• Care Home
  • Care home

Archived: West Ridings Care Home

Overall: Requires improvement read more about inspection ratings

Off Lingwell Gate Lane, Lofthouse, Wakefield, West Yorkshire, WF3 3JX (01924) 826806

Provided and run by:
Bupa Care Homes (CFHCare) Limited

All Inspections

16 November 2016

During a routine inspection

We carried out this inspection on 16 and 17 November 2016. The inspection was unannounced, which meant no-one at the service would know we were visiting. The inspection was prompted in part by notification of serious injuries to two people. These incidents may be subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incidents. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of falls and the seeking of medical treatment. This inspection examined those risks.

West Ridings Residential and Nursing Home is a multi-unit site providing care for up to a maximum of 180 people. The service has six units and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were five units open and 113 people who used the service.

The service had a registered manager in post at the time of our 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.

Staff had a secure understanding of safeguarding and whistleblowing procedures.

Staff’s knowledge of how to use equipment had improved since the last inspection and individual risk assessments for people were much more detailed to ensure staff had clear instructions for moving and handling people safely. People were appropriately assessed for equipment and the provider had taken steps to ensure equipment was suitable for people’s needs.

Accidents and incidents were recorded and analysed to good effect to evaluate and share where lessons may be learned and practice may be improved.

Staffing levels were sufficient to meet people’s needs and there was a reduction in the use of agency staff and staff being called from one unit to cover staff absence in another unit. Where a hostess was deployed this was positive and supportive of people’s dietary needs.

Systems were more robustly in place than at the last inspection to assess and monitor the competency of staff.

Training had improved and was more specific for staff to be effective and work safely, such as moving and handling. Staff knowledge of what was meant by people’s mental capacity and deprivation of liberty and processes they may need to follow where a person lacked capacity had been enhanced through training.

Staff were very caring and respectful in their interactions with people. People’s privacy and dignity was promoted well.

Assessment of people’s needs in care records was clearly documented.

There were many meaningful and interesting activities that supported people’s interests. The environment throughout the site had continued to improve since the last inspection and was more welcoming and homely.

There was more rigorous and regular quality monitoring throughout the site and the registered manager had a clear oversight of the strengths and areas to improve. Communication between units had improved which resulted in more cohesive teamwork at all levels.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found there was significant improvement to take the provider out of special measures.

21 June 2016

During a routine inspection

We carried out this inspection on 21, 23 and 30 June 2016. The inspection was unannounced.

West Ridings Residential and Nursing Home is a multi-unit site providing care for up to a maximum of 180 people. The service has six units and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were only five units open and 127 people living at the home.

The service did not have had a registered manager in post at the time of our inspection, although there was a manager who had been in post since August 2015 and whose application to register with the Care Quality Commission was in progress. 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.

Staff had a clear understanding of safeguarding and whistleblowing procedures.

Staff lacked knowledge of how to use equipment and individual risk assessments for people were not detailed enough to give staff clear instructions for moving and handling people safely. People were not sufficiently assessed for equipment and not all equipment was suitable for people’s needs. This was a continued area of concern from previous inspections.

Accidents and incidents were recorded with some analysis, although there was limited feedback given to staff or opportunities to evaluate lessons learned.

Staffing levels were variable and at times, not sufficient to meet people’s needs due to staff frequently being called from one unit to cover staff absence in another unit. The hostess role, where sufficiently deployed, was positive and supportive. Staff morale was variable and linked to staffing levels in the service.

Recruitment procedures were in place, but lacked rigour to ensure staff suitability was thoroughly determined. Where agency staff were used there were improvements in the suitability checks made. Ongoing suitability of staff was not checked thoroughly or consistently.

Infection control procedures were robustly in place and the organisation of systems to minimise the risk of infection was clear.

There was a new trainer who was enthusiastic about induction and ongoing training for staff. However, training around risk was not in place and some training was not specific enough for staff to be effective and work safely, such as moving and handling. Staff knowledge of mental capacity and deprivation of liberty was variable across the site, although training had been completed.

