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Archived: Wombwell Hall Care Home Good

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Reports


Inspection carried out on 19 October 2016

During a routine inspection

We inspected Wombwell Hall Nursing Home on 19, 20 and 21 October 2016. The inspection was unannounced. Wombwell Hall Nursing Home is a residential care home providing nursing support and accommodation for up to 120 older people. At the time of our inspection there were 116 people living at the service. Wombwell Hall Nursing Home is split into 4 units each being able to accommodate up to 30 people. Each unit had its own food service area, communal area, dining area, medicine room and staff room. There was also an additional building which contained a kitchen, laundrette, manager’s office, meeting room and staff rooms.

There was a registered manager in post who was registered with the CQC. 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 our last inspection on 14 July 2014, we found 7 breaches of the Health and social Care Act 2008 (Regulated Activities). These breaches were in relation to not being fully compliant with the Mental Capacity Act 2005 (MCA), not enough staff on duty, medicines not being stored or administered safely, poor infection control practice, people receiving treatment during lunch service, people being left in wheelchairs for long periods of time and poor quality auditing systems. The provider sent us an action plan stating that they would address all of these concerns by June 2015.

At this inspection, we found that the provider had taken action on all these areas and was fully meeting the regulations where breaches were found.

People were protected against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns.

Medicines were stored securely and administered safely. Staff had received training on medicines handling and administration, and checks had been undertaken to ensure staff were competent to administer medicines safely. However, we found that some people’s medicine records had not been updated and that some required further details. We have made a recommendation about this in our report.

The provider had ensured that the home was well maintained. Up to date safety checks had been carried out on electrical and gas installations. Equipment, such as hoists, were being checked and serviced. However, we found a back up syringe driver that had not been serviced since 2014.

The service appeared clean and tidy and there were cleaning rotas in place to ensure that all areas were cleaned. The provider had ensured that the premises were safe for use and had up to date safety certificates.

There were sufficient staff to provide care to people throughout the day and night. The registered manager used a dependency tool to identify the amount of hours required to provide support. When staff were recruited they were subject to checks to ensure they were safe to work in the care sector.

People’s needs had been assessed and detailed care plans had been developed. Care plans had appropriate risk assessments that were specific to people’s needs.

The principles of the Mental Capacity Act 2005 (MCA) were adhered to. People were being assessed appropriately and best interests meetings took place to identify the least restrictive methods of keeping people safe. Staff had training on MCA and had good knowledge. The provider had recently introduced new MCA forms that ensured that records were being completed appropriately.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate application

Inspection carried out on 14 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We visited the service on 14 July 2014. The inspection was unannounced. Wombwell Hall Nursing Home is registered to provide nursing and personal care for up to 120 older people. The service provided dementia and end of life care in addition to care for people who were experiencing a variety of illnesses such as stroke, Parkinson’s and conditions that affected their ability to move independently. The service was provided from four separate buildings (units). Each unit accommodated up to 30 people. There were 117 people living in the home at the time of our visit. There were separate facilities on site for the provision of administration, catering and laundry.

There was registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People had variable experiences of the service they received. While some people were very happy, others were not. In addition, our own observations and the records we looked at did not always match the positive descriptions some people had given us.

The service was not safe because there were not always enough staff; people were not adequately protected from the risk of infection and medicines were not always administered safely or stored securely.

The provider protected people from abuse. However staff did not always take account of the requirements of the Mental Capacity Act 2005 for people who lacked capacity to make a decision. Each person had an assessment of the mental capacity when they moved to the home, however these were not decision specific and had not been reviewed or updated. This showed that staff and the management team had not understood that mental capacity assessments should be relevant to specific decisions, at the time the decision needed to be made.

The provider operated safe recruitment procedures. However the provider did not have a system to assess and monitor staffing levels against the needs of people and make changes when people’s needs changed. Rotas showed that staff absence was not always covered. Some people we spoke with were concerned about the low numbers of staff and we found evidence in staff rotas for the four weeks before our visit that numbers of care staff had fallen below safe levels at times in each of the units.

Although people told us they felt safe at the home their safety was compromised because some areas of the premises and some equipment was not cleaned effectively. For example we found dirty commodes in some people’s rooms.

