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Archived: Wells Place Care Home Requires improvement

The provider of this service changed - see new profile

Reports


Inspection carried out on 17 December 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 23 and 25 June 2015. Breaches of legal requirements were found in relation to person centred care, safe care and treatment, good governance and staffing. As a response to this, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. We undertook this focused inspection on the 17 and 18 December 2015 to check they had met the legal requirements. Whilst the provider has made some improvements, we found they had not fully met their own action plan. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Wells Place Care Home’ on our website at www.cqc.org.uk

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.

Inspection carried out on 23 and 25 June 2015

During a routine inspection

This inspection took place on 23 and 25 June 2015 and was unannounced. At our last inspection in August 2014 the provider met the regulations we inspected.

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. 33 people were using the service at the time of our inspection.

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.

Although people spoke positively about the care they received, this was not always reflected in their care records or reviewed in a timely manner. Care records did not always contain sufficient information to provide personalised care. Potential risks to people were identified, but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the care and support they need. Care plans did not record all the information staff needed to care and support people in the way that suited them best and kept them safe.

People were supported by adequate numbers of staff who had been safely recruited. However, they were not supported by a suitably trained or supervised staff team which could lead to people's needs being unmet. There were insufficient arrangements to ensure that staff were appropriately trained and supervised to meet people's needs and carry out their role.

The provider had systems in place for checking and monitoring the quality of the service. However, these were not wholly effective in identifying areas for improvement and ensuring these were followed up. We also found that records related to staff and the management of the service were not readily available or consistently maintained.

People were protected from harm because staff understood their responsibility to safeguard people from abuse. Safeguarding matters were dealt with in an open, transparent and objective way and the service worked with the local authority to improve practice when required.

People told us they were treated well and staff were caring. Relatives similarly spoke positively about the care and support individuals received and felt able to discuss any concerns with the registered manager and staff. Arrangements were in place for people and relatives to share their views or raise complaints. The provider listened and acted upon their feedback.

People were treated with kindness and patience. Staff respected people’s privacy and made sure individuals’ dignity was protected. There were positive interactions and people were complimentary about the staff. Relatives told us people were well cared for and gave us examples of their family members’ health and independence improving at the service.

People were supported to maintain good health and had access to healthcare services where required. A GP visited the home regularly and staff made appropriate referrals to other health professionals when needed. This included the involvement of dieticians and tissue viability nurses to support people’s health and wellbeing. People were encouraged and supported to eat a nutritional diet that also recognised their choices. Staff took appropriate action when individuals were at risk of poor nutrition or dehydration.

People were able to take part in activities of their choice and were supported to maintain relationships with family and friends who were important to them. Although there was a varied range of activities provided we have made a recommendation about improving activities for people living with dementia.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to managing risk and care planning for people using the service, the support and training provided to staff, the systems for monitoring the quality of service provision and record keeping. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 27 August 2014

During a routine inspection

An inspector carried out a planned inspection and gathered evidence against the outcomes we looked at to help answer our five key questions; is the service safe, caring, effective, responsive and well led?

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.”

Inspection carried out on 10 April 2013

During a routine inspection

Since our last inspection in October 2012, Wells Place Care Home had undergone major refurbishment and redecoration. We were told that there were some minor outstanding works and repairs to be completed.

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.

Inspection carried out on 1, 2 October 2012

During a routine inspection

At the time of our inspection, Wells Place Care Home was undergoing major refurbishment and parts of the premises were inaccessible to residents.

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.

Inspection carried out on 16 March 2012

During a routine inspection

People said they like living at the home, they generally like the food and staff listen and help them.