Wyndham House Care

Wyndham House accommodates up to 44 people in one adapted building. At the time of the inspection there were 38 people living at the service.

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

Staff understood the risks to people and the measures in place to keep them safe. Systems were in place to manage people's medicines safely and to reduce the risks associated with the spread of infection.

Sufficient numbers of staff were employed to meet people's needs. Staff received training that gave them the necessary skills and knowledge to carry out their roles and meet the specific needs of people using the service.

The service was being managed by a manager in the absence of a registered manager. Staff were passionate about providing people with a good-quality service. Robust systems were in place to monitor the quality of care being delivered to people.

Complaints and concerns were investigated, and complainants responded to.

Robust systems were in place to monitor the quality of care being delivered to people.

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 this service was good (published 17 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the care people received. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at 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 coronavirus and other infection outbreaks effectively.

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.

Wyndham House accommodates up to 44 people in one adapted building. At the time of the inspection there 34 people living at the service.

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

People who lived at Wyndham House received care from a staff team who knew each person well. People’s views were respected, and they were involved in everything that happened in the service. People were happy living there and relatives trusted the staff team to look after their family members. One relative said, “I think if I am honest, the basic care is fantastic.” Another relative was asked if staff knew people well and they said, “Yes I do, it's taken a while though.”

Care plans were in place although they required updating to ensure they reflected the individual needs of each person. It was not clear from recording charts if people’s needs had been met in line with their plan of care.

Staff delivered care and support that was not always personalised and responsive to people’s needs. Staff respected people’s privacy, dignity and independence.

Staff understood the risks to people and the measures in place to keep them safe. Systems were in place to manage people's medicines and to reduce the risks associated with the spread of infection.

Sufficient numbers of staff were employed to meet people's needs. Staff received training that gave them the necessary skills and knowledge to carry out their roles and meet the specific needs of people using the service.

People were supported to maintain good health. Staff made referrals to health professionals when required. People were provided with the care, support and equipment they needed to stay independent.

People were supported to have maximum choice and control over 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 had access to food and drink based on their individual choice and preferences. People had access to a range of activities within the service, that reflected their specific needs and interests.

Systems were in place to monitor the service, which ensured that people's risks were mitigated, and lessons were learnt when things went wrong. There was an open culture within the service, where people and staff could approach the manager who acted on concerns raised to make improvements to people's 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 this service was Good (report published 19 January 2018).

Why we inspected:

The inspection was prompted in part due to concerns received about medicines and staffing levels. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needed to make improvements. Please see the responsive section of this full report.

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.

At our last comprehensive inspection on 27 October 2016 the overall rating of the service was, ‘Requires Improvement’. This summary rating was the result of us rating the key questions ‘safe’, ‘responsive’ and ‘well led’ as, ‘Requires Improvement’. In relation to the key question ‘responsive’ and ‘well led’, we found that there was a breach of regulations. This was because the registered manager had not ensured everyone had a care plan which met their needs at all times. We also found the registered manager had failed to maintain accurate and complete care records in respect of each person.

At our last inspection for the key question, ‘is the service safe?’ we found peoples risk assessments did not include enough detail to ensure people were supported safely. For example, we saw 'repositioning' charts were in place but there was not detailed information or guidance on the risk assessment to say how this was to be managed. Another person had been identified to be at risk of choking. There was no risk assessment in place to provide guidance to staff on how to manage this. We also found one staff member not following good hygiene procedures. Whilst supporting people to take their medication they used their hands to give it to them instead of using an appropriate hygienic method such as a spoon. They did not wash their hands in between each person's administration. This put people at risk of cross contamination.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question’s ‘safe’, ‘responsive’ and ‘well led’ to at least good. At this inspection the overall rating of the service was changed to, ‘Good’. We found significant improvements had been maintained and we rated each of our key questions as being, ‘Good’.

Wyndham House 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 regulates both the premises and the care provided, and both were looked at during this inspection.

Wyndham House accommodates 44 people in one adapted building. There were 37 people living in the service at the time of our inspection visit.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, the necessary provision had been made to ensure that medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service to support people to stay safe and meet their needs. Background checks had been completed before care staff had been appointed. People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong.

Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

Care staff had been supported to deliver care in line with current best practice guidance. People enjoyed their meals and were supported to eat and drink enough to maintain a balanced diet. In addition, people had been enabled to receive coordinated and person-centred care when they used or moved between different services. As part of this people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They were also supported to express their views and be actively involved in making decisions about their care as far as possible. Confidential information was kept private.

