Archived: Wainford House Residential Care Home

Wainford House is a residential care home providing accommodation and personal care for up to 28 people aged 65 and over. At the time of the inspection the home was supporting 18 people. The service does not provide nursing care.

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

At this inspection we found that risk assessments designed to record how to keep people safe had improved since our last inspection and were reviewed and amended as necessary. There were clear procedures in place which were operated effectively for the purpose of protecting people from abuse. The manager had addressed the issues identified at the last inspection regarding the heating of the service and recording temperatures, securing wardrobes to the wall, installing stair gates and radiator covers

People living at the service, their relatives and staff working at Wainford House informed us there were enough staff on duty throughout the day and night to provide the care required. The service had a recruitment process which was used by the manager to recruit staff. Senior staff had been trained in the administration of medicines and people received their medicines as prescribed. The manager reviewed events at the service with the staff to determine if any lessons could be learnt. Staff received training in various subjects including infection control and received supervision and appraisals.

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’s specific communication needs were known, respected and met. Each person had a care plan which included person-centred information about them. People’s desired outcomes were known, and staff worked with people, relatives and relevant professionals to help achieve and review these with their consent.

The manager had implemented a robust and effective governance system to monitor the service performance and act upon any issues identified. Staff understood their roles and responsibilities. Staff informed us they enjoyed working at the service because they were well supported. Annual surveys gave people, relatives, staff and visiting professionals an opportunity to express their views and contribute to improvements.

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 inadequate (published 29 January 2020) and there were two breaches of regulation. The provider completed actions after the last inspection to improve the service. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 29 January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

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.

Wainford House provides accommodation and personal care for up to 28 older people, some of whom were living with dementia. At the time of our visit 19 people were using the service.

What life is like for people using this service:

People were not always protected from the risk of harm because care planning did not accurately reflect the measures in place to reduce the risk. For example, the risk of choking or pressure ulcers.

Shortfalls in the heating had not been acted upon appropriately and no monitoring system was in place to check temperatures throughout the service. People told us they were cold and a thermometer stated the temperature in one person’s bedroom was 17 degrees. People told us about ongoing issues with the heating and their wish for this to be fixed.

The service had deteriorated in compliance again since the previous inspection on 1 August 2019, and is now in breach of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider has been unable to bring about sustainable compliance with regulations over an extended period of time. Eleven inspections have been carried out since May 2013 and the service has only been compliant with regulations and reflecting the characteristics of a 'good' rating at two of these.

Whilst we saw activities happening during our inspection, two of the four people we spoke with still made negative comments about the provision of activities and said they were bored. The service was recruiting for a second activities staff member to improve the opportunities people had for engagement.

We observed that staff and the management team were kind and caring towards people. However, the lack of sustained improvement over time meant we were not reassured that the providers were consistently ensuring, investing in and promoting a caring culture focused around the provision of good quality care.

Care plans had been further developed to include more personalisation. There were life histories in place so staff could find out more about the past life of people who may not be able to recall this information independently. People received the support they required at the end of their life.

People were offered a choice of meals which met their nutritional requirements. The risk of people becoming malnourished was identified, monitored and managed.

There were sufficient numbers of staff available to provide care to people. People told us staff were kind and caring and knew them as individuals.

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):

At the last inspection the service was rated Good. (Report published 21 August 2019)

At this inspection we found there had been a deterioration in the service provided to people and there were shortfalls that had not been identified and addressed. This included breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected:

This was a comprehensive inspection carried out to check whether improvements made previously had been sustained.

Enforcement:

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Wainford House provides accommodation and personal care for up to 28 older people, some of whom were living with dementia. At the time of our visit 21 people were using the service.

What life is like for people using this service:

People who live at Wainford House have their needs met by sufficient numbers of suitably trained staff. People told us staff were kind and caring and knew them as individuals.

Significant improvements had been made to the environment, including redecoration and refurbishment throughout.

Improvements had been made to the provision of activity. People were supported to remain engaged.

