Wharfedale House - Care Home Physical Disabilities

Wharfedale House- Care Home Physical Disabilities is a residential care home providing personal and nursing care to 14 people aged 18 and over at the time of the inspection. The service can support up to 18 people. The accommodation is purpose built to accommodate people with a physical disability and all rooms have en-suite bathroom facilities, there are several containing kitchen facilities.

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

We found there was enough staff however the service was dependent on agency staff. People told us they did not want to be supported by agency staff who did not know their needs “they haven’t even read my care plan, they don’t know me”.

The service had improved how agency staff record information related to the administration of people’s medicines. An electronic system had been implemented and all staff were trained. All staff who administered medication had been trained.

The leadership team within the home had undergone significant changes since our last inspection. This included several periods where the service did not have a manager; however, a new manager had been recruited and started in January 2022. Staff and people using the service told us they felt the service was improving under the new leadership “things have started to get better, yes there is improvement”.

The provider audited the service however, some of the audits we received were not robust. We saw evidence accidents and incidents were being recorded however, there was no analysis to identify patterns and trends which could be addressed and used to reduce any apparent risks. We recommend the provider reviews how effective their systems are and takes action to update their practice accordingly.

The provider had addressed and achieved compliance in relation to previously identified breaches of regulation 12 and regulation 17.

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 requires improvement (published 11 March 2021) 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. 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 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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report. 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 on our website at www.cqc.org.uk

Enforcement and recommendation

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We made a recommendation for the provider to review their implementation of effective quality assurance processes.

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.

Wharfedale House is a residential care home providing personal and nursing care to 15 people aged 18 and over at the time of the inspection. The service can support up to 18 people. The accommodation is purpose built to accommodate people with a physical disability and all rooms have en-suite bathroom facilities, there are several containing kitchen facilities.

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

People told us the best thing about the service was the familiar staff who cared for them and made them feel safe. They said these staff knew them well and how they liked their care to be provided. Managers told us staff had gone above and beyond to support people through the pandemic, picking up additional shifts to ensure people had the support they required.

People told us staff always used personal protective equipment (PPE) when providing care. Staff had been trained in how to use PPE effectively. The environment was visibly clean at inspection, but there were some improvements required to evidence enhanced cleaning during the pandemic.

We found issues with documentation and record keeping. Staff did not always record their actions accurately to evidence they were following people’s care plans and managing the risks to people’s health and wellbeing. This was particularly evident around pressure area care, weight and support when eating and drinking. It was not always clear staff were following up on referrals to external agencies to support people’s access to healthcare services to improve their health outcomes.

Recruitment practices were safe. However, the service was highly dependent on agency staff to support them. There was a lack of evidence to show the provider had assured themselves the staff had the knowledge, skills and competence to care for the people supported and they had assumed that the agency would only send staff with the required skills. People at the service spoke highly of some of the agency staff as they had been supporting them regularly. But some said they were fed up of having to tell staff how to care for them.

The provider had a good electronic medication system, but it was not being used effectively. Agency staff were not all trained to use the system, and were using paper records, which meant the records did not tally and it was not always clear people had been given their medicines as required.

People at the service, relatives and staff told us there had been inconsistent management at the service with several interim managers. They reported a lack of leadership had impacted on the quality of the service provided. More robust audits would have picked up on the issues we found and ensured improvements were made.

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 18 April 2018)

Why we inspected

CQC had received a number of concerns in relation to the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. 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 on our website at www.cqc.org.uk.

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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines, the management of risk and governance. Please see the action we have told the provider to take at the end of this report. 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.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide care and support for up to 18 people with a physical disability. Nursing care is not provided. The home is situated close to local amenities in Wetherby and has good transport links. At the time of this inspection there were 18 people living at the home. Some people had additional needs, such as living with dementia.

This comprehensive inspection took place on 20 February 2018 and was unannounced. At the last inspection in August 2015 we rated the service as 'Good' overall. However, we found improvement was required for the service to be 'Effective'. This was because was staff were not adequately supported with supervision and appraisal.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Wharfedale House - Care Home Physical Disabilities on our website at www.cqc.org.uk

At this inspection we found improvements had been made to support for staff. However, we recommend the provider review the current supervision system to make sure it is effective.

There were systems in place to look at the quality of the service and these identified areas that needed improvement. provided, action was not always taken where shortfalls or risks were identified. We recommend the provider review governance systems to make sure identified areas for improvement are acted on.

Overall, the systems in place to make sure that people were supported to take medicines safely were effective. However, we recommend the provider reviews the procedure for managing the disposal of skin patches.

There was a 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. The manager had good oversight of the service and there was a clear ethos of care.

People told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. Risks to people had been assessed and plans put in place to keep risks to a minimum. Improvements had been made to the environment to make it safe and this work was planned to continue.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background. Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted and they lack capacity to make their own decisions. 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 were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People told us that staff were caring and that their privacy and dignity were respected. Care plans showed that individual preferences were taken into account. Care plans were up to date and gave clear directions to staff about the support people required to have their needs met. People’s needs were regularly reviewed and appropriate changes were made to the support people received. People were supported to maintain their health and had access to health services if needed.

