they were involved in the decisions made about them and that there were a lot of choices about day time and evening activities. People felt happy about raising any issues of concern with the staff on duty.

We spoke to five members of staff who all gave examples of how they treated people with dignity and respect.

We found evidence of activities being planned to help promote choice, independence and participation in the wider community

We saw how care was provided safely, in accordance with people's preferences and by staff who had the right skills and experience.

We found that there were good quality assurance systems in place to minimise the risk of harm to people who use services. Staff, people who use services and partners were asked their views regularly through surveys. There was evidence that the manager implements actions to improve the service as a result of these surveys.