Archived: Ross Wyld Care Home

Ross Wyld is a care home with nursing for up to 54 people. 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.

Ross Wyld is divided into three floors providing nursing care to people with physical health needs and for those living with dementia. It is a large purpose built care home that is fully accessible to people with mobility needs. At the time of our inspection 51 people were living in the home and one person had been admitted to hospital.

The home did not have a registered manager. The new home manager was in the process of applying to register with us. 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 in December 2015 we did not find any breaches of the legal requirements.

At this inspection we found that care plans and risk assessments lacked detail or were inaccurate and were not personalised to each individual. They lacked detail regarding care preferences including personal care, dietary needs and end of life wishes. Records of care did not show people were supported to have their needs met.

People told us there were not enough staff deployed at the service to meet people’s needs and we observed that people received their meals late. Staff did not always receive the clinical support they needed to perform their roles because there was no clinical lead or deputy manager at the home.

The home had not always sought consent in an appropriate way and staff did not demonstrate a sound working knowledge of the Mental Capacity Act 2005.

The governance arrangements were not comprehensive and where those in place had identified issues with the quality and safety of the service actions had not been effective in improving the experience of people living in the home. The service was working with the local authority and clinical commissioning group to implement a plan to address concerns in the home.

Staff were knowledgeable about safeguarding adults from harm, and the provider took action to investigate and respond to allegations of abuse and other concerns raised.

The home was clean and odour-free and we observed staff using basic hygiene methods.

People living in the home had complex healthcare needs. They received support to access healthcare services and the home worked with healthcare professionals help meet people’s needs.

Medicines were managed safely and staff were appropriately trained.

Staff built positive and compassionate relationships with people in their care, and understood how to promote people’s dignity. Staff demonstrated they understood the impact people’s culture might have on their experience of care. Sexual orientation was included as part of the care assessment.

The provider had a clear complaints policy. There were systems to ensure people and relatives were able to provide feedback about their experience of the home.

Activities were delivered with enthusiasm and people felt the range of activities on offer were improving. The manager had plans in place to continue to develop the activities provision within the home.

We found breaches of five regulations relating to safe care and treatment, consent, good governance, person-centred care and staffing. You can see what action we told the provider to take at the back of the full version of the report.

The home was last inspected in May 2014 when it was found to be compliant with all the standards inspected.

People were kept safe from avoidable harm and abuse and were supported by staff that had been recruited safely. There were support and risk management plans in place and where risks had been identified there were plans in place to minimise them. Plans were reviewed and updated regularly and were personalised to individual needs. There were robust systems in place to ensure that the building was safe for people, and checks were performed regularly to ensure it remained so.

There were enough staff to support people. People were supported to take their medicines as prescribed and there were robust systems in place to ensure this was done safely.

People were supported by staff who had the knowledge and skills required to carry out their roles, including professionals registrations where required. Staff received regular training. Staff supervision was not clearly documented. We have made a recommendation about staff supervision.

Peoples consent to their care was sought in line with legal requirements and the service was following the Mental Capacity Act 2005 and associated guidance including regarding Deprivation of Liberty Safeguards.

People told us they liked the food and their nutrition and hydration needs were met, including where they followed special medical or religious diets. People were supported to maintain their health and the service had good links with relevant health professionals.

Positive relationships had been developed between people, their relatives and staff. People were offered choice and their privacy and dignity was respected. People were supported to have their cultural needs met.

The service sought and responded to feedback from people, relatives and professionals. There was a clear complaints policy in place which the provider followed when complaints were made.

There was a positive, open, person centred culture at the service which was led by the registered manager.

There were robust quality assurance systems in place to obtain feedback and monitor performance.

Our inspection team was made up of two inspectors. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe and respected by staff.

There were systems in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This contributed to help reduce the risks to people and helped the service to continually improve.

The service was safe, clean and hygienic. There were enough staff to meet people's needs and the service had recruited new staff to ensure they had staff who were competent and able to deliver care safely.

The manager prepared the staff rotas to ensure they had sufficient staff who had the qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

Is the service effective?

There was an advocacy service available if people needed it. This meant that when required people could access support to express their views about their care. We saw evidence that the home used the service so people were supported to have their voices heard.

There was evidence that people’s health and care needs were assessed with them, and they were involved in writing their plans of care. Where people could not speak English as their first language the service tried to get someone who could communicate with them. We saw evidence that the service had staff who could speak Portuguese, Polish and Bangladeshi. Within risk assessments we saw specialist dietary, mobility and equipment needs were identified with guidance on how to meet people's needs. We spoke with some relatives and they said that they had been involved in giving information about their relatives which demonstrated care reflected their current needs.

Is the service caring?

We found that staff at the service were kind and caring and made the time to speak to people even when they were busy. We saw someone who was receiving doll therapy and staff were taking the time to sit with them while they were interacting with their doll.

People referred to staff by name and spoke fondly of them which demonstrated people knew the carers and were comfortable with them. One person said "the staff are lovely here." Relatives spoke positively of the staff and said "there is always someone who greets you and talks to you when I come to visit."

Is the service responsive?

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. It was clearly documented in people's care plans what food they liked and disliked so staff would not give the wrong food which demonstrated personalised care for people.

On the day of the inspection we saw evidence of staff observing and working with other healthcare professionals where they identified somebody had become unwell. The service was responsive in calling a community matron to provide urgent care and provide medicines to them.

Is the service well-led?

Staff and relatives said they could speak to the manager at any time. The service had started to hold regular meetings for people and their relatives, care staff and nurses so that they were regularly involved in the running of the home to make improvements.

The service had an effective quality assurance system, which included audits. The manager conducted daily walk-rounds and spot checks at night, to monitor the welfare and safety of people who use the service. The manager spot checked records in people's room to ensure the quality of them as being maintained.

We viewed ten care files and found that care was assessed and people's risks identified and managed. However people did not always receive care as identified in their care plan, in particular continence care.

Management and care staff were knowledgeable about the safeguarding responsibilities and the importance of protecting people from abuse.

Equipment was readily available for people to use. We saw that everybody had a pressure mattress to help minimise the risk of pressure sores. We observed staff use hoists safely and they always checked that the equipment was safe to use and recorded repairs.

Records were kept but were not always accurate and fit for purpose. Information recorded in people's daily logs was sometimes vague and did not clearly indicate the care that had been given to people. Also records that were kept for people's call bells was not accurate as the record indicated that the bell was working yet we found two bells that were not operating.