Wentworth Court Care Home

Wentworth Court is registered to provide accommodation, nursing and personal care to 62 older people and people living with a diagnosis of dementia. At the time of our inspection 59 people were receiving support at the service.

The home had a range of communal areas on each floor for people to enjoy, as well as two garden areas where people could sit and relax.

We found the following examples of good practice.

¿ People and their relatives were supported to maintain contact with their relatives. Additionally, alternative ways, including the use of technology, had supported people’s ability to remain in contact with their relatives. At the time of our inspection, visits were being supported. These were pre-booked and were carried out in accordance with government guidance on visiting.

¿ The management team ensured people’s relatives had frequent communication, which included fortnightly phone calls, a social media contact group. Additionally, the home had carried special events to make people’s relatives feel supported and involved, including a special valentine’s day event.

¿ The service focused on people living as normal and fulfilling life as possible. The management team discussed the varying impacts the COVID-19 pandemic had had on people. On the day of our inspection people enjoyed a COVID-19 safe visit from a petting zoo.

¿ Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection.

¿ People’s health and wellbeing was monitored. People were observed for symptoms of COVID-19 and other potential infections. Staff had received further training to focus on promoting people’s health and wellbeing. Healthcare professionals had continued to provide clinical support to people when this was required. This included assistance with their medical needs.

¿ The service had been involved in a special pilot around social care assessments using virtual communications. The management discussed how this pilot, alongside virtual support from their GP and pharmacist, had enabled people to be supported whilst reducing unnecessary visits to the home.

¿ Action had been taken to reduce the risk of infection spreading which had included the correct use of personal protective equipment (PPE). Staff had received training and support in relation to infection control and COVID-19. The management team observed staff practice ensuring they were following the correct use of PPE.

¿ The management team had clear plans in relation to the isolation of people affected by COVID-19 and the cohorting of staff to reduce the spread of infection.

¿ People and staff were tested in line with national guidance for care homes.

¿ As part of full infection control measures laundry and waste arrangements had been correctly implemented to reduce the spread of infection.

¿ Cleaning schedules had been enhanced and were followed by care and maintenance staff. This included the additional cleaning of frequently touched surfaces to reduce the risk of infection spreading. People told us that the home was clean and that staff wore PPE as required.

¿ The provider’s policy for managing COVID-19 and related infection prevention and control procedures had been reviewed and kept up to date. COVID-19 guidance was also kept up to date for staff reference.

Wentworth Court is a residential care home which provides personal and nursing care to 62 people living with dementia. At the time of the inspection 57 people were receiving care. Wentworth Court is located in a suburb of Cheltenham. The home is set across two floors, with the first floor assisting people living with advanced dementia. The home is set in well presented gardens which people could access. There was a range of communal areas that people and their relatives could use.

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

People were safe, comfortable and well cared for at Wentworth Court. People received effective care and treatment which was based on current guidance and best practice. People’s risks were assessed, and staff followed guidance provided by healthcare professionals. Care and nursing staff were fully aware of their responsibilities to raise concerns and the manager and provider ensured lessons were learnt from any incidents or accidents.

Staff were well trained and had the skills to meet people’s needs. Staff had access to support, reflective practice and the professional development they needed. The manager and provider reviewed the training staff had and looked to provide additional training to increase staff knowledge. Staff spoke positively about the support they received from the manager and provider. The service worked alongside a range of healthcare professionals to ensure people’s health and wellbeing were maintained.

People and their relatives told us care and nursing staff were kind, caring and compassionate. Staff were attentive to people’s needs and when people were anxious, care staff took time to reassure them and promote their wellbeing. People were treated with dignity and respect.

People received care which was personalised to their needs. Where people’s needs changed or their health deteriorated, nursing and care staff took appropriate and effective action to ensure their health and wellbeing. The home worked with other services to ensure the needs of people could be met, reducing the strain on community services.

People benefitted from tailored, person centred care and a varied and active life at Wentworth Court. The home was heavily involved in the local community and people enjoyed the benefit of these connections. People and their relative’s spoke positively about the activities in the home as well as the one to one engagement they received. The manager and provider ensured people’s views were acted upon.

The manager and provider had clear and robust systems to assess, monitor and improve the quality of care people received. Systems were designed to continuously improve the service and drive positive changes.

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.

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 29 September 2017). At this inspection, we found the service remained Good.

Why we inspected

This was a planned inspection based on the previous rating of “Good”.

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.

During the inspection we followed up one legal requirement. This had been issued at the last inspection on 22 October 2016. This related to the maintenance of people’s care records in association with their nutritional risks. The provider submitted an action plan which told us how this legal requirement would be met and stating this would be fully met by the end of April 2017. At this inspection we found records pertaining to people’s nutritional risks had been improved and maintained well.

The arrangements in place helped to keep people safe. Risk assessments showed that risks to people’s health and well-being were assessed and managed. Staff were fully aware of what support they needed to provide people with in order to keep them safe. One relative told us they considered their relative to be safe. They said, “I know [name] is safe here and that [name] is not going to be ill-treated.” Relatives and people told us they were happy with the care provided. People were treated with dignity and respect. Comments referring to how well this was done were made by relatives on a website used to review the service.

Staff received training and support to be able to meet the needs of people who lived with dementia and challenging behaviour. Care was planned around people’s individual needs and their preferences. Relatives were supported to be involved in the planning and reviewing of their relatives care. They were encouraged to speak on behalf of their relative if their relative could no longer do this for themselves. Relatives were encouraged to provide staff with information about their relative’s lives. This information helped staff tailor people’s care and provide activities which were meaningful. The staff knew those they cared for well and had built up good relationships with family members. A relative told us that when they visited, staff always knew about their relative and were able to tell them what had been going on for that person. A review comment from the website we visited said, “You always seem to know [name].”

