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West Ridings Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 28 August 2019

During a routine inspection

About the service

West Ridings is a residential care home providing personal and nursing care for up to 180 people across six separate units, although one unit has not been used since 2015. Swaledale unit provides general nursing care, Wharfedale and Airedale units provide personal care, Wensleydale unit provides personal care for people living with dementia and Calderdale unit provides nursing care for people living with dementia. At the time of the inspection there were 130 people in the service. We did not visit Wensleydale during the inspection as the unit was closed to visitors, on the recommendation of the local authority infection control team, due to an outbreak of diarrhoea and vomiting.

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

People were happy with the care and support they received and told us they felt safe. Staff were aware of risks to people and knew how to keep them safe. Overall medicines were managed safely, although we raised some issues on the first day which were addressed promptly.

People gave mixed feedback about the staffing levels; some felt there were enough staff and said they came quickly, others reported they had to wait for staff and thought there were not enough. Overall, we observed staff were available to people, although staff were very busy at mealtimes on some units. Staff were trained and had the required skills to meet people’s needs. Staff told us they felt well supported. Recruitment processes ensured staff were suitable to work in the care service.

Staff knew people’s needs and how to meet them, although people’s care needs and preferences were not always fully reflected in their care records. People were not always given information in a way they could understand. We have made a recommendation about meeting people’s communication needs.

The home was clean and well maintained. The environment was decorated and furnished to a high standard with adaptations made to help people find their way around. Improvements had been made and were ongoing to make the environments on Calderdale and Wensleydale units more dementia friendly.

People and relatives praised the staff for being kind, caring and compassionate. We saw staff treated people with respect and maintained their privacy and dignity. People enjoyed a range of activities and events, including spending time outside in the garden and going out on trips. People had access to healthcare services. People’s nutritional needs were met but many complained about the quality and presentation of the food. The management were aware and were taking action to make improvements.

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. We have made a recommendation about obtaining and recording people’s consent to care and treatment.

A new registered manager had been appointed since the last inspection and everyone spoke highly of this individual. Leadership and management had improved, which resulted in better outcomes for people and an increase in staff morale. More thorough quality assurance systems had been implemented which identified similar issues to those we found during the inspection. Senior managers carried out regular reviews and provided assurances that actions were being taken to address these. The provider recognised these improvements need to be sustained and developed further to ensure the service is consistently well-led.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 7 March 2019) and there were breaches of regulations. We took enforcement action and issued warning notices. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This serv

Inspection carried out on 21 November 2018

During a routine inspection

The inspection was unannounced and took place on 21 & 22 November and 4 December 2018.

West Ridings 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. Accommodation is provided for up to 180 people, across six units, although one unit had not been in use since 2015. At the time of the inspection, there were 133 people living in the home.

At the time of the inspection West Ridings Care Home consisted of the units Swaledale (general nursing), Calderdale (dementia care nursing), Wensleydale (dementia care), Airedale (residential care) and Wharfedale (residential care).

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.

We identified four breaches in the regulations in relation to, safe care and treatment, staffing, fit and proper persons employed and good governance.

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.

We found weaknesses in how the service was run and managed. There was a lack of clinical oversight across the service. Some staff did not feel fully supported or clear in their roles and responsibilities. Audits of the quality of the provision were not robust and there were significant gaps in documentation.

Staffing levels on the whole were sufficient in number to meet people’s needs, although little consideration had been given to the skill mix of the team, particularly on the Calderdale unit.

Recruitment, induction and training was not robust and there was very little evidence staff were sufficiently vetted or had the right skills to support people safely. We found some concerns in the supervision and support of staff.

Management of medicines was not sufficiently safe. We found concerns around the supply of people’s medicines, stock balances and recording.

There were missed opportunities for lessons to be learned when accidents and incidents occurred.

People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice although staff understanding of the legislation around people's mental capacity was variable and decisions made in people’s best interests were not always clearly recorded.

People’s dietary needs were appropriately met, although people did not always have access to drinks in their rooms. There were effective links with other professionals to support people’s care and health needs.

Staff had a kind and caring approach and showed respect when interacting with people. There was appropriate regard for people's privacy and dignity.

Activities were variable; there were some meaningful opportunities in place and staff knew people as individuals, although not all people were happy with activity provision. People and relatives knew how to complain, although we found weaknesses in the recording of and response to complaints raised.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. T