Background to this inspection
Updated
23 August 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
This inspection was completed by 2 inspectors, a specialist advisor who was a registered nurse, a pharmacy specialist and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Waltham Hall Nursing and Residential Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Waltham Hall Nursing and Residential Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection, there was a registered manager in post, but unavailable during the inspection.
Notice of inspection
The inspection was unannounced.
What we did before the inspection
We reviewed the information we had received about the service. We sought feedback from the local authority who funded some people’s care packages. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with 11 staff members this included; the clinical lead, audit manager, managing director, nurses, the cook, care staff, the housekeeper, domestic, care coordinator and senior care worker.
We spoke with 6 people who lived at the service and 5 visiting family. We looked at aspects of care records for 12 people. We reviewed a range of documentation relating to the management of the service including training records, 3 staff recruitment files, audits and checks, incident analysis and meeting records. We also reviewed equipment and the environment. Following the inspection we sought feedback from 2 GP practices for their experience of the service.
Updated
23 August 2023
Waltham Hall Nursing and Residential Home is a residential care home providing personal and nursing care up to 81 people in 1 adapted and extended building, over two floors.
At the time of our inspection, on day 1, 36 people were living at the service and on day 2, 38 people were living at the service, 2 people had been admitted for a short stay.
People’s experience of using this service and what we found
The provider’s systems and processes that assessed, monitored and mitigated risks showed some improvements. However, further action was required to strengthen, embed and sustain improvements.
The management team were not always visible and easily available for staff.
The provider had implemented a new electronic care record system. Improvements were ongoing, in ensuring guidance for staff about how to meet people’s care and treatment needs was personalised and up to date.
The monitoring of people’s food and fluid intake needed improving. People’s lunchtime experience, meal choice and food quality needed to be improved.
Staff had received training in safeguarding and knew how to protect people from abuse and avoidable harm. Incidents and accidents were reviewed, and action taken to reduce risks. However, monitoring, actions and opportunities for learning needed to be further strengthened.
People were positive about the competency of staff and felt confident they knew and understood their individual care and treatment needs. Staff were recruited safely. People were supported to access health care services.
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.
People received their medicines safely. Staff had received medicines training and had their competency assessed. However, the provider's audits and checks had failed to ensure best practice guidance in the management and storage of medicines were consistently followed. Infection prevention and control best practice guidance was followed. The service was clean and hygienic.
The provider had a quality assurance procedure whereby they invited people, relatives and staff to share their experience of the service.
Staff worked with external health and social care professionals to support people to achieve positive outcomes. The management team were open and honest about the ongoing improvements required and were committed to achieve this.
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 rated inspection for this service was requires improvement (published 21 March 2023). Breaches in regulations relating to safe care and treatment and good governance were identified. The provider completed an action plan after the inspection to show what they would do and by when, to improve and meet the breaches in regulation related to safe care and treatment. A Warning Notice was served for the breach relating to governance.
At this inspection, we found some improvements had been made, however, the provider remained in breach of regulation and the rating remains requires improvement.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has remained requires improvement based on the findings of this inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Waltham Hall Nursing and Residential Home on our website at www.cqc.org.uk.
Enforcement
A continued breach of Regulation 17 Good Governance was identified.
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.