Wessex House

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

There had been significant improvements following the inspection of August 2019. Positive changes had been made to the oversight of pressure mattresses to ensure they were set at the required setting for each person. This helped to reduce the risk of people developing pressure sores. Protocols were in place for people who were prescribed blood thinning medicines following a fall. Thickening agents were stored safely and had been removed from people’s rooms. Records were revised and were clearer about the type of hoist slings that staff could leave in-situ for people. This meant the risk of harm to people had been reduced.

Rating at last inspection

The last rating for this service was Requires Improvement (published 17 September 2019). At our last inspection we found there was a lack of guidance for monitoring people on blood thinning medicines following a fall, unsafe storage of thickening agents and the incorrect settings for pressure mattresses presented a potential risk to some people. We recommended the provider reviewed the quality assurance system to reflect current best practice.

At this inspection we found improvements had been made. Changes had been made to manage the safety of people’s bed mattress’s to ensure they were set at the correct pressure for people. Thickening agents were safely locked away to avoid harm. Guidance was in place to help monitor people who were prescribed blood thinning meds. People were no longer left with hoist slings under them. If they were then risk assessments were in place and a different type of hoist sling had been purchased. Clear quality assurance systems were with in place with audits of the home and people’s care regularly carried out.

All staff understood their responsibility to keep people safe from harm. Risks to people had been assessed with actions in place to help keep people safe. There was enough staff to safely provide care and support. Checks were carried out on staff before they started work to assess their suitability. Medicines were well managed, and people received their medicines as prescribed.

People and staff felt positive about the registered manager and the management of the home. The registered manager was aware of their duty of candour. Effective quality assurance systems were in place to monitor the quality and safety of care. Audits had improved which helped to identify any shortfalls. There was an open and inclusive culture in the home. The registered manager worked closely with the clinical lead and the quality manager. The area manager had oversight of the home by visiting the home and carrying out checks.

Why we inspected

We carried out an inspection of this service on 8 August 2019. We rated the service requires improvement in Safe and Well Led due to the shortfalls, which we identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check the provider 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 Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Follow up

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

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

Wessex House is a residential care home providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. The service can support up to 56 people.

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

People told us they were happy living at Wessex House and that they felt safe. However, we found that people had been put at potential risk of harm due to pressure relieving mattresses not being checked to ensure they were at the right setting for the person’s weight. We also observed thickening agents left on a sideboard un-observed and stored in people’s wardrobes. This placed people at risk of harm because, the powder used to thicken fluids had the potential to cause a person to choke if they ate it. The systems to check the safety and quality of the service had not been effective in identifying these risks. When we mentioned this to the registered manager they took immediate action to rectify the shortfalls and ensure people were safe.

There were mixed comments on staffing levels, some people said there were enough staff whilst others said, “Staff are rushed of their feet,” and “Sometimes you have to wait as there are not enough staff around.” The registered manager aimed to provide 10% more staff than the numbers recommended by the dependency staffing tool they used to determine staffing levels.

People received effective care from staff who were well trained and demonstrated a good knowledge of people’s needs, likes and dislikes.

People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs. However, the dining experienced differed for people on different floors. On one floor staff sat with people and made the lunchtime a social occasion whilst on the upper floor people experienced a task orientated approach to support around serving and assisting with eating.

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 received care from staff who were kind and caring. Staff always respected people’s privacy and dignity.

Staff encouraged people to be involved in their care planning and reviews. People were supported to express an opinion about the care provided and were involved in the day to day running of the home.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes. However, people’s specific end of life wishes were not recorded in a person centred way.

People were supported by a team that was well led. The registered manager demonstrated an open and positive approach to learning and development. Everybody spoken with said they felt the registered manager was open, approachable and they could see them around the home most days. Staff said they felt they were valued and well supported. They told us they felt their ideas were listened to when they had a suggestion about working practices in the home.

There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from the issues raised.

The registered manager responded promptly to shortfalls raised during the inspection and took immediate action to improve outcomes for people. Following the inspection, the registered manager showed us evidence that all shortfalls discussed had been rectified and systems were in place to prevent them reoccurring.

We have identified one breach in relation to Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Rating at last inspection

The last rating for this service was good (published 13 February 2017).

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.

The last inspection of the service was carried out in September 2014. No concerns were identified with the care being provided to people at that inspection.

Wessex house is a purpose built home which can accommodate a maximum of 56 people. Accommodation is arranged over three floors. Bedrooms are for single occupancy and all have the provision of en-suite toilet and shower facilities. A garden pathway is available on two sides of the home and there is ample parking. The home provides a service to older people who require nursing care. At the time of this inspection there were 37 people living at the home.

There was a 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 registered manager demonstrated a great deal of passion and enthusiasm and spoke of their commitment to promoting and implementing on-going improvements to the service people received. They also spoke of their commitment to empowering and valuing the staff team. One person who lived at the home said “I don’t have any worries at all. If I did, I would say. [Name of registered manager] comes to see us every day and I know for sure she would be straight on it if you were unhappy.” Another person said “Do you know [name of registered manager] comes and chats with us every day. She is so lovely.” We heard people calling out the registered manager’s name when she walked through the home and heard friendly banter and chatter.

