Archived: Wychdene

Wychdene is a residential care home without nursing for 24 older people. At the time of this inspection there were 16 people living in the service.

People's experience of using the service and what we found

People and their relatives were positive about the service. A person said, “I like the staff and we’re a bit like a family here.” Another person who lived with dementia and who had special communication needs smiled and pointed in the direction of their bedroom when we used signed-assisted language to ask them about their home. A relative said, "I think Wychdene is lovely and homely.”

People were safeguarded from the risk of abuse. People received safe care and treatment in line with national guidance from care staff who had the knowledge and skills they needed. There were enough care staff on duty and safe recruitment practices were in place. People were supported to take medicines safely and lessons had been learned when things had gone wrong. Good standards of hygiene were maintained and people had been helped to quickly receive medical attention when necessary.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The accommodation was homely, people’s privacy was respected and confidential information was kept private.

People were consulted about their care and given information in an accessible way. People were offered some support to pursue their hobbies and interests and this was about to be increased with the appointment of a new activities coordinator. There were arrangements to quickly resolve complaints and people were treated with compassion at the end of their lives so they had a dignified death.

Quality checks had been completed. People had been consulted about the development of the service and their suggestions had been implemented. Good team work was promoted, regulatory requirements had been met and joint working was promoted.

For more details, please read 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 at our inspection (published 9 November 2018).

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.

Wychdene is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Wychdene is registered to provide accommodation and personal care for 24 older people. There were 20 people living in the service at the time of our inspection visit.

There was a registered manager in post who was present on the day of the 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 service is run.

At the last inspection on 29 March 2018, the overall rating of the service was ‘Inadequate’ and the service was therefore placed in, ‘special measures’. We found four continuous and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always treated with dignity, medicines were not well managed and the environment was unsafe. Furthermore, the quality of the service was not checked to make sure risks to people were minimised and suitable staff were employed to support people.

We required the registered persons to take action to make improvements to address each of our concerns. The provider sent us monthly reports detailing how they planned to address the breaches of Regulations and they regularly updated this to evidence what had been completed. The last update was received 30 August 2018.

At this inspection on 12 September 2018, we found that the provider had make significant improvements to the service. There were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, sufficient time had not elapsed to ensure that these improvements would be sustained or that identifying and addressing shortfalls in a timely manner had been embedded as part of the culture of the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

All potential hazards which we highlighted to the provider at the last inspection had been addressed. Actions identified in the provider’s fire risk assessment of November 2017 had now been completed, and fire drills undertaken by all staff. People had access to facilities of an appropriate standard to wash their hands and staff had received training in minimising infection and put this knowledge into practice. Repairs had been made to environment and new bedroom furniture sets purchased. However, sufficient time had not elapsed to be certain that improvements would continue to be made and sustained.

Quality assurance processes had been strengthened through the introduction of a programme of audits. However, the provider had historically not acted on shortfalls which had been identified in the inspection process and insufficient time had passed to ensure these changes had been embedded at the service.

The provider had not sought advice with regards to how to adapt the environment for people living with dementia and assessed what actions to take to meet people’s individual needs.

Assessments of potential risks to people’s individual safety had been undertaken such as risk of them falling or developing pressure sores, and strategies put in place to minimise their reoccurrence. Processes in place for keeping accidents and incidents under review had been strengthened and lessons learned when things had gone wrong.

The provider’s staff recruitment procedures had been followed to make sure that new staff were suitable for their role. People’s dependency levels were assessed to make sure there were enough staff available at the service.

Changes had been made to the management of medicines to make sure that medicines were kept at the right temperature and given at the times and correct intervals prescribed by people’s doctor.

Staff knew how to recognise and report abuse. Improvements had been made to records of people’s finances to minimise the risk of any financial mistreatment. Guidance was in place for people who presented behaviours that may challenge themselves or others and this was followed by staff to keep everyone safe.

Staff had received all the training they needed to make sure they had the necessary skills and knowledge. Staff understood the principles of the Mental Capacity Act 2005 and how to put them into practice.

People's health needs were assessed and managed by the staff team with support from a range of health care professionals. Referrals were made when needed and advice given by health professionals was followed. People’s nutritional needs were assessed and they were helped to eat and drink enough to maintain a balanced diet.

Improvements had been made so that the service was caring. People and relatives said that staff were kind and caring. Staff understood and promoted respectful and compassionate behaviour within the staff team. Staff knew people well, including their choices and preferences and communicated with people in a way they could understand. Locks had been fitted to people’s bedrooms and bathroom and toilet facilities to maintain people’s privacy and dignity.

