Wellburn House

We found the following examples of good practice.

At the time of the inspection the home was allowing essential visits only, for example a relative of a person receiving end of life care. Visitors were required to complete a health questionnaire before visiting the home. Temperature checks were completed on arrival and PPE (personal protective equipment) was available for all visitors. Lateral flow testing was also done, and results obtained prior to visits taking place.

Alternatives such as video calls were arranged for families who could not visit. People have also been supported to write to loved ones and send cards. A monthly newsletter was sent to families and the registered manager also held virtual relatives’ meetings via video call. There was a safe area set aside for visits within the home with a perspex screen and this area was fogged between each visit. Once the current visiting restrictions could be lifted an appointment system that had been used previously was to be reintroduced.

Staff changed into their uniform before the start of their shift and changed again before going home. We observed staff wearing PPE correctly throughout the home. Staff who needed to shield were supported to do so. Special provision and changes to working patterns had been made to accommodate staff who were more vulnerable.

There was a plentiful supply of PPE and a number of PPE stations around the home so staff could change their PPE prior to entering individual rooms. Clinical waste bins were in place for the safe disposal of used PPE. There were laminated posters all around the home reminding staff of the correct PPE procedures and the manager had also taught staff a simple acronym to help them remember. Staff had received support and training from a specialist infection prevention and control (IPC) nurse. Notices were placed around the home explaining to people why staff were wearing PPE and people living with dementia had been reassured by staff.

The home was very clean and tidy. Furniture in communal areas had been arranged to maximise social distancing and additional areas had been used at mealtimes to avoid dining rooms being overcrowded. Enhanced cleaning schedules were in place. These included regular cleaning of high touch areas such as handrails and door handles to reduce the risk of cross infection. Suitable arrangements were also in place to manage contaminated laundry.

There was a detailed infection prevention and control policy in place and regular checks were completed.

Wellburn House is a residential care home that provides accommodation and personal care for up to 90 older people and people living with dementia, at the time of the inspection there were 31 people using the service.

People’s experience of using this service:

Improvements had been made since the last inspection in June 2018. People and relatives told us that the changes had improved the service.

A new manager had been appointed and they had worked to recruit, coach and develop the staff team. This led to a motivated group of staff who were committed in providing care that was person centred.

Medicines were now managed safely. The manager and staff team worked together to support people to be safe. Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the manager was keen to make changes that would impact positively on people’s lives.

Staff were well trained and skilled and used this training to effectively support people to promote independence and choice. The dining experience had improved, and people were happy with the food provided.

The values of the organisation of offering choice and respect were embedded.

Care plans were person centred, reviewed and contained up to date information. Activities were taking place all day, and these were either group activities or one to one activities. Complaints were now fully investigated with an outcome provided to the complainant and lessons learned to improve the service.

The management team now had an effective system of audits in place which identified and addressed any concerns that were found.

Rating at last inspection:

The rating at the last inspection was requires improvement and inadequate in well led. The report was published 9 October 2018.

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

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.

We last inspected the service in October 2017. Following this inspection the service was rated 'requires improvement' and we identified breaches in two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we had concerns about the safe management of medicines and the lack of effective auditing.

Following the inspection in October 2017 we served a warning notice against the registered provider in respect of the breach in regulation 12, safe care and treatment. This was because of concerns we had regarding the safe management of medicines. The warning notice stated that they must take necessary action to comply with this regulation by 31 January 2018.

We also issued a requirement notice in respect of the breach in regulation 17, good governance. This was because the provider did not have an effective system of audits in place and they were not identifying the issues we found during the inspection. The registered provider sent us an action plan detailing how and when they would take action in order to meet this requirement notice. The action plan stated that all of the work necessary to become compliant with this regulation would be completed by the end of November 2017.

During this inspection we found some improvements had been made but there were still areas of concern and the service remained in breach of these regulations.

Wellburn House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Wellburn House can accommodate up to 90 people across three separate areas in a two storey building. One area, Laurel, provides residential care and the other two areas, Lilac and Fern, provide care to people living with dementia. Lilac is on the ground floor whilst Fern is on the first floor and provides care for people who have higher level care needs due to the advanced stage of their dementia. At the time of our inspection there were 45 people living at the service.

There was a registered manager in post. 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.

This is the fifth time the service has been rated Requires Improvement since September 2015. In June 2016 the service was rated Inadequate.

There was still no robust system of audits in place. Those audits that were taking place were not effective as they did not identify all of the issues we found during the inspection. When audits were completed action was not always taken to make the necessary improvements. Quality assurance surveys were conducted but there was no clear action plan produced as a result of feedback.

