Warde Aldam

Warde Aldam is care home providing personal and nursing care to up to 60 people. The service provides support to people in one adapted building with three separate units. Two units specialise in providing care to people living with dementia. At the time of our inspection there were 58 people using the service.

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

Risks to people were not always assessed. Records for people who required the use of hoists did not always contain enough information to keep them safe. The provider had auditing systems in place, however these were not always effective in identifying areas for improvement. For example, concerns were found during our inspection in relation to infection control, fire safety and care plan records and these were not identified by the service. We saw some furniture and flooring to be visibly stained and a malodour in some areas of the service. We have made a recommendation the provider reviews the quality monitoring systems.

People were protected from the risk of abuse. Incidents were monitored by the registered manager and staff told us they felt comfortable to raise concerns. People and relatives said they felt safe. There were enough staff, who had been safely recruited and received appropriate training, to meet people's needs. Medicines were safely stored, administered and disposed of. Accidents and incidents were monitored, and trends and patterns identified to mitigate future risks.

Staff felt supported by the registered manager and people and relatives were positive about how the service was managed. The management team worked closely with community health professionals to ensure people received appropriate care and support.

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 18 February 2019)

Why we inspected

The inspection was prompted in part due to concerns received about care and treatment, medicines and staffing. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 Warde Aldam on our website at www.cqc.org.uk.

Recommendations

We recommend the provider reviews the quality monitoring systems to ensure they identify concerns with premises and equipment in a timely manner.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were systems and processes in place, in line with guidance, to ensure visitors to the home did not introduce and spread Covid-19. Visiting was by arrangement and appropriate PPE was supplied.

Staff supported people’s social and emotional wellbeing. Alternative forms of maintaining social contact were in place, including regular telephone and video calls, a newsletter and social media groups. The home had a heated visiting pod in the garden to enable visiting.

Staff followed government guidance in relation to personal protective equipment (PPE). The home had sufficient supplies of PPE. We observed all staff to be wearing it appropriately.

All staff had undertaken training in infection prevention and control (IPC) and the donning and doffing of PPE.

All staff and people living at the home were being Covid-19 tested in line with current guidance and had received their first vaccination. Appropriate processes were in place should anyone display any symptoms of Covid-19.

The care home was clean, well maintained and odour-free. There were enhanced cleaning schedules in place.

Policies relating to infection prevention control (IPC), including coronavirus, were up-to-date. A recent IPC audit had been undertaken and the home had acted upon its findings.

Warde Aldam is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Warde Aldam can accommodate up to 60 people who require accommodation and nursing or personal care. The home consists of one adapted building across two floors. At the time of our inspection there were 57 people living in the home.

Our last inspection of Warde Aldam took place on 10 October 2017. We rated the service requires improvement. We found there was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Need for consent. This was because conditions on Deprivation of Liberty Safeguards (DoLS) authorisations had not always been recorded and evidenced throughout the care plan. We also found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Good Governance. This was because effective audits were not always in place in relation to peoples care plans.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the service to at least good. At this inspection we found sufficient improvements had been made to meet the requirements of both Regulation 11 and 17 and the service had improved to good.

There was a registered manager employed at the home. 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.

Staff had completed MCA training and during the inspection we saw staff asking for consent when providing care to people. People's care records evidenced their mental capacity had been considered and assessed, where appropriate. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice.

At the last inspection we found audits did not always pick up shortfalls in the running of the home. At this inspection we found significant improvements to the governance of the home. The registered manager completed regular audits of the service, to make sure action was taken and lessons learned when things went wrong. Effective systems were in place to support the continuous improvement of the service.

People and relatives told us they believed they were safe. There were enough staff available to meet people's needs in a timely way and to keep people safe. Staff had been trained in how to safeguard vulnerable adults and they had a good understanding of their responsibility to protect people from harm.

People received their medicines as prescribed from staff who had been trained in medicines management.

People told us the staff were kind and caring and respectful of their needs. During this inspection we observed staff treat people with kindness, dignity and respect.

