West Ridings Care Home

West Ridings Care Home is a nursing home which provides nursing and personal care for up to 180 people with various health conditions, including people living with dementia. Accommodation is provided in 4 purpose-built, single storey buildings with disabled access. These were known as Wensleydale, Calderdale, Swaledale and Wharfedale. There were 94 people using the service at the time of our inspection.

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

There was a system in place to manage medicines. However, we identified some shortfalls in relation to the storage and management of people’s medicines. The service was clean overall, although there was a need for more thorough monitoring of equipment in the kitchenettes in each unit.

People were supported to have maximum choice and control of their lives and staff supported them in them in the least restrictive way possible and in their best interests. The management team was working to ensure the records, policies and systems in the service always supported this practice. The management team were aware of the need for improvement in some areas of people’s care planning and records, including records about the Deprivation of Liberty Safeguards (DoLS). The manager had created an improvement plan and was working to this, to ensure shortfalls were addressed.

The manager was working to ensure the system to monitor and manage the quality and safety of the service was effective. However, there was further work to do to achieve this and some audits and checks needed to be strengthened.

Some areas of the home had been redecorated and further redecoration was needed, as not all units were of a similar standard. We received mixed feedback about the food and the staffing levels, although overall, we found people were supported to eat and drink enough and there were enough staff to keep people safe.

Staff received the training and support needed to help them to meet people’s needs. People said staff were proactive in supporting their health needs and arranged any health care they needed promptly. We received a lot of very positive feedback about the care staff from people and relatives. One person said, “I would know who to complain to. It is lovely and well run here. Just being here is the nicest thing. Nothing to improve. They [staff] are all nice and I love them all.”

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

Rating at last inspection

The last rating for this service was good (published 21 December 2022).

Why we inspected

We received concerns in relation to nutrition, unexplained injuries, and the standard and culture of nursing care. As a result, we undertook a focused inspection to review the key questions of safe and well-led. During our inspection visit, issues were identified, and the inspection was expanded to include the effective key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West Ridings Care Home on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Enforcement and Recommendations

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to safe care and treatment, and good governance during this inspection.

We have made recommendations regarding staff deployment and internet access in relation to people’s electronic care records.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

People and staff told us West Ridings Care Home was a safe place to live and work. The building was clean and hygienic, and staff were seen to wear appropriate personal protective equipment (PPE). Sufficient care and domestic staff were deployed to meet people's needs. Staff received safeguarding training and were aware of the processes to follow to enable people to keep safe. Risks were assessed and carefully monitored to ensure the safety of people. Staff were employed following a thorough recruitment process. Staff deployment was effective to ensure people's needs were met in a timely and consistent way. Systems were in place for people to receive their medicines in a safe way.

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. Mental capacity assessments had been carried out to establish whether people were able to make informed decisions about their care.

People were supported with activities and engagement that met their social needs. People were supported in a personalised way that was responsive to their needs. People's communication needs had been assessed and staff were supporting these. People felt confident that any issues or complaints would be dealt with to their satisfaction. Planning for people's end of life support was thorough and compassionate.

The home's management and leadership were visible with a culture of openness, positivity and honesty. The registered manager ensured that quality assurance systems were completed to monitor people's safety and care, and to drive improvement. The registered manager encouraged feedback from people, staff and professionals involved in people's care. Staff worked closely with health professionals and external agencies to promote good outcomes for people. People spoke positively about the registered manager.

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

Rating at last inspection

The last rating for this service was requires improvement (published 16 July 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

West Ridings Care Home is a residential care home with nursing, for up to 180 people across six separate units. However, one unit, Kingsdale, has not been used since 2015. There are two units which provide nursing care, Swaledale for general nursing care, and Calderdale for people living with dementia. The Wharfedale and Airedale units provide residential care and the Wensleydale unit provides residential care for people living with dementia. At the time of the inspection there were 100 people using the service.

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

Staff were aware of how to keep people safe from the risk of abuse and how to report concerns. However, some staff did not feel confident to raise concerns. Risks to people were assessed, however it was not always clear in records how staff kept people safe. People, staff and relatives did not feel staffing was sufficient to meet people’s needs. We observed on some units, people waiting long periods for staff support. Service improvement plans were up to date and reflected recent concerns, actions were on going to drive improvements. However, we found staff safeguarding allegations were not always investigated in a timely manner.

Infection prevention and control systems were in place. The home was visibly clean, however cleaning was not always completed in line with the homes schedule. Staff did not always follow up to date guidance in the use of face masks. Systems were not always in place to mitigate risks. Complaints were not always dealt with in a timely manner. We received mixed feedback from people, staff and relatives regarding the management team. Staff supervisions and appraisals were not conducted to support staff in their role Staff meetings took place and staff were involved in these. Residents meetings did not take place across all units. Relatives meetings were on hold due to COVID-19, however plans were in place to reintroduce these. Feedback had not been sought from people, relatives and professionals in line with company policy. Relatives we spoke with felt communication from the home was good.

People and their relatives felt safe and were positive about safety in the home. People and relative’s felt that staff were kind and caring. We observed staff interacting with people positively. Staff were suitably trained and recruited. Medicines were managed well. People were receiving their medicines as prescribed. Maintenance checks were in place and up to date. Policies and procedures were in place to manage accidents and the provider had oversight of all incidents in the service. Monthly provider reports were in place to monitor any concerns.

