Archived: Waverley Lodge Care Home

Waverley Lodge is a care home providing accommodation with nursing and personal care for up to 45 people. The service is primarily for older people, including people with dementia.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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 registered manager was present and assisted us during this inspection.

People told us they felt safe and were well cared for. Staff took steps to safeguard vulnerable adults from harm and promoted their human rights. Incidents were dealt with appropriately and referred on to the appropriate authorities, which helped to keep people safe.

The building was generally safe and mostly well maintained. A small number of maintenance items were identified and some bathing and shower facilities required refurbishment. The property was purpose built as a care home and further steps had been taken to make the building suitable for the people living there, including for people living with dementia. Additional signage and control measures were used to highlight and minimise potential hazards and orientate people to the building. Risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. The home was clean throughout, although some inappropriate storage was evident in a sluice room. There was limited availability of moving and handling equipment.

We observed staff acted in a courteous, professional manner when supporting people. Further guidance was required to promote safe manual handling for some individuals. We observed most staff adhered to safe manual handling practices, but queried the use of under arm support when staff transferred people from lounge armchairs to wheel chairs.

We received mixed views regarding the adequacy of staffing levels. The provider had a robust system to ensure new staff were subject to thorough recruitment checks. Improvements had been made to the way medicines were managed although record keeping and audit arrangements required further work to ensure medicines could be well accounted for.

As Waverley Lodge Care Home is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary, DoLS had been applied for, although further guidance was needed where people received their medicines covertly. We observed staff obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned on a regular cycle to ensure their skills and knowledge were up to date. The majority of staff told us they were well supported by the registered manager. Formal supervision meetings were conducted and staff told us they could seek guidance and advice from the registered manager and nurses on duty. Staff performance was assessed and targets set for their on-going training and development.

People’s nutritional status was assessed and plans of care put in place. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.

Staff displayed an attentive, caring and supportive attitude. We observed staff interacted positively with people. We saw that staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidentiality were maintained.

Activities were offered within the home on a group and one to one basis. Visitors were able to come and go freely. The home had a variety of communal rooms and quiet spaces which enabled people to sit in company or enjoy a quieter atmosphere. Staff understood the needs of people and we saw care plans and associated documentation were clear, up to date and person centred.

People using the service and most staff spoke well of the registered manager and they felt the service had good leadership. Some staff felt arrangements to rotate staff into different units in the home could have been more effectively managed. We fed back these comments to the registered manager. People using the service, visitors and staff said they would recommend the home to family or friends. We found there were a range of systems to assess and monitor the quality of the service, which included feedback from people receiving care and others. Some areas requiring improvements had not been fully addressed or improvements had not been sustained when the registered manager was absent.

We made recommendations regarding assessing and determining safe staffing levels and activities.

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

We undertook this focused inspection to check they had made improvements regarding safe care and treatment and staff recruitment, and to confirm that they met the legal requirements. This report only covers our findings in relation to those legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Waverley Lodge Care Home on our website at www.cqc.org.uk.

Waverley Lodge is a care home providing accommodation with nursing and personal care for up to 45 people. The service is primarily for older people, including people living with a dementia related condition. At the time of the inspection there were 33 people accommodated there. A registered manager was in post at the time of the inspection. 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.

We found the provider was still in breach of the regulations relating to safe care and treatment. Improvements had been made to hygiene and infection control. These included improvements to the first floor sluice room. Staff recruitment information, including verification of relevant qualifications, was also obtained before staff commenced duty.

Medication administration arrangements and records had not improved. We found continued shortfalls relating to the administration of medicines, record keeping, stock control, hygiene and the oversight of staff regarding their competency to administer medicines.

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

At the time of the inspection there were 31 people living at the home. Due to their health conditions and complex needs not all people were able to share their views about the service they received, but we did speak with six people. We observed their experiences to support our inspection. We spoke with the registered manager, five staff, the nurse on duty, four relatives and a community optician.

Is the service safe?

All the people we spoke with told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'I do feel safe here, the staff are so good.' All the relatives we spoke with told us they felt their relatives were safe at the home. One of them told us, 'My relative is so well cared for. I know she is very safe here, I have absolutely no concerns.'