Records were not always up to date, accurate or complete.

Medicines were not always managed safely for people. Improvements still need to be made in guidance and records for ‘when required medicines’ and topical medicines.

Risks assessment tools were not always used correctly. Some people did not have risk assessments in place to provide staff with information on how to manage and minimise all identified risks.

The provider had calculated the number of staff needed to safely meet the needs of the people using the service. We saw that the staffing levels were in line with these calculations however we received feedback from staff and relatives that people sometimes had to wait for assistance. We have made a recommendation about this.

Checks were carried out around the service to ensure the premises and equipment were safe to use. Staff had not always responded promptly during fire drills but no action had been taken to address this.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff had knowledge of safeguarding and were aware of the action to take if they had concerns.

Staff had not completed all of the training the provider had identified as essential. There were a number of gaps in the training record and a number of staff were overdue refresher training. We had made a recommendation about this following our inspection in October 2017 however the issue had not been resolved and as a result the provider was now in breach of regulation.

New staff underwent a seven day induction but the induction did not include completion of the Care Certificate. We have made a recommendation about this.

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.

People were supported to maintain a healthy diet, and any special dietary needs were catered for. However, there were no picture menus in dining rooms and although people were offered choice this was done in a way that was not suitable for those living with a dementia.

One area of the service had been decorated in a dementia friendly way however a second area for people living with dementia had been recently created and did not have similar dementia friendly décor. We have made a recommendation about this.

We saw evidence in care plans to show the service worked with external healthcare professionals to maintain people’s health.

Staff spoke to people kindly and patiently and we observed friendly interaction between people and staff.

We were told that one person was using an advocate but there was no evidence of this in their records. There was no information on display to help people access an advocate should they wish to.

We saw the complaints were investigated but this was not always in line with the provider’s complaint’s policy. The records relating to complaints were not clear or well organised.

Staff had an understanding of people's needs and how they liked to be supported but this was not always reflected in detail within care plans. Some care plans contained generic information and some plans appeared to be cut and paste documents as they referred to people by the wrong name or gender.

People, relatives and staff felt the registered manager was approachable and supportive.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service was last inspected in October 2016 and rated 'requires improvement.' We found breaches of Regulations. This was because improvements were needed in medicines and audits failed to highlight issues and concerns regarding medicines. Following our last inspection the provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the home.

Since receiving that action plan the registered manager left the service. A new manager was appointed who came to post in July 2017. The new manager was starting to make improvements but had only been in post two months, therefore a lot of the improvements had just been implemented.

At this inspection we found that medicines were still not being administered safely. Audits had started to take place and highlighted some of the concerns we raised but not all had been acted upon.

Wellburn House is a 90 bedded purpose built two storey care home. It has two units; the ground floor unit for people with personal care needs and the first floor unit for people living with dementia. All bedrooms have en-suite facilities and there is a large courtyard garden. At the time of inspection there were 44 people using the service.

There was a manager in place who was in the process of being registered with the Care Quality Commission since 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.

Risks to people arising from their health and support needs and the premises were assessed, and plans were in place to minimise them. Risk assessments were regularly reviewed to ensure they met people’s current needs. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff were now given effective supervision and a yearly appraisal.

Staff understood safeguarding issues and were aware of the whistleblowing policy [telling someone] if they had concerns.

Staff were in the process of receiving training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and clearly understood the requirements of the Act. Best interest decisions were made appropriately with the person and family were fully involved. This meant they were working within the law to support people who may have lacked capacity to make their own decisions. The manager understood their responsibilities in relation to DoLS.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food and everyone enjoyed what was on offer.

We saw evidence in care plans to show the service worked with external healthcare professionals to maintain people’s health.

We found the interactions between people and staff were kind and respectful and people were offered choice throughout the day.

Procedures were in place to support people to access advocacy services should the need arise. At the time of inspection no one was using an advocate.

Complaints were acted on using the guidance of the services complaints policy. However the outcome to show the complainant was happy was not recorded.

Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Support plans were well written and specific to people's individual needs.

