Weymouth - Weymouth Care Home

Weymouth Care Home is registered to provide accommodation with nursing care for up to 36 people aged 65 and over and younger adults. At the time of the inspection the service was supporting 30 people. Accommodation is provided on two floors with a lift to access the first floor.

People’s experience of using the service and what we found

We found the following examples of good infection prevention and control practice:

The home had a clear visiting protocol for all visitors. This included health screening questions and recorded temperature checks. Information about this was prominently displayed at the main entrance to the home.

The provider had worked closely with the local Clinical Commissioning Group since the outbreak in November 2020 to identify improvements to infection prevention and control. The provider had demonstrated progress on the identified issues.

Although visiting was currently suspended because of an outbreak, prior to this, visits were supported and carefully managed to ensure risks were minimised. Visits were by appointment only and met the latest best practice guidance. Visit times were structured to enable cleaning in between visits. All visitors were supplied with the required personal protective equipment (PPE) and were encouraged to follow social distancing guidelines.

The home was visibly clean and hygienic. Cleaning schedules guided staff on the cleaning regime required for each area of the home. These included general cleaning and advanced cleaning for high touch point areas such as light switches, keypads, handrails and door handles. Cleaning products were used in line with government recommendations. Management spot checks were conducted to ensure infection prevention and control compliance.

People who had tested positive for Covid-19 were supported to isolate in their rooms as per government guidelines. Discreet signage helped identify rooms where people were isolating. Designated staff provided support exclusively to these people to help avoid the risk of cross infection.

The home had a robust admissions policy. The pre-admission assessment included a thorough needs assessment, recent test status and any risks linked to where people were being admitted from, for example, a hospital ward. Admissions were currently on hold until the home was clear of infection.

People were supported to maintain their mental and physical wellbeing through tailored activities. These included one-to-one sessions in people’s rooms and access to electronic devices to facilitate contact with family, friends and health professionals.

Risk assessments had been completed on high risk staff to demonstrate what reasonable adjustments had been made to reduce risk for vulnerable staff.

Further information is in the detailed findings below.

Rating at last inspection

The last rating for the service was good (published 27 September 2018).

Why we inspected

We undertook this targeted inspection to check on concerns about an outbreak of Covid-19 at the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in post. This person started as manager at the home in March 2018 and became registered manager in July 2018. 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 we rated the service good. At this inspection we found the evidence continued to support the rating of good.

People felt safe. They were supported by staff with a good understanding of how to safeguard them and how to raise concerns either internally or externally if they suspected harm or abuse. There were enough staff to meet people’s needs. A dependency tool was used to help ensure that staffing levels continued to match the needs of the people living there. People’s individual risks were assessed and reviewed.

The home carried out monthly accident and incident audits. This included a description of what had happened, the result of the investigation, and follow up action taken. This helped reduce the risk of things happening again.

People had thorough pre-assessments to support their move to the home. These included people’s needs, preferences, social background and their abilities. People were supported by staff who had received an induction. This involved shadow shifts with more experienced staff and regular competency checks. People were supported to eat a balanced and healthy diet. They were given choice of what to eat and drink and could eat as much or as little as they wanted. Snacks were available to people outside of typical meal times. Where people required extra support with eating and drinking this was provided in line with guidance from health professionals.

People were supported to access health services such as dentists and dieticians to help maintain their health and well-being. Where people’s health needs changed there was timely contact with relevant health professionals. People were supported by staff who understood the importance of offering choice and support in line with what they needed and wanted. This gave people the opportunity to live their lives how they wanted to.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Where people lacked capacity to make particular decisions they were supported by staff who were trained and worked in line with the principles of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides the legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack capacity to make particular decisions, any made on their behalf must be in their best interests and least restrictive as possible.

Staff consistently demonstrated a kind and caring approach towards people. People’s privacy and dignity were supported at all times. They were given time and space to spend private and uninterrupted time with friends and relatives. People were encouraged to maintain their independence.

There was a varied and well publicised activities programme at the home supported by a new activities coordinator. The programme included group activities and 1:1 sessions in people’s rooms. These activities supported people to maintain their interests, develop new skills, and helped reduce the risk of isolation.

People were supported to maintain contact with family and friends. Relatives told us they could visit freely and were always made to feel welcome and involved. Staff were aware of people’s different communication needs and provided information in a way that was most beneficial for them. The home managed complaints in line with their policy. People and relatives expressed confidence that when issues were raised they were dealt with in a timely way and to their satisfaction.

Staff told us they enjoyed working there and felt supported by colleagues and the management team. Opportunities were provided for personal development. Regular team meetings were held to share information and learning. Annual surveys were used to find out how the service people received could be improved.

The home had developed good working relationships with healthcare professionals. This had resulted in pro-active in-reach services from GPs, hospice nurses and a local tissue viability team. These links helped to keep people well for longer and prevent unnecessary hospital admissions.

Further information is in the detailed findings below

Weymouth Care Home provides nursing care for 34 people. There were 32 people living in the home at the time of our visit, some of whom were living with dementia as well as other conditions such as a brain injury and multiple sclerosis. The home was organised into four areas across two floors. There was a passenger lift to allow easy access to the first floor. The majority of rooms had ensuite facilities and there was a communal dining area and lounge as well as a library room which was used as a quiet area or for meetings.

