Winifred Dell Care Home

Winifred Dell is a residential care home providing accommodation for persons who require nursing or personal care up to 76 people. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 71 people using the service.

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

The deployment of staff was not always consistent, however following the inspection the registered manager put plans in place to address this. Staff were recruited safely. Systems were in place to safeguard people from the risk of abuse. There were risk assessments in place to protect and promote people’s safety. The service had processes in place to learn from accidents and incidents.

People were 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.

People, staff and relative were positive about the service and the support they received.

The provider and managers had governance systems in place which provided oversight and monitoring of the service. These governance systems and processes ensured the service provided to people was safe.

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 January 2020)

Why we inspected

The inspection was prompted in part due to concerns received about unwitnessed falls. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Winifred Dell on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Winifred Dell Care Centre provides accommodation with personal and nursing care for older people, some of whom may be living with dementia, accommodating up to 76 people over two floors. At the time of the inspection 71 people were using the service.

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

Feedback from people and relatives about their experience of using the service was positive. People felt safe and well cared for by kind caring staff who often went the extra mile to meet people’s needs and wishes.

Staff knew how to recognise and report any suspicions of abuse and had a good knowledge of the risks to people and knew how to keep people safe. People’s medicines were safely managed by trained and competent staff.

People told us there were enough staff to meet their needs however we identified a staffing shortfall in one area of the service which placed people at increased risk of harm. This shortfall had already been identified by the registered manager and an additional staff member was added to the rota on the day we inspected.

Staff received training, supervision and observations of their practice to support them to be competent in their role. Staff felt well supported and enjoyed working at the service. People were supported to have as much choice and control over their lives and were supported in the least restrictive way possible. Policies and systems in the service support this practice.

The design and decoration of the service met the individual needs of the people who lived there. An excellent feature of the service was the refurbishment of upstairs where thoughtful consideration had been given to ensuring the environment was ‘dementia-friendly’, providing lots of opportunities for stimulation, exploration and reminiscence.

People were supported to have access to food and drink that met their health needs and preferences. People’s health needs were identified and monitored, and people were supported to access healthcare treatment and advice as needed.

The service was responsive to people’s individual needs and wishes. Best practice guidance was applied to support older people, including those living with dementia, to have opportunities for engagement and to promote social inclusion.

The service listened to people and responded positively to feedback to ensure people, relatives and staff were fully included in how the service was run.

The provider was committed to providing good quality end of life care. The deputy manager had taken the lead on completing the gold standard framework for end of life care which represents the benchmark for excellence.

The culture within the service was positive. Staff felt listened to, valued and worked well as a team. The management team was held in high regard by people, relatives and staff and was visible and approachable within the service.

The safety and quality of the service was monitored and assessed consistently by the management team and provider. Regular audits on all aspects of the service were completed and improvements were made when needed.

The registered manager was focussed on continuous improvement of the service to ensure good outcomes for people.

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 (April 2017).

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.

The inspection took place on 18 April 2017 and was unannounced.

Winifred Dell Care Centre provides accommodation and personal care for up to 76 older people who may also have dementia. Care is provided in four units over two floors. At the time of our visit there were 69 people living in the service. The service does not provide nursing care.

A new manager was in post who had applied to become registered.. 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 our previous inspection we found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not always minimise the risk of falls for people. At this inspection we found the service had improved how risks were assessed, reviewed and managed. There were robust systems in place to assess and manage risks to people. Risk assessments were regularly reviewed and evaluated to ensure they remained relevant. Staff demonstrated a good awareness of the individual risks to people and how to manage them.

People were protected by the service’s approach to safeguarding and whistleblowing. Staff were aware of the different types of abuse and action to take if abuse was suspected.

People who used the service told us that they felt safe, could raise concerns if they needed to and were listened to by staff.

Checks of the building, equipment and maintenance systems were regularly undertaken to ensure people’s health and safety was protected.

There were sufficient numbers of staff that had been safely recruited to meet people’s needs.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Only staff who had received training and been checked to ensure they were competent administered medicines.

Staff received on going training and regular supervision and appraisals to support them to carry out their duties and responsibilities effectively.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity that were of a high quality had been undertaken when required and appropriate applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority.

People were supported to have enough to eat and drink that met their preferences and any dietary or health requirements. However people living with dementia were not always adequately supported to make their own decision about what they would like to eat. We made a recommendation that the provider refer to best practice guidance on supporting people with dementia to make choices at mealtimes.

People were supported to maintain good health and wellbeing. The service was good at involving external healthcare professionals and obtaining advice and guidance when needed from specialists such as, the community nurse, dietician and GP.

Independence was promoted and people were treated with kindness, dignity and respect by staff who listened to them and knew them well.

Assessments were undertaken to identify people’s care and support needs. People’s care and support plans were regularly reviewed with people and their relatives. Care records contained up to date information about the care and support needed and included information about people’s likes, dislikes and personal choices.