Staff received a range of training which the provider considered to be mandatory. Staff told us they were happy with the training they received and felt it supported them in their roles. Staff were supported by the management team through supervisions and appraisals.

The service worked closely with community health professionals to support people with their health needs. People's care records evidenced they received medical attention when they needed it, to promote their health.

People were supported to eat a varied diet that met their nutritional requirements. The service had protected mealtimes where all staff supported the provision of the meal service.

A range of individual and group activities were provided within the home by staff and outside professionals including music therapy. Staff clearly knew people’s likes and dislikes and supported them to take part in activities of their preference.

People’s needs were assessed and the support they needed from staff was clearly recorded in their care plan.

People living at Warde Aldam, their relatives and the staff were all positive about the registered manager and about how the home was run. We found a welcoming and positive culture within the home.

Warde Aldam is a care home with nursing care. It provides care for a maximum of 60 people and consists of three different units. It is located in South Elmsall, near Pontefract. There were 58 people living at Warde Aldam at the time of inspection.

There was a registered manager, who had been registered with the Care Quality Commission to manage the service since July 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.

We saw in some people’s care plans information which was conflicting. In one care plan it stated the person should be weighed weekly but had been weighed monthly. We spoke to the registered manager who told us this was an oversight and should be completed monthly. We saw one person’s Deprivation of Liberty Safeguards (DoLS) conditions had not been adhered to. We spoke to the registered manager who told us this would be rectified and completed straight away. The registered manager sent an action plan showing how they would address the issues we found.

We saw some effective audits in place in relation to accident and incidents, staff files and quality assurance in relation to surveys from family and people who live at Warde Aldam.

Most people we spoke with told us they enjoyed living at Warde Aldam and were complimentary about the staff who supported them. They told us they felt safe, enjoyed the food and received good support with their health needs.

We saw most staff interactions were friendly, respectful and caring. Most visiting relatives were happy with the standard of care.

We felt staffing levels were sufficient to ensure people were supported with all their care needs and activities. However we felt the deployment of staff needed to be looked at in relation to allocation on the three units. We spoke to the registered manager about this. The home had a variety of activities within the home which we observed on two units Of the home. However on one unit we saw no activities taking place.

Staff understood how to safeguard people and knew the people they were supporting very well. Medicines were managed consistently and safely through an online system. However we did make the registered manager aware of the importance of ensuring the correct staff name was logged in and out on the online system.

We have made a recommendation to the registered manager to ensure the management of medicines were robust in relation to staff recording of their individual codes by completing regular audit checks.

People lived in a safe environment. Rooms were decorated to individual taste and people could choose what items to keep there. There was an odour across one unit of the home. The registered manager had allocated regular deep cleans within the home. We spoke to the registered manager who felt this would need to be looked at in relation to arranging new flooring across the units to maintain its effectiveness.

Information for people was displayed in the home, this included leaflets about people’s rights, standards people should expect and customer surveys results.

Staff we spoke with told us they were well supported by their colleagues and management. The staff received appropriate training, supervision, appraisal and observations around their practice which meant that staff had the right skills and knowledge for their role.

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

We carried out the inspection with our five questions in mind; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

Our previous inspections in October and December 2013 identified significant failings in people's care and welfare. Since our last inspection we were informed that serious concerns were looked into by the Local Authority and neglect was substantiated with regard to one person's care whilst in Warde Aldam. This was because the person had received insufficient food, drink or medical attention and had been severely dehydrated, resulting in their admission to hospital.

We found there had been significant improvements in the standards of care at Warde Aldam to ensure people's safety with regard to their individual care. Staff demonstrated a clear understanding of how to respond to people if they showed signs of illness, abuse or neglect and they were confident to approach managers or other appropriate agencies to pass on any concerns.

Is the service caring?

We saw staff were kind, patient and caring with the people they cared for. They communicated warmly and at people's eye level and demonstrated a person centred approach, acknowledging people's individual needs. We found interactions with people had significantly improved since our last visits.

Is the service effective?

We saw communication between staff had improved and there were clear systems to ensure people's care was personalised and effective. Staff had key information about people's needs at handovers between shifts and concise and clear information was contained in newly revised care records for staff to read.

