Archived: Keychange Charity Walmer House Care Home

We found the following examples of good practice:

Walmer House had arrangements for people to see families and friends, there was a booking system in place for socially distanced visits. There was a designated space for visitors, which had a supply of personal protective equipment (PPE) and clear signage on its use. All people living in the home had a visitor care plan in place. People were also supported to contact friends and family by use of social media and electronic devices.

We saw supplies of PPE around the home for staff to use. Staff wore face masks at all times and took their rest breaks separately. Wireless headphones were available for people who were deaf so they could hear staff speaking more clearly.

Furniture had been rearranged in communal areas to promote social distancing, but the people living in the home did not like this. The care home carried out a risk assessment and the furniture had been arranged in line with peoples’ wishes. There were garden spaces that could be used.

Areas had been set aside for staff to put on and remove PPE safely and clear signage was in place. All staff had received training on infection control processes, which included specific COVID-19 training. Hand hygiene audits and infection control audits were regularly carried out and recorded. The care home ensured that any actions identified from these audits were actioned to maintain safety.

If the home admitted new people they would make sure that a negative COVID-19 test had been received and they had enough information to meet the person’s needs. New admissions were isolated in accordance with current guidance. All people living in Walmer House had their temperature taken twice a day and their oxygen saturations measured once a day. Appropriate assessments were carried out for routine testing and vaccination of people and when necessary relevant persons were involved in the decision making process.

Staff who worked in the care home were tested three times a week in line with current guidance. There were no staff who were deemed to be in a risk group. The manager was aware of the need to carry out risk assessments for staff in risk groups if needed. Arrangements were in place to make sure staff isolated if they became symptomatic, which included isolation at home until they had received a COVID-19 test and its result. All staff participated in the testing regime, and if able had received a vaccine dependent on their personal health needs. If agency staff were used, they received COVID-19 testing on the same basis as permanent staff.

Walmer House was visibly clean and hygienic and appropriate cleaning products were in use. The cleaning schedule included increased cleaning of ‘touch points’ such as light switches and door handles. All food packages were wiped down with antibacterial wipes when they were delivered. On two days per week two cleaners were on shift to carry out deep cleaning of the home. All staff were required to change into uniforms at work. Appropriate cleaning products were in place, and the care home had suitable laundry facilities and clinical waste systems to deal with potentially infectious materials.

The care home knew where to access appropriate support and guidance and there was a business continuity and pandemic action plan in place, which were routinely reviewed.

Keychange Charity Walmer House Care Home (hereafter referred to as Walmer House) is a residential care home providing personal and nursing care to 13 people aged 65 and over at the time of the inspection. The service can support up to 17 people. Walmer House is in an adapted property with some period features over two floors, it has a lift and stair lifts for ease of access and mature gardens.

At our last inspection we identified eight breaches of regulation, and we were concerned about the quality of care in the service. At this inspection we found lots of improvement and the service was no longer in breach of any regulation.

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

People told us they felt safe and happy at Walmer House. We did find that some aspects of safety needed further improvement. We made the registered manager aware that some windows were not safely restricted in line with national guidance and discussed how some care plans and risk assessments could contain greater detail. We did not feel that people were unsafe. Medicines were managed safely, and people were supported in an environment that was clean and tidy. There were enough staff to meet people’s care needs, but we discussed with the registered manager whether further staffing could be explored to support people with activities.

People were supported to access healthcare services and remain healthy. Staff were provided with training that supported them to meet people’s needs. Food was plentiful, well presented and balanced. People told us they enjoyed the food and there was now a variety on offer. The environment had undergone several improvements since the last inspection, and the service was easier to navigate for those people who may have been living with a dementia.

People were now 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. We saw improvements in staff training and recruitment, and people were now supported by staff who were supervised, worked well as a team, and felt supported by the management team.

Staff were kind and caring and people said they trusted staff and could approach them about anything. People were supported to maintain their independence and more involved in their care decisions by staff that knew them well and enjoyed their company.

Care plans and care provided was person centred and in line with people’s preferences. People and relatives felt comfortable to complain and were confident their views were listened to. The service arranged activities and entertainers. Some people expressed they would like to go out more but the majority of people we spoke with were happy with the level of activities in the service.

The registered manager was visible, and people and relatives knew who they were. There was now a strong sense of putting people first and the registered manager had worked hard to improve the culture of the service, so it focussed on a quality service for people living there. Quality assurance systems were more robust, and the service was working in partnership with key professionals to ensure positive outcomes were achieved with and for people

We made one recommendation regarding staffing levels.

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 26 September 2019) and there were eight 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 was a planned inspection based on the previous rating.

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

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.

Walmer House is a ‘care home’ without nursing, operated by Keychange Charity, who operate 10 care homes nationwide. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home has a Christian ethos, but people of all faiths or none were welcome to live or work there.

People living at Walmer House were older people, many living with long term health conditions or dementia. The service accommodated up to 17 people in one adapted building, with a lift to access many of the rooms on the first floor. A short stair lift was in use to access other rooms. 16 people were living at the service at the time of the inspection. Walmer House had an underpinning Christian ethos, but managers we spoke with were clear the service was open to people of all faiths or none. There was a regular communion at the service but people were free to attend this or not as they wished.

