Archived: Well House

Well House provides accommodation and personal care for up to 43 older people who may also be living with dementia. The service does not provide nursing care. At the time of our inspection there were 32 people using the service.

At this inspection, we found four breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

The service had a registered manager in post who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

The registered provider had not ensured effective medicine management systems were in place at the service. There were no protocols in place for medicines that are prescribed as and when needed. We found discrepancies in stock levels of medicines.

The registered manager had not done all that was required to reduce risk. Moving and handling risk assessments were not being updated and bedrails were in place without an appropriate risk assessment.

The provider had not ensured that the building was well maintained. We found that windows were in a poor condition, and two bathrooms had been condemned and were not in use. Some refurbishment works had been started but other works did not have specific dates of completion.

The provider had not worked in line with the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) as mental capacity assessments and best interest information was not recorded when people's freedom of movement was restricted. There was no overview in place for deprivation of liberty safeguard authorisations, which meant the registered manager did not have oversight of authorisations in place or whether people still required them. We saw that people were supported with making decisions around their care. Staff sought people's consent before providing them with care and support.

There were gaps in staff training. We requested a revised training record which showed there were many staff who required updates in mandatory training subjects such as health and safety and fire training. Some training, such as safeguarding adults had been updated but other subjects still required updating.

Arrangements were in place for the provision of meaningful activities and stimulation. However, these arrangements were not consistent or always available for people that used the service. More opportunities are required particularly for people living with dementia. We have identified this as an area of practice that needs improvement.

People could not be assured that they would receive the support they required as care plans did not always contain accurate, up to date information.

Quality checks had not reliably identified and resolved shortfalls in some aspects of the quality and safety of the service provided.

Appropriate recruitment checks took place before staff started work. Sufficient staffing levels were being maintained.

Staff spoke positively about wanting to provide people with a high standard of care. People were supported by staff that knew them well. People were treated with kindness and compassion in their day-to-day care. People and their relatives spoke highly of the staff and the care and support they provided.

People were happy with the food and drinks provided. The chef had a good knowledge of people's likes and dislikes. People also had good access to drinks and snacks.

The above concerns in relation to the quality and safety of the service resulted in us finding breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

On the day of our inspection we saw that people enjoyed their lunch and we saw that there were processes in place to ensure that people received appropriate nutrition to meet their specific needs.

Staffing levels were sufficient to meet the needs of people who lived at Well House; staff received the support and training they needed to enable them to care for people safely.

Suitable arrangements were in place to support staff and provide training to enable them to deliver care safely.

People's views were taken into account and there were processes in place to make improvements in response to any concerns raised or feedback from people who used the service.

Improvements had been made to records which contained the information staff needed to deliver care safely.

We visited the home to follow up on the warning notice on the 8 July 2013.

We found that the provider had taken steps to improve the care management and associated record keeping at the home.

On this occasion we did not speak to the people living in the home about the inspection but those we spoke with were happy and comfortable within their surroundings and the interactions with staff were positive.

As part of this inspection we checked on the standards that were not met at our last inspection in May 2012. These related to care and welfare, staff training and record keeping. The care plans and risk assessments were still not being kept up to date following changes in people's medical condition and care needs. This meant that people's care and treatment was not planned and delivered in a way that ensured their health, safety and welfare and enabled staff to provide a consistent standard of care.

Staffing levels were not consistent and this at times impacted on the standard of care provided. People's nutritional needs were not always being met. We found that there were still gaps in staff training and therefore people using the service could not always be assured that their care and support would be delivered safely and to an appropriate standard. The service had a quality assurance programme but greater analysis was needed for it to be effective.