Improvements had been made so the service was responsive to people’s needs. An activity coordinator had been employed so that people were regularly offered opportunities to pursue their interests and to engage in social activities. People’s care plans set out their assessed needs and the support and assistance they required from staff. Provision was in place to support people at the end of their life to have a comfortable, dignified and pain-free death.

People knew how to make a concern or complaint and the provider had systems in place to investigate and respond to any issues that were raised. Steps had been taken to present information to people in an accessible way.

The registered manager led by example and had helped staff to understand their responsibilities and develop good team work. They actively working in partnership with other agencies to support the development of joined-up care.

Wychdene is registered to provide accommodation and personal care for 24 older people. There were 19 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. There was a registered manager in post. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 27 and 28 July 2017 the overall rating of the service was, ‘Requires Improvement’. We found that there were five breaches of the regulations. This was because there were shortfalls in the arrangements made to manage medicines in the right way so that people reliably received safe care and treatment. Also, suitable arrangements had not been made to obtain people’s consent to the care they received. Furthermore, we noted that there were oversights in the maintenance of the accommodation. In addition, we found that people did not always receive care in a way that promoted their dignity. Lastly, we concluded that the registered persons had failed to operate quality checks to enable problems in the running of the service to quickly be put right.

We told the registered persons to take action to make improvements to address each of our concerns and they subsequently told us that this had been done. However, at the present inspection we found that only one of the breaches of regulations had been met. This referred to the arrangements made to obtain people’s consent to the care and treatment they received. The four remaining breaches had not been suitably addressed because suitable arrangements had not been made to ensure that people consistently receive safe care and treatment. Also, the accommodation was not designed, adapted and decorated in a way to meet people’s needs and expectations. In addition, people did not always receive care in way that promoted their dignity and quality checks had not been completed in a robust way to ensure the smooth running of the service.

Full information about CQC’s regulatory response to the breaches of regulations noted above will be added to our report after any representations and appeals have been concluded.

At this inspection we also found a further breach of regulations. This was because the registered persons had not completed suitable background checks before two new care staff had been appointed to assure themselves of the applicants’ previous good conduct. You can see what action we have told the registered persons to take about this shortfall at the end of the full version of this report.

As a result of these breaches of regulations the overall rating for this service is ‘Inadequate’ and the service is therefore in, ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered persons’ registration of the service, will be inspected again within six months. The expectation is that registered persons found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of ‘Inadequate’ for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the registered persons from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. When necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of ‘Inadequate’ for any key question or overall, we will take action to prevent the registered persons from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Our other findings at the present inspection were as follow. People had not been fully safeguarded from the risk of financial mistreatment. Although there were enough care staff on duty the registered persons had not established a robust system to ensure that sufficient care staff continued to be deployed to meet people’s changing needs for care. Also, records did not clearly demonstrate that there were effective systems and processes to enabler lessons to be learned when things had gone wrong.

Arrangements were in place to assess people’s needs and choices so that they did not experience discrimination. Also, care staff knew how to provide people with the reassurance they needed if they became distressed. Although in practice care staff knew how to care for people in the right way, some of them had not received all of the training that the registered persons considered to be necessary. People were helped to eat and drink enough to maintain a balanced diet. Also, suitable arrangements had been made to help people receive coordinated care when they moved between different services.

People were given emotional support when it was needed. Also, they had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Furthermore, confidential information was kept private.

People had not been offered sufficient opportunities to pursue their interests and to engage in social activities. Although people received responsive practical assistance sufficient steps had not been taken to present information to them in an accessible way. However, suitable arrangements had been made to promote equality and diversity and to manage complaints. Furthermore, provision was in place to support people at the end of their life to have a comfortable, dignified and pain-free death.

Care staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. Also, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Wychdene is a residential care home providing accommodation and personal care for up to 24 older people some of whom may be living with dementia. The service is built over three floors and has a passenger lift. Nine bedrooms are en-suite and the remainder have a hand basin in them. The service is set in large gardens edged by trees. It is a short walk from Broadstairs town centre and close to Broadstairs beach. On the day of the inspection there were 18 people living at Wychdene.

The service was run by a registered manager. 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 and associated Regulations about how the service is run. Having a registered manager is a condition of the registration of the service. The registered manager was not present on the days of the inspection. The provider and care manager were present. The registered manager resigned after the inspection.

We carried out an unannounced comprehensive inspection of Wychdene in June 2016; the service was rated ‘requires improvement’. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 and we asked the provider to take action to make improvements. We issued requirement notices relating to failing to have a registered manager in post, failing to effectively monitor and assess the quality of the service, failing to complete relevant checks to make sure staff were safe to work with people and failing to ensure staff received the appropriate support and training. The provider sent us an action plan. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and some of the breaches met. However, we found three new breaches and one continued breach of Regulations.

