We carried out a review of the data available to us about Widecombe House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Widecombe House, you can give feedback on this service.
Widecombe House is a residential care home that provides accommodation and personal care for up to 18 older people. At the time of our inspection there were 18 people were living at the home.
People’s experience of using this service and what we found
People, their relatives and health professionals told us people living at Widecombe House were well cared for and staff were respectful, kind, and caring. People's rights to privacy and dignity were understood and promoted by staff.
People told us they felt safe. Staff were trained in safeguarding and knew what to do if they were concerned about the welfare of any of the people who lived at the home.
People continued to receive care that was personalised, responsive to their needs and effectively delivered to ensure the best outcomes were achieved. People were placed at the centre of their care and staff developed strong relationships with people and fully understood what caused each person stress or anxiety. Staff involved people and their relatives in their care and support, so they felt consulted, empowered, listened to and valued, which achieved good outcomes for people.
Staff were passionate about helping people to live happy and fulfilled lives. The home developed and provided meaningful activities for people tailored to people’s individual hobbies and interests. Staff understood the importance of meaningful occupation in helping people to maintain their independence.
Staff continued to demonstrate a strong commitment to supporting people to receive a comfortable, dignified and pain-free death. Staff understood the importance of spending time with people to comfort and reassure them whilst respecting their individual wishes. The home received many letters and cards sent by relatives thanking staff for the care, compassion and support they gave to their loved ones at the end of their lives.
Risks to people's health and welfare were assessed and care plans were in place to manage and mitigate the risk. Where people had risks associated to their health needs care plans did not contain sufficiently detailed information to guide staff. However, staff we spoke with were knowledgeable about these health needs and had received training in these areas. We made a recommendation to the provider to ensure records contain sufficient information for staff to follow.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed. However, improvements could be made within the home regarding the way best interests decisions were recorded. We made a recommendation to the provider about this.
People received care from staff who had received suitable training and induction. There were sufficient numbers of staff on duty to meet the needs of people living at the home and spend quality time with them. During the inspection visit we observed staff had the time they needed to support people safely. If people needed assistance this was provided promptly, and staff were always present in communal areas to observe people and keep them safe.
Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.
Records showed people were referred to the appropriate health care professionals when necessary and that their advice was acted upon. This meant people were supported to maintain good health.
People were very complimentary about the meals provided at the service. Mealtimes were a social affair and meals were enjoyed in a calm and relaxed environment. Where people were at risk of poor nutrition, advice from health care professionals was sought and their recommendations followed.
People received their medicines safely and as prescribed. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.
People, relatives and staff expressed a very high level of confidence in the leadership and management of the home. Comments included, “The management are lovely. You never feel as if the home is ‘managed’, it’s very personal, more like a home” and “It’s managed well. The care is being provided to a high level even when they [managers] are not here and that’s a sign of good leadership.”
People and their relatives were listened to and there were systems in place to obtain people's views about their care. People and relatives were encouraged to provide feedback on the service and felt they could raise concerns.
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 19 August 2017).
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.
The home was last inspected in April 2015 when it was rated as 'Good' overall.
Widecombe House is a residential home in Torquay, Devon providing accommodation and care for up to 18 people. People living at the home are older people, some of whom were living with dementia or a physical disability. On the day of the inspection, 18 people were living at the home.
The home was managed by a manager. The manager was in the process of applying to become the registered manager. 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.
The home was extremely caring. We observed a range of warm and affectionate interactions during our inspection, with people and staff sharing jokes and laughter. Staff were kind and caring and had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. They supported people to enable them to remain as independent as possible. Staff showed that they understood how to assist people living with dementia through the use of good moving and handling techniques when they supported people to move about the home. They communicated clearly with people in a caring and supportive manner.
We found that people’s end of life care was exceptional. Staff supported people compassionately, sensitively and with love in a familiar environment as they approached the end of their lives. One visiting healthcare professional told us, "Staff have gone above and beyond, particularly with regard to end of life care. They managed that really well and staff take the time to understand people's end of life wishes. People at the end of their lives receive one to one care at Widecombe and that is truly exceptional."