Improvements were required for the service to be effective because meal times were not managed effectively to make sure that each person received the support and encouragement they needed to eat their meals. For example, we saw there were times when there were no staff in the lounge/dining area to assist people who lived on ‘Copperfield’. There were systems in place to protect people from risk of harm through malnutrition or dehydration. However, advice and training offered by the dietician was not always implemented. People told us they enjoyed their meals and described the food as, “Very good” and “Excellent”. Staff were provided with training, including induction and essential training, to make sure they had the knowledge and understanding to provide effective care and support for people. Nursing staff were supported to continue their professional development (CPD). All staff received regular supervision and appraisal to make sure they were competent to deliver appropriate care and treatment.

People were supported to manage their health care needs. Nursing staff carried out regular health checks on people who lived in the home and these were recorded. People told us they were able to see a GP whenever they wanted to. Referrals were made to health professionals such as chiropodists, speech and language therapists, occupational therapists and dieticians when people needed additional support with their health care needs. A visiting optician was assessing people’s sight during our visit.

Improvements were required for the service to be caring because staff did not always provide the support people needed to maintain their privacy and dignity. For example, it was the usual practice in the home to leave people’s bedroom doors open when people were in their beds. Although people who were able to speak with us said they preferred them open, many people were not always able to recognise issues of dignity and privacy due to cognitive impairment. Staff permitted opticians who were visiting the service to carry out eye tests in communal areas of the units and at dining tables while people were eating their lunch. However, staff were careful to protect people’s privacy and dignity when personal care was given.

People were treated with kindness and compassion during their interactions with nursing and care staff. People’s care was planned with them or their representatives to make sure all their needs were understood by staff who provided their care and treatment. People’s personal information was treated confidentially and records were stored securely.

Improvements were required for the service to be responsive because people did not always receive the support they needed when they needed it. Staff were largely focussed on completing tasks rather than responding to and engaging with people who lived in the home. For example, we observed that one person sitting in a wheelchair, the foot rests were not in place and the persons feet did not rest on the ground. They remained in this position for three hours. There were times when people spoke or called out to staff who were walking by or were in another part of the room and they did not get any response because staff appeared too busy with other tasks they were performing.

People’s needs were assessed with them before they moved to the home to make sure the home was suitable for them. Their individual preferences, interests and aspirations were taken into account in the way care and treatment was planned and delivered. People were provided with a choice of suitable and meaningful activities to suit their individual interests. Their religious and cultural needs were responded to and met. For example, links had been established between the home and local religious groups to obtain support for people from local churches, temple and Gurdwara (The Sikh place of worship). Ethnic menus were also provided.

People were comfortable with the management and staff in the home. There was a clear complaints procedure available to people and their representatives to make sure they knew how to make a complaint if they were unhappy with any aspect of the service. People and visitors we spoke with felt able to raise any concerns with staff or the management.

Improvements were required for the service to be well-led because quality assurance and monitoring systems had not been effective in identifying shortfalls in the service. For example, the provider did not have an effective system for monitoring and reviewing people’s dependency levels to ensure that there were always enough staff. Staff absence was not always covered which meant that there were times when people’s needs were not met.

Our observations and discussions with people, staff and visitors, showed us that there was an open and positive culture in the service. People and their relatives were encouraged to express their views about the home through residents and relatives meetings and satisfaction questionnaires. These were taken into account in improvement plans for the home. Staff were clear about their roles and responsibilities. The staffing and management structure ensured that staff knew who they were accountable to.

Inspection carried out on 6 January 2014

During an inspection to make sure that the improvements required had been made

This was a follow-up inspection because at our last inspection on 20th June 2013 we found the registered person was not fully meeting all of the regulations set out in the health and social care act 2008. The registered person sent us an action plan dated 14th August 2013 telling us what actions they would take and when they would become fully compliant with the regulations.

At this inspection we found that the registered person had taken action to ensure that people were encouraged to be involved in how the service was provided to them and that this was embedded into the working culture of the home.

We found that staff responded promptly and respectfully to requests for support from people who used the service. For example one member of staff politely asked a person to wait a few minutes because she was already supporting another person, we saw that other staff were made aware of this and two staff arrived to assist the person to the toilet within one minute of the requests being made. We spoke to three people who used the service and they all told us that staff responded in a timely manner to their request for support.