Staff were patient, kind and caring in their approach on the whole. People’s privacy and dignity was respected and staff gave good explanations to people about their care and support.

Assessment of people’s needs in care records lacked key detail around areas of risk, such as for equipment or support with moving and handling.

There was limited evidence of meaningful and personally engaging interesting activities that were in keeping with people’s interests. The environment for those people living with dementia had improved since the last inspection.

Systems with which to monitor and evaluate the quality of the provision showed some improvements over recent inspections, although they were disjointed and lacked consistency across the service. There were weaknesses in communication, between the units, with the manager, and with the wider organisation. Where serious failings in the service had been previously identified around the management of risk, no action was taken to improve practice and prevent future harm to people.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC is now considering the appropriate regulatory response to resolve the problems we found. 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.

You can see what action we told the provider to take at the back of the full version of the report.

16 & 17 November 2015

During a routine inspection

We carried out this inspection on 16 and 17 November 2015. The inspection was unannounced.

Prior to this inspection we had made a focused inspection of the Kingsdale unit on 30 September and 2 October 2015. The Kingsdale unit discharged all patients following the inspection and the registered provider closed the unit on 13 November 2015.West Ridings Residential and Nursing Home is a multi-unit site providing care for up to a maximum of 180 people. The service has six units and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were only five units open and 117 people living at the home.

The service did not have had a registered manager in post at the time of our inspection, although there was a manager who had been in post since August 2015 and had applied for registration. 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. There had been a high turnover of managers at the service which had impacted upon the consistency of quality. The new manager had begun to make some improvements to the service and feedback from people, staff and relatives was positive. It was not possible due to the manager’s limited length of time in post to see how the improvements noted were being embedded and sustained.

Staff engaged in some safe practice and knew individual risks to people. However, not all equipment was suitable or safe for people to use and staff were not all competent in moving and handling.

There had been a high number of falls on the Kingsdale unit which had recently closed, some of which had resulted in serious injuries to people. There had been no management investigations into these incidents and no analysis or monitoring of accidents and incidents on the unit.

Staffing levels were acceptable overall although there were variations in staff visibility across the units.

Staff were kind and caring in their approach and engaged positively with people overall. Staff took time to involve people, although where people could not verbally communicate, staff sometimes lacked skills in communication.

Care plans up to date, although variable in quality across the units and up to date. There was little evidence people had been involved in discussions about their care and there were some inconsistencies in the information recorded.

There were limited activities to engage people in meaningful and personally interesting activities that incorporated individual interests. The environment for those people living with dementia was not always supportive of their needs.

Systems with which to monitor and evaluate the quality of the provision had improved since the last inspection, although they varied in consistency and rigour.

The overall rating for this 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 not enough improvement is made within this timeframe so that there is still 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 for any of the five key questions it will no longer be in special measures”

30 September and 2 October 2015

During an inspection looking at part of the service

We carried out this inspection on 30 September and 2 October 2015. The inspection was unannounced. This was a focused inspection on the quality of care in the Kingsdale unit only.

The Kingsdale unit provides accommodation and nursing care for up to 28 people, who are in need of intermediate care and rehabilitation.

There was a registered manager in post for the whole site. However, upon our arrival we were told the site was being managed by a temporary manager and the registered manager had moved to another location. We had not been made aware of these changes. 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.

Staffing levels were not supportive of people’s needs and people had to wait for assistance.

People told us that although staff were kind and caring, there were not enough staff to support them and help them feel safe.

There had been a high number of falls, some of which had resulted in serious injuries to people. There had been no management investigations into these incidents and no analysis or monitoring of accidents and incidents on the unit.

There were no individual risk assessments for staff to understand how to manage people’s care safely, particularly with regard to moving and handling

Medications were not managed safely. People were prescribed and given medication that they were allergic to. There were errors in the recording of medication.

