Wray Common Nursing Home

People’s experience of using this service:

Staff were kind and caring and treated people with respect. There was a friendly, family atmosphere at the home which people enjoyed. Staff respected people’s decisions about their care and encouraged people to be as independent as possible.

There were enough staff available to meet people’s needs. Staff were recruited safely and understood their role in safeguarding people from abuse. Accidents and incidents were reviewed to identify themes and the actions needed to prevent further incidents. Lessons were learned from adverse events and these were shared with staff.

The home was clean and hygienic. Staff attended training in infection prevention and control (IPC) and had access to appropriate personal protective equipment (PPE). Medicines were managed safely.

People’s needs were assessed before they moved to the home to ensure staff could provide their care. People were supported to maintain good health and to access healthcare services when they needed them. Staff monitored people’s health effectively and acted promptly if they identified concerns.

Staff had the induction and training they needed to carry out their roles. Staff were supported through regular one-to-one supervision, which gave them opportunities to discuss their training and development needs. Handovers and team meetings kept staff up-to-date about any changes in people’s needs or to working practices.

People’s care was provided in line with the Mental Capacity Act 2005 (MCA). 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 care was planned to meet their individual needs. The views of people who lived at the home, their relatives and staff were encouraged and acted upon. People and their relatives felt able to raise any concerns they had and were confident these would receive an appropriate response. The registered manager and staff had established effective working relationships with other professionals involved in people’s care.

The registered manager had improved many aspects of the service since taking up their post, including the quality of care people received, the support provided to staff, communication with relatives, and governance systems. The registered manager acted on feedback we provided at the end of the inspection where we identified areas for improvement.

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 24 May 2019) and there were two breaches of regulation.

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 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.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

At our last inspection we found that there were not always sufficient staff deployed to meet people’s needs and that non- care staff had not had a police check completed, medicines management process were not always robust and infection control procedures were not consistently followed. Although people were receiving responsive care, records were not always up to date and quality assurance processes were not effective in identifying shortfalls in the service provided. At this inspection we found although some of these concerns had been addressed, there were still areas of the service which required continued improvement.

The registered manager told us most people living at Wray Common were living with dementia. However, we found that the provider had not given sufficient consideration to ensuring the environment was designed to meet the needs of people living with dementia and staff had not received training in this area. Records did not always contain guidance for staff on how to provide people’s care and people’s life histories were not always known to staff. There was little engagement or activity provided to people who spent most of their time in their rooms. The registered manager told us they were exploring ways of making activities more person centred.

There was a lack of robust management oversight in some areas of the service. Whilst improvements were noted in audits and spot checks in some areas these principles had not been applied throughout the service. The provider had not ensured that effective quality assurance processes were in place to support the registered manager and staff in their roles. Where possible, the registered manager responded immediately to concerns noted in people’s care records.

Feedback received from people and their relatives was positive regarding the service they received. People described staff as caring and told us they felt happy and safe living at Wray Common. Feedback received by the CQC since our last inspection was all positive and reflected that staff and the registered manager were always willing to help solve any concerns. Visitors were welcomed into the service and we observed staff greet them by name.

There were sufficient staff available to support people and this was monitored on an on-going basis. Staff told us they felt supported in their roles and received regular supervision. People were supported by caring staff who provided choices regarding their day to day care. Visitors were made to feel welcome to the service and people’s religious beliefs were respected. Staff treated people with dignity and ensured their privacy was respected when supporting them with personal care.

There was good communication between care, staff nurses and management regarding people’s healthcare needs. This meant that healthcare concerns were addressed promptly and advice from professionals was followed. Robust medicines processes were followed and people received their medicines in line with their prescriptions. People told us they enjoyed their food and were provided with alternatives. Where people required support to eat this was provided in a caring way.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published on 15 February 2018)

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

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. We will check that the provider has made the improvements we identified as necessary through further inspections.

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

This inspection was carried out over two dates, both of which were unannounced. The first inspection was undertaken early morning on 21 December 2017. This was because we were responding to some concerns we had received about the way people were being cared for. We then returned to the service on 5 January 2018.

The home had a registered manager. 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. The registered manager assisted us with our inspection.

We last carried out a comprehensive inspection of this service on 14 April 2016 when we rated the service as Good.

This inspection was brought forward in response to concerns we had received about the care being provided at Wray Common. Due to the nature of the concerns that were raised, we carried out a focused inspection of the service early in the morning on 21 December 2017. We focused on Safe and Well-Led at this inspection. Following the first inspection date, we spoke with the registered manager to discuss our findings. The second inspection visit was carried out to look at the other key questions that we inspect on – Effective, Caring and Responsive.

Although people received responsive care, we found records relating to people were not sufficiently well maintained and that people were not always being cared for by an adequate number of staff. Although the provider carried out pre-employment checks for care and clinical staff, we found that non care staff had not undergone a police check to ensure they were suitable to work at the service.

People’s risks had been identified, however action taken by staff to satisfy themselves that people were kept free from potential risks was not always carried out. People lived in an environment that, although clean, posed potential infection control risks.

Medicines management procedures were not always followed in line with best practice and the legal requirements in relation to obtaining people’s consent were not being adhered to. Quality assurance processes in relation to care records and the monitoring of the service being provided were not robust. This included a lack of routine audits on areas such as medicines.

