Archived: Weetslade Court

We undertook this focused inspection to check if the provider was now meeting legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Weetslade Court on our website at www.cqc.org.uk.

Weetslade Court is an assisted supported living service based in Wideopen, North Tyneside. The people accommodated at the service receive a range of personal care, from minimal support such as being prompted to wash, to more extensive practical support. Some people are living with a range of physical and cognitive impairments. People live in their own individual flats and have 24 hour personal care and support available to them from a team of care staff based within the building. There are communal areas and restaurant facilities available, as well as activities provided on a daily basis.

This focused inspection took place on 14 February 2017 and was unannounced. This meant the provider, manager and care staff did not know we would be visiting.

At the time of our visit a manager was in post who was in the process of applying to the Commission to become the registered manager of the service. 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.

We did not review all of the key lines of enquiry in the safe and well led domains. This was because at our last comprehensive inspection, legal requirements in relation to the other regulations that fall within these domains, had already been met and incorporated into the overall rating.

We found at this visit that improvements had been made in relation to both of the regulations that had previously been breached, although some further work around the management of medicines, risk assessment documentation and governance was necessary to ensure improvements continued and reflected best practice guidance. We have not changed the ratings in the relevant domains and the overall rating of the service at this inspection, as we need to be sure that improvements continue to be made. We also need to be satisfied that those improvements implemented to date, are sustained in the long term.

Risks that people were exposed to in their daily lives had been assessed and risk assessments drafted to ensure that staff had relevant and pertinent information available to them to support people safely. However, some of these risk assessments would benefit from being expanded to include more specific person-centred detail. We fed this back to the manager who told us that this would be addressed promptly.

The management of medicines had improved and where there had been gaps in recording about the medicines that people had been offered, refused or not offered for some reason, these had reduced to a lower level. In addition, explanations about these gaps and why they existed could be found in people's daily notes which reflected the care they had received each day. People's medicines were appropriately stored and systems were in place to book medicines into and out of the service, for example, when they were ready for disposal. The provider's medicines policy needed to be reviewed as it did not contain clear procedures about the actions staff should take when people refused their medicines. The manager told us they would review this policy and all other areas of medicines management so that improvements continued.

At our last inspection the manager post at the service was vacant. Since our last visit a new manager has been recruited, who has applied to the Commission to be the registered manager for the service. The new manager displayed a positive approach to the service and a willingness to drive improvements across the board. An action plan had been created which was regularly reviewed and updated to reflect the current improvements made in relation to set objectives. Auditing within the service had improved and external management input from a regional manager and members of the quality team from the provider's head office, had been introduced. This had led to increased governance and management oversight of the service delivered. Paperwork had been reviewed since our last visit and staff competencies in medicines administration and moving and handling had been assessed. The manager shared with us their plans for the further development of the service. This included some new tools they planned to introduce imminently, designed to encourage reflective practice by staff and lead to an improved handover of information.

At our last visit to the service there were no formal feedback tools in place via which the provider could measure the satisfaction levels of people who used the service and other third parties who engaged with the service. At this visit we found surveys had been introduced about various elements of the service, and these had been sent out to people who used the service in December 2016 and January 2017. We saw that where people had given negative feedback about the activities provision within the service, action had been taken by the manager to address this. The manager told us that there were plans in place to expand surveys to people's relatives and external healthcare professionals.

Weetslade Court is an extra care service with 51 apartments contained in a complex. There is an office base and care staff provide people with a range of services including; personal care, medicines management, shopping, domestic and enabling services. Not everyone who lived there received care services from the provider and not all of the services delivered were regulated by the CQC. At the time of our inspection 50 older people lived at Weetslade Court and 44 of them received personal care and support from the provider.

There was no registered manager in post as the previous one had recently resigned. 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.

People we spoke with told us they felt safe living at Weetslade Court. Staff were trained in the safeguarding of vulnerable adults and they were able to describe to us their responsibilities with regards to protecting people from harm and abuse. Policies, procedures and systems were in place to support staff with the smooth running of the service. Care needs were assessed and work to ensure care plans were person-centred had started. Some risks to people were assessed. However, risk assessment documentation and information for staff on how to mitigate and control risks was either missing, inaccurate or the records were basic and brief. We discussed this with the national care service manager who agreed with our findings and told us development work in this area had been made a priority for the interim care manager.

There were mixed opinions amongst people and relatives as to whether there were enough staff employed at the service. The interim care manager told us they used agency staff most weeks to cover vacant shifts but had tried to use the same agency for consistency. Care staff told us they did not feel hurried in their duties and they were able to meet people’s assessed needs. The national care service manager was in the process of recruiting more staff to strengthen their team of permanent care workers.

There was a medicines policy and procedure in place. A recent medicines audit had identified an increase in medicine errors. The interim care manager told us she had booked all of the care staff onto a medicine refresher training course. Other elements of medicine management required improvement, such as risk assessments.

Accidents and incidents were recorded, investigated and monitored. Action plans were in place to reduce the likelihood of a repeat event. The interim care manager reported all incidents to external bodies as necessary. Senior management analysed this information to track trends throughout the organisation.

Routine safety checks were carried out throughout the scheme by the provider’s on-site housing support staff as well as by external professionals where necessary. Personal emergency evacuation plans had not been drafted for all of the people who required support.

Care staff told us they felt supported by the management team and had received regular supervision and appraisal. Staff meetings had not been held as often as planned, however, care staff told us they felt able to approach the interim manager and the national care service manager whenever necessary.

The management and care staff demonstrated an understanding of the Mental Capacity Act (MCA) and their responsibilities under this Act. The service assessed mental capacity and reviewed it as necessary. Care records showed that people had been involved in making some decisions, but more complex decisions that were made in their best interests’ had been appropriately taken with other professionals and a relative involved.

We observed the care staff interacting with people over lunchtime. They displayed kind, caring and compassionate attitudes and people told us everyone was nice to them. We saw staff treated people with dignity and respect. We saw discreet interactions between care staff and people who required support to eat their meal. People and staff enjoyed a friendly relationship and knew each other well.

Improvements had been made and work was in progress to make support plans person-centred. We saw the service had introduced a ‘Riverside Care and Support Plan’ which included sections entitled, ‘Who am I’, ‘Where I lived’ and ‘Things I enjoy’. One page profiles were also completed with essential information recorded at a glance. We reviewed five individual care records and found that not all of them were completed and accurate.

The provider promoted communal activities which were arranged by the housing support staff based at the scheme. We saw information on display about forthcoming activities and we observed people engaging in activities during the inspection which included an entertainer and games.

There was a complaints procedure in place. We reviewed eight complaints. Provider representatives had responded to these complaints in the absence of a registered manager. We reviewed response letters and saw evidence of internal investigations into the issues raised. Relatives told us they were not happy with the time it had taken to get a response and some were still not satisfied with the outcome.

The provider was monitoring the quality of the service. A provider representative had recently carried out a service audit which looked at aspects of the service such as accidents, incidents and complaints. The interim care manager was completing weekly medicine audits which we were able to review. The regional care services manager told us the interim manager had conducted an audit of care records however this had not been robust enough to identify the issues we raised during the inspection. We discussed this with the national care service manager who told us they would ensure a full review of the service was undertaken.

We have identified two breaches 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.