People’s health care needs were not well managed. Staff had insufficient knowledge of people’s treatment plans for wound care. There was no action taken when people showed signs of deteriorating health.

Staff’s knowledge of people’s needs was poor. Care documentation lacked detail and there was conflicting information in care plans.

There were ineffective processes for monitoring the quality of the provision and poor management oversight of people’s care delivery.

Following the first day of our inspection we liaised with the provider and with Mid Yorkshire Hospitals NHS Trust, who gave assurances they would take immediate steps to improve patient safety on the Kingsdale unit. When we visited on day two, we saw there was a significant effort being made to address the concerns we had raised.

27 January 2015 and 3 February 2015

During a routine inspection

The inspection took place over two days; 27 January and 3 February 2015. At the previous inspection in July 2014, the provider was asked to make improvements to records relating to people’s care. The provider had made some effort to improve care records; although we found they still lacked detail and clarity. The provider informed us new documentation was planned to be implemented in the near future.

West Ridings Residential and Nursing Home is located on the outskirts of the city of Wakefield. It provides accommodation for people who require; residential care, nursing care and care for people with dementia. The service comprises of six separate houses – Wharfedale unit (residential); Calderdale unit (nursing dementia); Wensleydale unit (residential dementia); Airedale unit (residential); Swaledale unit (general nursing) and Kingsdale unit (nursing intermediate care). The care provided on Kingsdale unit is commissioned by The Mid Yorkshire Hospitals NHS Trust and provided in partnership with staff employed by the Trust.

At the time of our inspection there was no registered manager in post. An acting manager from the organisation was running the home and the recruitment process was being implemented to secure a permanent manager. 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.

Staff understood how to ensure people were safeguarded. They knew people’s individual abilities and risk assessments to help people maintain their safety. There were many illustrations of safe practise, although there were some concerns in relation to how we saw one person moved and handled and how one person’s dressings were applied.

Staffing levels were adequate in some areas, although in some units we found staff numbers were not always sufficient to meet people’s needs in a timely way.

Some aspects of the premises were in need of refurbishment and there were strong odours in places, which created an unpleasant environment for some people. This was most apparent on the Wensleydale unit, which we were told was due for refurbishment. We saw the Kingsdale unit had been reorganised to create a more homely feel to the communal areas than when previously inspected.

Medicines were managed safely overall. However there were some recording discrepancies relating to stock levels and temperatures of the refrigerator and medicine room in one unit. There was a medication error on one unit that was being addressed by the acting manager.

Staff had opportunities to complete regular training, although they had received limited training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant their knowledge of people’s rights in relation to consent was inconsistent.

The quality of the food and drink provided was good and the cook was knowledgeable about people’s individual dietary needs. People enjoyed their meals on the whole and they were supported to make sure they had adequate nutrition and hydration. People were supported appropriately to maintain good health and had access to healthcare professionals as required.

People were appropriately supported by caring staff who demonstrated patience and compassion in their work. There was evidence of strong and supportive relationships and staff knew people’s individual needs well. People were encouraged to express their views and their privacy and dignity was promoted.

People’s individual care needs were regularly assessed and reviewed and care records were kept up to date to reflect this. However, care records were mostly task focused rather than person-centred.

The complaints procedure was prominently displayed and people and relatives knew how to make a complaint if they wished to. The acting manager was aware of complaints that had been received and responded to these appropriately.

There was a temporary management arrangement in place and staff reported poor morale that was slowly improving. Staff were clear about their roles and responsibilities and described a more positive and open culture than was previously apparent.

There were weaknesses in the quality assurance systems. The recording and analysis of information was not robust enough to ensure management had reliable indicators of the strengths and weaknesses of the service. There was no clear strategic vision for the future of the service development.

You can see what action we told the provider to take at the back of the full version of the report.

