Wythall Residential Home

Wythall Residential Home is a residential care home providing accommodation for persons who require nursing or personal care for up to 22 people. The service provides support to older people. At the time of our inspection there were 17 people using the service.

Wythall Residential Home accommodates people in one adapted building.

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

We carried out a previous unannounced inspection of this service on 27 and 28 July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance. At our last inspection, improvements were required around medicines management, managing people's risks, risks within the environment, quality of record keeping and quality assurance systems.

At the last inspection we recognised that the provider had failed to appoint a registered manager. This was a breach of regulation, and we issued a fixed penalty notice. The provider paid this in full.

At this inspection we found the provider remained in breach of regulation. The service remains rated requires improvement.

Whilst some improvements to record keeping and managing people’s risks had been made and a new governance system had been implemented, we continued to find improvements were needed in these areas. Systems and processes to safeguard people from the risk of abuse or avoidable harm needed to be more robust. Staff had not always followed the provider’s medicines procedures or national guidance when ordering, administering, or storing medicines. We identified some shortfalls during our inspection.

Feedback we received from people, relatives, and staff we spoke with during the inspection was positive. People told us they felt safe living at Wythall Residential Home.

People and relatives told us the home was managed well and felt confident to raise matters with the managers. The service still did not have a registered manager in post. However a manager had been appointed and was applying to be registered at the time of our inspection.

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.

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 November 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 and well-led.

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 Wythall Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to safe care and treatment, medicines management and 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.

Wythall Residential Home is a residential care home providing accommodation for persons who require nursing or personal care for up to 22 people. The service provides support to older people. At the time of our inspection there were 17 people using the service.

Wythall Residential Home accommodates people in one adapted building.

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

We found no evidence of harm to people but systems to manage people’s risks required further development and to be embedded into staff practice. Improvements needed to be made in how people’s medicines were stored, administered and managed, so people always had these as prescribed. Potential safeguarding concerns needed to be consistently managed and appropriate action taken to inform Local Authority safeguarding teams and The Care Quality Commission when such incidents occurred. People’s assessments needed to be consistently updated when their needs changed.

There had been multiple changes to the staff running the home and a manager was not registered with The Care Quality Commission, as legally required. Where checks on the quality of care had been undertaken by the provider these were not effective in making improvements to the care people received.

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 in the service supported this practice. However, the systems to ensure people’s rights were consistently promoted required further development. This was required to ensure staff knew which people had a DoLS authorised and these were promptly notified to The Care Quality Commission.

Some people had enjoyed improved help since moving to the home, but we found action was not always promptly taken to seek advice from people’s GPs or health specialists. People and relatives told us staff had the skills to care for people. However, staff’s induction records did not evidence they had completed the full range of the provider’s induction training.

Some people’s health and care needs assessments were not always updated as their needs changed. Areas of premises management required further development, to reduce risks to people further.

The provider had started a programme of premises improvements, to increase the number of rooms with ensuite facilities. There were enough staff to care for people, and people did not have to wait long if they wanted assistance from staff. There were no restrictions on visiting arrangements and staff took action to reduce the likelihood of the spread of infections.

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 June 2019) and there were breaches of regulation relating to people’s safety and how the service was managed. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety and the management of the service. We also wanted assurances following our inspection of the home on 2 May 2019 that the provider had followed their action plan, and legal requirements were now met. As a result, we undertook a focused inspection to review the key questions Safe, Effective and Well-led which contain those requirements.

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.

We have found evidence that the provider needs to make improvements, to reduce the risk of harm to people further. Please see the Safe, Effective and Well-led sections of this full report.

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 and will take further action if needed.

We have identified breaches in relation to the management of people’s safety, how people are protected from the risk of abuse and how the service is managed at this inspection.

You can see what action we have asked the provider to take at the end of this full report. The provider began to take action to address identified concerns during the 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.

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

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

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

People's experience of using this service:

• People felt safe but the provider’s procedures to protect people from harm had not always been followed.

• People’s care was not consistently provided in line with the Mental Capacity Act 2005 (MCA). Action was taken to address this.

• The provider and registered manager had not met their regulatory responsibility to inform us about significant events that happened at the home.

• Risks to people’s health and wellbeing had been assessed. Action was being taken to ensure staff followed risk management plans.

• The provider’s quality audits and checks were not always effective.

• People spoke positively about how staff administered their medicines. However, the administration of prescribed creams required improvement.

• Staff knew people well and were available when people needed them.

• Staff were recruited safely and completed the training they needed to be effective in their roles.

• The home was clean, and the environment met people’s needs.

• Feedback from people and staff was encouraged. People were happy with the service they received.

• Prior to moving into the home people's needs were assessed to ensure they could be met by the service.

• Most people had been involved in making decisions about their care.

• Care plans contained information to help staff understand how to support people according to their needs and preference.

• People's end of life wishes were recorded.

• Staff communicated effectively with people and people received information in a way they could understand.

• Staff respected people's right to privacy and supported people to be independent.

• People had mixed views about the social activities provided.

• People had access to healthcare professionals and their nutritional needs were met.