People we spoke with and their relatives were unanimous in their praise of the caring attitudes of staff. We found the atmosphere to be extremely relaxed, calm and welcoming and all relatives we spoke with told us this was the case whenever they visited. We saw people were treated in a dignified manner with regard to personal interactions with staff, as well as having their rights upheld, such as the right to choose where they spent their time.
People, relatives and staff felt the home was well–led. People and staff described the manager as approachable, available and supportive. Staff talked positively about their jobs and took pride in their work.
The manager was inspiring and dedicated to providing care which met the highest of standards. They strived for excellence and were passionate and dedicated to providing outstanding care to people and a loving family home. They led with a dynamic approach and continually reflected on how to improve the home further. They demonstrated a strong and supportive leadership style, seeking feedback in order to further improve what was offered. The provider's vision and values were understood and shared across the staff team, and they were fully supportive of development plans.
People told us they felt safe living at Widecombe House and staff knew how to safeguard people from the risk of abuse or poor practice. Staff knew what actions to take if they had any concerns for people's wellbeing. The manager knew what action to take if concerns regarding people's safety were brought to their attention.
The home had robust quality assurance processes in place. People's opinions were sought formally and informally. Feedback was sought from people and their relatives to assess the quality of the service provided. Audits were conducted to ensure the quality of care and environmental issues were identified promptly. Accidents were investigated and, where there were areas for improvement, these were shared for learning.
Staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and people’s right to make decisions about their care and treatment and to say how and where they wished to be supported. Staff confirmed a number people living at the home lacked the capacity to make decisions about their care. Care plans showed evidence of capacity assessments and best interests decision outcomes. Staff supported and encouraged people to make individual choices in how they lived their lives. For people who lacked capacity to make certain decisions, staff prompted and offered people choices which were made in their best interests.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection applications had been submitted to the supervisory body (local authority), some were currently waiting approval and four had been authorised.
There were sufficient staff on duty at any one time to meet people's needs safely. People were protected by safe recruitment procedures. Staff were supported with an induction and an on going training programme to develop their skills and staff competency was regularly assessed. Staff received training in dementia care to support people living with dementia. Staff displayed a sound understanding of all aspects of care we asked them about during the inspection and we found care to be delivered extremely effectively.
Staff ensured people received a nutritious, balanced diet and people who required it were supported to eat their meals. People were very happy with the quality of their meals and said they were given enough to eat and drink.
People had their health needs met. People received visits from healthcare professionals, for example GPs and community nurses, to ensure they received appropriate care and treatment to meet their health care needs. Professionals confirmed staff followed the guidance they provided. This ensured people received the care they needed to remain safe and well.
People's medicines were managed, stored, and disposed of safely. Senior staff administered medicines and had received training and confirmed they understood the importance of safe administration and management of medicines.
Where possible people were involved in their care planning. Care records were personalised, comprehensive and detailed people's preferences. Staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.
People's risks were considered, well-managed and regularly reviewed to keep people safe. Where possible, people had choice and control over their lives and were supported to engage in a wide range of varied activities within the home. Records were updated to reflect people's changing needs.
There were quality assurance systems in place which enabled the provider and manager to assess, monitor and improve the quality and safety of the service people received. Procedures were in place for the manager to monitor, investigate and respond to complaints in a timely manner.
Widecombe House was registered to provide care and accommodation for up to 18 people. People living at the service were older people who in most cases had some degree of memory loss or dementia.
This inspection took place on 5 February and 10 March 2015 and was unannounced. There were 16 people living at the home.
This was the first inspection following the re-registration of the service. Although the service had re-registered it was still run by the same family. There is no requirement for a manager to be registered at this service. However, the service does have a manager.
Prior to this inspection we had received some concerns about the level of care provided by the service. The concerns included there not being enough staff, people not receiving prompt medical attention and people’s personal care needs not being met. We found no evidence to support any of the concerns. There were also concerns about medicine administration and we found some evidence to support this.
People’s medicines were not always managed safely. Medication administration record (MAR) charts were not completed correctly. There were written procedures in place so staff would know when to administer medicines that that been prescribed to be taken when needed. However, these procedures were not clear and in one case stated the medicine was to be given when the person became distressed. The procedure did not say how staff would recognise when the person was beginning to become distressed, or if distraction techniques should be used before the medicine was given. This meant people were at risk of being given the medicines inconsistently. Creams that had been prescribed and were in use did not have the date written on them when they had been opened. This meant people were at risk of using creams that were past their use by date.
