Archived: Waypoints Verwood

The service is registered to provide accommodation and residential and nursing care for up to 42 older people. At the time of our inspection the service was providing residential care to 24 people most of whom were living with a dementia.

Waypoints Verwood 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. People were supported in a large purpose built home which was separated into four separate units spread over two floors. Each unit had a lounge area and there were two large communal lounge and dining areas on the ground floor. Access to the first floor was via lift or three staircases and there were accessible outside areas to the rear of the home and two first floor enclosed terraces.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the last inspection in November 2017, we asked the provider to take action to make improvements in a number of areas. These included; staffing levels, risk management, fire safety measures, medicines and incident reporting. Further improvements were also needed around Deprivation of Liberty Safeguards, involving people and relatives in decisions and handling and responding to complaints. These actions had been completed.

We found that improvements were still required in monitoring and improving the service. People’s topical cream Medicine Administration Record sheets and repositioning records had not been completed accurately and were out of date. Quality monitoring systems were not fully effective or robust as they did not monitor whether tasks or actions had been completed. This meant that the service had not identified these recording errors.

The home had not had a registered manager in post since August 2018. 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 acting head of care had been offered the head of care role and a new home manager had recently been recruited and was due to start in October 2018. The director of operations was basing themselves at the home in the interim period so that they could provide additional management support to staff and people at the service.

People were at risk of avoidable skin damage because pressure-relieving air-mattresses were set incorrectly Staff were checking that mattresses were set but had not ensured that these were at the correct weight for people. Although this had not resulted in any pressure areas, it meant that people were not always supported with safe pressure care and were therefore at increased risk of developing sore skin.

Staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. People had person centred risk assessments which identified that individual risks they faced and provided actions for staff to safely manage these. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

People and families had been involved in assessments care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. Consent to care was sought in line with the principals of the decision making. However, there was not sufficient oversight of people who had Deprivation of Liberty Safeguard authorisations in place, or any conditions which were attached to these.

People, professionals and their families described the staff as caring, kind and friendly and the atmosphere of the home as homely. People were able to express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they could communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes. People had opportunities to take part in activities and outings which met the interests and preferences.

People, relatives and professionals told us that they had experienced improvements in the home since the last inspection. Leadership was visible and promoted teamwork. Staff spoke positively about the management and had a clear understanding of their roles and responsibilities. The service understood their legal responsibilities for reporting and sharing information with other services.

During our inspection we found a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

The service is registered to provide accommodation and residential and nursing care for up to 42 older people. At the time of our inspection the service was providing residential care to 37 people most of whom were living with a dementia.

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 absent at the time of inspection and temporary management arrangements were in place.

Waypoints Verwood 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. People were supported in a large purpose built home which was separated into four separate units spread over two floors. Each unit had a lounge area and there were two large communal lounge and dining areas on the ground floor. Access to the first floor was via lift or three staircases and there were accessible outside areas to the rear of the home and two first floor enclosed terraces.

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.

Risks people faced were not consistently monitored or actions taken when people’s needs changed. We found that risks of people falling or developing pressure sores were not safely managed and this placed people at increased risk of harm.

People did not always receive safe care and treatment because there were not enough staff to meet their assessed needs. The service was using agency staff daily and this meant that staff did not always know people well.

Notifications of allegations of abuse were not sent to CQC and we identified and raised three safeguarding alerts to the local authority during our inspection.

People did not always receive their medicines as prescribed, this included issues with recording, times that medicines were given and incidences where people did not receive their medicines.

Fire checks were in place but there were not enough staff with sufficient fire training at weekends.

People did not always receive joined up care because the home didn’t consistently work with external professionals.

People were supported in a purpose built building but there were some stained carpets and offensive odours in some areas of the home. There were plans in place to replace these.

Relatives told us that agency staff did not always communicate with, or know people very well.

Staff did not always use language which was respectful.

Concerns and complaints were not always responded to identify how the service could be improved.

People did not receive end of life care which was effectively planned and did not consistently include the views or wishes of relatives and those important to people.

Activities were varied and person centred but were restricted by the availability of activity staff with no-one covering weekends and one person during the week for 37 people.

Reviews were completed by staff but were not used as an opportunity to involve people or their loved ones in discussions or decisions about their care.

Audits and oversight were not comprehensive and did not always identify shortfalls in the requirements of the regulations being met.

Staff did not all feel valued or supported in their role and communication between staff and management was not effective.

Staff were recruited with appropriate pre-employment checks and received regular supervision and training in topics which were relevant for people living at the home.

