Archived: Wells Place Care Home

Wells Place Care Home is registered to provide accommodation and nursing care for up to 42 older people, some of whom are living with dementia. Accommodation is arranged over three floors, with access to the lower and upper floors via stairs or a passenger lift. 38 people were using the service at the time of our inspection.

At the time of this focussed inspection a registered manager was not in place. An operations support manager for the provider was temporarily fulfilling the role as manager of the home. 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.

People living at Wells Place Care Home had needs relating to living with dementia, mobility and general health. We were not assured that staff had the skills and knowledge to meet these needs. Staff had not received all the training they needed to deliver care safely and effectively. There were inconsistencies in staff’s experience of training, supervision and support. We found that care practices were not effectively monitored to identify shortfalls in staff performance.

People who used the service and their relatives were complimentary about the conduct of staff and improved staffing levels. However, because improvements were needed in staffing skills and knowledge in supporting people with dementia, people were not always provided with meaningful activities to meet their needs and reduce social isolation. Areas in the home were not suitably designed for people living with dementia.

The service had taken action to review records about people’s care and this was still in progress at the time of our inspection. Care plans for people reflected their identified needs and the associated risks. Further work was required to embed and sustain the practice of effective care planning.

We saw new aspects of quality assurance and there were some systems in place to look at the quality of the service. However, the service required sustained and effective leadership to maintain this and provide guidance and stability to staff.

Following our inspection the provider informed us they had placed a voluntary embargo on new admissions to the home. In addition, the local authority safeguarding team and commissioners had begun action to review people’s care.

At this inspection we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. We also identified a new breach in relation to managing complaints. You can see the action we have told the provider to take at the end of the report. We will carry out another comprehensive inspection to check on all outstanding legal breaches.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relative and the staff supporting them. We reviewed a range of records and were also able to speak to a visiting GP. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Records showed people experienced safe and appropriate care. Their needs had been assessed and their care and treatment was identified and delivered in accordance with individualised care and risk-management plans. For example, staff followed guidance in care plans to minimise risk of falls when people were moving around the home. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

We found people's medicines were handled safely and in line with guidance. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

The provider and staff understood their responsibilities under the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). At the time of our inspection one person was subject to a DoLS authorisation or application and the requirement for DoLS in respect of all people living at the home was being reviewed by the manager.

Procedures were in place for dealing with emergencies and staff were suitably trained to ensure people's safety and welfare.

Is the service caring?

We spoke with relatives of people using the service who all gave positive feedback about staff and said were caring. On relative told us, 'The staff are generally very caring. They all give individual attention to the people living there.' People were dressed in clean and appropriate clothing. Attention had been given to their personal hygiene and grooming. We found staff to be knowledgeable about people's preferences, for example, their choice of food, beverages and activities. We observed people were supported by kind, attentive staff and empathetic staff. Staff showed patience and gave encouragement when supporting people. People using the service told us they felt safe when being cared for by staff.

Is the service effective?

People's health and care needs were assessed and we saw evidence to show they (or their relatives where appropriate) were always involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support they needed. Staff had received training to support the needs of people living at the home.

Is the service responsive?

We saw the provider had effective complaints, accident and incident reporting procedures. We found these were addressed within appropriate timescales. We found the provider monitored people's support needs and was able to respond appropriately if and when those needs changed. For example, during our inspection we observed a GP visited the home to examine two people whose needs had changed and update prescriptions for other people. We saw effective systems were in place to ensure those medicines were delivered the same day. We spoke with the GP who was very positive about the quality of care and responsiveness of the registered nurses and manager telling us, 'They are very good at contacting me. Their diagnosis is usually the same as my diagnosis.'

Is the service well led?

We found the provider carried out monitoring and reviews of the service and highlighted actions were completed in a timely manner. This meant the quality of the service could be assured by people living at Wells Place, their relatives and staff.

Staff told us they felt greatly supported by the new manager. Comments included, 'She is very good and supports everyone. She is the best manager we've had here so far.'

At the time of our visit there were nine people using the service. We met with eight of them, the new home manager and six members of staff. Due to their needs, most people using this service were unable to share their direct views about the standards of care. We therefore used a number of different methods to help us understand the experiences of people who used the service. This included observing care, looking at records and talking to staff. People who were able to share their experiences were happy with the service. One person told us they liked their new room and that 'the staff are kind.'

Throughout our visit, staff spent time with people, treated them as individuals and were patient and attentive. Staff told us that they had the training and information they needed to care for people and that the new manager was supportive.

Since our last inspection, care plans had been updated to reflect people's agreed care and support needs and people were being supported to make decisions about their lives. Record keeping and care practices had improved where people were at risk of poor nutrition.

Since joining in January 2013, the new manager had completed a quality audit of the service and begun to implement an action plan for improvement.

Due to their needs, most people using this service were unable to share their direct views about the standards of care.

We therefore used a number of different methods to gather evidence of people's experiences in order to help us understand what it was like for people living at this home. These included observing care practices; interactions with staff, reviewing care records and other records related to the running of the home

People who were able to communicate with us said they felt well cared for and spoke positively about the care and support they received. Comments included, 'They are a decent bunch in here. They treat me nice enough,' 'the staff are always kind' and 'they employ the best staff, they are nice and always trying to please the residents.'

We observed that staff respected people's routines and preferences and ensured their dignity when providing personal care. Staff told us that they had the training and information they needed to care for people and that the new owner was supportive.

We found that there were two areas for improvement. People's views and experiences were not always taken into account in the way the service was provided and delivered in relation to their care. There were arrangements in place for those at risk of poor nutrition and hydration but these were not consistently followed.