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.

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 requires improvement (published 05 July 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had made improvements and was no longer in breach of regualtion12 (Safe care and treatment). However, the provider was in breach of regulation 17 (Good governance). This service has been rated requires improvement for the last three consecutive inspections.

You can see what action we have asked the provider to take at the end of this full report

Why we inspected

The inspection was prompted in part due to concerns received about staffing, managing risks to people and management and governance of the service. A decision was made for us to inspect and examine those risks

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

West Ridings Care Home is a residential care home with nursing, for up to 180 people across six separate units. However, one unit, Kingsdale, has not been used since 2015. There are two units which provide nursing care, Swaledale for general nursing care, and Calderdale for people living with dementia. The Wharfedale and Airedale units provide residential personal care and the Wensleydale unit provides personal care for people living with dementia. At the time of the inspection there were 102 people using the service, although two people were in hospital.

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

People said they feel safely supported overall. Relatives said they felt practice was safe. Staff understood safe ways of working, although care plans did not always provide enough guidance for staff to understand risks to individuals. People’s needs were met in a timely manner during our inspection; staffing levels were adequate although deployment of staff was not always effective. Staff had a good understanding of safeguarding procedures and were encouraged and confident to raise issues of concern.Safe systems of recruitment were followed to ensure staff were suitable to work with vulnerable people, although checking of registered nurse status needed to be more robustly recorded.

Infection prevention and control practices to prevent the spread of infections were variable. The units were visibly clean throughout, with additional cleaning being completed as a result of the COVID-19 pandemic, although there was a lingering malodour in the Wensleydale unit. Whilst there were many aspects of good practice, the occasional wearing of PPE, such as face masks was not in keeping with up to date guidance. Some equipment was also in need of thorough cleaning and when we brought this to the attention of staff this was immediately addressed.

There was evidence of improving training with clear systems and processes in place to track training requirements, inform individuals and unit managers when training was due. The resident experience manager had oversight of these processes to enable staff to have the knowledge and skills to support people.

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.

Since the last inspection, the provider had taken steps to improve the unit leadership and governance by making the unit managers supernumerary, supported by Clinical Service Managers. In addition, there was a new Regional Director coming into post. There was a clear governance structure at corporate level, but improvements were needed to assure quality at the level of each individual unit.

Accidents and incidents were reviewed to ensure appropriate action had been taken and there was a clear process to trigger further investigation of incidents. Analysis of incidents was completed although this needed to be more robust to show clear actions, rather than recommendations.

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

Rating at last inspection

The last rating for this service was requires improvement (published 27/01/2021).

At this inspection the provider was in breach of regulation 12, Safe care and treatment. This was because there were weaknesses in the identification and management of some risks. Although new systems and processes were being introduced to improve the quality and safety of the care provided, these were not yet embedded in practice. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections, although there were encouraging signs of improving quality.

Why we inspected

This inspection was prompted in part due to concerns received about infection prevention and control, staffing levels, medicines, managing risk and the management and governance of the service. A decision was made for us to inspect and examine those risks. We found evidence during this inspection that people were at risk of harm from some of these concerns, however we did not find evidence that harm had occurred.

This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements and concerns. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same as requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement, although improvements were in progress and being developed. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West Ridings Care Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority and CCG to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 116 people using the service, six of whom were in hospital.

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

The registered provider did not have effective systems of governance in place to maintain and improve the quality and safety of the service.

There had been improvements in infection prevention and control practices to prevent the spread of infections, however not all risks had been recorded. The provider took action to address this and risk assessments were completed to evidence the measures in place to reduce risks.

Staff were not always supported with role specific training, to ensure they had the knowledge and skills to support people.

Feedback about whether there were enough staff to meet people’s needs was mixed. People’s needs were met in a timely manner during our inspection. The provider did not evidence people’s dependency levels were used to allocate staffing, as the staffing level tool was faulty and managers at the home were not aware of this. The provider rectified this after our inspection and reviewed staffing levels.

Staff were knowledgeable about people’s needs and people told us the staff were caring. Some care records needed to be updated.

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. Improvements were required in the recording of best interest discussions for some people.

People told us they felt safe and staff we spoke with had a good understanding of how to safeguard adults from abuse.

Safe systems of recruitment were followed to ensure staff were safe to work with vulnerable people.

Accidents and incidents were reviewed to ensure appropriate action had been taken and lessons had been learned to reduce the risk of a re-occurrence. People received their medicines as prescribed.

The home was clean throughout, with additional cleaning being completed during the COVID-19 pandemic.

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

Rating at last inspection

The last rating for this service was requires improvement (published 31/10/2019).

At this inspection the provider was in breach of two regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted in part due to concerns received about infection prevention and control, staffing levels, medicines, managing risk and the management and governance of the service. A decision was made for us to inspect and examine those risks. We found evidence during this inspection that people were at risk of harm from some of these concerns, however we did not find evidence that harm had occurred.

This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements and concerns. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same as requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West Ridings Care Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority and CCG to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 service has been in Special Measures since 7 March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.