Wraysbury House Limited

Wraysbury House Limited is a residential care home providing care and support for up to 30 people. People were living with a range of needs associated with the frailties of old age and some other physical and mental health needs, including dementia. 27 people were living at the service on the day of our inspection.

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

People received personalised care and support specific to their needs and preferences. One person told us, “I’m happy, they are very kind.” People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Staff understood the risks associated with the people they supported. Risk assessments provided guidance for staff about individual and environmental risks. People received their medicines safely, when they needed them.

Care was person-centred and promoted people’s dignity, privacy and human rights. People’s individual needs and choices were recognised, and respected. People were supported to have 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.

The provider and staff had worked hard to develop good leadership. Quality monitoring systems had been embedded and morale was good amongst the staff team. We received positive feedback in relation to the care people received and how the service was run. One person told us, “I can’t complain.” A relative added, “[My relative] can often be very difficult, but they manage this well. The home feels like a home, rather than an institution and I don’t think we could do better.”

Staff had the skills and knowledge to meet people’s needs and preferences. They received training, regular supervision and attended team meetings to support them in their roles. People’s nutritional and hydrational needs were met. There was also regular involvement from health and social care professionals.

We observed a kind and caring culture. People spoke positively about the support staff gave to people. We observed positive interactions between people and staff throughout the inspection.

People’s care plans were personalised and gave staff the information they needed to support people. We saw people were supported with their communication needs and their preferred activities in accordance with their care plans.

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 September 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wraysbury House is a residential care home providing personal care for up to 30 older people. People were living with a range of needs associated with older age and some people were living with dementia. There were 27 people living at the service on the day of our inspection.

People’s experience of using this service

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “I’ve got no concerns whatsoever. The staff are fantastic, very helpful. [Registered manager] keeps me updated regularly about [my relative]. Everyone is doing a very good job, and everyone is very welcoming and professional.”

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.

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 COVID-19 and other infection outbreaks effectively.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received good care that met their needs and improved their wellbeing. The staff team were dedicated and enthusiastic.

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 14 September 2018).

Why we inspected

We received concerns in relation to the cleanliness of the service, staffing levels, medicines administration, COVID-19 testing and the management of the service not acting on concerns raised. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the key questions of effective, caring and responsive. We therefore did not inspect these. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The service was clean and tidy and specific processes were followed to ensure all cleaning tasks were consistently completed. This included frequent disinfection of areas which were regularly touched, for example, door handles and handrails.

Hand-washing facilities were available, and visitors had their temperatures taken and completed a questionnaire before entering the service. Personal protective equipment (PPE) was available throughout the service.

The registered manager and staff completed detailed risk assessments for both people living at the service and staff to ensure their safety. The registered manager had a full record of test results for people and staff. The registered manager also worked closely with other stakeholders, such as the Local Authority and Public Health England.

Staff were wearing appropriate PPE in-line with government guidelines. Staff had completed infection prevention and control (IPC) training. The registered manager had undertaken additional IPC training to support staff with best practice.

Further information is in the detailed findings below.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. However, we identified some issues in respect to recording. This had already been recognised by the registered manager and did not place people at risk.

We have made a recommendation in respect to compliance with the Accessible Information Standards (AIS).

Risks associated with people’s care, the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were cared for in a clean and hygienic environment and appropriate procedures for infection control were in place.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as the care of people living with dementia.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. Notifiable events and actions had been reported to the CQC in a timely manner.

A registered manager was 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 and associated Regulations about how the service is run.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. People’s care was enhanced by adaptations made to the service.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. Staff had received supervision meetings with their manager, and formal personal development plans, such as annual appraisals.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included, arts and crafts and visits from external entertainers. There were visits from local churches, so that people could observe their faith. People were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views. People said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where the registered manager was always available to discuss suggestions and address problems or concerns.

We inspected Wraysbury House on 27 October and 1 November 2017. The inspection was unannounced.

Wraysbury House 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.

Wraysbury House provides accommodation, nursing and personal care for up to 27 people in one adapted building. At the time of the inspection there were 24 people living in the home. People living at the home were older people with various support needs, including dementia, mental health and physical disabilities.