9 July 2014

During a routine inspection

This inspection was carried out by four inspectors, an expert by experience and a specialist advisor. Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff, senior managers, our observations and from looking at records. We spoke with over 30 people who used the service, 13 relatives and 26 staff.

West Ridings comprises of six separate houses ' Wharfedale unit (residential); Calderdale unit (nursing dementia); Wensleydale unit (residential dementia); Airedale unit (residential); Swaledale unit (general nursing) and Kingsdale unit (nursing intermediate care). The care provided on Kingsdale unit is commissioned by The Mid Yorkshire Hospitals NHS Trust and provided in partnership with staff employed by the Trust.

At our inspection we gathered evidence to help us 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?

Is the service safe?

People told us they were treated with dignity and their rights were respected. People's comments included:

"It's like a 5 star hotel here."

'Staff are lovely they are very obliging.'

'Very kind.'

All the people we spoke with told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

However, we found people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate care records were not always maintained. We found care records were, in the main, difficult to navigate around and complex.

We looked at the recruitment of new staff. We saw recruitment practice was safe and all necessary pre-employment checks had been carried out.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, policies and procedures were in place and under review to ensure people's rights were protected.

Is the service effective?

People who used the service told us they were asked about their care and able to make decisions about this. However, care records did not show how people who used the service or their relatives were involved in their on-going review.

Staff described how they met and monitored people's health needs. Care records showed that people had regular contact with health and other professionals.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Training records showed that most staff in the home had completed mandatory training and other appropriate training to meet people's care and support needs. This included dementia care. We were told that further training was planned in end of life care and emergency aid.

Is the service caring?

Throughout our observations we saw staff treated people with kindness and courtesy. We saw staff were kind, patient and encouraging when giving support to people who used the service.

People's comments included:

'I'm very happy living here.'

'Would rather be at home but I couldn't wish for a better place.'

'Staff are lovely they are very obliging.'

'I can't thank them enough.'

'I can't grumble about the care and treatment. The staff are very good.'

Overall, people's family members were complimentary of the staff and care and support their relative received. One said, 'I have never, ever heard anyone speak to a resident in anything other than a very nice way.' They said the staff were quick to inform them of any significant changes in their relative's general health and they were always made to feel very welcome when they visited.

Is the service responsive?

We spoke with people who lived in the home about activities. Most people said they had enough to do and enjoyed the activities on offer. However, a number of people said they would like to go out more. The Manager of the service said they had identified the need for a mini-bus but did not at this point know if they would get one.

We saw people who used the service were responded to promptly when they asked for any support or assistance. However, we noted on Kingsdale unit that people had long waits for their lunch time meal.

People knew how to make a complaint if they were unhappy. We looked at complaints records to see how they were dealt with. We found they had been investigated thoroughly and people were responded to in a timely manner.

Is the service well led?

Staff said they felt the service was well managed and the management team were supportive. They said they had confidence any issues brought to their attention were always dealt with properly and thoroughly.

The provider had systems in place to identify and assess risks to the health, safety and welfare of people using the service.

Senior managers from the organisation carried out a monthly audit to check standards and the quality of care being provided. We saw there were action plans developed when any shortfalls were identified.

5, 6 March 2014

During an inspection looking at part of the service

West Ridings comprises of six separate houses ' Wharfedale unit (residential); Calderdale unit (nursing dementia); Wensleydale unit (residential dementia); Airedale unit (residential); Swaledale unit (general nursing) and Kingsdale unit (nursing intermediate care). The care provided on Kingsdale unit is commissioned by The Mid Yorkshire Hospitals NHS Trust and provided in partnership with staff employed by the Trust.

This inspection was carried out to check compliance actions had been completed following our inspection in August 2013. During the inspection we spent time on all six units in the home. We spoke with sixteen people who were staying in the home, ten relatives, fifteen staff, the registered manager and other senior managers.