People were offered a choice of meals which met their nutritional requirements. The risk of people becoming malnourished was identified, monitored and managed.

People received the support they required at the end of their life.

The quality of care plans had been improved upon and these now accurately reflected people’s needs in sufficient detail.

Improvements had been made to the quality assurance system in place. This meant there was better oversight of shortfalls and areas for improvement. The service was working through action plans to further develop the quality of care provided. Due to the service's history of failing to sustain compliance, more time was required to assess whether these improvements will be sustained.

Positive comments about the management team and providers were made by people who used the service, relatives and staff.

The service worked well with other organisations to ensure people had joined up care. People were supported to have input from external healthcare professionals in a timely way.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

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):

At the last inspection the service was rated Inadequate. (Report published 27 February 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 27 February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected:

This was a planned inspection based on the previous rating.

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.

At the last inspection on 22 and 23 November 2017, we rated the service ‘Requires Improvement’ overall and we told them to make improvements to the quality assurance system in place and how people’s capacity and consent to care was assessed and recorded. At this inspection, we found that the standard of service provided to people had deteriorated. The service was found to be in breach of Regulations 12, 9, 10, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A new manager had started working for the service three weeks prior to our inspection and was in the process of registering with the Commission. 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 were not enough suitably skilled, supported and knowledgeable staff to meet people’s needs in a timely way, including their social and emotional needs. People told us staff did not have time to spend with them and that interaction with them was linked to tasks.

People were not adequately supported to be engaged in meaningful activities and people told us they got bored.

The provider had failed to bring about sustained improvement to meet the fundamental standards and maintain compliance with regulations. The service has not met the fundamental standards or complied with regulations since an inspection in March 2014. This means that people have continued to receive a poor service over an extended period of time.

The décor and overall condition of the service did not promote people’s dignity and respect. Some areas of the building were in a poor state of repair and redecoration had been completed to a poor standard. The service was not decorated in a way which helped people living with dementia orientate themselves around the building.

Medicines had not always been administered in line with the instructions of the prescriber and it was not clear why. This had not been identified and acted on by the service.

There were environmental risks that had not been identified by the service. Actions to ensure the safety of the premises had not always been completed and checks were not consistently carried out to identify issues.

Not all staff had received training in key subjects, nor had they received regular supervision or appraisal to develop their skills. The new manager had identified this and booked all staff onto training.

People and their relatives told us they did not remember being involved in care planning. Care planning did not make clear people’s views about their care and evidence their involvement. Improvements were required to fully personalise care plans and improve information about people’s personal preferences. Despite this, staff knew people well and provided them with personalised care.

The service was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Risks to people were appropriately planned for and managed. Staff understood the risks to people and how they could be reduced. People received appropriate support to maintain healthy nutrition and hydration.

Staff treated people with dignity and respect. People were supported to have the privacy they wished for. Interactions between staff and people using the service were caring, kind and considerate. People told us staff were kind to them.

The new manager was visible in the service and led by example. Staff told us they felt supported by the new manager and able to raise any concerns with them and make suggestions. People and their relatives were invited to meetings to express their views.

The overall rating for this service is 'Inadequate' and the service therefore is 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.

Further information is in the detailed findings below.

This unannounced comprehensive inspection took place on 22 and 23 November 2017.

There was a registered manager in post when we inspected the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 overall rating of this service was Requires Improvement at our last inspection of 6 July 2016. The key questions Effective, Responsive and Well-led were rated as Requires Improvement. Safe and Caring were rated as Good.

There had been some improvements made in the service but not sufficiently in Effective and Well-led which remain at Requires Improvement and therefore the service rating remains overall at Requires Improvement.

We undertook this unannounced inspection to provide a rating for the service and to check that the service was now meeting legal requirements. There had been a breach in regulations regarding the implementation of the Mental Capacity Act 2005 (MCA). We found that improvements had been made but that further improvements were still required with documentation.