There was manager in post at the home who was currently in the process of applying to be a registered manager for 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.

We last inspected the service on 26 April and 3 May 2016. At this inspection, we asked the provider to take action to make improvements as we found people were at risk of their care needs not being understood or met as their care planning records had not been fully completed, personalised and were not fit for purpose. We also found the provider had not ensured people’s consent to care and treatment was sought in accordance with the Mental Capacity Act (MCA) 2005. The provider sent us an action plan on 31 July 2016 outlining how they would take action to address the matters.

Since the last inspection, the provider had been sold to another company in February 2017. The new owner of the provider had retained the same registration responsibilities as the previous ownership. These included ensuring that actions on the plan sent to us on 31 July 2016 had been completed. At this inspection we checked to see if the provider had made the necessary improvements in these areas. We found people were still at risk of not having their care needs met as the provider had not been able to ensure people’s care planning records were fully completed, personalised or fit for purpose. We found the provider had taken adequate action to ensure people’s care and consent was sought in accordance with the MCA. The manager and staff understood and put into practice the principles of the MCA when supporting people. People’s care plans clearly documented that they or an appropriate person had consented to their care and this was open for review at any time.

The provider was not ensuring safe and proper management and practice when supporting people with medicines. Arrangements for managing medicines including obtaining, recording, storing, disposing and administering were not safe and people were at risk of harm due to this.

Identification, assessment and management of risks to people at the home was not always safe. We found that, although identified, there was a lack of detail and guidance in people’s risk assessments and care plans about how to manage risks safely. Equipment in place to help manage risks to people was not always functioning.

Fire alarm checks and fire drills were taking place regularly along with health and safety checks and maintenance audits. However, there was no current fire risk assessment at the home so it was not certain the premises were safe from all fire risks and there was a lack of detail in people’s personal emergency evacuation plans about how to support them safely in the event of a fire.

The provider had systems in place to audit quality and safety, but we found these systems were not effective. Identification of risks to people or areas in need of improvement was not consistent. Actions taken in response to any identified risks or improvements were not always implemented or successful.

The provider had not consistently followed safe recruitment practices. Records showed two references had not always been historically obtained for all staff before commencing their employment. The provider was now taking action to locate the missing references.

The home was not always clean and hygienic. On the first day of the inspection there were strong offensive smells of urine in the front entrance, hallway and from people’s bedrooms. Areas of the property were not clean and furniture was stained and in poor condition. Housekeeping staff were under-recruited, leading to shortfalls in maintaining an acceptable standard of cleanliness. The provider had addressed these issues on the second day of the inspection.

People were involved in decisions about their care and relatives told us they felt the home provided kind and compassionate support. We observed staff supporting people in a caring manner. Staff we spoke to showed a good understanding of the importance of treating people with respect. However, during the inspection we found people’s privacy and dignity was not always respected. We discussed this with the provider and they took immediate action to address this.

The home had enough staff to meet people’s needs. The manager logged and reviewed accident and incident forms to help identify any themes and subsequent actions needed to keep people safe. Staff received safeguarding training and showed a good understanding of their responsibilities to keep people safe.

Staff received an induction that met the Care Certificate standards and received training in subjects relevant to their role. Some staff training was missing or required updating, there was a plan in place to address this and the provider was in the process of delivering this.

The manager was proactive in arranging and maintaining links with organisations to provide on-going guidance and training to help improve support at the home. Staff received regular supervisions and appraisals to support them to understand their responsibilities.

People had support to maintain good health and had access to healthcare professionals and services. Staff had a good understanding of people’s health needs and monitored these appropriately. People had support to access sufficient food and drink and the home supported people to manage any dietary or nutritional needs. The service placed an emphasis on supporting a healthy, varied and balanced diet. Meal times were flexible and people had an active input in the menu and could choose what they wanted to eat.

The provider encouraged feedback and sharing information with people and their relatives in order to help them to respond to people’s needs quickly and effectively. People and their relatives knew how to raise a complaint and felt confident to do so. People we spoke to who had raised a complaint were happy with the response they received.

