Archived: OSJCT Wyatt House

Following our previous inspection on 21 and 22 March 2017 the service was rated ‘Requires Improvement’. We found the provider needed to make improvements to how the home was managed. It required consistent management by a manager who was registered with the Care Quality Commission (CQC), improvements were needed to people’s care plans so they accurately reflected people’s care needs and the provider’s quality monitoring processes needed to be more effective in making improvements which could be fully embedded and sustained.

At this inspection we found some improvements had been made. People had benefited from a consistent manager being in post who was registered with the CQC. Some care plans had been re-written but several still did not reflect people’s needs. Quality monitoring processes had taken place but these had not, identified the shortfalls in the management of people’s risks, identified during this inspection, or successfully achieved full improvement in people’s care plans, required following our previous inspection.

We requested that the provider send us an immediate action plan on how they were going to ensure people’s risks were fully assessed and safe and effective care was planned. An action plan was subsequently received which we will follow up in due course.

Following this inspection an overall rating of ‘Requires Improvement’ was awarded. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Wyatt House is a ‘care home’. 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. The home can

accommodate 30 people in one adapted building. At the time of our inspection 29 people lived there. The home specialises in the care of people who live with dementia and who also require nursing care.

Wyatt House is a circular design with an inner, secure garden. People are accommodated across two floors. One floor provides accommodation for a small group of people who need less support and which promotes their independence. On the second floor people required all support with their daily needs which the design of the home and its fittings supported. The circular design is experienced on this floor, which allows people to walk freely, without interruption; but a seated area also provides a place to rest. People could access an outside seating area safely from this floor, but they were supported by staff to visit the whole of the garden. There was ample car parking in and around the home’s grounds and wheelchair access to the home.

A registered manager was 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.

Although the provider had processes in place to assess people’s risks, these had not always been completed, in a timely manner, to ensure people would remain safe. Some people had been left with risks and areas of need, which had not been fully assessed or addressed through the planning of safe and effective care. A breach of regulation was identified in relation to this. Practices were not consistent as we saw that other risks had been well assessed and appropriate care planned and delivered to reduce these.

People’s care plans still did not always give accurate detail about the care people required. This was despite staff completing regular reviews of these. This had potential for people to receive unsafe or inappropriate care and a breach of regulation was identified in relation to this.

Since the last inspection and since the registered manager had been in post the provider had carried out quality monitoring checks of the home’s overall performance. There had however, been less consistent follow up following these checks to ensure necessary areas of improvement were completed. The system in place had not been sufficiently effective and a breach of regulation was identified in relation to this.

There were arrangements in place for complaints and areas of dissatisfaction to be raised, although, the action taken in response to issues raised about people’s laundry, had not led to these being resolved. We made a recommendation about the management of complaints.

People’s medicines were managed safely and people were supported to take their medicines. People lived in a clean home where infection control measures were in place. There were enough staff to meet people’s needs and staff had been safely recruited. There were arrangements in place for staff to receive appropriate training and support. Staff understood their responsibilities with regard to protecting people from abuse and poor practice.

People had access to health care professionals. People were supported to make decisions about their care and treatment and where necessary, people’s representatives were consulted. The principles of the Mental Capacity Act were followed to protect those who lacked mental capacity. 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 had a choice in what they ate and drank and in what activities they took part in. Staff were particularly kind and caring towards people and knew individual people well. This helped them to deliver people’s care, support people’s independence and promote people’s self-worth. Staff responded straight away to anyones distress. Family and friends were welcomed and kept informed about people’s progress, where appropriate. Activities were tailored to people’s abilities, likes and preferences; they were meaningful to people and some had a therapeutic value.

People’s end of life wishes were explored and they were supported to have a comfortable and dignified death. Staff supported people and others during times of loss and bereavement.

The registered manager had provided consistent leadership and was respected and liked by staff and relatives. There were arrangements in place which helped the registered manager to communicate effectively with all staff and relatives. We observed people, staff and relatives feeling comfortable enough to communicate with the registered manager when they needed to. The registered manager had made significant improvements to how the service operated and this was evidenced through past and present audits. The home was advertising for a deputy manager to help support staff further and to help embed and sustain the improvements already made.

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

Wyatt House provides nursing, residential, and respite care for up to 30 people living with dementia and some day care places. At the time of our inspection 26 people were living there. The home is purpose built over two floors. There is a small day centre which people from outside the home can access four days a week and join in with activities there.

There had been no registered manager in post for six months and a new manager had not been appointed that the provider had applied to register with CQC. 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. A peripatetic interim manager was currently managing the service until a new registered manager was appointed.

There were three breaches of legal requirements at the last inspection in October 2015. At our comprehensive inspection on 21 and 22 March 2017 the provider had followed their action plan which they told us would be completed on 30 June 2016 with regard to referring people to healthcare professionals when required, staff completing regular training updates and notifying the Care Quality Commission about all incidents.

Improvements could be made to the care plans we looked at to ensure they were more responsive to people’s needs and we have made a recommendation about the care plan information. Staff knew how to keep people safe and were trained to report any concerns. The home was well maintained and safety checks had been completed. People had their medicines administered by the staff and they were safely managed.

People were able to make some choices and decisions and staff supported them to do this. External healthcare professionals supported people when required and they were supported regularly by their GP.

People were supported by staff that were well trained and had access to training to develop their knowledge. There was a choice of meals. We observed one meal time and people’s experience could be improved with regard to waiting for their food to be served. People were treated with kindness and compassion. We observed staff engaged with people in a positive way and they were caring when they supported them. Relatives felt welcomed in the home and told us the staff were kind.

People had a range of activities to choose from which included cookery, quizzes, ball games, arts and crafts and musical entertainment. Community links included people being part of the local ‘memory walks’ in Stratford Park and Stroud Christian Fellowship provided a weekly service in the home.

The provider’s representative and the manager monitored the quality of the service with regular checks and when necessary action was taken. Staff felt well supported by the management team. Staff meetings and resident/relative meetings were held and they were able to contribute to the running of the home. All complaints we looked at from relatives had been investigated robustly by the manager and responded to within the required timescales.

Staff told us that the home was frequently under staffed. There were high levels of sickness absence and this was not effectively managed. Systems to monitor quality and safety were not effective; in particular there were inadequate systems to capture the views of people who used the service or their representatives.

When we returned to the home we found significant improvements had been made. Staff had completed records training and this included training in the Mental Capacity Act. Records provided good evidence that people's needs were assessed, regularly reviewed and met. We observed that people received prompt and appropriate care and support.

Staff told us that staffing level, team working and morale had improved. This corroborated the findings of a staff survey which the home carried out following our last visit. The home was taking steps to capture more feedback from relatives of people who lived at Wyatt House. The home had an effective complaints system.

We saw little documentary evidence that people were consulted about their care, although we observed staff allowing people to make choices. We saw incorrect practice and documentation in relation to obtaining consent for those people who lacked capacity, which demonstrated limited understanding of responsibilities under the Mental Capacity Act.

People's needs were assessed and regularly reviewed but the standard of record keeping was generally poor, particularly for the most dependent and vulnerable people.

The home was clean and tidy and we observed staff taking appropriate steps to minimise the risk and spread of infection. The home was fully staffed when we visited but staff told us that they were frequently short staffed. There were high levels of sickness absence and this was not effectively managed.

There were systems in place to monitor quality but these were not effective. There were inadequate systems to capture the views of people who used the service or their representatives and the provider failed to act promptly in response to staff concerns about the management of the home.