People felt safe living at Wray Common Nursing Home and staff were aware of their responsibilities to ensure that if they had any concerns about the way people were being cared for they should raise this. In the event of an emergency people’s care would continue in the least disrupted way possible.

Staff received training to carry out their roles and as such relatives and professionals felt staff were competent. However, we found that staff had not always been given the opportunity to meet with their line manager on a one to one basis. The registered manager was aware of this and addressing it.

People enjoyed the food that was provided to them and told us they could eat their meals in the place of their choice. People had access to health care professionals as and when needed and when people moved into the home staff assessed their needs in order to help ensure they could provide appropriate care. Staff worked in conjunction with external agencies to provide suitable and responsive care to people.

People were cared for by staff who were kind, attentive and respectful to them. People and their relatives gave us very positive feedback in relation to staff and the way that they treated them. We observed gentle, caring interactions between staff and people and it was clear staff knew people and their family members well. People had the opportunity to participate in a range of activities and where they chose to spend time in their rooms they had interaction from dedicated staff.

In the event that people or relatives felt the need to complain they told us they would not hesitate to speak to the registered manager or staff. We saw any complaints received by the service were addressed.

People, staff and relatives felt involved in the service and we heard that people felt the service was well managed. Where ideas and suggestions had been raised these were listened to and relatives told us the registered manager was approachable and managed the home well. Staff told us they felt supported and valued by the registered manager and enjoyed working in the home. The registered manager was aware of their statutory duties in relation to registration with CQC and as such had notified us of any significant events. The registered manager had a clear vision for the service and the care they wished to provide and they worked closely with external healthcare professionals and agencies.

During our inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made three recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in post on the day of the inspection visit. ‘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 were protected from the risk of abuse. Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. They told us they would report anything they were uneasy with to the nurse in charge.

Risks were well managed and when hazards to people were identified assessments were in place to minimise the risk of harm to people. These were supported by guidance in people’s care plans for staff to follow to help keep people safe.

There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who lived at the service. Staff received regular support in the form of annual appraisals and formal supervision.

Staff recruitment procedures were robust to ensure that staff had appropriate checks undertaken before they commenced employment.

Medicines were well managed and people had their medicines when they needed them. All medicines were administered and disposed of in a safe way.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the persons rights were protected.

People were encouraged and supported to be involved in their care. People’s bedrooms had been decorated to a good standard and were personalised with their own possessions.

Health care needs were being met. People had access to a range of health care professionals, such as the GP, a community psychiatric nurse, palliative care nurses from the local hospice, a dentist and opticians. Qualified nurses managed the clinical health care needs of people.

People told us the food was very good and there was lots of choice. We saw people had access to drinks and snacks at any time during the day and people said they were able to have a cup of tea during the night if they asked.

Staff were kind and compassionate. We saw people were treated with respect and their privacy and dignity were respected at all times. For example staff knocked on people’s doors before they entered their room and undertook personal care in private.

People had individual care plans which gave clear guidance to staff on what support people needed. They were detailed and updated regularly. Relatives told us they had been consulted regarding people’s care plans and were able to attend reviews of care.

The registered manager operated an open door policy and we saw several examples of people, relatives and staff visiting the office to discuss various subjects or just for a chat. The registered manager also ensured she visited people in their rooms if they were unable to access the office.

People were aware of the complaint procedures and told us they would know how to make a complaint. A relative told us they would know how to make a complaint but never had to. Complaints were dealt with in a timely way and in accordance to the procedure in place.

The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. The registered manager and deputy manager had systems in place to record and monitor the quality of the service provided and to make improvements where necessary. Accidents and incidents were recorded and acted upon.

People would be protected in the event of an emergency at the home. Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. The premises provided were safe to use for their intended purpose.

People who used the service had the choice regarding how their care was delivered. People who were able to contribute were asked to be involved in the development of their care plans. They also told us they could make choices about activities they participated in and how they spent their time.

People were very complimentary about the food. They said the food was appetising and plentiful. They said if they did not like the choices available there was always a lighter option available.

People said they felt safe and we saw the home had safeguarding procedures in place.

People were cared for in an environment that was clean and well maintained.

Staff told us they liked working in the home and said they had the necessary training and support to undertake their roles. People who used the service told us the staff were kind and caring and nothing was too much trouble for them.

A relative told us there was always sufficient staff on duty and they never had to look very far if they required to speak to a staff member.

We saw the provider had systems in place to monitor the quality of service provision.

We saw that people were consulted about their care and that this was recorded in individual care plans, which were signed and dated.

We saw that there was a varied activities programme in place and people were decorating the Christmas tree during our visit.

The standard of catering was good and people gave us positive comments regarding the food. We were told that "the food is very nice", and " the food here is varied and tasty".

Staff told us that they felt they had the appropriate training to undertake their roles and responsibilities. We saw evidence in staff filed to support this.

We found that the home was well manager by an experienced manager with the skills and qualifications required for this role.

We saw systems were in place to monitor quality assurance and including quality audits of care, staff meetings, and Service user questionnaires.

We saw that the health, safety and welfare of people who user the service and the staff were observed to be promoted by regular health and safety audits.