Archived: Old Wall Cottage Care Home

Old Wall Cottage is a nursing home which accommodates up to 33 people in one adapted building. The building is divided into two units. There were 26 people living at Old Wall Cottage at the time of our inspection.

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

People and relatives were positive about the care and support given by staff, and the changes being made by the new manager. While we noted that a number of improvements had been made to address the concerns we raised at our last inspection, we have identified several ongoing issues around management of risk and how the service was led.

Risks to people’s health and safety were still not well managed. The home environment and equipment were not kept consistently clean, which put people at risk of infections. Staff were also observed to carry out unsafe moving and handling practices which put people at risk of injury.

The home had not had consistent day to day leadership since our last inspection, and the provider had not ensured that improvements were made in response to the concerns raised at our last inspection.

Some aspects had improved, for example deployment of staff had improved to ensure that there were enough to meet people’s needs. The management of people’s medicines had also improved, so that they had them when they needed them, and the systems that were being used minimised the risk of errors. We have recommended that the provider updates their policies with regards to the use of covert medicines.

Where accidents and incidents had taken place, these had been reviewed to see if anything could be learnt, and to prevent reoccurrence. The new manager had not yet completed a review of this information for August or September 2019, so we have recommended that this is completed.

New staff were recruited in a safe way to ensure they were suitable to support the people that live here. Staff understood their roles and responsibilities in keeping people safe from abuse.

Staff now received training and supervision to ensure they had the skills needed to meet people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to access health care professionals such as the GP, dentist and chiropodist when needed. We have recommended that the staff review the level of detail in oral healthcare plans, so they are clearer on how staff should support people.

The home was all on one level, so people did not have to negotiate stairs. They also had access to the gardens, which had several points of interest for them. We have made a recommendation around the internal environment and how it should be reviewed as part of the planned refurbishment to better meet the needs of those people living with dementia.

The choice and variety of food had improved since our last inspection, and people were supported to have enough to eat and drink.

People were supported by kind and caring staff; however, we have made a recommendation because they could have been more attentive to people and their needs.

People had more access to activities than at our previous inspection; and their care records were in the process of being updated to ensure they better reflected the care and support people needed. As both these processes were just being introduced at the time of the inspection, we have recommended that the provider continues to make improvements in these areas.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 September 2018) and there were six breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection although some improvement had been made, not enough had been done, and the provider was still in breach of two regulations. This is the second consecutive inspection where the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Old Wall Cottage on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Old Wall Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Old Wall Cottage is a nursing home which accommodates up to 33 people in one adapted building. The building is divided into two units. There were 26 people living at Old Wall Cottage at the time of our inspection.

There was no registered manager in post. 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. The last registered manager left Old Wall Cottage in October 2017. Since this time the service has been managed by an existing staff member (acting manager) with support from the regional management team.

Sufficient staff were not deployed to meet people’s needs. People were left waiting for their care on occasions and there were not always sufficient staff present in communal areas to monitor people’s safety. Staff employed did not always receive the training they required to meet people’s needs. Clinical staff training had not been regularly updated although a programme of training had been organised. Staff had not always received regular supervision although systems to ensure this took place had been implemented.

Risks to people’s safety were not always adequately monitored and records of risk monitoring were not accurately maintained. People did not always have access to a call bell in order to summon assistance when required. Infection control practices were not monitored and some areas of the service were not clean. Medicines were not always managed safely. The temperature of medicines storage was higher than recommended limits and action had not been taken to minimise this risk. People had not always received their medicines in accordance with prescription guidelines and topical creams were not appropriately managed.

Quality assurance processes were not always effective in ensuring that any shortfalls in the care people received were identified and acted upon. Although staff told us they felt supported in their roles, there was a lack of management oversight and the values of the service were not consistently upheld. Complaints were responded to although were not reviewed to ensure they did not happen again. We have made a recommendation regarding this.

People’s legal rights were not always respected as the principles of the Mental Capacity Act 2015 were not always followed. People’s capacity to make specific decisions was not always assessed and restrictions in place were not always discussed to ensure they were in people’s best interests. People were not always treated with dignity as elements of people’s personal care were not always attended to. People’s care was not always personalised as people’s preferences and past lives were not always taken into account. Care plans regarding the care people wanted when reaching the end of their lives lacked detail. There was a lack of activities for people to be involved in. We have made a recommendation regarding how people were supported with food choices although people’s nutritional needs were met.