People health needs were assessed and met by nurses employed by the provider and other visiting health care professionals. The service had trained staff so that certain health needs could be met by staff in the care home. This sometimes avoided the need for unsettling visits to the GP surgery or hospital. Staff worked closely with GP’s, end of life specialists and the NHS rapid response teams to help achieve this. The principles of the Mental Capacity Act were followed. 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. Where people were deprived of their liberty this was done lawfully with authorised Deprivation of Liberty Safeguards in place or these having been applied for.

There were arrangements in place for complaints and areas of dissatisfaction to be expressed, listened to, investigated and resolved. There was an open and positive culture in place and senior management staff were keen to learn from and improve the service from the feedback they received. Relatives told us they felt comfortable in raising any concerns or areas of dissatisfaction they may have. They told us these were listened to and improvements made. Meetings were held with people, relatives and staff to aid communication and feedback. A strong leadership team had been established and although the registered manager was preparing to take a longer-term period of leave at the end of September 2017, she was confident that the service would be effectively managed in her absence. Effective monitoring systems were in place which ensured the service remained compliant with all necessary regulations and legislation and that action were taken to constantly improve the service.

We found records relating to people’s nutritional needs were not sufficiently maintained. This put people at risk of potentially not receiving safe or appropriate care and treatment due to a lack of accurate information held about their needs. This is a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report. We did however observe people receive the support they needed to eat and drink and there was evidence to show that some people’s nutritional health had improved.

The registered manager had managed the service since October 2015. 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 and her senior management team had provided stability to the service. This team were now in a position to provide consistent and effective leadership to staff. They shared the same values, visions and expectations and these were communicated to the staff effectively. The provider had a quality monitoring system in place, which in places recorded detailed findings. The audit process had been effective in highlighting some gaps in practice and process but there was not always the evidence to show that the auditing process was fully completed.

Wentworth Court had been a previous care home which the current provider completely re-configured and extended. Existing areas of the building were complemented by the addition of areas of new build. People lived across two floors with the first floor being accessed by a passenger lift or stairs. Each person had their own bedroom which they could or were supported to personalise. Each bedroom had a private toilet and washing facilities [a wet room]. There were additional bathrooms and toilets which had been adapted to help those who required specialised equipment to bathe safely. Each floor had its own communal rooms where people sat, socialised and ate. The main reception area also offered a place to sit with an on-site café which was staffed on a regular basis. This provided an opportunity for family and friends to enjoy a coffee or tea with homemade cakes and pastries with their relative or friend. This facility was also open to and used by the local community. Leading off this was an outside court-yard style garden. People could sit inside and observe the seasons and the plants or they could enjoy the outside safely. In addition to this the main garden was fully enclosed. Major improvements to this had been carried in the last year. It provided people with another outside place to enjoy with relatives, friends and staff. Following the improvements this included raised plant borders, chickens and a large shed. The shed was a project specifically designed to provide men with activities that would be more meaningful to them.

The registered manager had managed the service since October 2015. 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.

Family members considered their relatives to be safe at Wentworth Court. There were arrangements in place to protect people from potential abuse. Visitors were confident they could raise concerns and these would be acted on. People were not discriminated against and behaviours which could be perceived as challenging were managed in a non-judgemental way and in the least restrictive way. All accidents and incidents were monitored and actions were taken to help reduce, for example, falls reoccurring. Risks to people were identified and managed.

The service’s recruitment processes had not always been fully effective but the provider had recognised this and taken appropriate action to improve this. Staff employed had been closely monitored to ensure good character and had completed competency checks so the risk to people from this had been low. These improvements now needed to be embedded and sustained. Any poor practice or unacceptable staff behaviour was addressed straight away. There were enough staff to meet people’s needs and staff were deployed in a way which helped to meet people’s needs. People’s medicines were managed safely and staff who administered these had been trained to do so safely.

People were supported to make choices on a daily basis and where possible to make independent decisions. Where they lacked mental capacity to do this appropriate people, such as relatives and legal representatives were given opportunities to speak on their behalf. Decisions made on behalf of people were made in line with current legislation and only in the person’s best interests. Staff had received training and support to look after people who lived with dementia. Their skills and knowledge had improved over the last year and on-going training and support was planned in order to support good practice. People received support to eat and drink and to make choices about this. Arrangements were in place to ensure people had access to local health care professionals and specialists when needed.

People received care from staff who were kind and attentive. They were treated with respect, their dignity was maintained and they were afforded privacy at the appropriate times. People who mattered to those living at Wentworth Court were welcomed and also supported. Care plans had been improved and work was still in progress to make sure these recorded the necessary detail to support staff to deliver personalised care. Improvements to the senior staff team now meant these records could be better maintained going forward. Other arrangements such as staff hand-over meetings helped to ensure staff were updated with people’s current care requirements.

People were supported to socialise and to join in activities which had some meaning to them. The contribution made by relatives in helping to maintain people’s well-being, sometimes at difficult and upsetting times, was valued by the staff and seen as integral to people’s overall holistic care. Senior managers were open to suggestions and ideas from relatives if these were aimed at improving the service and outcomes for people. People’s relatives told us they felt able to raise areas of dissatisfaction or make a complaint. These were taken seriously by managers and addressed.