The manager was a visible presence at the service, and was actively involved in monitoring standards and promoting good practice. People, relatives and staff felt confident in the manager. Feedback was sought from people, and relatives to assist in this. The service had quality assurance systems in place. However, they were not effective in identifying the issues we found.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of concerns around medicines and the lack of audits. You can see what action we told the registered provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At an inspection in July 2015 we found a shortfall in relation to safe care and treatment, medicines were not managed safely and people were at risk on receiving incorrect nutritional intake; premises and equipment; staffing; consent to care or treatment; safeguarding and good governance. We also made a recommendation that the registered provider looks at the dining experience for people who used the service, care plans to become more person centred and to ensure people are involved in the care plan development and review where they are able.

The registered provider told us they would be compliant with the regulations by December 2015 in light of safeguarding concerns we completed an inspection in November 2015 and we found no improvement.

At the last inspection in March 2016 and April 2016 we found that the registered provider had not made required improvements and identified more shortfalls so we rated the service as inadequate. The service was place in special measures and we have been following our enforcement policies.

The shortfalls we identified were in relation to:

• Safe management of medicines, risk assessments provided limited or no information. Not everyone had a personal emergency evacuation plan (PEEP), staff could not tell us how many were at the service and the list in the emergency evacuation pack did not match who lived at the service.

• We found the registered provider was not following up and reporting safeguarding concerns.

• We found the registered provider was not employing sufficient staff, inductions were not effective and staff did not have the knowledge and skills to support people who used the service.

• We found the registered provider was not obtaining consent from people who used the service.

• We found bathrooms and shower rooms out of use.

• We found the registered provider was not completing audits effectively.

• We found the registered provider was not involving people in their plan of care, the care records were confusing and not person centred.

• We found the registered provider was not documenting reasons for gaps in employment or following up on problems with references.

• We found the registered provider was not providing a dignified dining experience.

• Also the registered provider was not notifying the Care Quality Commission of significant events.

We completed this inspection to review the action the registered provider had taken in response to the shortfalls we identified at the last inspection.

Wellburn House is a 90 bedded purpose built two storey care home. It has three units and at the time of the inspection two of the units were operational; the ground floor unit for people with personal care needs and the first floor unit for people living with dementia. All bedrooms have ensuite facilities and there is the availability of a large courtyard garden. At the time of inspection there were 45 people living at the service.

Since our last inspection the manager and the area manager had left Akari Care. A new manager had started at Wellburn House in May 2016 and became registered with the Care Quality Commission in August 2016. 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 new area manager had taken over this service in April 2016.

At this inspection we looked at how medicines were handled and found that although improvements had been made the arrangements were not always safe.

People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were now monitored each month to see if any trends or patterns were identified.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people worked at the service. Staff were receiving support through supervision and received relevant training.

People told us that they were very happy with the food provided. We observed that people’s nutritional needs had been assessed and individual food and drink requirements were met. There were snack stations around the home with juice, fruit, crisps, biscuits and sweets.

People’s care records were person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person. People’s care plans recorded information about their individual care and support needs and their life history. This helped staff to have an in-depth knowledge of people’s needs .

People who lived at the service and relatives told us that staff were very caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff and staff had a good understanding of people’s individual care and support needs.

Meetings were taking place for people who used the service, relatives and staff. These were all booked in for the year ahead.

People were supported to access healthcare professionals and services.

A variety of activities were provided to meet people’s individual needs and people were encouraged to take part. People were happy with the activities on offer.

The premises were clean, hygienic and well maintained and there was plenty of personal protection equipment [PPE] available. We saw there was appropriate signage, decoration and prompts to assist people finding their way around.

We saw certificates for safety checks and maintenance which had taken place within the last twelve months such as fire equipment, electrical safety and water temperature checks. We found that since the last inspection the maintenance person had been enabled by the registered provider to complete all of the repairs and could now take action in a timely manner to fix any problems.

Staff, people who lived at the home and relatives told us that the home was now well managed. Quality audits undertaken by the registered manager were designed to identify whether systems at the home were protecting people’s safety and well-being. When quality audits identified that improvements needed to be made, there was a record of when actions had been completed.

We identified that work was needed to ensure one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was rectified. You can see what action we told the registered provider to take at the back of the full version of the report.

Wellburn House is a 90 bedded purpose built two storey care home. It has two units; the ground floor unit for people with personal care needs and the first floor unit for people living with dementia. All bedrooms have ensuite facilities and there is the availability of a large courtyard garden.

On the first day of our inspection the service had a manager who was planning on registering with the Care Quality Commission. We were informed before the second day of inspection that this manager no longer worked at Wellburn House. 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.

