Waltham Hall Nursing & Residential Home

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.

Waltham Hall Nursing and Residential Home is a residential care home providing personal and nursing care to 37 people at the time of our inspection.

Waltham Hall Nursing and Residential Home accommodates up to 81 people in one adapted and extended building. Bedrooms and communal living areas are over two floors.

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

Quality assurance and audit checks were not completed regularly or consistently in some key areas of the service. The provider and registered manager could not assure themselves that systems to assess, monitor and improve the quality of the service were effective. This included the areas of health and safety, infection prevention and control, and care records.

The provider and registered manager could not assure themselves of the quality and safety of care provision to people living in the service in all areas. There were no records of management oversight of people's care records covering daily monitoring checks such as food and fluid charts, repositioning charts, daily notes and specialist health checks.

People's care plans and risk assessments were not always accurate or easily navigated. Information found in one care plan was not transferred to another which raised the risk of inconsistent care provision. A significant piece of work was ongoing to renew care plans before moving to an electronic system. This needed time to take place and embed into practice.

Staff had not received training in all key areas of care provision to help ensure they had the skills and knowledge to fulfill their roles. We did not find any negative impact upon people’s care due to this.

People and relatives told us people were safe living in the service. Staff had received training in safeguarding. Recruitment checks took place prior to new staff commencing work, although not all application forms contained full employment and education histories.

There were enough staff to meet people’s care needs. People were supported with their medicines safely and medicines practices were effective. The service was clean and infection control practices were followed.

Accidents, incidents and falls were reported, followed up and regularly reviewed. A new system had been implemented recently in this area and needed time to be embedded and sustained in practice.

People's care records contained assessments prior to their moving into the service, which covered their care and support needs.

People were observed to receive physical support with their eating and drinking where this was needed. People were supported to promptly access health care services when required. Positive feedback was received from 2 health professionals who we spoke to as part of this inspection.

The registered manager was well regarded by the staff team and staff felt supported by the management team. The registered manager was committed to making the required improvements to ensure people received continued good quality care supported by effective governance arrangements. The local authority was involved in offering regular support to identify and drive 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.

Rating at last inspection

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

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.

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 Waltham Hall Nursing and Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to people’s safe care and treatment, and governance arrangements at this inspection.

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

Waltham Hall Nursing Home is a residential care home providing personal and nursing care to up to 81 people. The service provides support to older people some of who had dementia. At the time of our inspection there were 38 people using the service.

The service was provided in one adapted building suitable for care and nursing needs including end of life care.

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

The care people received was safe. The service had systems and processes in place for safeguarding people and managing incidents and accidents. Medicines management was safe and followed good practice guidance. Staff numbers and deployment promoted safe care.

Staff received training and support required to fulfil the responsibilities of their role. They ensured people had prompt access to required services and professionals to maintain their health and wellbeing.

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 the staff communication system used within the building.

Staff were kind and compassionate. They involved people in decisions about their care and respected the choices people had made. Staff treated people with dignity, respect and supported them to be as independent as possible.

The care people received was tailored to their individual needs. Care plans reflected people’s needs, their preferences and their choices. People were supported to maintain good well-being and reduce the risk of social isolation.

The service was well-led. Leaders were visible and accessible. There was a culture of openness, inclusion and person-centeredness. There were systems in place to monitor the quality of care people received. The provider acted on their findings to improve the quality of care.

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 the service under the previous provider name was Good, published 02 May 2019.

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.