At the time of the inspection the service did not have a registered manager in post. The registered manager had left the service at the end of April 2018. A new manager had been in post for five days at the start of the inspection, and was making plans to apply for registration. Throughout the report they are described as the 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.

At the last inspection of the service on 17 and 18 December 2015 the service was rated as ‘good’ in all areas. On this inspection we found the service had not maintained this and we have rated them as requires improvement overall. This was because we identified failures of management systems had led to breaches of legislation across many areas of the service.

People were not always being kept safe, because the service had not always identified or acted on concerns about risks to people’s safety. We identified concerns over risks to people from their care, healthcare needs, and risks from the environment. These included support for people to eat and drink sufficient amounts to maintain their health, and the oversight and understanding of risks from long term health conditions. Although many of these had already been identified by the service, plans to address them were either still in development or had not yet demonstrated sustained improvement.

Care plans did not always contain sufficient detail to enable staff to respond to people’s needs in a person centred way. For example staff understanding how to support them in ways that made use of known information about the person’s history. People living with specific support needs such as dementia had not always received information in formats tailored to meet their needs. Some care plans for people at most risk had been prioritised for re-writing which was being done while we were at the service. We saw this was being done with the person concerned who was encouraged to express their wishes about the plan, likes and dislikes.

People were not always supported by sufficient numbers of staff on duty to meet people’s needs and there was no formal system in use to assess how many staff were needed. Systems for the safe recruitment of staff were not robust, and recruitment files showed there had been gaps in the recruitment process that had potentially put people at risk. Immediately following the inspection the manager took action to increase the staffing levels to enable people’s needs to be met. Recruitment for new permanent staff was underway.

People were supported by staff who did not all have the skills, training or support to help them understand and meet people’s needs. Staff training had been put in place in core subjects such as fire, safeguarding and first aid to be delivered immediately after the inspection.

Systems were not in place to learn from accidents or incidents and some records relating to previous accidents or incidents could not be located. People were not always protected from abuse, because staff were not always clear about who to report concerns to outside of the service. Staff had not received training in identifying and reporting concerns about abuse, but told us they would report any issues to the senior staff on duty.

People did not always receive their medicines as prescribed. The medicines cupboard was untidy and this meant delays for staff identifying the medicines people needed in a timely way. Some medicines were ‘out of stock’ or had not been given to people on the day of the inspection because staff were engaged in other tasks. We have asked the service to seek clarification on how some people’s medicines should be given to maximise their effectiveness.

People’s rights with regard to the Mental Capacity Act 2005 were not well understood. Where Deprivation of liberty authorisations (DoLS) had been granted, conditions of the DoLS were not always well understood or being followed. This meant people’s rights were not always being supported.

Walmer House is a long established care home, set in a converted Victorian villa in a residential area of Torquay. Areas of the building were looking tired and worn. Some furnishings were in poor condition or unstable which presented risks. Some bedlinen was in very poor condition and the service did not have measures in place to identify when items needed routine replacement. Where we identified one person’s bed was in poor condition the manager took immediate action to order a new higher quality profiling bed for them, and plans were being developed to improve the environment. We have made a recommendation regarding this to reflect the needs of people living with dementia. People’s rooms contained evidence of their own personal belongings, pictures and ornaments.

Activities were provided that people enjoyed, but opportunities were also being missed to engage with people living with dementia in positive ways that reflected their interests. We saw some positive examples of support and involvement, such as staff supporting one person to listen to music they enjoyed. We also saw instances where staff were supporting people to eat while using a phone or leaving people unsupported mid task to attend to others in more immediate need with no discussion.

Visitors were able to visit the service at any time and one told us they felt welcomed at the service. They told us they were satisfied with the care their relation received.

We identified eight breaches of Regulations on this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We found that people were well supported within the home and that the home worked closely with external agencies to provide a good quality service.

Records confirmed that people's needs were assessed and monitored and that all necessary steps to maintain optimum health and wellbeing were being addressed.

People who lived at the home told us that they felt safe and comfortable and that staff were competent and knowledgeable. one person told us " I feel in safe hands when they help me". this was confirmed by a family member who told us that " the staff are very kind and nothing is too much trouble for them".

The home was warm and clean with a fresh smell and comfortable atmosphere.

People who lived at the home and family members we spoke to confirmed that they knew how to raise a concern or what to do if they felt something was wrong.

We found that people were being involved in making decisions about their care. We saw people were supported well and that the home were working with other agencies to ensure the support people received was as far as possible consistent across all agencies involved.

We found that people's healthcare needs were being assessed and supported well. We found that the home's staff and management understood people's needs, including communication needs where this was impaired. We found that they understood people's rights and supported them.

People using this service felt safe and were confident that staff had the skills needed to safeguard them and to meet their needs. Staff training, supervision and annual appraisals were linked to ensuring that staff had the skills to meet people's needs.

The home was clean. However two bedrooms were malodorous.

People said they felt safe living at the home and knew how to raise any concerns or complaints.