Wainfleet Care Home

Wainfleet care home is a residential care home providing accommodation and personal care to up to 43 people across 2 floors. At the time of our inspection there were 29 people using the service.

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

Medicines were managed safely, and people received their medicines in a way that suited them.

Staff were safely recruited. The provider carried out the required checks on newly appointed staff before they started working at the home. Staff had received training that was appropriate to their role and the people they were supporting.

People were protected from abuse and avoidable harm. Staff had completed training on how to safeguard people. Risk assessments were completed and followed to identify and reduce potential hazards.

Effective infection, prevention and control measures were in place to keep people safe, and staff

supported people and visitors to follow them.

People had access to healthcare services and staff worked proactively with other organisations.

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.

People had access to good quality food and drink and were supported to eat and drink when needed. People’s personal care needs were met, and their dignity and independence were considered.

Governance was well-embedded into the running of the service. There was a strong framework of accountability to monitor performance and risk. Quality improvements had been made to the service.

The registered manager worked in partnership with key organisations, including the local authority, safeguarding teams and integrated care boards which supported positive outcomes for people.

The culture of the service was open, and people and staff felt able to 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 and update

The last rating for this service was requires improvement (published 19 October 2022) and there were breaches in regulation.

At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

We carried out a focused inspection to follow up the Warning Notices we previously served to check whether the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wainfleet Care Home on our website at www.cqc.org.uk

Wainfleet Care home is registered to provide accommodation and personal care for up to 43 people. At the time of inspection, 37 people were using the service. People were accommodated over two floors.

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

People's care needs were not always risk assessed. Relevant information was not available for staff to give safe care and treatment. Care plans and risk assessments were not always reviewed and updated when a care need had been identified. People’s care needs associated with choking and needing a modified diet were not well managed. Information relating to Speech and Language Team (SALT) assessments were not readily available to staff. Training needs were identified around modified diets. The provider has taken action to organise this training.

There were not always enough staff deployed to provide safe care and treatment to the people living at the service. During our inspection we witnessed people having to wait for care, as well as people with complex needs left unsupervised for long periods of time.

Personal protective equipment (PPE) and disposal bins were not always situated in appropriate locations in order to promote good infection prevention and control practice. In addition, managers did not always act as positive role models for the use of PPE. This had been raised with the service at the last inspection. However, sufficient improvements had not been made.

Since the last inspection the provider had appointed a manager and a deputy manager. However, there are still concerns regarding the culture at the service. Staff did not always feel able to raise concerns with the manager or the provider.

The provider was working with the local authority and CQC. However, governance systems and processes were still not effective.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s medicines were not always stored correctly and protocols for the safe disposal of unused medicines were not followed. However, people did receive their medicines in their chosen way by trained staff.

People using the service told us they felt safe and enjoyed the food prepared at the service. However, they also said that they were bored as there was a lack of activities.

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 requires improvement (Published 19 April 2021). The service remains rated requires improvement.

Why we inspected

We received concerns in relation to Safeguarding, closed culture and leadership at the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wainfleet Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk assessments, staffing levels, training and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wainfleet Care Home is registered to provide accommodation and personal care for up to

43 people. At the time of inspection, 32 people were using the service.

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

Care plans were not always in place to reflect how staff should support people with risks that had been identified. In addition, care plans had not always been reviewed and updated when people’s needs had changed.

Personal protective equipment (PPE) and disposal bins were not always situated in appropriate locations in order to promote good infection prevention and control practice. In addition, managers did not always act as positive role models for the use of PPE.

A high turnover of managers and care staff had impacted the culture within the home. However, the provider had taken action to recruit into vacant posts.

Governance systems had not always been effective in identifying shortfalls. However, the provider was working with the local authority and CQC to make improvements.

There were enough staff employed to provide care for people in a timely manner.

People received their medicines in the ways they preferred.

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 January 2019).

Why we inspected

We received concerns in relation to the management of medicines, risk assessing and leadership within the home. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme.

We found the following examples of good practice.

• The provider ensured there was a sufficient stock of Personal Protective Equipment (PPE) in place and infection control polices had been amended to reflect the current national guidance.

• There was a testing programme in place for staff and people living in the service. This was to ensure if any staff or people had contracted Covid-19 and were asymptomatic, this was identified in a timely way.

• There was a clear procedure in place to ensure people were admitted to the service safely.

• Information and guidance was available to staff and people living in the service relating to Covid-19 and infection control.

• The provider had introduced a visiting procedure's where all visitors were required to have their temperature taken, have sufficient Personal Protective Equipment (PPE) and were instructed regarding social distancing. They had also purchased a safe pod, which would enable people to see their relatives safely when restrictions have been reduced in the future.

• The provider had ensured staff were skilled in infection prevention control. This included modules about infection control and training relating to ‘Donning and Doffing’, how to put on and remove Personal Protective Equipment (PPE). An additional PPE station was to be introduced on the top floor of the home to support staff and reduce risks when changing PPE.

• The service was clean and was odour free . There were cleaning schedules in place, which incorporated deep cleaning and cleaning of high risk touch areas.

• Covid-19 staff surveys were conducted on a regular basis. This sought staff feedback on PPE levels they were using, access to support and information, and ideas, concern and/or comments they had about the management of the pandemic. This enabled the provider to shape and develop their approach.

Further information is in the detailed findings below.

People’s experience of using this service: People continued to receive safe care. Staff understood safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage risks within people’s lives, whilst also promoting their independence.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staffing support matched the level of assessed needs within the service during our inspection.

Staff training was provided to ensure they had the skills, knowledge and support required to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the registered manager, and had regular one to one supervisions. The staff we spoke with were all positive about the senior staff and management in place.

People's consent was gained before any care was provided. 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

Staff treated people with kindness, dignity and respect and spent time getting to know them. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

People were involved in their own care planning and were able to contribute to the way in which they were supported. People and their families were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

The service continued to be well managed. The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection: Good (report published 14/04/2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.