People received personalised care that was responsive to their needs. Care staff had promoted positive outcomes for people who lived with dementia including occasions on which they became distressed. People’s concerns and complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a management framework to ensure that staff understood their responsibilities so that risks and regulatory requirements were met. The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made. Quality checks had been completed to ensure people benefited from the service being able to quickly put problems right and to innovate so that people consistently received safe care. Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the registered manager worked in partnership with other agencies to support the development of joined-up care.

This unannounced inspection took place on 27 October 2016.

We carried out an unannounced comprehensive inspection of this service on 3 August 2015. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. This was because improvements were needed to make the home effective, caring, responsive and well led. We asked the provider to take action to make improvements to ensure that people were receiving adequate nutrition, hydration and had opportunities to take part in activities in the home and in the community. During this inspection although action had been taken to make improvements, further improvement were still needed.

There was a registered manager in post at the time of this inspection. 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.

Care plans and risk assessments did not always give staff the information they required to meet people’s needs.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

People were provided with a good choice of meals. When necessary, people were given any extra help they needed to make sure that they had enough to eat and drink to keep them healthy.

Staff had received training, which was regularly updated in order to enable them to provide care in a way which ensured people's individual and changing needs were met. Staff knew how to manage any identified risks and provided the care people needed. Peoples health needs were supported as they had access to a range of visiting health and social care professionals.

Clear arrangements were also in place for ordering, storing, and disposing of people's unused medicines. However, improvements were required in the administration of medicines to ensure people were protected from cross contamination.

The provider had a recruitment process in place and staff were only employed after all essential pre-employment checks had been satisfactorily completed.

Staff treated people with dignity and respect.

A process was in place to identify record and respond to people’s concerns and complaints. Complaints were resolved to the complainant’s satisfaction.

Whilst we found audits had been undertaken, these were not all effective.

We found two 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.

Below is a summary of what we found.

Is it safe?

We spoke with three people who used the service. They were able to communicate that they felt happy and safe. We spoke with four relatives. They said they felt confident to report any concerns to the manager. The relatives we spoke with also said that they felt their family members were cared for in a safe way. Records showed that assessments of any potential risks to people had been carried out and measures put in place to reduce the risks.

There were effective systems in place to reduce the risk and spread of infections. Staff we spoke with were knowledgeable and clear about their responsibilities with regard to cleanliness and infection control. This meant that people were protected from the risk of infection.

We found that the manager did not have processes and procedures in place to ensure that medicines were administered safely.

The provider did not have a system in place to demonstrate that they had given consideration as to whether each person using the service had the capacity to make decisions about their day to day care under Mental Capacity Act (MCA) 2005. The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone's behalf is recorded, including the reasons why it has been made, how the person's wishes and preferences have affected the decision and how they were involved in the decision making process.

Is it effective?

Our observations showed that staff members knew people's individual health and support needs. Staff knew how to support people living with dementia. We saw that people had a positive relationship with the staff who supported them. Staffing levels were satisfactory to meet the needs of people who lived at the home. We saw that there were sufficient skilled and trained staff on duty to meet the needs of people who used the service. Care plans were in place for each person using the service, however we saw that the recording was not always as reliable as it needed to be.

Is it caring?

We saw that staff interacted very positively with people using the service. Staff supported people in a professional way, with respect and in a kind and friendly manner. The relatives we spoke with all said that the staff were very caring to their family members and they made relatives feel welcome when they visited. We saw that personal care was offered and delivered discreetly so that people's privacy and dignity was respected. The staff we spoke with said that they enjoyed their work. They demonstrated a sensitive understanding of the needs of people who lived at Wyndham House and a desire to support each person to enjoy a good quality of life.

Is it responsive?

People's needs and care plans were regularly reviewed by the staff and management at the home. One person's relative said, 'The staff here are fantastic. I have nothing but praise for them." Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills. Support plans included information on people's likes and dislikes and their preferences. This was done to ensure care and support was delivered in the way that people wanted it to be. People participated in a range of activities and we saw that staff actively encouraged them to participate. There were enough qualified, skilled and experienced staff to meet people's needs.

Is it well-led?

There was effective leadership in place. Staff told us they felt well supported by the manager and trained to do their job. One member of staff said, "The manager is brilliant. It's lovely working here." Relatives told us they felt the manager had made a positive impact on the service. However, staff were not receiving regular supervision and appraisals. This meant that staff had not been adequately supported to do their job. The provider had some effective quality assurance and audit systems in place to monitor aspects of the service. Other quality assurance systems needed some improvement.

We saw that staff had consulted with people who used the service (and their representatives) about what care was to be provided.

People said or showed us that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

We found that the provider had measures in place to help safeguard people from abuse (including financial abuse).

Records showed that security checks had been completed on staff to help ensure that only suitable and trustworthy people were employed in the service.

We saw that there were measures to check that people were reliably provided with the facilities and services they needed.