Staff told us about the dementia care training they received and how this helped them care for people with dementia. Staff were careful to speak slowly and calmly and gave people time to process any information, good eye contact was also maintained. When moving and transferring people staff used good techniques and reassured people while they were being moved.
Staff had a clear understanding of the Mental Capacity Act 2005 (the MCA) and the deprivation of liberty safeguards. Staff told us that most people could make their own decisions about their care, but may not be able to consent to more significant decisions. People were asked for their consent before staff provided personal care. One person told us staff always asked if it was alright to help them and said “Oh yes, no problem with that”. When staff thought people may not be able to make significant decisions an assessment of the person’s capacity to make decisions had been undertaken. There has been a recent change to the interpretation of the deprivation of liberty safeguards and the manager told us they had made the appropriate applications to the local authority in order to comply with the changes.
People were protected from the risks of abuse because staff demonstrated a good knowledge of different types of abuse and knew how to report any suspicions. People were protected by robust recruitment procedures that minimised the risk of unsuitable people being employed.
Some people were at risk of falling or of choking and there was evidence that professional advice had been sought in order to minimise the risks. Staff were aware of people’s risks and we heard how they monitored people in order to minimise their risks. Procedures were in place to protect people in the event of an emergency. Staff had been trained in first aid and were aware of how to safely evacuate people from the building if this was needed. People’s needs were met by ensuring there were sufficient staff on duty that had the skills and knowledge to meet their needs.
People were supported to receive a balanced diet with sufficient to eat and drink. They were offered plenty of snacks and drinks throughout the day. One person told us “meals are very good, plenty of choice”. Care was taken to find out what people liked to eat. People were supported to maintain good health and had access to healthcare services where required. Records showed people had seen their GPs and district nurses. A member of the district nursing team told us staff always contacted them appropriately and followed any instructions they were given.
People and their visitors told us staff were very good and caring. All the interactions we saw between people and staff were positive. There was appropriate friendly banter between staff and people, with staff often sitting and chatting to people. Staff and people sang and danced and laughed throughout the inspection. One health care professional told us staff were “compassionate and caring, quick to respond to professional advice, and very good with more challenging people”.
One person’s first language was not English. Staff had produced a list of common sayings in the person’s first language that they used to reassure the person if they began to become distressed. We saw the person smiling and laughing when staff acknowledged them in their first language.
Not everyone was able to verbally express their views. Those who could knew about their care plans and said the manager discussed it with them. Visitors told us that where their relatives could not express their views they had been involved in making decisions about their care. One relative told us they had gone through their relative’s care plan when their needs had changed and were asked if they agreed with things. They told us they were “100% involved in everything”. All visitors told us they were always kept updated about their relative’s care. One relative told us they had been asked to stay for meals with their relative, as staff felt this may encourage the person to eat more. Another visitor said when their relative had been in hospital staff had visited to encourage them to eat.
Visitors told us they could visit at any time and were always made welcome. All visitors said that they visited most days and one said they spent most of the afternoon and evening there every day.
People’s privacy was respected and all personal care was provided in private. Staff recognised people’s needs when people could not tell them what they needed and quickly responded to them. For example, people were discreetly offered the toilet when staff recognised this may be what people wanted.
Everyone we spoke with told us they had never had to raise any concerns about care. They were confident that if they did raise concerns they would be dealt with quickly by the manager. A complaints procedure, using symbols was displayed in the entrance porch.
The manager was very open and approachable. They had a clear vision for the home and staff told us this was to ensure the home was “people’s home”. It was clear people knew who the manager was, people greeted them in a warm and positive manner with plenty of laughter and smiles.
There were effective quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor safety and quality of care. Where improvements were needed action had been taken to improve matters. For example, an infection control audit from November 2014 had highlighted areas of the home that needed more cleaning. The manager had addressed the issues with the cleaner and the matters had been rectified.
All accidents and incidents which occurred were recorded and analysed. This helped staff identify any triggers that may help prevent further accidents and incidents.
Records were well maintained. A computerised care planning system was used and all staff had an individual password to maintain confidentiality.