There was a registered manager who had been promoted into their current position three years ago. 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 had opportunity to engage in activities within the home such as games and reminiscence. There were trips out twice a week, some people had one to one time with staff to support them with their social and recreational needs. The provider had reviewed how activities were organised and delivered , this included feedback from meetings and questionnaires. They identified that improvements were required to ensure that activities were varied, planned according to people's interests and were a positive experience for people. There had been staff changes and a vacancy for an activity coordinator was in the process of being completed. This demonstrated the provider had reviewed how activities were organised and was actively making improvements.

There were sufficient staff to meet people’s needs. Staffing was planned according to people’s care and support needs. Staff were supported with their professional development and the registered manager told us three staff had recently left to commence their nurse training. There had been use of agency staff while new staff were recruited and the registered manager told us all vacant staff positions had been filled. Checks were made by the provider to ensure new staff were recruited safely and that the appropriate pre-employment checks were carried out.

The provider told us they had made improvements to training and development. Registered nurses had received training in a range of clinical procedures such as catheterisation and verification of death. All staff were up to date or had training booked which the provider identified as essential such as infection control and health and safety. Some staff had trained as trainers in specific areas such as moving and assisting, which meant training could be delivered when it was needed in the home environment.

People told us the food was good and we saw they were offered a choice of what they would like to eat and where they would like to eat it. People who needed support to eat their meals were supported with dignity. Staff sat with them on a one to one and were unhurried. People had their nutritional needs assessed and a plan of care was developed to ensure the persons needs were met. For example there were several people who had swallowing difficulties. They had been referred to the speech and language team (SALT) for a specialist assessment. We saw staff were following the recommendations which had been made to ensure people were supported safely to have enough food and drink. People who were identified at risk of not having enough to drink were monitored throughout the day and staff told us it was all of the staff teams’ responsibility to ensure people were appropriately hydrated.

People were at reduced risk of harm and abuse. Staff were able to describe to us how they would recognise abuse and were aware of their responsibilities in reporting actual or potential abuse. Staff understood how they would escalate concerns about poor practice and told us about the whistleblowing procedures. One member of staff told us they would not hesitate to contact the CQC if they felt concerns about poor practice were not being addressed by the provider.

People had their risks assessed which included a moving and assisting risk assessment and skin integrity risk assessment. When a risk was identified there was a care plan which provided guidance to staff how to support the person in such a way as to reduce the risk

The environment was well maintained. There were maintenance staff available on a daily basis. There was a maintenance schedule which demonstrated that equipment was service as required and a range of checks were made including electrical items and water quality.

People and their relations told us they were involved in decision relating to the persons care and support needs as well as decisions affecting the home. There were regular review of people's care plans which were updated accordingly.

Staff told us they enjoyed their work and worked well as a team. People were relaxed with staff and we saw positive interactions. Staff were caring and friendly and respectful of people’s individual preferred routines. People had personalised care plans which reflected their likes and dislikes and provided guidance for staff.

The registered manager was accessible and visible within the home and had a good awareness of people’s care and support needs and people were comfortable talking with them.

Registered nurses were supported to complete their revalidation with the Nursing and Midwifery Council (NMC). The registered manager had provided training and as a registered nurse had completed it themself. Registered nurses administered prescribed medicines safely and monitored people to ensure they received as required medicine when needed. They liaised with healthcare professionals for medical or specialist advice when necessary.

There were quality monitoring systems in place which meant any areas for improvement were identified and plans put in place to rectify them.

People who received care at Weymouth care home have substantial and complex needs. They were not all able to verbalise their experiences. We used a variety of ways in which to determine their thoughts and feelings. We were able to talk to members of nursing staff, care assistants, chef, cleaner, family members and some people who use services. One person told us they had recently arrived at the home was "very happy, as been able to bring items from my own home such as my television and can watch satellite TV". We reviewed care plans, medicine charts, nutritional guidelines, staff records and training.

There were adequate numbers of staff on duty able to demonstrate systems that provided effective safeguarding and response to people's needs. Staff were aware of risk assessments and emergency procedures, how to report these and evaluate outcome.

One person's records showed evidence of recent risk assessment, that indicated a fall risk due to being unsettled for short period of time before they went to sleep. To reduce risk, information was written in their care plan to use increased observation during this time and use a bed with lowering facilities and to place "crash" mats either side of the bed while they were unsettled.

People had personalised care plans, choice in diet and activities. Family involvement was encouraged and one family told us they felt welcome any time and could visit when they wished.

Three of the four people we spoke with told us care needs were met. One said, 'I don't think I could wish for better care'. An external health care professional told us, 'The nurses I've seen have good standards of care, but the home needs more consistent staffing'.

Not everyone was able to tell us about their experiences. We therefore used the Short Observational Framework for Inspection (SOFI2) to observe care and help us understand the experience of people who could not talk with us. We saw care and support being provided in a warm, friendly and respectful way.

Medicines were not managed appropriately. One medicine was out of stock, two were not recorded accurately and there was a lack of guidance about when to use some 'as required' medicines.

Appropriate checks were undertaken before people started work. People were cared for by staff who were appropriately trained and knowledgeable about their health conditions. Staff received supervision and appraisal.

People's personal records including medical records were accurate and fit for purpose. Records were held securely and retained for the appropriate length of time.