Archived: Wickwar

At our last inspection we rated the service good. At this inspection we found evidence that this was no longer the case and that the service required improvement. We brought this inspection forward because we had received information that suggested standards had deteriorated. Two visiting health care professionals had contacted us with their concerns and told us some staff who worked at the home did not think the service was meeting the current rating of Good awarded in December 2017. In addition, we received information from a whistle-blower and relatives who also expressed concerns. This inspection report will evidence and focus on areas that compromise the safety and quality for people who use the service.

The manager in post had worked at the home since April 2018 and had applied to CQC to be the registered manager. Their application was being processed by CQC registration at the time of this inspection.

Why the service was rated Requires Improvement.

A number of improvements were required to ensure people were kept safe and received quality care. The arrangements in place to ensure the service was well led from provider level down were unsatisfactory. Monitoring the quality of the service was not robust enough to ensure quality and safety. The manager lacked knowledge and understanding about their legal obligations.

We could not be satisfied that staffing levels and routines would keep people safe. Medicines were not always managed safely. People were not protected from the risk of cross infection. This was because appropriate guidance had not been followed. People were not cared for in a clean, hygienic environment. Parts of the environment still required improvement. We could not be satisfied that induction for new staff was effective.

People did not consistently receive person centred care and respect and dignity was not always promoted and practiced. Activities and people’s emotional and psychological well-being required improvement. Staff were knowledgeable about people's lives before they started using the service. Improvements were required to enhance this knowledge so that their life experiences remained meaningful.

Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Staff received supervision and training required to meet people’s needs.

Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice.

We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from them was positive. Those people who used the service spoke well of all staff.

Further information is in the detailed findings below.

At the time of the inspection the registered manager had been on long term leave and they had submitted an application to CQC to de-register as the 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 2008 and associated Regulations about how the service is run. A temporary manager was in post to help ensure smooth running of the service whilst plans were in place to recruit a new manager.

At our last inspection in September 2016 we rated the service overall as Requires Improvement. This was because we found a breach in Regulation 12 and people were not protected from the risks associated with cross infection. In addition we could not be satisfied that good management and leadership of the service would be sustained.

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good.

Even though there was a temporary manager in post their appointment had already significantly helped improve the previous lack of management of the service. Their previous experience as a manager had equipped them with the skills and knowledge required for their roles and responsibilities. It was evident they were confident and committed to embrace the new challenges and to improve the service. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received quality care.

Improvements had been made to help ensure people were protected from the risk of cross infection. This was because appropriate guidance had been followed. People were now cared for in a clean, hygienic environment.

The manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They felt supported by the manager and deputy at all times. The manager, deputy and nurses had a good understanding of the Mental Capacity Act 2005 (MCA). The care staff understood its principles and the importance of supporting people to make decisions and protect their rights.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. Staff demonstrated a genuine passion and commitment for the roles they performed and their individual responsibilities. It was important to them that those living at the service felt ‘valued and happy’.

People benefitted from a service that was well led. People who used the service felt able to make requests and express their opinions and views. Staff were embracing new initiatives with the support of the manager and provider. They continued to look at the needs of people who used the service and ways to improve these so that people felt able to make positive changes.

The provider and manager had implemented a programme of improvement that was being well managed. The manager and provider demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.

The new manager had been in post since May 2016 and they had applied 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 2008 and associated Regulations about how the service is run.

During 2015 there had been a lack of consistent management within the service. Because of this a significant number of improvements were required to ensure people were kept safe and received quality care. The arrangements in place to ensure the service was well led were unsatisfactory. The provider acknowledged the deterioration in the service provision earlier this year and contracted an independent company to oversee the operation and running of the service. Health Care Management Solutions joined the home in February 2016. It was evident at this inspection they had made significant improvements.

A comprehensive action plan had been developed highlighting areas for improvement. We were able to see where action had been completed and where other areas were being addressed. Work had been prioritised and realistic timescales had been put in place so that the quality of work and further development was not compromised. The service had been supported by various health and social care professionals and this had been embraced by the management and staff. They acknowledged shortfalls, learnt lessons and took action to resolve issues. It was evident that much had been achieved and working progress continued.

We did however find one area where the service was in breach of regulation. People were not protected from the risk of cross infection. This was because appropriate guidance had not been followed. People were not cared for in a clean, hygienic environment. On the second day of our inspection some concerns that required a quick fix had been addressed.

People and visitors told us they were happy and things were improving. Despite the areas for improvement, people said things were satisfactory and staff always did the best they could. Comments included, “There is a lot going on and they are doing their best”, “I cannot fault the staff, they are a lovely” and “I am very happy living here, it was the right decision”. Two relatives we spoke with shared their views about where they felt there was room for improvement and we fed this back to the area manager.

Staff were knowledgeable in safeguarding procedures and how to identify and report abuse. People were protected by the recruitment policy and practices to help ensure that staff were suitable. The manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift. Despite staff vacancies, every effort was made to ensure continuity when using agency staff.

A training programme had been developed for all staff and good progress had been made rolling this out to staff. Staff acknowledged the training had been useful and effective. People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting people had chosen. Staff took prompt action when people required access to community services and expert treatment or advice if they were at risk of malnutrition or dehydration.

People enjoyed receiving visitors and had made “friends” with the people they lived with. They were relaxed in each other’s company. Staff had a good awareness of individuals' needs and treated people kindly. People moved into the service only when a full assessment had been completed and the manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.

We found one breach 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 this report.

There were various activities organised for the party and we participated in a Christmas quiz with a small group of people. The quiz was very popular and we saw relatives also joining in. Some staff were sat with people individually because they required help with the quiz, they were supported sensitively.

The atmosphere in the home was happy, we were introduced to people throughout the day and they were glad to see us. We spoke with people in small groups and individually in their own rooms. Feedback from everyone was positive and people were happy living at Wickwar.

We were supported by management and staff throughout the day. They were knowledgeable about the people in their care, the policies and procedures in the home and were confident to share with us their views and experiences.

One relative recently wrote to the home 'We want to thank a special member of staff. We were impressed with their attitude when we first visited Wickwar looking for a home. They were instrumental in our choice'.

The area manager and deputy were available throughout the day and both were very knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home.

People shared with us their experiences about living in the home and we spoke with four people at length. Everyone expressed positive comments.

People told us, 'I couldn't wish for a better place, we have everything we want and nothing could be too much trouble for the staff' and 'I made the right choice. I can honestly say I have never has any problems and the staff are so very, very kind'.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at the home received. There was a constant interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company.