People were encouraged to follow their interests and take part in a range of activities.

People had opportunities to make comments about the service and how it could be improved. A complaints procedure was in place and people told us they knew how to raise a concern if needed.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

We spoke with seven members of staff and most told us they had recently had safeguarding training. Some members of staff had refresher training booked. One member of staff told us "The atmosphere is much better here now, people are not complaining as much." Another member of staff said, "I feel the bosses are listening to us now and I feel if there are any concerns they will take them seriously."

The provider in conjunction with people who used the service had implemented a 'Keeping Safe Protection Plan'. We spoke with seven people who used the service and most told us they thought the 'Keeping Safe Protection Plan' had helped them to feel safer. However, two people we spoke with said it had not helped at all. We saw each person had signed to say they agreed with the plan.

Two people who used the service told us they thought the atmosphere was still unpleasant sometimes. People told us they were aware a safeguarding investigation by Adult Social Care could not be continued and this had caused them concern. One person who used the service said, "I am happy here, I feel safe with the staff, it's a lovely environment." Another person said, "I like some people and others I don't, but I feel safe here. Staff are very good, if I had any concerns I would talk to them."

Is the service effective?

We did not look at this domain during our inspection.

Is the service caring?

We did not look at this domain during our inspection.

Is the service responsive?

We saw the '2013/2014 customer survey' was available to people and where required included action plans. We saw people had been asked questions for example, 'How happy are you with the way you are treated by staff and volunteers?'. The majority of people said they were 'very happy'. People were asked 'Do you feel safe in the service?' with the exception of one person everyone who completed the survey said 'always'. Where people had asked for changes to be made we saw an action plan which included for example, a better internet connection, we saw this was being installed shortly after our visit. People had said there were problems with their clothing being shrunk in the drier; the action was for staff to read clothing labels and to ask if people wanted their clothing to go in the drier.

We asked to see a log of complaints since our last visit and we were told there had not been any formal complaints. We spoke with a person who used the service who told us they had complained directly to a senior manager and this complaint was still to be resolved.

Is the service well led?

During our last inspection some staff told us they did not feel supported by the senior management team at Leonard Cheshire Disability. As a result of this a risk assessment had been completed which looked at areas causing staff stress. We saw the 'risk assessment' which included 'additional risk control actions'. We spoke with seven members of staff including the manager, their comments included;

"It's become more comfortable to work here."

"We all work as a team."

"I've seen a big change, I now feel supported, they help us."

We saw the minutes of five meetings with residents since our last inspection which covered various issues. We saw three of these meetings had been attended by the provider's senior managers. We also saw there had been three staff meetings.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they did not always feel safe. Safeguarding policies and procedures were robust but these were not always followed.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

People told us they felt their rights and dignity were mostly respected.

Is the service effective?

People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in their person centred plans where required. One person told us, "It's absolutely excellent here, I'm really spoilt."

Is the service caring?

Care staff were attentive and spent time talking with people and making sure their needs were being met. People commented, "It's nice here, we have a laugh, we get on with all the staff." People who used the service had completed satisfaction surveys in March 2014. We were told the results were currently being collated by the provider.

Is the service responsive?

People who used the service told us they knew how to complain and felt confident in some cases their concerns would be listened to and action would be taken to resolve them.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff did not feel supported by the senior management team at Leonard Cheshire Disability. Staff told us there had been ongoing problems at Wharfedale House which had led to several people resigning. One member of staff we spoke with said, "I don't think anyone is listening to us, we have got no help."

Everyone we spoke with said they thought the manager at Wharfedale House was very good. A person who used the service commented, "She's a wonderful manager." and a staff member said, "I have never worked for a manager like her, she is so dedicated and so professional."

People were appropriately dressed, in clothes of their own choice. The staff responded to people's needs and spoke to them in a caring and supportive way.

People told us the staff understood how to support them. One person said, 'The staff that look after me know me pretty well, we have an understanding.'

People had individual care plans. The plans were well organised and included an index to each section. There were personal profiles, details of what was important to people and what others admired about them. People told us they had been involved in writing their care plans and had their own copies to refer to. One person said, 'I have mine in my bedroom and it is reviewed every month with my key worker.'

There were effective systems in place to reduce the risk and spread of infection. However, we noticed some of the bathrooms and toilets were in need of repair and difficult to keep clean.

There were effective recruitment and selection processes in place. One person told us, 'I do the interviews for new staff which really helps to know who is coming to care for me.'

People who used the service were asked for their views about their care and treatment and they were acted on. One person told us the new manager had asked them how they would like their room to be decorated. They said, 'I went out for the day and when I came back it was done in the colours I wanted, I love it.'