Archived: Wentworth Croft Residential and Nursing Home

Wentworth Croft Residential and Nursing Home provides accommodation for up to 156 mainly older people who require nursing and/or personal care. The service offers accommodation over one floor within four separate houses. Woolsack House provides personal care, Hayward House provides dementia care, Harvester House provides dementia care and nursing, and Yeoman House provides nursing care. Each house has single occupancy bedrooms with ensuite facilities and there are internal and external communal areas, including lounges, dining areas, a pamper room, cinema room, and gardens for people and their visitors to use. There were 69 people using the service at the time of our inspection.

During this inspection there was no registered manager in place. A manager was working at the home and they had started to apply to become the registered manager. 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 2008 and associated Regulations about how the service is run.

At the last comprehensive inspection on 12 April 2016 this service was placed into special measures by the Care Quality Commission (CQC). Breaches of seven legal requirements were found and the service was rated overall as ‘inadequate.’ After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to; safe staffing levels; safe medicines management; robust safety checks on all new staff; safe moving and handling techniques to be used on people; improvements in staff training and staff support; people’s nutrition and hydration needs being meet and robust quality monitoring, good governance and management of the service.

During this inspection we found that there was sufficient improvement to take the service out of special measures. We found that the provider had made the necessary improvements to demonstrate that the majority of the legal requirements were now compliant. However, we noted that some improvements were still needed. We found that there were still concerns around the safe management of people’s prescribed medicines. This was because we could not be assured that people were receiving their medicines safely. Detailed records as guidance for staff on when to administer people’s ‘as required’ medicines were not always kept.

Safety checks were carried out on all new staff to make sure that they were deemed safe to work with people who lived in the service.

There was a sufficient number of staff to provide people with safe assistance and care.

People had care and support plans in place to give guidance to staff on the assistance a person required. Records included how people wished to be supported, and what was important to them. People's care records had been reviewed and they or their appropriate relatives had been involved in this process.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Where people had been assessed as lacking capacity, decisions were made in their best interest and this was clearly recorded in their care and support plans. Applications had been made to the local authorising agencies to lawfully restrict people’s liberty where appropriate.

Staff understood their roles and responsibilities to report any concerns of poor care practices and harm.

Staff had received training to develop their skills and knowledge to support people’s individual care and health needs in an effective way. Staff received regular supervision and appraisals.

The majority of people’s nutrition and hydration needs were met.

There was a system in place to receive and manage and resolve people’s complaints.

Improvements had been made to the provider’s and managerial oversight of the service. Quality monitoring systems were in place and improvements identified and completed or were on-going. However, improvement for the safe management of people’s medicines had not been identified by the provider’s audits.

People and their relatives provided feedback on the quality of the service so that the provider could see what was going well and what required improvement.

We found one breach 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 the report.

Wentworth Croft Residential and Nursing Home provides accommodation for up to 156 mainly older people who require nursing and/or personal care. The service offers accommodation over one floor within four separate houses. Woolsack House provides personal care, Hayward House provides dementia care, Harvester House provides dementia care and nursing, and Yeoman House provides nursing care. Each House has single occupancy bedrooms with ensuite facilities and there are internal and external communal areas, including lounges, dining areas and gardens for people and their visitors to use. There were 87 people using the service at the time of our inspection.

At the time of our inspection there was no registered manager was in place. A manager was in place and they were intending to apply to become the registered manager. However, we were informed during the inspection that this person had resigned. 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 2008 and associated Regulations about how the service is run.

At our previous inspection on 31 July 2015 we found that improvements had been made following our inspection on 30 October and 12 November 2014 where we had found breaches. These breaches were due to concerns identified about low staffing levels, ineffective quality monitoring systems and notifications of important events the provider is required to notify us about by law not being submitted. Following this inspection on 30 October and 12 November 2014 the service was rated overall as ‘requires improvement’. At this inspection on 12 April 2016 we found that the improvements across the service evidenced in the July 2015 inspection, had not been sustained by the provider and that people were still placed at risk.

During this inspection we found that there were concerns in two out of the four houses. These were Yeoman House and Harvester House. This was because there were not enough staff to meet people’s care and support needs in a timely manner. We could not be assured that people received appropriate care to meet their needs.

People’s care and support plans were in place to give guidance to staff on any individual assistance a person required. Records included how people wished to be supported, and what was important to them. However, due to the lack of staff available in two of the houses, people were not receiving the support that they required. We found that not all of these records documented people’s up-to-date care and support needs. Staff told us that they did not have time to read these records in full.

People's care records and reviews of these records documented that where reasonably practical, people or their appropriate relatives had been involved in this process.

People were not always protected against the risks associated with the unsafe management of their prescribed medicines. Robust processes were not in place to ensure that people received their medicines safely and as prescribed.