People had assessments of their capacity and where needed, decisions were made in their best interests.

People had a choice of meals and were supported to eat safely with modified diets where required.

Permanent staff knew people well and interactions were kind and compassionate.

Relatives told us that they were able to visit when they chose and were welcomed.

During our inspection we found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Our last inspection on 27 and 29 September 2014 found that arrangements around responding to peoples challenging behaviour and the use of restraint were not robust enough to ensure people were fully protected. We found that people were not always protected from the risks of unsafe or inappropriate care and treatment because appropriate records were not always maintained and that the registered provider had not notified the Care Quality Commission of incidents occurring in the home. During this inspection we found that improvements had been made.

The service has 42 en-suite bedrooms spread across four units on two floors. There was a large communal area with creative art work on the walls and a dining room. There was a quiet lounge and small kitchen on each unit. The service also had a library which is often used by relatives visiting their family, a hair salon and a training room. There were coded stair ways and two passenger lifts one on each side of the home.

The service has a registered manager in place. 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.

People were at a reduced risk of harm because they were supported by staff who understood how to respond to risk and how to identify and report potential abuse. One person said, “I feel safe here because everybody is lovely”. A staff member told us, “Signs of potential abuse may include, unexplained bruises, skin tares, withdrawn or changes to behaviour. I have received training in safeguarding and there is a policy for it along with a whistleblowing policy too which we all have to read and sign”.

Staff were knowledgeable of people’s needs and received regular training which related to their roles and responsibilities. We reviewed the training matrix which confirmed that the majority of staff had received training in topics such as moving and handling, challenging behaviour and restraint, first aid and Mental Capacity Act. A relative told us, “Staff are well trained, they know and do a lot. I see it when I visit my wife. I’m confident in the staff, I wouldn’t have her anywhere else”.

The service used behaviour charts for people who may challenge the service. The charts used the ABC method of breaking down the incident to identify what might have triggered the situation and how it was responded to and resolved. The Registered Manager explained how she used these to identify trends by reviewing and analysing the data collected.

Staff were aware of the Mental Capacity Act and told us they had received Mental Capacity training. The training record we reviewed confirmed this. A staff member told us, “We always assume people have capacity and then assess this if necessary to identify what people may not be able to make choices or decisions in”. Another staff member said, “We always ask people for consent here”.

We reviewed capacity assessments and best interest meeting records which clearly identified why decisions were made and the people who were involved for example the GP and relatives. A relative told us, “I am always part of any best interest meeting and decisions. My wife lacks capacity in a number of areas”. A CPN said, “A person recently had a best interest meeting due to their lack of capacity. Medication was discussed; I was involved in this with the family, GP and staff”.

We reviewed the lunch and supper menus and there was plenty of choice for example, two meat choices and one vegetarian with main meal at lunch time and a hot pudding. There were always two vegetables offered alongside potato. The Head Chef informed us that in addition to this menu there is another menu that people can choose food from anytime of the day for example an omelette or cooked breakfast. The provider told us that the chef kept records of meetings they had with people regarding their preferred food choices.

People were supported by staff who were caring and respectful of their privacy and dignity. We observed a staff member supporting a person who had become distressed. The staff member remained calm and reassured the person. They supported the person to sit down and relax. After about five minutes we observed the staff member come back to the person and check on them. This showed a positive, caring approach was being used and that relationships were established between the person and staff.

Peoples care files recorded key professionals involved in their care, how to support them and medical conditions to name a few. This information supported new and experienced staff to understand important information about the people they were supporting. People had a “This is me” profile completed on admission. . This was a person centred profile which reflected key summary information on them covering topics such as important things for me, how best to support me and likes and dislikes. The provider told us they were enhancing this to gather more information from people on what their favourite songs and past days were.

The service used an online system to complete some records for example; health care assessments and daily records. Some people’s health care assessments we reviewed were due for a review by the service. We discussed this with the Registered Manager who said they were aware of this and were working with an IT team to move over and use a new online system which will hold all records. The Registered Manager said that this was taking longer because existing data needs to be transferred and she wanted to minimise the risk of losing any information.

The service employed an activities coordinator who arranged many activities during the day for example a breakfast club where people can come together, eat, listen to music and read newspapers. Other regular activities included knitting, art and flower arranging. Day trips were also arranged for people to local museums and attractions. We observed that there were a large number of males using the service and asked if there had been any thought to a males only club. The coordinator replied no and said that she would look into this.

