Wentworth Residential Home

We found the following examples of good practice.

The home was clean and hygienic in appearance. Infection control policies and procedures had been updated in line with the national guidance relating to COVID-19 and staff were provided with regular updates to ensure they were following best practice recommendations. The training for staff regarding infection control had been updated to include guidance relating to COVID-19.

Staff were following current infection prevention and control guidance to help people to stay safe. For example, all staff were observed using appropriate Personal Protective Equipment [PPE] when supporting people. Where a person was in isolation supplies of PPE were available at the entrance to their room. Regular discussions took place between staff and people to ensure they understood the reasons for social distancing. People who had limited capacity were sensitively encouraged to social distance by staff.

There were appropriate procedures to ensure that infection control risks were reduced. For example, in the communal areas the furniture was arranged to enable social distancing. Increased cleaning schedules ensured that communal areas were cleaned regularly. All rooms had a deep clean weekly. Regular audits and visual checks were made to ensure infection control procedures were effective.

The manager worked with the whole staff team to ensure infection prevention and control measures were in place. This included introducing separate entry and exit points for staff so they could access and exit the service without walking through the home. The changing area included individual storage space for staff clothes. Uniforms were laundered on the premises to reduce the risk of cross infection.

Clear signage and sanitiser dispensers were in place around the service. They were informative and highlighted what PPE was required to protect people.

People who used the service were supported to communicate with their friends and family. Telephones and electronic devices were used to communicate. At the time of the inspection a national lockdown was in effect and visitors were not admitted to the home apart from to see people who were receiving end of life care. However, there was a plan to create an isolation pod which would mean people would be able to visit in a safe sealed environment.

Further information is in the detailed findings below.

Wentworth Residential Home provides accommodation over three floors. Some bedrooms are on the ground floor where communal areas are also present. The remaining bedrooms are on the first and second floor which is accessed by chair lifts. Staff continuously monitor people if they remain in their rooms to ensure people’s needs are met at all times. People are able to access a patio and garden area. The home is near to St Austell town centre which people visit.

There was a registered manager in post who was responsible for the day-to-day running 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. Wentworth Residential Home has been owned by the provider for 38 years and is a family run business. The registered manager is a family relative. and has been in this post for seven years.

We carried out this unannounced inspection on 27 January 2018. At the last inspection, in January 2016, the service was rated Good. At this inspection we found the service remained Good.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People who were able to talk to us about their views of the service told us they were happy with the care they received and believed it was a safe environment. Comments from people included, “All the staff are amazing”, “it’s lovely here”, “What I like about this place is you are treated as an equal” and, “You are treated as individuals, not as a crowd, I’m treated as a person.” Relatives we spoke with told us they were “very pleased” with the care that their family members received. Comments included “it’s a happy home, it feels like home.” Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People’s behaviour and body language showed that they felt cared for by staff. Staff said they were proud to work at Wentworth and told us “The people are lovely. It’s lovely here we [staff] work well as a team.”

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety. People said they felt safe at Wentworth, and relatives echoed this view.

The service was warm, comfortable and appeared clean with no unpleasant odours. The service was well maintained by the in house maintenance staff and using contractors as required. Bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Some people living at Wentworth were living with dementia and were independently mobile around the service. The service had pictorial signage to help people who need additional support recognising areas of the building such as their bedrooms, toilet and shower rooms.

People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at Wentworth. Staff were prompt at recognising if a person’s health needs had changed and sought appropriate medical advice promptly. One person told us “I didn’t feel well the other day, they [staff] asked me lots of questions to see what was up and looked after me well.” Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

People told us they were able to take part in a range of group and individual activities. A programme of activities for the month was on display so that people could decide if they wanted to participate in the group activities. We saw people undertaking individual activities such as reading newspapers, word searches, socialising and watching TV

There were safe arrangements in place for the administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained. Medicines which required stricter controls by law were stored correctly and records kept in line with relevant legislation.

People told us the food was “amazing” and “great.” Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs.

Staff were recruited in a safe way. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.

Staff were supported by a system of induction training, one-to-one supervision and appraisals. The induction and on-going training of staff ensured they were effective in their role. Staff knew how to ensure each person was supported as an individual in a way that did not discriminate against them. People’s legal rights were understood and upheld.