People were not always fully involved in the writing and review of their care planning. Staff had been trained in the MCA and Deprivation of Liberty Safeguards. We observed that they put this training into practice when providing day to day care. However, the principles of the MCA were not always put into practice with regard to recording information in people’s care plans about mental capacity assessments and best interest decisions

People felt safe living in the service. There were systems in place designed to protect people from the risk of harm. Individual risk assessments were in place and covered key risks specific areas to the people such as personal emergency evacuation plans, moving and handling and falls.

The staff demonstrated a clear understanding of the actions they would take if they suspected or witnessed any concerns about people’s safety. Risks were assessed and management plans were in place to minimise the risk to people’s safety. Medicines were managed safely and sufficient numbers of staff were deployed to meet people’s needs.

Staffing levels were calculated using a dependency tool and there were sufficient numbers of staff to support people to meet their individual needs. Safe recruitment practices were followed. Staff had received training and support to enable them to provide people with appropriate support.

Staff had received infection control training and used this information for the storage of food and cleanliness of the accommodation.

The registered manager learned from incidents or accidents within the service and made the necessary improvements. They shared this information with the staff through supervision and staff meetings.

Staff were provided with a wide range of training appropriate to the various needs of the people living at the service. People were provided with a healthy and well balanced diet and their choices had been taken into consideration.

Other professionals worked with staff so that people had access to healthcare services and on- going healthcare support.

People were involved in the running of the service. They had been asked to give their views about the decoration of the premises. The decoration and signage within the service had been updated and improved.

People were supported to have maximum choice and control of their lives. However this information had not always been recorded.

People were treated with kindness and compassion. It was evident that positive relationships had developed between people and the care staff. People expressed their views to staff about the support they required and their dignity and privacy were respected.

Care plans were person-centred and preferences were clearly documented regarding individual choices of food. People were supported to raise concerns.

Staff, people living at the service and relatives spoke positively about the registered manager and the support they received. Staff viewed that the registered manager was approachable and would listen to suggestions made in how to improve the quality of care provided. Regular reviews of the quality of care were carried out and the service worked in partnership with other agencies for the benefit of the people living there.

We had previously carried out an inspection on 16 February 2016. Breaches of legal requirements were found. After that inspection the provider wrote to us to say what they would do to ensure legal requirements were met.

We undertook this inspection to check that they had followed their plan and to check if they were now meeting legal requirements. We found that improvements had been made but that further improvements were still required.

Wainford House is a care home providing care and support to a maximum of 28 people. On the day of our inspection there were 23 people living in the service some of whom were living with dementia.

The service had a registered manager in place. 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 were not always fully involved in the writing and review of their care planning. We have made a recommendation about involving people in decisions about their care.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. We observed that they put this training into practice when providing day to day care. However, the principles of the MCA were not always put into practice when sharing information with others.

The decoration and signage within the premises did not meet the needs of people living in the service, particularly those living with dementia. We have made a recommendation regarding decoration of the service.

People felt safe living in the service. There were systems in place to protect people from the risk of harm. Individual risk assessments were in place and covered key risks specific to the person such as moving and handling and falls.

Staff levels were calculated using a dependency tool. We were told, and observed, there were sufficient numbers of staff on duty to support people’s needs. Safe recruitment practices were followed. Staff had received training and support to enable them to provide people with appropriate support. Support with training had been sought from key agencies outside the service.

People were involved in meaningful activities. Staff provided a range of activities for people to participate in. Plans were in place to develop and personalise activities.

The Registered Manager was developing an open and honest culture within the service. They were receiving support from the provider to do this. A range of audits were in place or being planned to monitor the quality of the service provided. These need to be sustained and used to drive improvement in the service.

We carried out an unannounced comprehensive inspection of this service on 12th October 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wainford House on our website at www.cqc.org.uk.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

• Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

The home had a registered manager in place. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.

People told us they felt safe living in the service. However, people were put at risk of harm because care records and assessments did not reflect current areas of risk and how these should be managed to protect the person from harm.