Complaints were recorded and captured the detail and evidenced the steps taken to address them. The service had a comprehensive complaints policy and procedure in place which included contact details of external bodies for example the local council or Care Quality Commission. However, there were no local internal contact details for people to contact which could mean that some people would be unsure who to raise issues with at the service.

The Registered Manager told us that she chairs quarterly friends and family meetings. These are opportunities for people’s relatives and friends to come together and find out what’s new and in development at the service. The meetings enabled the service to discuss involvement opportunities for example recruitment and quality checking. The service also used these meetings to seek feedback from people. A relative told us; “I attended the friends and family meeting a few weeks ago” they went onto say “I found the meeting very useful, we were told about things coming up like, the changes to the front garden area”.

Staff, relatives and health professionals all said that they felt the home was well managed. A staff member said, “The Registered Manager is very good and supportive. They are always open and approachable. They are involved in the front line and the Head of Care is always checking on what’s happening”.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There were some arrangements in place to help ensure that people received the care they needed and risks to their welfare were reduced. For example, where people were at risk of falls or developing sore skin we found that arrangements were in place to promote their safety and comfort. Staff checked on people regularly to ensure they were safe and their needs were met. However, improvements were needed to care records to ensure that all aspects of people's health were consistently recorded and monitored and they were protected from the risks of inappropriate care. We also found that improvements were needed in relation to arrangements around people's challenging behaviour and the use of restraint to help ensure a safe and consistent approach at all times.

There were procedures in place to keep people safe from abuse. Staff knew what action to take if they had concerns about people's welfare. People who used the service, and their relatives, told us they felt safe in the home.

The provider had not notified the Care Quality Commission of incidents of abuse and serious injury in the home. This meant that people who used the service could not be confident that important events affecting their welfare, health and safety were being reported, as required by law, so that we could take action where appropriate.

We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.

Is the service effective?

The home provided a suitable environment for people with dementia. We found that the home was designed to take account of the needs of people with dementia and promote their independence. There was a strong emphasis on ensuring people's rights were promoted and that care was provided in a flexible and individualised way. Most people we spoke with told us that staff understood their needs and made sure they received appropriate support.

There were activities available to meet people's emotional and social needs. We found that the home was taking action to develop their activities programme and ensure it was varied and included everyone.

Is the service caring?

People were treated with respect. Staff greeted people warmly and responded to their needs in a calm and friendly manner. We saw staff including people in conversation and taking action, where needed, to promote their dignity.

People told us that staff were kind to them and treated them well. One relative, for example, told us, "Everybody here treats people with respect. There's a happy atmosphere." Another relative commented, "Nothing is ever too much trouble. I can't fault the carers at all. They do go the extra mile."

Is the service responsive?

People, and their relatives, were involved in their care. People told us that staff asked for their opinions and listened to their views. They had confidence that staff would act on any concerns they raised and told us that care was centred around people's needs and preferences.

Staff took appropriate action in response to changes in people's health and well-being. Where one person's health had recently deteriorated, we found that staff had taken appropriate action to assess their symptoms and call the emergency services. Staff also obtained advice and support from a range of health care professionals where needed and ensured their recommendations were followed. People told us they were satisfied with the way the home had responded to changes in their family member's health and welfare.

Is the service well-led?

The provider had some effective systems in place to monitor the quality of the service that people received and manage risks to their welfare. For example, new procedures had been put in place to ensure that regular checks were carried out on people's well-being and to reduce the risk of falls. People who used the service, and their relatives, were also consulted about the care provided and their feedback was used to make improvements. Relatives told us that communication between themselves and the home had improved in recent months and they had received a suitable response to issues they had raised.

There were arrangements in place to promote communication between managers and staff which included regular meetings and group supervision. Staff told us that communication in the home was effective and they were kept up to date with any changes that affected their work. We found that staff were also encouraged to express their views and be involved in discussions about people's care and the running of the home. This helped promote a positive culture within the home which ensured people's views were listened to, valued and acted upon.

The care plans contained detailed information on people's needs including their behaviour which may cause concern. For example, one person had particular behaviours which occurred after a visit from family. Staff were advised what to do to support both the person and their family.

We observed staff supporting people. Staff were kind, respectful and knew how people needed to be supported. For example, one person needed to be turned every two hours to ensure their skin was not damaged. Staff knew what to do, why it was important and how it should be recorded.

There were appropriate systems in place to ensure people received the medicines they needed to maintain their wellbeing.

Staff told us there was enough staff to meet people's needs. At the time of our inspection there were 40 people being supported by 10 lifestyle assistants and two qualified nurses.