Archived: Wheatridge Court

Wheatridge Court is a purpose-built care home which provides a period of re-enablement to people who have experienced deterioration in their physical and sensory health. The service can support up to 30 people.

There were nine people living in the home at the time of our inspection. The aim of the home is to support people to maximise their level of independence by developing new skills before they return to their own home or alternative accommodation.

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

Medicines were managed safely within the home and people received their medicines in a person-centred way. We have made a recommendation that the provider reviews their processes of recording investigations and lessons learnt.

Safe infection control practices had been implemented, reviewed and sustained to help reduce the risk of spread of infection.

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 9 January 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about unsafe medicines management. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the ‘Is this service safe?’ sections of this full report.

We undertook this targeted inspection to check on a specific concern we had about unsafe medicines management. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

During the inspection, we were informed that Wheatridge Court is becoming temporarily dormant therefore we will continue to liaise with provider to understand their plans to re-open and deliver the regulated activity. We will then return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wheatridge Court is a ‘care home’ and provides a period of re-enablement to people who have experienced deterioration in their physical and sensory health. 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. Wheatridge Court accommodates 30 people in one adapted building. There were 16 people living at Wheatridge Court at the time of the inspection.

There was a registered manager in post 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run

The previous inspection was completed in October 2017 and the service was rated ‘Requires Improvement’ overall. At the inspection in October 2017, we found two breaches of the regulations. Risks to people’s health and wellbeing were not always assessed and guidance was not available to support staff to keep people safe. We also found that management systems were not always effective to check the quality of the service and, identify and address shortfalls.

At this inspection, we found improvements had been made and the requirements of the regulations had been met. Following this inspection the service has been rated ‘Good’ overall.

People received safe care and treatment. Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. The administration and management of medicines was safe. There were sufficient numbers of staff working at the service. There was a robust recruitment process to ensure suitable staff were recruited.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, themes and trends had been analysed, and action had been taken to ensure people were safe and plans put in place to minimise the risk of re-occurrence.

Staff had received training appropriate to their role. People were supported to access health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities.

People were supported in an individualised way that encouraged them to be as independent as possible. People were given information about the service in ways they wanted to and could understand.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and could describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care. People were supported to engage in activities which were to their personal preferences.

The service was well led. People, staff and relatives spoke positively about the registered manager. Quality assurance checks were in place and identified actions to improve the service. The registered manager sought feedback from people and their relatives to continually improve the service.

At our last comprehensive inspection in April 2016, a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) was found in the relation to documentation of people’s consent to their care and support. After the inspection, the provider wrote to us to say what they would do to meet legal requirements.

We undertook this full comprehensive inspection to check they had followed their plan and to confirm they now met legal requirements. The provider now met their legal requirements with regards to the above requirements however we have made a further breach of Regulation 17 as effective systems were not in place to check the quality and consistency of the service.

People’s care records showed risks to their health and welfare were not always identified and assessed to provide staff with sufficient guidance they needed to support people with their wellbeing or if their health deteriorated. People’s medicines were managed safely, although the reasons why some people may require medicines as needed was not always clearly recorded. A comprehensive system was not in place to assess the skills and knowledge of staff who had been trained in the management of people’s medicines. We have made a recommendation about the assessment of staff knowledge in the management of people’s medicines.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals. People were supported to achieve their re-enablement goals and plans to return to their home or find alternative accommodation. Some people required support to plan and prepare for their meals and eat a healthy diet or manage their medicines. Most people preferred to spend time in their bedrooms, however plans were in place to hold social events for people to join and engage with others.

People praised the staff and management team. They told us staff were always willing to support them. A new system to deploy staff across the home was being implemented to improve the response time of staff when people called them for assistance.

The provider and registered manager had suitable recruitment systems in place to recruit new staff. Staff felt trained and supported to carry out their role. Staff had confidence in the registered manager and felt that the management team was supportive and approachable.

People told us they could approach staff and raise their concerns and were confident that any concerns would be dealt with promptly. The registered manager and staff had responded and acted on concerns and accident and incidents

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.

At our last comprehensive inspection on 7 and 9 July 2015, breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) managing people’s risks and medicines and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) documents relating to people care and treatment and effective systems to monitor the quality of the service.

We undertook this full comprehensive inspection to check they had followed their plan and to confirm they now met legal requirements. The provider now met their legal requirements with regarding to the above requirements however we have made a further breach of regulation to Regulation 17 regarding the records of people’s consent to their care and support which we will follow up at our next inspection.

A registered manager was in place as required by the service’s conditions of registration. 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’s individual needs had been assessed before they started to use the service. They had been involved in planning for their care. People’s support plans included information about how they preferred to be supported. Staff were knowledgeable about their needs, wishes and preferences. However, the details of the lawful consent to receive care were not always evident when people could not make a decision about their care and support for themselves.

People made positive comments about the care and support they received at Wheatridge Court. People were treated with kindness and respect. They told us staff were kind and caring. This was confirmed by their relatives and visiting health care professionals. People were supported to maintain a balanced diet. There was good links with relevant health care professionals.

People were encouraged to reach their potential in their daily living skills. They were encouraged to retain or learn skills in preparation for their life at home. People were involved in their goal planning and their support needs were regularly reviewed. Their individual risks had been identified and recorded to guide staff. People’s medicines and health care needs were managed in line with their care plan. They were safeguarded from the risk of abuse and harm.

There were adequate numbers of satisfactorily recruited staff to meet people’s needs. Staff had received support and training to develop their knowledge and skills for their role.

The registered manager was visible and accessible to people and staff, providing clear leadership and developing ideas to continually develop the service. Quality assurance systems had been put in to place to monitor the quality of service being delivered and the running of the home.

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

Our inspection of 28/29 January 2013 found care records were not current or accurate in relation to the care and treatment provided to each person. At this inspection we found a new format had been introduced and these contained details of people's individual needs. These were kept under review and updated as required. People told us and we saw evidence in their care records that they had access to external health and social care professionals.

People were encouraged to maintain their independence with meal preparation and shopping for their own food.

Safe procedures were in place for the management of people's medication however these were not always based on their individual needs.

Comments received by the provider about the domiciliary care service included, 'I would recommend the service to anyone to help regain their independence'.

People using the respite service said, 'We get 24 hour care, escorts to the supermarket and help with paperwork'. Staffing levels reflected people's individual needs.

We found that people's needs were assessed and care plans provided a brief account of the support and care they needed. The staff demonstrated a person centred approach to the service they provided which was backed up by their daily records. Arrangements were in place to record people's consent for their care and support.

The environment was designed and adapted to meet people's assessed needs. It was well maintained and promoted people's independence. People had access to a range of equipment and specialist adaptations.

Systems were in place to deal with comments and complaints including monthly forum meetings and quality assurance surveys. Action was taken by the provider to address any concerns raised.

We found that people's care records were not always an accurate reflection of the care and support they were receiving. This standard was not met.