There was a wide range of activities and events available for people to participate in. People were supported to access the community and provided with varied opportunities for social interaction.

The provider had a system in place for responding to people’s concerns and complaints. Any issues were investigated and dealt with appropriately by the manager.

There had been improvements in managerial oversight of the service and staff. Robust systems were now in place to monitor the quality and safety of the service. A wide range of audits had been undertaken to help identify any areas that required improvement.

People, relatives and staff were included in the running of the service. Any feedback provided was received positively and the service responded by making the necessary changes.

The inspection took place on 3 May 2016 and was unannounced.

Winifred Dell Care Centre provides accommodation and personal care for up to 76 older people who may also have dementia. Care is provided in four units over two floors. At the time of our visit there were 70 people living in the service. The service does not provide nursing care.

A registered manager was 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff did not always minimise risk for people who were at risk of falls. Staff did not always analyse the reason why people fell or make necessary changes to the support being provided in order to keep people safe. You can see what action we told the registered person to take at the end of the full version of this report.

Whilst there was adequate staffing in some of the units, staffing on other units was insufficient to meet people's needs. In particular, where people with complex needs were visiting for a short term stay, staffing levels were not always increased as required.

The provider had systems in place to check the quality of the service, however these were not being used effectively to minimise risk and highlight areas of concern in the support people were receiving.

There was an open culture where people and staff felt able to express their views. Staff were enthusiastic about their work.

People were protected from the risk of abuse. There were appropriate arrangements in place for medication to be stored and administered safely.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. People were enabled to make their own decisions about the service they received. Staff followed processes in place to ensure decisions were made in people’s best interest, involving family and outside professionals as appropriate.

People's nutritional needs were well met. Alternatives were offered where required, and drinks and snacks were available throughout the day. People's food and liquid intake was recorded and monitored.

People were supported to maintain good health and wellbeing and to access relevant health and social care professionals.

People were treated with kindness, dignity and respect by staff who knew them well. People knew who to complain to and the manager responded to people’s concerns.

Care plans and risk assessments were person centred and provided guidance for staff about how best to work with people to meet their needs. Staff supported people to lead meaningful lives and to maintain links with the outside community.

At our review of compliance undertaken in October 2013 we found that there was a safeguarding concern under investigation for this service that had not yet been concluded.

In January 2014 a representative of the provider sent us evidence to confirm that the local authority safeguarding team's investigation had been completed and that the allegation was found to be unsubstantiated.

At our inspection on 22 October 2013 we found that improvements had been made. We observed people as they were spoken with respectfully and with kindness. When a person spoke or asked a question, they were answered appropriately. For example, a person asked if they could have a cup of tea and a member of staff, who was on the other side of the room, turned round and said, 'Of course, the kettle is on and then I'll brew another pot.' We then saw the member of staff bring a freshly made pot of tea and offer it to the person.

We saw that care needs were being met in accordance with people's care plans. People we spoke with told us that the service had improved. One person told us, staff members were, ' always respectful'

The service had systems in place in relation to safeguarding people from abuse and staff were aware of this. However, we noted that there were a number of safeguarding investigations currently on-going. We looked at staffing at the service and found that the manager had ensured shifts were covered and that the staff were working as an effective team.

At our inspection on 30 April 2013 we found that the service was not meeting the individual care needs of people. At our inspection on 9 July 2013 we found that there were still areas of improvement required.

At our inspection on 30 April 2013 we found that due to the staffing structure, the service was not able to meet people's needs appropriately and in an acceptable time frame. This caused anxiety amongst people living at the home and impacted on their care needs. At our inspection on 9 July 2013 we found that the service had rearranged the layout of the unit and reorganised the way staff were distributed. We saw that the people who lived at the home were much more relaxed.

During our inspection we looked at how people's nutritional needs were being met. We found that any dietary requirements and preferences had been identified in the care plans and had then been communicated to the chef.

We looked at medication management which included looking at the medication administration records (MAR charts). We found that all medication was recorded and stored appropriately.

We looked at staffing at the service as concerns had been passed to the Care Quality Commission regarding the number of skilled and trained staff available to meet the needs of people who used the service.

The service completed monthly audits and surveys which generated action plans to improve the service.

Care plans contained clear information on how the people communicated their needs, and the measures that staff should take to meet those needs appropriately.

A new manager had started work at the home during the week of our inspection. They had qualifications and experience of managing services providing dementia care, and they discussed measures to further improve the quality of dementia care.

The provider notified us of six safeguarding referrals to the local safeguarding authority between August and November 2012. There was evidence that the provider had taken the appropriate action by immediately informing the relevant authorities and following their own procedures for responding to these concerns.

We also had concerns about the safety of people in the home following notifications of four unobserved falls resulting in fractures during the same period. We saw evidence that the provider had investigated and addressed the increased incidence of falls in the home.