In other aspects of people’s care staff demonstrated a caring approach and responded to people’s needs positively. People were supported to maintain their independence and interacted positively with people. Visitors were made to feel welcome and there were no restrictions on visiting times. People and their relatives were involved in the care planning process and any guidance from relatives was listened to. Regular resident and relative’s meetings were held and feedback gained was positive.

People were assessed prior to them moving in so the service could be sure they were able to meet their needs. People were supported to remain healthy and had access to a range of healthcare professionals. The environment was suitable for people’s needs and aids and adaptations were available.

Staff understood their responsibilities in safeguarding people and protecting them from potential abuse. Safe recruitment processes were in place to ensure that staff employed were suitable to work at the service. Accidents and incidents were recorded, reviewed and action taken to minimise the risk of them reoccurring. Regular health and safety checks were completed and equipment was serviced to check it remained safe for use.

During this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service did not have registered manager in post on the day of the inspection visit. ‘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 and associated Regulations about how the service is run.

There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who lived at the service. Staff received annual appraisals and regular formal supervision. .

Staff recruitment procedures were robust to ensure that staff had appropriate checks undertaken before they commenced employment.

The guidelines to minimise the risk had been reflected in people’s care plans to help keep them safe. Risks were well managed and assessments of risk to people were reviewed and updated on a regular basis.

People were protected from the risk of abuse. Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. They told us they would report anything they were uneasy with to the nurse in charge. The staff we spoke to knew of types of the different abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

Medicines were well managed and people had their medicines when they needed them. All medicines were administered and disposed of in a safe way.

Where people were not able to make decisions for themselves we checked whether the staff were working within the principles of the MCA. We read whether any conditions on authorisations to deprive a person of their liberty were being submitted appropriately and found that they were.

People were encouraged and supported to be involved in their care. People’s bedrooms had been decorated to a good standard and were personalised with their own possessions.

Health care needs were being met. People had access to a range of health care professionals, such as the GP, a community psychiatric nurse, dentist and opticians.

People told us the food was very good and there was lots of choice. We saw people had access to drinks and snacks at any time during the day or night.

Staff were kind and compassionate. We saw people were treated with and respect and their privacy and dignity was respected at all times. For example staff knocked on people’s doors before they entered their room.

People had individual care plans which gave clear guidance to staff on what support people needed. They were detailed and updated regularly. Relatives told us they had been consulted regarding people’s care plans and were able to attend reviews of care.

The manager operated an open door policy and we saw of this throughout the day when staff were able to have discussions with the manager. They also ensured they were visible on the floor as their office was not easily accessible to people with mobility needs.

People were aware of the complaint procedures and told us they would know how to make a complaint. A relative told us they were satisfied with the way their complaint was managed.

The manager had maintained accurate records relating to the care and treatment of people and the overall management of the service. The manager and deputy manager had systems in place to record and monitor the quality of the service provided and to make improvements where necessary. Accidents and incidents were recorded and acted upon.

People would be protected in the event of an emergency at the home. Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

We were told that the staff respected people's privacy and dignity and were instructed to knock on individual's doors before entering a private room and to communicate appropriately with individuals. People who use the service told us that the staff were 'very good' and that they felt able to speak to them should they have any concerns.

Staff told us they were happy working in the home. One person said, "It's like a big family here" and another person said, 'I'm very happy, I love it here.' People told us they had been made aware of the provider's complaints procedure but they had no complaints about the service they received.

People told us they liked living at the home and were happy. Comments included "I can't fault it" and "It's ok, I'm happy with it here".

We were told that the staff respected the privacy and dignity of people by knocking on doors before entering the room and speaking appropriately to them. People told us that staff were "Very good" and that they felt able to speak to them should they have any concerns.

People told us they were involved in their care and support. One person said "We have regular meetings with everyone to talk about the care here".

Relatives of people told us they are happy with the service and felt that people were safe. They told us that if they had a problem or a concern then they would know who to speak to about it. Comments included "I'm confident that my relative is safe here" and "If I have any concerns then I can speak to the staff or the manager and I know they will sort it out".

Staff told us they felt "Supported" and were happy working in the home. One person said "It's like a big family here" and another person said "I'm very happy, I love it here".