Archived: Walton Manor Residential and Nursing Home

Walton Manor is a two storey care home situated in the Walton area of Liverpool, Merseyside and is registered to provide accommodation, nursing and personal care for up to 49 people. The service is fully accessible and fitted with aids and adaptations to assist people with their mobility. A passenger lift and staircase provide access to the first floor. The service is located close to a busy shopping area with good public transport links.

There was a registered manager in post at the service. 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 last inspected the service in August 2014 and the registered provider met all the regulations we reviewed.

We have made a recommendation about the environment. Improvements had recently been made to parts of the environment, including the redecoration of corridors and bedrooms and the replacement of flooring. However, further improvements to the environment were required to help promote the independence of people living with dementia.

Risks people faced had been identified and plans which were in place provided staff with guidance on how to reduce the risk of harm to people. However, sufficient checks were not carried out on pressure relieving equipment to minimise risk to people. During our visit the registered manager and staff took immediate action to rectify this.

Medicines were stored appropriately, managed safely and comprehensive audits completed. However, care plans for PRN (as required) medication were not in place for staff guidance. This meant that people could be administered more medication than required. The registered manager informed us that this would be reviewed immediately.

There were sufficient numbers of staff on duty to meet people's needs. Robust recruitment processes were in place and the required recruitment checks had been completed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

Health and safety checks had been carried out on the environment and equipment used. The service was clean and tidy and the registered manager carried out regular checks on the cleanliness of the environment to ensure this was maintained. There was a fire risk assessment in place and checks of the fire safety equipment had been carried out. Staff had received training in fire prevention and safety.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

Staff understood their role and responsibilities. Staff received training to ensure they had the skills and knowledge to support the people living in the service. Staff were supported in their roles and received regular supervision and appraisals. New members of staff received a comprehensive induction into their roles.

People could choose when, where and what they wanted to eat. Additional drinks and snacks were

made available to people in between main meals and staff knew people's food preferences. People were provided with a varied and balanced diet and they were supported to make choices in relation to their food and drink.

People were assisted to access other healthcare professionals to maintain their health and well-being, when required.

Staff spoke kindly to people and respected their privacy and dignity. Staff knew people well and had a caring approach. Staff responded to people without delay and cared for people in an unrushed manner.

Records were comprehensive and kept up to date. Care plans contained detailed information on each person and how their support was to be delivered. Information was regularly reviewed with people living at the service. This meant that people received personalised care in line with their wishes and preferences.

People were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and support. Relatives were also encouraged to give their feedback on how they viewed the service.

There was an effective complaints system in place. People and staff knew who to raise concerns with and there was clear line of accountability amongst senior staff.

The registered manager demonstrated a 'hands-on' approach and knew people well. Quality monitoring audits were effectively used to identify where actions needed to be taken and to drive future improvements in the service. Accidents and incidents were reported and analysed to identify any patterns and themes.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives and staff and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were assessed and managed.

People who lived at the home and staff told us that staffing levels were sufficient to ensure people's welfare and safety were protected.

Staff recruitment processes were robust and this aimed to ensure that people who lived at the home were safeguarded against the risks of abuse.

Is the service effective?

Care was planned and delivered in line with people's assessed needs and people's needs were regularly reviewed to make sure they received the care and support they required.

People who lived at the home, relatives and staff told us that staffing levels were sufficient to ensure people received the care and support they needed.

Is the service caring?

People who lived at the home described staff as 'caring' and 'kind'. People's comments included, 'They're very good here I can't complain' and 'I love living here.'

We saw that staff were respectful and warm in their interactions with people who lived at the home.

Is the service responsive?

The service worked with other agencies to make sure people received the care and treatment they needed. GPs and other health professionals were referred to promptly when people required support with their health care needs.

The manager advised that they reviewed staffing levels regularly to ensure there were sufficient numbers of staff on duty to meet people's needs. The manager had determined that additional staff were required to improve the quality of the service people received. The manager was in the process of recruiting new staff to achieve this.

Is the service well-led?

The service was managed in a way that aimed to protect people's health, safety and welfare. The manager was taking action to improve the service through providing greater staffing levels.

At the time of our inspection the manager was not registered with CQC. The manager advised that they intended to submit their application for registration as a matter of priority.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager.

The manager was aware of their responsibilities under the Mental Capacity Act 2005 to assess people's capacity to give consent when required and to refer for specialist advice if it was felt that a person may be deprived of their liberty.

The provider has a system of checks in place to ensure people who used the service were provided with a safe home environment.

The staff recruitment process was robust and staff only started working at the home when all required checks on their suitability to undertake the role had been obtained.

Is the service effective?

We found that people's care and treatment was not always planned effectively. The lack of appropriate care planning meant that people who used the service were at risk of not receiving the care, treatment and support they needed.

People who lived at the home felt listened to and included in day to day decision making.

Is the service caring?

People who lived at the home told us staff were caring and respectful. Staff told us they were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity.

People's comments about the care they received included 'The care is excellent' and 'The carers are lovely you only have to say and it gets done.'

Is the service responsive?

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done through the use of surveys and meetings with people who lived at the home. People's feedback was then used to make improvements to the service.

Is the service well-led?

The provider had systems in place for assessing and monitoring the quality of the service. People who used the service, visitors and staff told us they had seen improvements to the service more recently and people felt they could approach the manager if they had any concerns or complaints.

The manager of the service was not registered with CQC at the time of our inspection. The manager confirmed that they have submitted an application for registration with CQC.

People told us they were happy at Walton Manor and spoke positively about the support provided by the staff. Comments included, "The staff are marvellous, you can't fault them" and "They see to everything and they understand the help I need."

All the staff we spoke with said the service had made improvements since our last inspection visit, that they felt well supported by their manager and that staff morale was high. Staff told us that they have regular supervision and were able to access training opportunities appropriate to their role.

We found that the service was storing confidential records securely and that care records were only available to the staff who required them.

During this inspection we used different methods to help us understand the experiences of people using the service. We spoke with eight of the people living at Walton Manor and with four of their visitors. We also spoke with nine members of staff who held different roles within the home. Some of the people using the service had complex needs which meant they were not able to tell us their experiences. Due to this we have used a formal way to observe people in this review to help us understand how their needs were supported. We call this the 'Short Observational Framework for Inspection' (SOFI).

The people living at Walton Manor and their relatives told us that they had noticed improvements to the service they received. Comments from people living there included, 'I am very pleased. They make me very comfortable,' and 'What more do you want? People wait on you.'

We spoke with nine people who used the service and five relatives. People told us that the care they had received had been delivered in a way that respected their privacy and dignity. Their comments included:

"I'm very happy living here'

'It's very nice'.

'I feel safe'.

'I have nothing to complain about'.

"Missing the edge".

We found that the care records had been regularly reviewed and updated.

Procedures to protect people from abuse had been followed and all incidents had been appropriately to the relevant authorities including CQC.

We found the home to be clean and regular checks had been carried out to ensure the required standards of cleanliness and infection control.

Improvements were required to help make sure medicines are always handled safely.

We found that there was sufficient staff on duty to provide people with the care and support they needed.

Staff told us that they had not had a performance review this year.

Improvements were required to ensure the effective monitoring of the quality of service provision.

People told us that they understood the care they were receiving and had been involved in discussing their care records. We found that the care records had been regularly reviewed and updated.

We observed that some service users had to wait a long time for their lunch which impacted on their mealtime experience. One person told us "Sometimes there is no one around".

We found that some improvements had been made since our last visit but we observed that the provider was still experiencing some issues in terms of maintaining the right staffing levels with a consistency of care.