Is the service responsive?

We found the home worked in cooperation with other professionals to ensure people's care was responsive to their needs. For example, where people's weight or food intake gave a cause for concern, we saw the home referred promptly to the GP or dietician. We saw within the daily routine, staff were responsive to people's needs. For example, one person seemed to be in a draught and staff responded to ensure the person was comfortable. We found people's buzzers were promptly attended to.

Is the service well led?

We saw all staff were well informed and supported in undertaking their roles through regular training, supervision and appraisal, plus day to day team and peer support. Staff told us: 'We all work really well together. It's a good team'. We found the managers within the organisation had responded positively to areas of concern highlighted through inspections and complaints, ensuring systems to improve people's care were implemented and the quality of the provision was monitored.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service caring?

Most staff interacted with people in a kind and friendly manner. We saw the majority of staff were attentive to people's needs overall and acknowledged people with smiles, gestures and friendly greetings. Staff talked with people at their eye level and gave them time to communicate at their own pace.

We observed staff were kind and supportive of people at mealtimes, although we noticed there was insufficient engagement for one person being supported to eat. We saw when one person was upset, staff gave sensitive reassurance until they felt better.

Is the service responsive?

We found improved systems were in place to help staff be aware of people's individual needs. For example, we saw staff divided up into teams, with named staff responsible for each person's care. Every staff member carried a laminated card in their uniform pocket, with key information at a glance about every person's needs and particular requirements. Staff we spoke with were confidently able to describe people's needs and had a sound knowledge of how to care for each person.

However, one person told us they sometimes had to wait to go to the toilet because staff were busy. We observed this happening during our inspection and we had to remind staff this person was waiting to be supported to go to the toilet.

Is the service safe?

Individually named staff had been allocated responsibility for ensuring specific care tasks had been completed. This information was updated on the daily handover report and included safety checks as well as people's individual information to ensure care was delivered safely. Handover information was more detailed and enabled managers to maintain an overview of care delivery.

Is the service effective?

Our findings at this inspection were that the provider had made some improvements to people's care following the last inspection. However, we found that the warning notice had not been fully complied with. For example, some people's care records were not fully updated and still contained some out of date and conflicting information. The manager told us care records had yet to be finalised for the Upper and Lower Cedar units.

Due to the improvements that had been made we decided it was appropriate to give Warde Aldam a further period of time to enable them to fully meet the requirements.We will make further checks to ensure requirements are met.

Is the service well led?

The manager had applied for registration with the Care Quality Commission, although this process was not yet complete at the time of our visit.

Since our last inspection, managers had implemented systems to ensure closer monitoring of people's care and their food and fluid intake. We saw there had been many positive steps taken to address the issues raised and to improve the quality of care for people. In particular, the provider had made arrangements for people's care records to be fully revised and we saw new care plans were in the process of being completed.

We observed care given to people, spoke with four staff, including the senior nurse in charge. The manager was not present during our inspection. We looked at care records for six people.

We found although there had been some improvements to care records, there were also gaps in recording, inconsistencies of information and four of the six records we looked at had not been updated since September 2013.

We found people spent a lot of time either seated or wandering round, with little available for them to capture their interest. We found staff deployment did not promote people's care and welfare as we observed people alone in the main lounge, dining room and corridors, with little staff interaction.

The atmosphere on each unit was very warm and welcoming, with staff joining in and supporting people. We saw people were attended to promptly on the whole and appropriate consent was given for their care and treatment. People seemed happy and their behaviour showed they were content in their environment.

We saw people were mostly happy and settled in Warde Aldam. People had smart clothes on and visited the hairdresser if they wanted to. We found communal areas to be homely and people spent time doing activities of their choice. However, we found that not all people had their care needs met effectively.

Staff showed interest in ensuring people's needs were met. Staff expressed satisfaction in their role. We found staff were recruited and vetted thoroughly and had attended mandatory training to enable them to carry out their roles effectively.

We found the premises to be clean and free form offensive odours, with practices in place that prevented the spread of infection.

We saw the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.