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager understood the home's responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). A deprivation of liberty application had been submitted to the local authority regarding one person. Following a recent court ruling regarding DoLS in care settings, the provider may wish to review people's living arrangements to check whether their circumstances amount to a deprivation of liberty, according to the revised definition.

Is the service effective?

Comments from people included, 'I feel quite well looked after here. The staff always give me a choice. Most of the time I like it in my room.' A relative told us, 'We feel our relative is well supported, it's a good home for her.'

People explained how their care and welfare needs were met. People told us that they had support with health appointments and felt that the service was flexible. One person told us, 'When I am poorly the staff will contact my doctor. I have a nurse that comes to help with things as well.'

One person told us, 'It's like having my own apartment. I have everything I need in my room. The staff will always come and do whatever you ask.' All the people we spoke with told us that staff always asked them if they needed help or assistance and provided it when necessary.

Each staff member we spoke with told us they felt supported in their work. They told us they received a full training programme and had regular supervision and appraisals. One person told us, 'We help each other. We are a team. Nearly all of us have completed an NVQ in Health and Social Care (National Vocational Qualification). The training is good here.' They all told us that they felt supported by the registered manager and could approach them at any time for support or to raise any issues or concerns or suggestions.

Is the service caring?

We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. People were not rushed when care was delivered and we saw that staff interactions with people were caring. All the people we spoke with said they felt the care was very good. One relative said, 'The staff are marvellous. They are lovely and caring. We feel our mother is well cared for. We feel that she has really settled here.'

We saw that staff treated people with respect and dignity. One person told us, 'The staff always give me a choice. They are great. I have no complaints.' We saw that people were given choices in relation to their care. Both people and their relatives told us they were very happy with the care they received.

Is the service responsive?

All the people we spoke with told us that staff would respond to any of their requests for support. One person told us, 'I feel quite happy and well looked after. I have a buzzer next to me all the time. If I need anything at any time I just buzz and the staff will come and help me.'

All the relatives told us that they were very happy with the service.

Some of the people we spoke with told us they were involved in decisions about their care. They said that staff were flexible and responded to their requests promptly. We saw that staff responded to people's requests for help in a timely manner.

We saw that there was a complaints policy at the home. People told us they found the manager very approachable and would not hesitate to raise any issues or complaints.

People's care needs had been reviewed at least every six months. We saw that when people's requirements had changed the provider had responded appropriately and altered the care and support they delivered in line with these changes. Care records had been updated to reflect the person's current needs.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

We spoke with the registered manager. They showed us that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people, relatives and staff had been regularly gathered, recorded, analysed and responded to.

We saw the home had systems in place that ensured managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

Staff told us they understood their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people could receive good quality care at all times.

We found that people were asked for their consent before agreeing to their care and they received appropriate care and support. We saw staff treated people with courtesy and compassion. Appropriate arrangements were in place to manage medicines. They were stored safely, handled hygienically and clearly recorded.

There were sufficient staff to meet people's needs. We heard positive comments about the staff. For example one person commented, "The staff are great." Another comment was, "No problems with any of them." The atmosphere in the home was calm and relaxed. This meant people could receive care without undue delay.

We found arrangements were in place to monitor the quality and safety of the service. These arrangements included obtaining the views of people using the service and their representatives. We also found confidential records were safely stored, accurate and up to date. This included up to date assessments and care plans, which helped guide staff on how to meet people's needs safely. This meant people's confidences were maintained.

The provider had made improvements to the security and accuracy of people's care records. New secure record storage facilities had been provided, and most records we looked at were up to date and accurate. Malnutrition screening records were not completed accurately.

Medicines were not always handled safely and some improvements were needed. We observed part of the morning medicines round and saw people were given support and encouragement to take their medicines.

People received help to eat their meals and were encouraged to drink throughout the day, but staffing levels were not sufficient to ensure adequate supervision and timely care. We saw people with high levels of need. Many required one to one help, and for some areas, help from two staff. People received the help they needed at mealtimes, but this was not always done in a timely manner.

The reason for this visit was to check if improvements had been made following a previous inspection. We found the provider had made improvements to the security and accuracy of people's care plans. Although these improvements were made, some confidential records were not kept securely and some records were not sufficiently accurate to ensure people remained safe or received timely care.

Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.