Worplesdon View

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. The registered manager was at the home during the time of our inspection.

We last carried out a comprehensive inspection of Worplesdon View in August 2017 where we found the registered provider was in breach of seven regulations. These related to the safe care of people; staffing levels; the responsiveness of the service to people’s needs, and how they managed complaints; and the effectiveness of the provider’s quality assurance systems. Following this inspection the registered provider sent us an action plan of how they would address these issues.

The inspection took place on 8 March 2018 and was unannounced. During this inspection we found that the concerns raised at our previous inspection had been dealt with. The provider now needed time to embed the processes to show they were robust and effective at ensuring people continued to receive a good standard of care.

There was positive feedback about the home and caring nature of staff from people who live here. The registered manager had been in post for over three months, and had made many positive changes to the standard of care people received. Quality assurance processes were now picking up day to day issues, so that corrective action could be taken.

People were safe at Worplesdon View. Staff understood their duty should they suspect abuse was taking place. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. The home was clean, and staff practiced good infection control measures, such as hand washing and correct use of personal protective equipment.

There were sufficient staff deployed to meet the needs and preferences of the people who lived at the home. In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported. People’s nursing needs were met by competent staff.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were supported to have a balanced diet and they were encouraged to keep hydrated. People had enough to eat and drink, and specialist diets either through medical requirements, or personal choices were provided.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment.

People received the care and support as detailed in their care plans. The staff knew the people they cared for as individuals, and were positive in their interactions with them. Staff treated people with kindness and respect. People were involved in their day to day care decisions. People were supported at the end of their lives to have a dignified death.

People had access to wide range of activities in the home. These helped keep people fit, and stimulate their minds to prevent them becoming bored or isolated.

People knew how to make a complaint. Where complaints and comments had been received the staff had responded to try to put things right.

There was a registered manager in post and present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were mixed responses from people and relatives about whether there were enough staff to support people. Our observations were that in some parts of the service there were not enough staff both at night and during the day and this put people at risk.

People’s risks were not always been managed in a safe way including call bells being out of reach, accidents and incidents had not always been analysed. Risk assessments were not always in place. Other risks were being managed well including skin integrity and clinical risks.

We did find occasions where staff treated people in a caring, kind and considerate way. However there were also occasions where people were not treated respectfully or with dignity by staff.

Care plans for people did not always provide detailed guidance for staff on how best to support people. Staff did not always share detailed handover information about people’s needs. We did see other care plans that were detailed around the guidance staff needed to provide care. People and relatives said that staff communicated well with them.

Although people and relatives said they knew how to complain, when they did complain this was not always resolved to their satisfaction. Complaints were not always being recorded in line with the provider’s policy.

Medicines were being managed appropriately. We asked the registered manager to ensure that staff were recording when they had offered people ‘as and when’ medicines as there were some gaps around this on the medicine charts.

There were aspects to the competencies and skills of staff that required improvement. Health care conditions were not always being identified in a timely way and staff needed additional training to help support the needs of people living with dementia. Some staff were receiving one to one supervisions with their manager but clinical supervisions with nurses were required.

The environment where people lived with dementia required improvements and this was being undertaken by the provider.

There were mixed responses from people, relatives and staff about how well the service was being managed. Staff had differing opinions about whether they felt supported, valued and listened to.

There was a lack of leadership in some parts of the service. Systems and processes were not established and operated effectively to make improvements. Records were not always accurate or kept securely.

Notifications that were required to be sent to the CQC were not always being completed including safeguarding concerns and notifiable injuries.

People told us that they felt safe with staff and were not concerned about how they may be treated. Relatives also felt their family members were safe with staff. Staff understood what they needed to do if they suspected abuse and who to report it to. Staff employed at the service underwent robust recruitment before they started work.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA). We noted that DoLs applications had been completed in line with current legislation to the local authority for people living at the home.

People enjoyed the food at the service and people’s hydration and nutrition needs were being met. We did recommend that people that were on modified diets were also offered a choice of meals. People told us that they were able to access health care professionals when they needed.

People and their relatives told us that activities took place at the service. People had access to activities that were important and relevant to them. People were protected from social isolation and there were a range of activities available.

During the inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Worplesdon View provides 24-hour general nursing and residential care, which includes care for people who have a range of needs related to different types of dementia.

The service did not have 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. The registered manager had left the home approximately three weeks prior to our inspection visit. The provider had arranged for a temporary manager to be in place, and at the time of our inspection they had been in place for approximately two weeks. The manager confirmed they intended to remain at the home, and would be submitting an application to become the registered manager in due course.

People were comfortable with the staff who supported them and relatives were confident people were safe living in the home. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from harm. Risks to people’s safety were assessed and minimised to keep people safe.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed, but guidelines in place for people prescribed ‘as required’ medicines were not always clear.

There were enough staff to meet people’s needs. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed.

The provider ensured staff had information on the level of support people needed with decision-making so people were protected. Staff and the registered manager had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people before delivering care and support. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure they were in people’s ‘best interests’, and applications for legal authorisation had been sent to the relevant authorities.

Staff had basic training to help them keep people safe, but nursing staff and all staff supporting people living with dementia required more specialist training to be fully effective in meeting people’s individual needs.

Staff were kind and caring, and treated people with dignity and respect. People were supported to make choices about their day to day lives.

People had access to health professionals when needed and we saw the care and support provided in the home was in line with what had been recommended.

Relatives told us they felt able to raise any concerns with the new manager, who was already making positive changes. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the management team were approachable, but recent changes in management had proved unsettling. There were systems in place to monitor the quality of the support provided in the home. However, these systems were not always effective because they had not identified some of the issues we found during our inspection.

We had not always been notified as required about incidents and events in the home.

Staff had received training in relation to safeguarding vulnerable people and knew what to look out for, and how to report such matters if they should arise. People living in the home said they felt happy with staff and were confident in their skills. We saw that there were thorough recruitment procedures in place, which ensured that only suitable staff were employed.

The service took into account the views of people living there and also monitored the standards of its services through a range of different methods, including surveys and audit. People expressed positive comments to us on the service, such as, "It is very good, clean rooms, they are nice","Staff respect my choices and preferences as far as possible, and "I am very happy and restful."