People received care and support which was adjusted to meet their changing needs. People had access to appropriate healthcare professionals to make sure they received effective treatment when required. People received their medicines when they needed them and medicines were stored securely. Medicines were managed and administered by registered nurses or senior care staff whose skills and knowledge were regularly monitored.

Risks to people were minimised because there were effective procedures in place to identify and manage risks. These included reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin. A plan of care had been developed to minimise risks and these were understood and followed by staff.

People told us they felt safe and well cared for. One person told us “I couldn’t feel safer really. I know if I use my call bell the staff will come straight away.” Another person said “I prefer to stay in my room. The staff are always popping in to see if I am alright. If I need anything during the night I just ring my bell and they come pretty quickly.”

Risks of abuse to people were minimised because there were effective recruitment processes for all new staff. Staff had been trained and had a good understanding of how to recognise and report any signs of abuse.

People were cared for by staff who were well trained and competent in their role. There were effective systems in place to monitor the skills of staff. One person who lived at the home said “I think the training staff get must be good because they all seem to know what they are doing.” A visitor told us “All the staff are excellent. I find them friendly, professional and confident.”

People were supported to have enough to eat and drink however; views about the quality of the food provided were mixed. The registered manager was aware of this and was currently addressing. Staff knew about people’s preferences and were aware of people’s abilities and any risks associated with eating and drinking. We observed people were provided with food and drink which met their needs and preferences.

People were asked for their consent before staff assisted them with a task. One person said “Everything I do is up to me and my choice. I have never been told to do something.”

People were provided with opportunities for social stimulation and they were supported to maintain contact with their friends and family. People told us they could see their visitors whenever they wished and that they were always made to feel welcome.

People and their visitors knew how to make a complaint. Everyone we spoke with said they felt confident any concerns would be addressed.

There were effective systems in place to monitor and improve the quality of the service provided.

We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We found the service to be safe because care and treatment was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

The people we spoke with told us they felt safe at the home and they commented on the kindness of the staff. Comments included 'I feel very safe here. The staff are friendly and helpful' and 'the staff would do anything you ask without a grumble.'

The provider had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.

Visitors were only able to access the home when they were let in by staff and all visitors were required to sign a visitor's book when they arrived and left the home. This helped to provide a safe environment for people who used the service.

Is the service effective?

We found the service effective in meeting people's physical care needs. The care plans we looked at had been regularly reviewed. This meant that people received care and support which met their up to date needs and preferences. Records showed that the home liaised with people's relatives and representatives as appropriate and that the individual was involved in the review of their care plan where appropriate.

We spoke with two visitors who were complimentary about the care their relatives received. They said 'you cannot fault the general care. My X had a seizure and they got the doctor to review the medication straight away' and 'my X is always clean and warm.'

The service could be more effective in meeting people's social needs. The home employed an activity co-ordinator for 27 hours a week. We met with this person. They appeared very enthusiastic and committed to providing people with a varied programme of activities. Given the number of people and layout of the home, it was not possible for the activities co-ordinator to offer activities or one to one time to each person who lived at the home on a daily basis. Staff told us they did not have time to offer support with activities and did not have time to take people out. Following the inspection we were informed by a member of the provider's management team that there were plans to increase activity hours from 27 to 57 per week.

Is the service caring?

People told us staff were kind and caring. We observed staff interacted and supported people in a gentle and professional manner. People appeared comfortable with the staff who supported them.

People made the following comments 'I think the nurses and carers are first class' and 'the staff are very friendly and will do anything for you anytime.'

Is the service responsive?

People received care that was responsive to their individual needs. People's health care needs had been monitored and appropriately responded to. Information about people's health needs and contact with health and social care professionals had been recorded. We were informed that the service received good support from health care professionals and there were no problems obtaining their input for people when required. The manager told us that people were seen by a doctor within 48 hours of moving to the home.

Staff had up to date guidance on how to support each individual. We read five care plans. These contained assessments of need and outlined how needs would be met. The assessments were regularly reviewed to ensure that they reflected people's up to date needs. We saw people received care in line with their assessed needs. Examples included pressure area care and reducing the risk of malnutrition.

Staff had a very good knowledge of people's healthcare needs and were able to tell us about how they monitored and treated individual needs.

The people we spoke with were generally satisfied with the care they received. However they told us they would like more quality time with staff. The staff we spoke with told us they were able to meet people's 'basic' care needs but did not have time to spend the time they would like to with people. People made the following comments 'the staff are very good. They come in and wash me from head to toe every morning' and 'I need to be turned every two hours and they always make sure that happens.'

Is the service well led?

There was a registered manager in post. A registered manager is a person who has been registered by the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Staff morale was low and we noted a lack of leadership on one of the floors during the lunch time period. This resulted in people having to wait for their lunch to be served. We shared this with the manager during our visit.

There had been a period of instability within the staff team and a number of staff had left employment. However, we saw the manager had communicated staffing arrangements with the staff team through staff meetings. They were in the process of interviewing for staff vacancies and we saw agency staff had been booked in advance to cover shortfalls.

Staffing rotas showed that senior staff were available to support and offer advice to less experienced staff.

There was a complaints policy in place. We saw that any complaints made were fully investigated and responded to. People we spoke with told us they would be comfortable to make a complaint if they were not happy with any aspect of their care.