The service supported people to access a range of social activities they could choose to take part in. There was an on-site activities co-ordinator and people had support to take part in activities in the local community. People had support to develop and maintain relationships with people important to them and had support to meet their cultural and spiritual needs.

There was a positive culture at the service and staff and relatives spoke highly of the manager. There was a good level of shared understanding from all staff at the home of the vision and values of delivering high quality care. Staff and management showed a willingness to work together to overcome challenges and concerns and develop the home to realise this vision. Staff felt supported and the provider was committed to supporting the manager and the team with any necessary resources to drive improvement at the home.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and that in some areas the service was failing to meet the national standards that people should be able to expect. You can see what action we told the provider to take at the back of this report.

Wraysbury House Limited is registered to provide accommodation and personal care for up to 27 people. At the time of the inspection 27 older people were living at the home. People had various needs including dementia and physical disabilities.

Wraysbury House is an older styled detached property close to the centre of Worthing with easy access to shops and the seafront. Spacious communal areas include a lounge leading to a conservatory dining area which overlooks a large garden and a further sitting room. The surrounding gardens were maintained to a high standard, hanging baskets were positioned all around the building. All rooms were single occupancy apart from one which was shared. All bedrooms had en-suite facilities.

We found the home to be clean and tidy and maintained to a high standard. Home furnishings such as pictures, flowers and ornaments decorated communal areas. Paintings were hung within vintage frames adding to the ‘grand’ style of the home.

A registered manager had been in post since January 2016. 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.

Care records showed how people were assessed prior to receiving support from the service and how current care was planned. Care plans failed to reflect the individual needs of people living with dementia. Care plans lacked involvement from people and their relatives. Two care plans held no information about people’s personal histories, likes, dislikes and preferences. Therefore lacked the level of guidance required for staff supporting people within the home. The registered manager was able to share how improvements to care plans would be made.

Where people lacked capacity to give their consent to their care best interest meetings were held in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards legislative. However, the registered manager was unable to demonstrate that the Mental Capacity Act 2005 (MCA) had always been followed because capacity assessments had not always been completed on behalf of people.

Our observations and records confirmed there were sufficient staff on duty to keep people safe.

Staff had been trained in how to recognise signs of potential abuse and protected people from harm. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks.

Staff demonstrated how they would implement the training they received in core subject areas by providing care that met the needs of the people they supported. Staff received regular supervisions and spoke positively about the guidance they received from the registered manager.

Additional drinks and snacks were observed being offered in between meals and staff knew people’s preferences and choices of where and what they liked to eat.

Staff spoke kindly to people and respected their privacy and dignity. Staff encouraged people to be as independent as possible. Staff knew people well and had a caring approach.

People and staff told us they were happy with the activities that had been organised. The home employed an activities coordinator to help engage with people.

There was a complaints policy in place. All complaints were treated seriously and were managed in line with the complaints policy.

People and their relative’s views were obtained mainly through informal means however the registered manager had plans to develop their systems further. The registered manager met with people routinely to check on their wellbeing.

There were was a range of audits in place, overseen by the registered manager to measure the quality of care delivered, including checks on the environment.

Generally, people and their relatives felt the home was well-run and staff felt supported by the registered manager and other members of the management team.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

People living at the home told us that staff were kind and respectful towards them. One person said 'the staff are very nice'. Relatives told us that the staff seem well trained. One relative said 'the staff are good at listening to people and therefore have a good understanding of what people might want to do'. They explained this was important when people could not express themselves easily.

People and their relatives told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations. A relative told us "the home is really nice and the manager is always open to relatives ideas and opinions'.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs.

Care records we looked at showed that people's consent had been sought regarding their care and treatment.

We found that people's needs and wishes were recorded in a plan of care that was kept under regular review and risks to people's safety were assessed.

We saw that people were protected from the risk of infections because the provider had infection control systems in place.

Records showed that people were supported by staff who had received training appropriate to their roles, and had been recruited appropriately.

The provider had an effective complaints system in place. We found that comments and complaints people made were responded to appropriately.