Archived: Wealstone Residential Care Home

Wealstone Residential Care Home was providing personal care to 38 people at the time of the inspection. The service can support up to 42 people across two separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

Since our last inspection, improvements had been made and the service was no longer in breach of regulations.

Systems were now in place to manage risks to people’s health and wellbeing and medicines processes were safe.

Care plans contained detailed person-centred information to ensure staff could meet the preferences of people receiving care. There were now plenty of activities available for people to engage in. This enabled people to pursue their social and leisure interests and reduce the risk of social isolation. The communication needs of people were known, ensuring information could be presented to people in the most appropriate format.

People received a caring service and felt supported and valued as individuals. People told us they were treated with respect and staff upheld their privacy and dignity during personal care. People were supported by staff who knew them well and trusting relationships had been formed.

The service was well-led, and staff felt supported by an open and honest culture. Staff were motivated to deliver a high standard of care and received training appropriate to their job role. The registered manager worked with other professionals to ensure positive health outcomes were achieved for people.

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 24 March 2020) and there were multiple 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

We carried out an unannounced comprehensive inspection of this service on 04, 06 and 11 February 2020. Breaches of legal requirements were found.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

We found the following examples of good practice.

• The service had a system to facilitate visiting. Visitors booked onto an allocated slot which were spaced out throughout the day to allow for cleaning and to avoid potential infection transmission with other visitors. All visitors were asked to complete a health screening form and were provided with face masks to wear throughout their visit. We observed visitors following these procedures.

• Staff had been proactive in reducing the impact of loneliness by facilitating video calls to loved ones and sharing photographs sent in by family members who were unable to visit in person.

• Staff wore the correct personal protective equipment (PPE) throughout the inspection. One resident told us this could make communication difficult however they said staff, “do their best” under the circumstances.

• There were signs displayed around the service explaining the reasons for staff wearing facemasks. In addition, the registered manager had developed pictorial handwashing guidance. This was in all handwashing areas where people living with dementia accessed.

Wealstone is a residential care home providing personal and nursing care to 38 people at the time of the inspection. The service can support up to 42 people across two separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

Since the last inspection we found the necessary improvements had been made to the cleanliness of the service however we did identify issues regarding the safe management of medicines.

Aspects of record keeping remained insufficient and had not improved since the last inspection. although care plans were detailed and person-centred, records relating to some medicines and personal care were incomplete and there was a lack of effective systems in place to identify and drive improvements in this area.

There was a lack of activities on offer across the service and people consistently told us they were “bored” and there was “nothing to do”. There was also a lack of accessible information available. Whilst the registered manager began to address this during the inspection, significant improvements were required to ensure people received personalised care. Despite this, we did find staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We observed staff seek peoples consent before delivering care and decisions were only made in a person’s best interest where they were unable to make a decision for themselves.

Staff were recruited safely however we received some feedback from people about the staffing levels. Although we found consistent staffing levels in place, we have made a recommendation around staff deployment, so staff are available at the right place at key times of the day.

Although care plans were person centred and detailed people’s personal histories and preferences, we could not always see how people had been involved in developing their own care plan. We have made a recommendation regarding recording this involvement.

People spoke positively about the food available at the service and the care and kitchen staff were aware of and able to support people with any dietary needs.

The registered manager ensured people had access to appropriate healthcare services.

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 13 February 2019) and there were two 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 enough improvement had not been made and the provider was still in breach of regulations.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to providing personalised care, safe management of medication and ensuring adequate systems were in place to monitor the safety and quality of care provided at this inspection.

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

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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wealstone is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and we reviewed both areas during this inspection.

This is the first time this service has been inspected under the new registered provider.

The service has a registered manager. 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.

Wealstone is a single storey residential care home which has 42 single bedrooms, seven of which have en-suite facilities. Within the 42 beds, there is a separate 11 bedded unit called Bluebells that provides care for people with mild dementia. At the time of our inspection there were 37 people living in the home.

The building was not always clean and hygienic. This visit found that there were offensive odours in some bathrooms and toilets and that areas were not clean and had not been subjected to a thorough deep- clean in order to maintain hygiene standards and minimise the spread of infection. The second day of our visit found that some remedial action had been taken but this was not sufficient to address the issue. Some maintenance issues had also been identified within the building.

The registered provider did not have effective systems in place to monitor the quality of the service. For example, not all people had a care plan in place and this had not been identified by the registered provider before we visited. This was subsequently addressed. The registered provider had also not identified before our visit that concerns from a relative had not been responded to. This had now been addressed. While the registered provider routinely sent notifications to us regarding significant incidents, they had not understood the procedure for notifying us of significant grades of pressure ulcers.

The registered provider had systems in place to ensure that people were protected from abuse. Staff were aware of who to contact if they had concerns about the care provided by the service.

Staffing levels were maintained although difficulties in recruiting domestic staff had had some impact on cleanliness standards within the building. Staff were recruited appropriately.

The management of medication was safe. Assessments were in place to ensure that people were not at risk of malnutrition, pressure ulcers or falls.

Equipment used by people were regularly checked to ensure that their use was safe.

Staff received the training they required to perform their role. Staff were also supervised appropriately.

The registered provider ensured that people’s nutritional needs were met. The health needs of people were responded to appropriately.

The registered provider operated within the principles of the Mental Capacity Act 2005.

People felt cared for and that they were treated in a kind and patient manner. People had their personal information protected. People had access to advocacy service if they wished.

Care plans were person centred. Not all daily records were detailed.

We have made a recommendation in respect of daily record writing.

An activities programme was in place. Details on activities were not always advertised in line with people’s communication needs.

We have made recommendation in relation to reviewing information provided to people in line with their communication needs.

A complaints procedure was in place but issues with the governance of the service meant that not all were responded to in a timely fashion.

The staff team felt supported by the registered manager. The views of people were asked for and taken into account.

The registered provider co-operated with other agencies to ensure the wellbeing of people who used the service.