Risks to people were assessed, identified and monitored. However, not all pressure relieving equipment was set correctly placing people at risk of developing pressure areas. Medicines were stored, and disposed of safely. Staff had not consistently completed the medicines records.

People told us there were generally sufficient staff during the day. However, contingency plans were not in place in the event of an emergency. On the second day of the inspection there was an unexpected shortage of staff. The provider took immediate action to bring in another member of staff and increased the numbers of staff on duty from then on.

The service was tatty and some areas of the service smelled strongly of urine. Some carpets and flooring needed to be replaced. Staff wore personal protective equipment, such as, aprons and gloves when supporting people with their personal care.

The provider had recruitment and selection processes in place, which were followed, to make sure that staff employed were of good character. Staff completed training and had one to one supervision meetings with the registered manager or care manager. There were some gaps in staff training and refresher courses had been booked to cover these.

Staff knew the importance of giving people choices and gaining people’s consent. However, records about people’s capacity were inconsistent and contradictory. Staff understood the requirements of the Deprivation of Liberty Safeguards and applications for DoLS had been made in line with guidance.

People were not consistently treated with kindness, dignity and respect. Records did not always contain appropriate language. Staff knew people well including their likes and dislikes and knew their relatives well. People were encouraged to be as independent as possible.

People took part in a variety of activities within the service. However, people’s views on the quality of the activities offered varied. People said they were bored and would like to go out. There was a limited variety of activities within the service. People had voiced their wish for more activities at a residents meeting and this had not been acted on.

Some audits of the service were being completed and recorded. Action had been taken when shortfalls were identified. However, shortfalls found during the inspection had not been identified. The provider’s website had a link to their last CQC report. However, the rating and last report were not on the ‘Home page’ where people looking for information about a service would see it.

People were offered a choice of home-cooked meals. People’s health was monitored and staff worked with health and social care professionals to make sure people’s health care needs were met.

People’s confidentiality was respected and their records were stored securely. People told us they felt safe living at Wychdene. People were protected from the risks of abuse and avoidable harm. Staff knew how to recognise and respond to abuse and understood the processes and procedures in place to keep people safe.

People and their representatives were involved in planning their care and support. People’s care plans were reviewed by staff to make sure they were kept up to date.

People and their relatives knew how to complain or raise concerns and felt confident to do so. People were asked for their input into the day to day running of the service and their ideas were acted on.

People knew the staff and registered manager by name and told us they could rely on them to provide the right support.

Notifications had been submitted to CQC in line with guidance.

We last inspected Wychdene in June 2016 when a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. At this inspection improvements had been made. However we found one continued breach of regulation and four new breaches. You can see what action we have asked the provider to take at the end of the full report.

Wychdene is a residential care home providing accommodation and personal care for up to 24 older people some of whom may be living with dementia. The service is built over three floors and has a passenger lift. Nine bedrooms are en-suite and the remainder have a hand basin in them. The service is set in large gardens edged by trees. It is a short walk from Broadstairs town centre and close to Broadstairs beach. On the day of the inspection there were 22 people living at Wychdene.

The service is run by a manager who had been in post since 4th May 2016. They had applied to be registered with the Care Quality Commission (CQC) but they had not yet completed the process. 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 and associated Regulations about how the service is run. Having a registered manager is a condition of the registration of the service.

Risks to people’s safety were identified, assessed and managed. Assessments identified people’s specific needs, and showed how risks could be minimised. There was not consistent guidance for staff of what to do if an incident happened, for example, if someone at risk of choking choked. Accidents and incidents were recorded, analysed and discussed with staff to reduce the risks of them happening again.

Recruitment processes were in place to check that staff were of good character and safe to work with people. These processes had not been consistently followed, for example, references had not always been requested and not all staff files had an application form.

There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided. There were some staff who had not completed essential training, such as moving and handling, to ensure they knew how to move people safely. The manager did not coach and mentor staff through regular one to one supervision.

There was no robust auditing process to assess, monitor and improve the quality of service being provided at Wychdene.

People said they felt safe living at the service. Staff understood how to protect people from the risk of abuse and the action they needed to take keep people safe. Staff were confident to whistle blow to the manager or other organisations if they had any concerns and were confident that the appropriate action would be taken.

People were consistently supported by sufficient numbers of staff who knew them well. People received their medicines safely and people told us they received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The manager had sent applications to the local authority in line with guidance.

People felt informed about, and involved in, their healthcare and told us they had as much choice and control as possible. People were able to make choices about how they lived their lives, including how they spent their time. Staff had received training on the MCA and understood the key requirements of the MCA and how it impacted on the people they supported. They put these into practice effectively, and ensured that people’s human and legal rights were protected.