Management and some staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). However staff demonstrated the principles of the MCA in the way they cared for people. Staff believed that everyone at the service had the right to make their own decisions and respected them. The provider told us currently the people they supported had capacity to make decisions about their health and welfare and this was constantly reviewed. The provider knew the process to follow if a person’s level of capacity changed so that the service would act in accordance with legal requirements.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example.

People and relatives all described the management of the home as open and approachable. People and their relatives told us if they had any concerns, or comments about the service that they could approach the provider, manager or staff “without hesitation.” People were asked for their views on the service regularly. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

The last inspection took place on 20 August 2014. The service was meeting the requirements of the legislation at that time. Prior to this inspection the CQC had received anonymous information of concern regarding staff struggling to manage the needs of some people living at the service. We were not able to substantiate the concerns raised.

Wentworth is a care home which offers care and support for up to 20 predominantly older people. At the time of the inspection there were18 people living at the service. Some of these people were living with an impairment of their mental health. The service comprised of a detached house over three floors.

The service had 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 was not present on the day of this inspection. The provider was present.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. We found it was always possible to establish if people had received their medicines as prescribed. Regular medicines audits were consistently identifying if errors occurred.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had no staffing vacancies at the time of this inspection. Short notice absences due to sickness were always covered by the existing staff members and agency staff were not used.

Staff were supported by a system of induction training, supervision and appraisals. However, the service did not have plans in place to implement the Care Certificate for new staff who did not have experience of the role. We were assured this would be addressed. Staff meetings were not formally held but staff were able to speak daily to the registered manager and the provider as needed. Staff felt able to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. However, we identified one person whose needs had increased and there was no specific guidance for staff regarding how to respond to behaviour that challenged them. Where appropriate, relatives were included in the reviews.

Activities were provided regularly. The service had a minibus and regularly encouraged people to take trips out in to the local area.

The registered manager was supported by the provider who also worked regularly at the service. The policies and procedures held at the service had been reviewed by the registered manager in July 2015. However we found some had not been updated effectively and were not providing staff with accurate up to date information. The provider assured us this would be addressed immediately.

The provider sent us an action plan setting out how they would address the concerns raised at the last inspection. We carried out this inspection to review the action taken by the provider. This inspection was carried out by one inspector.

We gathered evidence against the outcome we inspected to help answer one key question: Is the service safe? We gathered information from people who used the service and a visitor by talking with them.

Is the service safe?

At the time of our inspection we found the service to be safe.

Care plans were individualised and contained information that directed and informed staff to provide appropriate care and support.

We reviewed the medication administration records (MAR). We did not see gaps in these records. This ensured that people received their prescribed medication at the appropriate time.

Creams that were prescribed for people and stored in their rooms had been dated upon opening. This ensured staff were aware of the expiry date of the cream.

At this inspection we saw the management held a training matrix showing which staff had attended certain training programmes. We saw individual staff files contained records of supervision/appraisal and training certificates.

Since our previous inspection the provider had taken action to improve the management and completion of care documents which meant, people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We found the provider had appropriate arrangements in place to manage medicines; people received their medication at the appropriate times. However, creams used by service users were again found to not have been dated upon opening. We saw handwritten entries on medicine charts which did not follow procedure laid down in the medicine policy.

We found people were not protected from the risks of unsafe or inappropriate care and treatment. The daily records were not held securely, risk assessments had not been dated and medicine records were not accurate.

We found people who used the service had their privacy and dignity respected.

We found people did not always receive their medication at the appropriate time.

The staff at Wentworth told us they felt well supported by the manager, we saw from their records they had received regular supervision. We did not see any evidence of appraisals having been carried out.

People were not protected from the risks of unsafe or inappropriate care and treatment as care plan and risk assessment reviews were not always recorded in a consistent and timely manner. We saw some records were not stored securely.

The relatives of people who used the service were positive in their comments about the home and the staff. Comments made included 'The owners and staff are lovely, very kind and look after me well', 'there is always a choice of food and the food is good'. People told us they would feel able to go to the owners or staff if they had any concerns, and they said they felt confident the owners would resolve any issues.

A visiting health professional told us Wentworth Residential Home was 'one of the best around', and they did not express any concerns about the care provided. We found the care documentation did not always identify that people's care needs were consistently met.

People were protected from abuse and staff were trained and supported to carry out their roles, although staff were not always kept informed of relevant guidance and procedures.

The home was hygienic and clean, and free from odours.

People were protected by the home's recruitment procedures, and staff were supported with training and supervision.

The service had an effective system to monitor quality of care.