The Waynes - Bridlington

The Waynes -Bridlington is a residential care home providing accommodation and personal care to up to 30 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 21 people using the service.

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

Although the provider had implemented a new auditing system, this had not always been effective at identifying areas for improvement. We noted improvements in some areas but not all areas raised at the last inspection had been addressed.

Risks to people had not always been managed. Monitoring charts in place to reduce risks to people’s health were not sufficiently robust. Improvements had been made to the safety of the service in terms of the environment.

Medicines systems had improved, and a clear system was in place to ensure people received medicines in line with the prescribers instructions. Work was required to ensure all records were completed in line with best practice.

We have made a recommendation about the need for consent. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Capacity assessments and best interest decisions continued to not always be recorded.

Improvements had been made to the mealtime experience; however further work was required to ensure people with memory impairments were fully supported to make choices.

Staff received regular supervision and felt supported by the management team.

People told us they felt safe and were happy with the support they received. People and relatives spoke positively about the consistent staff who knew them well.

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 and update

The last rating for this service was requires improvement (published 1st July 2022)

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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 22 April 4 and 5 May 2022. Breaches of legal requirements were found and we served a Warning Notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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 inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. 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 The Waynes- Bridlington on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to risk management and governance at this inspection. We have made a recommendation in relation to the Mental Capacity Act (MCA).

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 for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The Waynes -Bridlington is a residential care home providing accommodation and personal care to up to 30 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 21 people using the service.

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

Quality Monitoring systems were not always effective and failed to identify the shortfalls found during the inspection. The provider had failed to follow their own policies and procedures and learn from external audits to improve the quality and safety of the service.

Risks to the health and safety of people were not always managed. Records did not always accurately reflect people's care needs to ensure people’s health, safety and welfare was appropriately supported. Risks that could put people at harm, for example, risk of falls from height and security of the building had not been suitably identified and addressed.

Medicines were not safely managed. Best practice guidance was not followed to ensure the safe administration of medicines. Records in relation to medicines were not accurate, up to date or legible.

There was not always staff on duty with up to date training, this meant tasks such as medicines administration were at times carried out by staff who did not have up to date training. Staff did not always have up to date training or competency assessments to ensure they had the required skills and knowledge to complete their roles.

Recruitment procedures were in place, but records were not always robust. We have made a recommendation regarding recruitment.

The service was not clean on the first day of inspection. We have made a recommendation regarding preventing and controlling the spread of infection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Records were not always accurate and up to date to show people's capacity had been assessed and when people were giving consent on people's behalf it was unclear if they had the legal authority to do so.

Staff felt well supported by the management team and told us there was a ‘family feel’ to the service.

People told us they felt safe. Staff understood their responsibilities to report any safeguarding concerns. People and relatives spoke positively about the service and the kind nature of the staff team. Staff knew people well and treated them with kindness and respect.

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

Rating at last inspection and update

The last rating for this service was good (published 29 September 2018).

Why we inspected

We undertook a targeted inspection to review the infection prevention control measures in place.

We inspected and found there was a concern with risk management and infection prevention control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

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.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to risk management, medicines management, staffing and governance.

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 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.

At our last inspection we rated the service good overall. At this inspection we found the evidence continued to support the rating of good. 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.

The inspection took place on 1 August 2018 and was unannounced.

People felt safe and staff understood their responsibilities around safeguarding adults and reporting concerns.

Risks to people’s physical and mental health had been identified and guidance was available for staff to manage those risks. The environment and equipment was safely maintained.

Staff recruitment procedures ensured background checks were made before people were offered employment and there were sufficient staff on duty to meet people’s needs.

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 had access to healthcare professionals in the community such as their GP or community mental health team.

Staff maintained positive relationships with people and showed care and compassion in their interactions.They consulted people about the way in which they wished to receive their care and gave them the necessary support.

There was a quality monitoring system in place which identified where improvements were needed although could be improved by adding more detail around the actions taken.

People and staff were invited to share their views and give feedback about the service

Further information can be found in the detailed findings below

The service is registered to provide accommodation for up to 30 people who require assistance with personal care. On the day of the inspection 18 people were living at the service and one person was staying on respite care. The service is situated in the seaside town of Bridlington, in the East Riding of Yorkshire. The property is detached and accommodation is offered on ground and first floor levels in single or double rooms.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who was registered with the Care Quality Commission (CQC). 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.

During this inspection we found that the service was safe. People’s needs were assessed and risk assessments put in place to reduce the risk of avoidable harm. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities for protecting people from the risk of harm.

The service had an effective recruitment and induction process and provided on-going training to equip staff with the skills and knowledge needed for their roles and only people considered suitable to work with vulnerable people had been employed by the service.

Staff told us that they felt well supported by the registered manager and could approach them if needed. They told us that they received formal supervision but could also approach the registered manager with any concerns at any time.

Staff had received training on the administration of medicines and we saw there were safe systems in place to manage and handle medicines.

The registered manager was able to show they had an understanding of Deprivation of Liberty Safeguards (DoLS).

People were supported to eat and drink enough and, where necessary, supported to access healthcare services.

People told us that staff were caring and that their privacy and dignity was respected. We observed people were cared for by staff with a positive and responsive manner.

We saw that there were systems in place to assess and record people’s needs so that staff could provide personalised care and support. People told us they felt able to make comments or raise concerns and there were systems in place to seek feedback from people who received a service and feedback had been analysed to identify any improvements that needed to be made.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and had systems in place to ensure these were responded to.

People who lived in the home told us they were happy with the support they received with their medication. Comments included 'I have no problems with medication, they come round and ask' and 'I don't take many tablets, but I get the ones I do and yes I get my creams.'

There were systems in place to ensure the safe receipt, storage, handling and disposal of medication in the home. Records were up to date and staff had received refresher training to help ensure the correct practices were followed.

We also saw that quality assurance systems had been improved upon and the majority of records were up to date. There were systems in place for gaining the views of people who lived in the home and for information sharing.

Risk assessments and polices were in place and the majority had been reviewed and were up to date. Systems were also in place for the maintenance of the home; sampled safety certificates were also up to date.

We saw that people were supported through a care planning process to have their needs met. Systems were also in place to meet peoples nutritional and medication needs. However some improvements were required regarding assessments to ensure up to date information was available to make sure that this remained the case.

Additionally medication practices did not meet with the guidelines from the Royal Pharmaceutical Society.(RPHARMS)

We saw that the home was on the whole clean and tidy and that people could personalise their rooms. However there was no evidence that the electrical systems in the home were safe.

There were quality assurance systems in the home but health and safety risk assessments were not all up to date.