Wells Lodge Nursing Home

Wells Lodge Nursing Home is registered to provide accommodation, nursing and personal care for 22 older people. There were 22 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. There was no registered manager in post. A registered manager is a person who has registered with the CQC 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. However, there was a manager who was in charge of the day to day running of the service and who had applied to be registered with CQC. In this report we refer to the company as being, ‘the registered person’. When we speak about the person who was in day to day charge of the service we refer to them as being, ‘the manager’.

At the last comprehensive inspection on 24 and 25 January 2017 the overall rating of the service was, ‘Requires Improvement’. We found that there were two breaches of the regulations. This was because there were shortfalls in the arrangements that had been made to provide people with person-centred care. In particular, suitable provision had not been made to fully support people who had special communication needs to express their wishes about all parts of the care they received. We also found that robust arrangements had not been made to complete background checks in relation to new nurses and care staff.

We told the registered person to take action to make improvements to address both of our concerns. After the inspection the registered person told us that they had made the necessary improvements.

At the present inspection we found that suitable provision had been made to provide people with person-centred care and to complete background checks in relation to new nurses and care staff.

Our other findings were as follows. People had been safeguarded from situations in which they might experience abuse. People received safe care and treatment. Medicines were managed in the right way and there were enough nurses and care staff on duty. Suitable provision had been made to prevent and control infection. Lessons had been learned when things had gone wrong.

People received care that achieved effective outcomes in line with national guidance. This included providing people with the reassurance they needed if they became distressed. Nurses and care staff knew how to care for people in the right way and had received training and guidance. People were helped to eat and drink enough to maintain a balanced diet. Appropriate arrangements had been made to help people receive coordinated care when they moved between different services. People had been supported to access healthcare services when necessary. Suitable arrangements had been made to obtain people’s consent to the care and treatment they received. The accommodation was adapted, designed and decorated to meet people’s needs and expectations.

People were treated with kindness and compassion in a way that respected their dignity. People were given emotional support when it was needed and they had been supported to be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received responsive care that met their needs for practical assistance and which took into account their special communication needs. People had been offered sufficient opportunities to pursue their hobbies and interests and to engage in social activities. Suitable arrangements were in place to promote equality and diversity including supporting people if they chose lesbian, gay, bisexual or transgender life-course identities. There were suitable arrangements for managing complaints and provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was no registered manager in post. However, the person in day to day charge of the service had promoted an open and inclusive culture and there were suitable management arrangements to ensure that regulatory requirements were met. People who lived in the service and members of staff were actively engaged in developing the service. There were systems and procedures to enable the service to learn, improve and assure its sustainability. The registered person and manager were actively working in partnership with other agencies to support the development of joined-up care.

Wells Lodge Nursing Home is a large detached house with accommodation spread over three floors accessible by stairs and a passenger lift. People had access to a communal lounge/dining area, a seating area by the nurse’s station, kitchenette and shared bathrooms. Each person’s bedroom had its own ensuite facilities. There was a large garden which people could access when they wished.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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.

Although a long established service, this is the first time that Wells Lodge Nursing Home has been inspected while under the ownership of the Victoria Nursing Group Limited. This inspection highlighted some areas where regulations were not met and other aspects which required improvement.

Aspects of mandatory staff recruitment checks were incomplete and elements of some care plans lacked guidance for staff about how to communicate effectively with some people to meet their needs.

People who may become anxious or display behaviours which could challenge themselves or others were not always well supported. The processes in place to help support them were not always fully developed, they were stand alone and did not link into a plan to review or address possible causes or solutions.

New staff received induction training and, although staff were happy with training provided, checks of their understanding and observation of the practical application of training received were not in place.

Personal emergency evacuation plans were in place, however, some required further development to provide clear guidance to staff about the support some people required in the event of an emergency. The service could not demonstrate that the frequency of testing electrical appliances met with their policy or provide an electrical wiring conformity certificate for the service.

People had access to a complaints policy displayed in the main entrance of the service. However, people who could not leave their rooms could not access this document and people who had difficulties with communication had not been offered an alternative easy read version of the policy.

People commented that activities at the service were limited; the registered manager acknowledged this and was taking positive steps to recruit an activities coordinator.

The registered and deputy managers, together with their staff had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards. They understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were respected and upheld.

There were enough staff to meet people’s needs. People were safe because staff understood how to protect people from the risk of abuse and the action they needed to take to alert managers or other stakeholders if necessary, if they suspected a person was at risk.

There were low levels of incidents and accidents and these were managed appropriately by staff who sought appropriate action or intervention as needed to keep people safe.

People’s care plans were reviewed regularly and included the views of the people and their relatives or advocates when needed. The service showed an awareness of people’s changing needs and sought professional guidance, which was put into practice.

People were able to choose their food each meal time and snacks and drinks were available. The food was home-cooked. People told us they enjoyed their meals, describing them as “excellent” and “first class”. However, food choice could be further improved by the use of pictures or objects of reference for people with communication difficulties.

The service was led by a registered manager who worked closely with the deputy manager and staff team. Staff were fully informed about the ethos of the service and its vision and values. They recognised their individual roles as important and there was good team work throughout the inspection. Staff showed respect and valued one another as well as people living at the service.

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