We found improvements had been made in five of the houses we visited. People were involved in their care and staff respected their wishes and preferences. We found people's privacy, dignity and rights were respected in these houses. Comments from people who were staying on these units included:

'The staff are helpful and I always feel they treat me properly. If I say I don't want something they respect that and if I need help, they help me'.

'It's good here, it's not like when I was at home, but it's good'.

'I can get up and go to bed when I choose. Staff are very good like that'.

However, on Kingsdale unit we observed practices which showed people's rights were not promoted or respected and their wishes were not considered.

We found improvements had been made in the care documentation and care delivery in five of the houses. People told us they were satisfied with the care they received. One person told us: 'I feel safe and well cared for. The manager is very good and always has time for you and deals with things'.

However, on Kingsdale unit we found there was a lack of management and leadership which meant people did not always receive the care and support they required.

There were effective systems in place to keep people safe by preventing and controlling the spread of infection.

We found there were safe systems in place which ensured people received their medicines when they needed them.

There were effective systems in place to monitor the quality of service people received.

Overall improvements were found across the site in relation to infection control, the management of medicines and quality assurance processes. In five of the houses we found people's privacy, dignity and rights were respected and they were receiving the care and support they needed. However, on Kingsdale unit there remained shortfalls in the provision and quality of care people received, which we considered was due to a lack of effective management and leadership in the unit. Following the inspection the provider took immediate action and transferred an experienced manager and senior nurse onto the unit.

28, 29 August 2013

During a routine inspection

West Ridings comprises of six separate units ' Wharfedale (residential); Calderdale (nursing dementia); Wensleydale (residential dementia); Airedale (residential); Swaledale (general nursing) and Kingsdale (nursing intermediate care). Prior to the inspection we had received concerning information about the service relating to a lack of activities, staffing levels, medicines, aspects of care and infection control.

We spent time on all six units in the home. We spoke with twenty eight people who used the service, ten relatives, sixteen staff, the registered manager and the regional manager.

We found inconsistencies across the home in how people's privacy, dignity and choices were respected. We saw people were offered some choices such as what they would like to eat and drink. However we also saw people who wanted to lie on their beds in the afternoon were not able to as their beds had not been made. We found there were some activities taking place, however a number of people told us they were bored.

We found people were generally well cared for but found shortfalls in the care documentation which we considered could impact on the care people received.

We found there were not effective systems in place to keep people safe by preventing and controlling the spread of infection.

We found people received their medicines in a safe way but medicine records were not always accurate and complete.

We found there were sufficient staff to meet people's needs. However feedback from people who used the service and staff suggested there were times when staffing levels were not sufficient.

We found there were not effective systems in place to monitor the quality of service people received.

7 February 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. However through our observations we found that people were well supported and appeared content and at ease in their surroundings.

We spoke with the relatives of two people. Both gave positive feedback; one person said 'We are very happy with care provided, people are well cared for.'

We spoke with two people who live in Swaledale, one of the units within the home, they told us that they had been included in decisions about what care and support they received and when this would be available. One person said 'The staff are wonderful." Another person said 'I have no complaints, If you can't live at home this is the next best thing'. When we asked people about raising concerns one person said 'I feel any concerns would be listened to and resolved.'

We spoke with seven members of staff who were able to demonstrate a good understanding of the needs of the people who lived at the home. They commented that they were well supported by managers of the home.

We had some concerns about the availability of staff to provide occupation and activities for people. We spoke with the manager about this and she told us similar feedback had been made in a recent satisfaction survey. She said they were in the process of looking at ways to address this.

11 May 2012

During an inspection looking at part of the service

At this inspection we visited the Calderdale and Wharfedale units. We spoke to relatives and people who use the service at both units. All those we spoke to were positive about the care that they receive. They felt the staff were good and helpful, the food was good and that their rooms and the environment was clean and well maintained.

7 October 2011

During an inspection in response to concerns

We spoke to the relatives of people who use the service who told us that the felt the quality of care was good and that the home was clean, but that they were concerned about recent staff turnover levels on the Calderdale unit.