Robust safety checks were not always carried out on all new staff to ensure that they were deemed safe to work with people who lived in the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Where people had been assessed as lacking capacity, decisions were made in their best interest. Applications had been made to the local authorising agencies to lawfully restrict people’s liberty where appropriate. Not all staff had an embedded understanding of this legislation.

Staff understood their roles and responsibilities. Although records showed that staff received training, we found that staff were not able to support and care for people’s individual needs in an effective way. Not all staff received regular supervision where they could discuss any issues they may have and where they could review and agree their skills and development needs.

People at risk of malnutrition were assessed by external health care professionals and we saw that this input and advice had been followed by staff. The choice of foods available to some people was limited. Records for people deemed to be at risk of malnutrition or poor skin integrity were not always completed in full or in enough detail for their intake to be monitored effectively.

There was a system in place to receive and manage complaints. However, the provider could not demonstrate whether a complaint had been resolved to the person’s satisfaction.

Quality monitoring systems were in place, but there was a lack of provider and managerial oversight of the service and improvements had not been sustained.

People and their relatives had been asked to provide their feedback on the quality of the service so that the provider could see what was going well and what required improvement. Feedback showed that people wanted an improvement in the quality of care that they/their family member received.

The overall rating for the service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If no improvement is made within this timeframe so that there will still be a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate in any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Below is a summary of what we found. The summary describes the number of different methods we used to help us understand the experiences of people using the service. This is because the majority of people using the service had complex needs. We looked at records; we spoke with ten people and six relatives of people using the service and 13 staff members. We used the Short Observation Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The provider informed us that no applications had been approved and we saw that proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

In the care records we looked at we saw that risk assessments regarding people's individual care and support needs were carried out and that measures were in place to minimise those risks. However, in one of the four units we visited, the provider was unable to demonstrate to us that the four people we observed, who were being cared for in bed, had their individual needs met to ensure their health and well-being. We have written to the provider to ask them to tell us how they intend to make the improvements required.

Improvements had been made since our last inspection on 12, 14 and 26 November 2013. Staff we spoke with demonstrated to us that they understood their role in safeguarding the people they supported and that they would be confident to raise any concerns should they need to do so.

The staff rota we looked at for the day of our inspection demonstrated to us that the provider took into account people's care needs when making decisions about the staff numbers and skills mix. This ensured that people's needs were met.

Is the service effective?

Records of staff training we looked at demonstrated to us that staff received training to ensure that they were able to meet the needs of people living in the home.

Improvements had been made since our last inspection on 12, 14 and 26 November 2013. Staff we spoke with told us that they received supervisions and this was confirmed in the provider's records we looked at.

People living in this home and their relatives made positive comments about the care people received. One person told us that, 'On the whole I am kept well, I am able to do my own thing.' From our SOFI observations and on speaking to staff we saw that staff understood people's care and support needs and knew them well. However, in one unit we found that the care and support people received did not always meet their individual care needs.

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Is the service caring?

Our SOFI and general observations demonstrated to us that people were supported by kind staff. One person we spoke with told us that, 'Staff speak nicely and give you a choice.' We observed that people were supported by staff in a pace they were comfortable with and were not rushed.

Improvements had been made since our last inspection on 12, 14 and 26 November 2013. During this inspection we saw that people were well presented, clean and tidy. We observed that staff interacted with people in a kind and attentive way. We found that people were assisted with their personal care needs behind closed doors to respect their dignity.

Is the service responsive?

People's care records we looked at confirmed people's preferences, interests and we saw that people's diverse needs had been recorded. We found that the care and support met their wishes.

We saw that people had access to activities should they wish to take part and that the home encouraged visitors to help support people maintain relationships with their relatives and friends.

Is the service well-led?

People we spoke with told us how staff assisted them with the care and support that they had agreed to.

Quality monitoring systems were in place so that people were listened to and were safe from the risk of unsafe and inappropriate support and care. We discussed our concerns about the quality of care being delivered in one of the four units with the provider. They told us that they had already identified this unit as requiring improvement.

People using the service and their relatives were asked for their feedback on the service provided. People said that they were aware of how to raise concerns and that they would be confident to do so.

People received the care and support they required to improve their health and well-being. Care records were generally written in detail and provided guidance to staff members. However, some records were not completed accurately and this did not provide an accurate account of the risks to some people or the care they had received.

Not all people who used the service were protected from the risk of abuse. Staff had received appropriate training in the prevention of abuse and there were policies and procedures in place. However, some staff in one unit had not been treating people with respect or dignity and these practices had been going on for some time.

Most staff members received supervision and training from the provider or from external sources to ensure they had the skills and support to properly carry out their roles and care for people. However, on one unit staff said they were not properly supported and did not receive adequate supervision.

Systems were in place to regularly check and monitor the way the service was run.