At our last full inspection of the home in July 2015 we found six breaches. These were in relation to safe care and treatment. We found medicines were not managed safely and people were at risk on receiving incorrect nutritional intake. There was also a breach in relation to Premises and equipment. The cleanliness and condition of the service was not maintained. Staff did not receive support through supervision. Staff were not seeking consent before any care or treatment was provided. The service was not safeguarding service users from abuse and improper treatment. People were being deprived of their liberty without lawful authority. Audits were not taking place and people’s views were not sought. We also made a recommendation that the registered provider looks at the dining experience for people who used the service, care plans to become more person centred and to ensure people are involved in the care plan development and review where they are able.

Following concerns being raised we also completed a focused inspection in November 2015. This inspection concentrated on looking at whether the service was ‘safe’. We found that action was needed to ensure fire procedures were effective; people received appropriate care and treatment; recruitment procedures were safe; and staffing levels met the needs of the people who used the service.

During this inspection we found measures to improve the service had not taken place.

Medicines were not always managed safely for people and records had not been completed correctly. People did not receive their medicines at the times they needed them and in a safe way. Medicines were not administered and recorded properly.

Although the manager had knowledge of the Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS], records made it difficult to understand who was subject to a DoLS authorisation. We checked this on the second day of inspection but due to records the area manager could not establish who had a DoLS authorisation or where a request had been put in.

Risks to people’s health or well-being had not always been assessed and plans were not always put in place to protect people. One person who had grade four pressure sores was placed on two hourly turns and 30 minute observations. There was no record of two hourly turns or 30 minute observations taking place.

Accidents and incidents were not monitored each month to see if any trends or patterns were identified.

We found people were cared for by insufficient numbers of staff. People were left sitting alone in wheelchairs due to needing two members of staff for support and two members of staff not being available. Recruitment and selection procedures were in place but appropriate checks had not been undertaken before staff began work. Staff did not receive support through supervision or did not receive relevant training.

Staff we spoke with understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow (raise concerns about the home, staff practices or registered provider) if the need ever arose.

On the first day of inspection staff did not feel they were supported by the manager. One staff member had highlighted risks and concerns to the manager. However the manager did nothing with the concerns raised.

The area manager carried out monthly quality monitoring reports. These reports did not highlight any issues or concerns we found during inspection.

People were provided with a meal and choice of vegetables downstairs and enjoyed the food on offer. However the dining experience on the unit for people living with a dementia needed improving. People were asked in the morning what they would like for lunch the following day.

People’s care records needed to be more person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person.

Staff were observed to know people well and to be caring. However due to lack of staff people’s privacy and dignity was not always respected.

Staff meetings did not take place regularly. No meetings for people who used the service or their relatives took place. Feedback of people’s views was not sought.

People were supported to access healthcare professionals and services.

Activities were taking place. People were happy with what activities were on offer.

We saw that the service was clean and tidy and there was plenty of personal protection equipment [PPE] available.

We saw certificates for safety checks and maintenance which had taken place within the last twelve months such as fire equipment, electrical safety and water temperature checks.

The registered provider had not been sending CQC notifications about incidents. Statutory notifications include information about important events which the registered provider is required to send us by law.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. Improvements were needed in many areas where the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

At this inspection we found that improvements had been made. We found that life for people living at Wellburn House was much more flexible and reflected their individual choices and preferences.

We saw that there was sufficient care staff available to meet people's needs. However, more analysis was needed in relation to the different roles and skill mix within the service to determine the needs across all departments.

We saw that a range of records had improved. Records relating to fire evacuation were up to date and in place. Care records were in the main up to date and reflective of people's needs. We found that work had commenced on other records such as accident analysis and the duty rota, however there was still further work to do.

Relatives said, 'The staff are very good. They do work very hard and are always very busy but I find they are always friendly and caring', 'We are happy with the care and find the staff are fantastic.'

There was one area that relatives were unhappy with and that was the lack of refurbishment. We requested that the provider send us information about the refurbishment programme and timescales.

We spoke with six people who lived at Wellburn House. They said that they found staff attended to their care needs in a timely manner. All the people spoken with were very positive about the staff and how they were treated. People said, 'The staff try their best', 'The staff are very good and are very kind' and 'I'm not sure why I need to be here but the staff are good."

We also spoke with ten staff and the manager of the service.

We found that whilst people had up to date care records and assessment, these did not wholly reflect people's needs. We found that people's lifestyle preferences, choices and decision making had not been fully considered.

We found that there was limited understanding about people's capacity and the legal frameworks that supported people's rights.

We found that the way in which staff were deployed within the home did not provide for person centred care.

We found that some of the records were not up to date or accurate.