People were provided with a choice of healthy food that they told us they liked. One person commented, “There is plenty of food. We can always have more if we want it too”. If people were not eating enough they were seen by a dietician or their doctor. Staff followed the guidance given when fortified drinks and diets were required.

People were supported to maintain good health and had access to health care professionals when needed. Staff had developed good working relationships with health professionals, such as, the GP’s and community nursing team.

People were happy with the care and support they received. People received their care in the way that they preferred. Care and support plans contained information and guidance so staff knew how to provide people’s care and support. Staff were familiar with people’s life histories and were knowledgeable about people’s interests, likes, dislikes and preferences.

People and their relatives were involved with the planning of their care. Care and support was planned and given in line with people’s individual care needs. People spoke positively about staff and told us they were kind and caring. Privacy was respected and people were able to make choices about their day to day lives, such as what time to get up or go to bed. Staff were respectful and caring when they were supporting people.

People, their relatives, staff and health professionals were encouraged to provide feedback to the manager about the quality of the service. People said their views were taken seriously and any issues they raised were dealt with quickly. People told us they did not have any complaints about the service or the care and support they received from the staff. They knew how to complain if they needed to.

People enjoyed a range of different activities each day. People made suggestions of new activities they would like to do. Some people preferred to sit and chat with each other or read rather than join in with activities and this was respected by staff.

People, their relatives and staff told us the service was managed well. Staff said they felt supported by the manager and that they were approachable. Staff were clear about what was expected of them and their roles and that the manager worked with them as part of the team. There was an open culture at the service and people, their relatives and staff could contribute ideas and raise any concerns about the service.

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

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what actions we have asked the provider to take at the end of this report.

Wychdene can provide accommodation for up to 28 people. There were 22 people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people and the registered manager:

Is the service safe?

The service was safe.

People felt safe living at the service. They felt confident that any concerns they had would be listened to and dealt with quickly. Staff knew how to keep people safe.

People had a care plan which detailed their care and support needs. There was guidance for staff to follow to reduce risks and make sure people were as safe as possible.

The service had systems to manage risks to the people's care without restricting their activities or their life styles.

There were sufficient numbers of staff on duty at all times to make sure people were safe and received the care and support that they needed. The registered manager was available in case of an emergency.

When people had accidents the most appropriate and safe action was taken to make sure they received the treatment they needed. There were systems in place to make sure that the registered manager and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations.

Is the service effective?

The service was effective.

People were able to express their views about what mattered to them at regular meetings organised for them.

Care was consistently planned and delivered in response to people's changing needs. People's health and care needs were assessed with them and / or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person's needs.

Staff had the knowledge, skills and competencies to carry out their role effectively and safely because staff were properly trained.

Is the service caring?

The service was caring.

Staff understood people's needs and provided care with kindness, respect and compassion. Staff showed patience when supporting people and promoted their independence.

Relatives told us that they were involved and informed with the care of their loved ones. People and their relatives were happy with their care.

Is the service responsive?

The service was responsive.

People received the care and support they needed to meet their individual needs.

People and their relatives felt they would be listened to if they raised any concerns with the registered manager.

The service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led.

There was a clear management structure and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the registered manager.

People and their relatives told us that the registered manager was approachable. People were given the opportunity to comment on the service provided and their views were taken into account.

People living at the home stated they were very happy living at Wychdene. One told us, 'I wouldn't want to live anywhere else'. Another said, I feel safe here because everyone is so caring'. A family member visiting a relative told us, 'I wish we had found this home earlier and dad had all his respite here rather than in hospital first. We looked at some homes that were more like hotels in their decoration but it's the people who make the home what it is and why we chose here'.

Staff were observed to be very relaxed and friendly in their interactions with people living at the home, but showed respect and a good understanding of those they were caring for.

We will monitor the service closely to ensure that all the required improvements are made.

All of the five people with whom we spoke gave us positive feedback about most aspects of the service. One of them said, 'I've found the staff to be very kind and friendly. They've always been willing to help me and I like them.' Some people voiced reservations about the accommodation. One of them said, 'I think that the place is a bit rough and ready. I don't want it to be posh but some of it looks tired and unloved.' Some people also had concerns about the adequacy of the staffing arrangements. One of them said, 'The staff are too busy in the morning because they have lots to do at the same time and simply can't get round to everyone as quickly as during the rest of the day.'

A relative said, 'I see mum lots. She needs a lot doing for her but the staff are kind and overall I'm happy with the care she gets. Although the accommodation is run down, I think mum is okay here.'