• Complaints were managed in line with the provider's procedure.

• The staff culture in the home required improvement. Action was being taken to address this.

• The management team welcomed our feedback and assured they were committed to driving forward improvement to benefit people.

• At this inspection we found the evidence supported a rating of 'Requires Improvement ' overall.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 13 Regulated Activities Regulations 2014 –Safeguarding service users from abuse and improper treatment.

Regulation 17 Regulated Activities Regulations 2014 Good governance.

Regulation 18 of the Care Quality Commission Registration Regulations 2009. Notifications of other incidents.

Rating at last inspection: Good (report published December 2017.)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We carried out an unannounced comprehensive inspection of this service on 3 November 2016. After that inspection we received concerns in relation to the safety of people, the care people received and the management of the home. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

Following the previous inspection we rated each of the five key questions as Good. The overall rating for the service was Good. We have not changed our overall rating of the service. However, the question ‘Is the service well-led’ is now rated as Requires Improvement.

The rating following our previous inspection was not on display within the service on our arrival. This was later seen to be in place.

There was a manager in post. This person had commenced on the process necessary to register with the Care Quality Commission although no application had been received by the commission at that time. 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.

People we spoke with told us they felt safe living at the home. Staff had an awareness of their responsibility to report poor or potentially abusive practice. People told us they were able to get up when they wanted. Information about when people got up in the morning was included within their care plan. Care records were not always detailed such as the assistance needed in the event of a fall however staff had an awareness of people’s needs

People were supported around the home as they wished with the guidance of staff to reduce the risk of falling. Equipment was available such as hoists if needed. We saw staff administered people’s medicines and record as required. Staff were seen to respond to people’s needs throughout the day. People were able to undertake their interests and staff were seen spending time with people.

You can see what action we told the provider to take at the back of the report.

There was no 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.

We had previously carried out an unannounced comprehensive inspection of this service on 24 September 2015. A breach of legal requirement was found in relation to Need for Consent. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements as people who use services were not supported to make decisions or have their capacity assessed. We found these improvements had been mad.

People and their relatives told us the service was safe. Staff knew how to keep people free from the risk of abuse and had undergone safeguarding training, had access to policies and guidance which enabled them to safeguard people.

People’s risks were managed and had been assessed in relation to their mobility skin care and other health risks. Care staff identified risks and understood how to mitigate the risks. People told us that cares staff were approachable supportive and motivated to provide good care to people.

There were enough care staff who had the correct skills and knowledge to safely meet people's needs in ways that they preferred. People's medicines were ordered, stored and disposed of safely. Staff had completed medicines training and updated their internal medicines training and told us they felt confident in administering medicines.

People told us the staff were trained. Care staff had received suitable training, on-going support and professional development to ensure they were competent to deliver people's care. People reported that their consent was asked for when care was being given. Care staff were able to demonstrate how it applied to their day to day work with people.

People were happy with the quality of the meals provided. People were appropriately supported by staff wherever they were eating within the service. People's weights were monitored and appropriate action was taken if people were at risk from weight loss. People reported there was good healthcare provision. Staff arranged for people to see a range of health care professionals as required.

People and relatives said the care delivered was good and the care staff were friendly, kind, helpful and respectful. People experienced positive relationships with the staff who cared for them and who upheld their privacy and dignity when providing their care.

People told us they received the care they needed and were cared for by staff who had information about how to respond to their individual needs. People were encouraged to enjoy interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

People, their families and staff all told us the service was well led. Staff had a good understanding of their roles and responsibilities and felt appreciated. They described the culture as friendly and that there was good teamwork. The provider identified that improvements in medicine administration and care plans were required and were working to improve these areas.

We spent time in the dining room and observed the care and support received by people who were using the service. We saw that staff supported people in a respectful manner and offered them choices of how and where they wanted to spend their time.

People told us that they were happy with how their care and support needs were being met. One person told us:" I am very comfortable living here." People told us that staff were available at the times they needed them and that they felt safe living at the home. People told us that they were satisfied with the choice and quality of meals available to them.

Arrangements were in place so that people received their medicines in a safe and timely manner.

Arrangements were in place to ensure that staff employed were suitable to work at the home. Staff turnover was low and we obtained positive feedback in relation to support provided by staff.

Systems were in place to monitor the quality and safety of service provided at the home. People using the service and their relatives were involved in this.

Records were complete and easily located upon request. Records about care had been reviewed and updated to ensure they reflected people's current needs.

People told us that they were happy with how their care and support needs were being met. They told us that staff were available at the times they needed them. A person told us 'I enjoy having a bath. I can have one whenever I want to.'

People told us about the quality and choice of food and drink available. They told us that they were satisfied about the choice and quality of meals. A person told us 'The food is great, there is a choice.'

People told us that they felt safe living at the home and that they would speak to the staff if they had any concerns. A person told us 'I enjoy the security of living here.'

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They told us that they did not have any concerns about the quality of care provided. However, they told us that dementia care training provided by themselves had, on occasions, been poorly attended by staff. Further training dates had been arranged.