At this inspection we saw that the registered manager had taken steps to ensure that the rooms that did not have an opening external window but had sliding patio doors could be ventilated either by trickle vents in the patio doors or by the door being held open a few inches by a bolted security lock.

We found that we were able to push open two patio doors that should have been in the locked position. Being able to open these doors meant that we could enter the bedroom and gain access to the whole premises; both bedrooms were unoccupied. This meant that vulnerable elderly people were at risk from people from outside the premises gaining access to their personal bedrooms and the rest of the premises. We discussed this with the registered manager and they told us that they would flag-up the risk to security from the patio doors with their line manager and with the BUPA health and safety advisors.

At this inspection we found that the registered manager had updated the training plan for the staff team and that this showed that 100% of staff had completed moving and handling training and dignity and respect training. We talked with four staff and they told us that they had recently been on training that included moving and handling training.

We found that nursing staff were receiving appropriate opportunities to continue their professional development (CPD) and that the registered person was making suitable arrangements for staff supervisions and appraisals.

Inspection carried out on 20 June 2013

During a routine inspection

We found that care plans contained detailed information about the person including people’s preferred name, the people closest to them and health professional information. We saw that an initial assessment had been completed to assess people’s needs. People told us that they were not always involved in planning their care and treatment.

We spoke to eleven people who used the service or their relatives and staff. People we spoke with told us that they thought people were safe. One person said “Staff are very kind and seem competent at their jobs” another said, “My relative looks forward to the activities in the home. Some people told us that they were unhappy about not being supported to the toilet when they wanted to go.

We saw that the building refurbishment process had started. We spoke to people who used the service about this and they told us that the works had been carried out with minimal disruption and that the works were being carried out to a good standard. We found that most of the external bedroom doors were open when we walked around the property and that the site could be accessed by the general public and the rooms we saw did not have any form of ventilation if the patio doors were closed.

We found that staff had been on training and the manager of the home told us that the provider organisation (BUPA) was developing a training plan. However, we could not see a current effective training and development plan for individual staff or the service. This meant that we could not be sure staff were trained to meet people’s needs. We found that most staff were being supervised, but that the service had no clear supervision plan.

We looked at the provider’s quality assurance system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality.

Inspection carried out on 7 September 2012

During an inspection to make sure that the improvements required had been made

We did not speak with people using the service as part of this inspection visit. We focused on the improvements to the environment that the service provider had made since our last visit.

Inspection carried out on 10 May 2012

During a routine inspection

The inspection visit was carried out by one Inspector and lasted for eight hours. We (i.e. CQC) spent time in each of the four houses, and during the day we talked with 14 people who were living in the home, 11 relatives, 1 visiting health professional, and 16 staff, as well as the manager.

The manager was available throughout the day, and we spent time talking with her at the beginning and end of the inspection visit.

Most of the comments we received were very positive, and some of these included:

(From people living in the home)

“They couldn’t do any better. We are warm, safe and well fed. The staff are wonderful. If I am not feeling very good the staff are always there for me.”

“This is my home. I am waited on hand and foot.”

“It is all very good here. All the staff look after us well. I don’t have to wait to be attended to.”

“It is wonderful in here. The care is beautiful.”

“The staff are very, very busy, but they do a good job.”

(From relatives)

“We can voice any concerns and know we will always get answers. The care has generally been good here.”

“It is all very good. The staff have got my mother through a difficult time over the last few weeks.”

“We can’t fault them. You only have to ask for something and it is done.”

“Mum is happy, so we are happy. They look after her very well.”

“I am happy with the care. They look after X pretty well.”

Inspection carried out on 18 May 2011

During a routine inspection

We talked with fourteen residents from all of the houses, and eight relatives, during the course of the visit. People thought that the staff were dedicated to their jobs, and were kind, caring and helpful. They said that staff responded promptly to their calls for help, and that there was always someone who they could talk to about concerns or day to day issues. They said that they were happy in the home, and were looked after very well.

Relatives said that the home had a pleasant atmosphere, and they had peace of mind knowing that people were well cared for.

Reports under our old system of regulation (including those from before CQC was created)