Wainford House Residential Care Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection we rated this key question Inadequate. At this inspection the rating has changed to Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The findings identified a repeated breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Ineffective checks and incomplete follow-up meant risks could remain unidentified or unresolved, leaving people at risk of avoidable harm and inconsistent care.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had made progress in developing a more positive culture. Staff described improved communication, clearer working arrangements and increased support. One staff member told us, “Everything here is different now, the way we treat [people]… now we explain to [people] and document everything.” Another said, “Absolutely for the better, staff can go to the manager easily to improve things and do things better.” Staff also described the home as “a happier, calmer place to be.”

However, the provider’s values and expectations were not yet consistently embedded in all aspects of the service. We identified environmental and safety concerns, including areas being poorly lit when people were moving around the home, outstanding maintenance and cleanliness issues. Some people also had limited opportunities to take part in meaningful activities that reflected their interests.

This meant the improvements in culture described by staff and seen in their interactions with people had not yet resulted in consistently positive experiences across all areas of the service. People were not always supported in an environment which was safe and well maintained or provided with meaningful opportunities that promoted their wellbeing and quality of life.

Some improvements were made following our feedback, including removing instructions to staff about switching off lights and the heating. However, these concerns had not been identified and addressed through the provider’s own oversight arrangements. This demonstrated that further work was needed to ensure the provider’s expectations for safe, person-centred and high-quality care were understood and consistently embedded in everyday practice.

Relatives also spoke positively about communication and their involvement in people’s care, and we observed staff providing calm, kind and respectful support. This showed improvements in the culture of the service and in how staff engaged with people and those important to them.

The service did not have a CQC registered manager in post at the time of our assessment. However, staff and relatives spoke positively about the manager and described them as approachable and supportive. Staff told us the manager was visible and available, which was consistent with our observations.

The manager had access to remote compliance support and operational support from senior staff. However, leadership arrangements did not always provide sufficient on-site oversight to ensure regulatory responsibilities were consistently met. This included ensuring required CQC notifications were submitted and that identified risks and areas for improvement were effectively addressed.

The service remained reliant on the manager for much of its day-to-day leadership. The evidence did not demonstrate that wider leadership arrangements provided sufficient capacity and oversight to consistently identify shortfalls, meet regulatory responsibilities and sustain improvements. This increased the risk that improvements would not be consistently embedded or maintained.

People, relatives and staff felt able to raise concerns and share feedback. Relatives described an open and approachable service. One said, “The management team is approachable; [manager’s] door is always open.” Another told us, “Anything they are worried about they call me into the office, good interaction and always an open-door policy.” A further comment was, “All the staff are very approachable, polite and friendly.”

Staff understood how to report concerns to senior staff, managers, or the local authority safeguarding team. This helped ensure safeguarding concerns could be escalated appropriately, reducing the risk of people experiencing avoidable harm.

Relatives described an open and approachable management culture and gave examples of concerns being responded to promptly, including issues relating to personal care and people’s belongings. Staff and relatives were also able to provide feedback through surveys. This meant people, relatives and staff had opportunities to speak up and felt confident that concerns would be listened to and acted upon. We found no evidence that people or staff were discouraged from raising concerns.

Staff described an inclusive and supportive culture and told us they felt valued, respected and treated fairly. They did not raise concerns about discrimination or unfair treatment. The provider had equality and diversity policies in place, which staff understood.

Staff had opportunities to share their views and raise concerns through surveys, meetings and feedback arrangements. This supported a culture where staff felt able to speak openly and were treated fairly and with respect, regardless of their background or protected characteristics.

The provider had systems to oversee the service and check quality. However, these systems did not always find or address problems with risk management, medicines, infection control, the building and care records. Some checks said all standards had been met even though we found problems during the assessment. Management reports did not always show enough analysis or comparison of information to help identify themes and trends to drive improvement and learning. Action plans did not always say who was responsible, when work should be completed or how the provider would check whether improvements had worked and been sustained and embedded.
The service did not have a manager registered with CQC. Leadership arrangements did not always provide enough management presence and oversight at the service to make sure legal responsibilities were consistently met. The provider dealt with several concerns during the assessment. However, this showed that managers sometimes acted only after problems had been found, rather than finding risks before they affected people.
Further improvement was needed to strengthen leadership and oversight, learn from problems, and make sure improvements were checked and maintained.

The service was operating below capacity, with 13 of 28 places occupied at the time of assessment. This raises concerns regarding the sustainability of the service. Furthermore, aspects of the environment and the condition of the premises require attention to ensure the building remains well-maintained and suitable to meet people's needs.

The provider had not notified CQC when the lift was out of service. The appropriate notification was submitted retrospectively following our feedback. Risk assessments relating to the lift and stairs were also not sufficiently robust. Although these were reviewed during the inspection, they did not consistently demonstrate that people’s individual risks had been fully considered or that appropriate professional advice and supporting information had been used to ensure risks were effectively mitigated.

Several actions were taken in response to concerns we identified. However, this demonstrated that governance and oversight remained reactive in some areas, rather than independently identifying and addressing risks before they affected people. The provider could not therefore be assured that its systems would consistently identify shortfalls, drive improvement and protect people from avoidable harm.

The provider worked in partnership with relatives, healthcare professionals and other organisations to support people’s care. Staff maintained links with healthcare professionals, and relatives described good communication with the service. The provider and manager had also worked with the local authority and healthcare professionals to support improvements since the previous inspection. This helped promote a coordinated approach to people’s care and supported continuity when people needed input from different services.

The manager had identified opportunities to strengthen people’s connections with the wider community, including developing links with a local church and gardening group. These arrangements had not started at the time of our inspection, so their impact on people’s opportunities for community involvement and social connection could not yet be evaluated.

The provider had made improvements since our last inspection, including changes to staffing arrangements, daily allocations and oversight of care. However, the provider could not consistently demonstrate that learning from audits, monitoring and identified concerns resulted in sustained improvements.

Audits and governance reports did not always identify the shortfalls we found or demonstrate that actions had been completed and their effectiveness reviewed. For example, infection prevention and control audits recorded full compliance despite concerns we identified with cleanliness and surfaces that could not be effectively cleaned. Monitoring had also identified concerns about people’s care, but records were limited in detail and did not always demonstrate what action had been taken or whether this had improved outcomes for people.

Some action plans did not clearly identify who was responsible for completing actions, timescales for completion or how improvements would be evaluated. This meant the provider could not consistently demonstrate that learning was translated into effective action or that improvements were embedded and sustained. As a result, there was an increased risk that shortfalls could recur or opportunities to improve people’s care could be missed.