Medicines were not consistently managed and administered safely.

People told us, and we observed, that there were not always enough staff available to meet people’s physical and emotional needs. The manager had not made improvements to the staffing levels.

The manager and provider had not taken action to ensure the competency of staff following our previous inspection where we identified that the training staff had received was ineffective and did not provide them with the knowledge they required for the role. Staff did not receive the appropriate support from the management of the service to develop in their role.

Improvements had been made to ensure that appropriate Deprivation of Liberty Safeguards referrals had been made where required, and assessments of people’s capacity had been completed where appropriate. However, staff remained confused and unsure about the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.

People were not consistently supported to live full and active lives, and to engage in meaningful activity within the service.

Care planning for people did not reflect their current needs and the information was generic. There were limited life histories for people living with dementia, and care records were not personalised to include people’s hobbies, interests, likes and dislikes. Some work had been undertaken to improve these following our inspection, but they remained unfit for purpose.

People told us they were not consistently involved in the planning of their care. Improvements were required with regard to how people are involved in the planning of their support in the future, and how their views are reflected in their care records.

There were no adequate systems in use to monitor the quality of the service and to identify shortfalls and areas for improvement. There wasn’t an open culture at the service. There was no process in place to gain the feedback or views of staff, and discussions had not been held with staff following our previous inspection.

There was a complaints procedure in place and people told us that they knew how to complain.

There was a recruitment procedure in place to ensure that prospective staff members had the skills, qualifications and background to support people.

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

We greeted and talked generally to people who used this service, but did not ask their opinions about the their care or running of the service on this occasion.

During this inspection we found that the new manager had instigated changes and improvements to the quality assurance monitoring within the service and they were now compliant. We looked at the way the service assessed and monitored the quality of service it provided and found that the provider had an effective system to regularly assess and monitor the quality of service that people received .

We saw that the service had taken precautions to protect people from infection and that staff had received training in infection control and food hygiene.

We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We looked at the care records of four people who used the service. We found that they contained appropriate assessments of people's needs and plans for their care. An infection control specialist looked at infection control in Wainford House and has identified a number of areas for improvement. A pharmacy inspector inspected the management of medicines within the service and has again identified some areas for improvement.

We looked at the way the service assesses and monitors the quality of service it is providing. We found that accurate records relevant to the management of the premises were not always kept and that although audits were being carried out these were not effective.

We looked at the care records for five people who used the service. They contained conflicting information and had not involved the person they related to or their relatives. Other records we looked at included medication records, quality audits and cleaning schedules. We found a number or omissions and errors in all of these records and could not be satisfied that they were accurate or up to date.

Measures to assess the quality and effectiveness of the service provided were not sufficient and there was no evidence that where errors were identified, appropriate action was being taken.

Although work had started on installing a new kitchen this had not taken into account the impact on people who used the service. Measures were put in pace while we were there to remedy this.

During our inspection we spoke with six people who used the service. They told us about the care and support they received. One person said that they thought the care was, 'Reasonable.' They added that they were, 'Luckier than some of the people here because I can still get out and about on my own.'

We looked at the care people received and found that there had been significant improvements in the quality of care plans since our last inspection. However, this still required further attention.

We looked at the maintenance of the premises. We found that the premises were not adequately maintained or cleaned. Cleaning schedules showed that cleaning of the premises was not planned and cleaning which took place was not monitored.

The service did not have an effective complaints system in place. People were not able to bring complaints to the attention of the service with confidence that they would be investigated.

The service did not have effective systems in place to assess and monitor the quality of service which was being provided.

The service had improved record keeping since our last inspection. Care plans had been revised and were kept in a secure cabinet.

We inspected four people's care records. We found that they were not kept securely and did not accurately reflect the care and treatment people required. Advice from visiting professionals such as a social worker was not followed.

The service did not have an effective complaints procedure.

We inspected the premises and looked at maintenance records. We found that maintenance and cleaning was not adequately planned and recorded.