Wykewood

Wykewood is a care home providing personal care and nursing care to up to 40 people. The service provides support to people living with a range or physical, neurological, and mental health issues, including brain injury and dementia. At the time of our inspection there were 14 people using the service. 3 out of the 4 units were being occupied and used in the home. The fourth unit was not in use.

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

Systems were in place to keep people safe from abuse. We found medicines were being managed safely however we recommended the provider reviewed the process for administering medication covertly with prescribing professionals. Risk assessments were in place which linked with care plans however we found not all risks to people were being effectively monitored. We found examples where people were not on ABC charts despite having some behaviours which challenge and could pose a risk to themselves or others. Staffing levels according to the dependency tool were sufficient however we made a recommendation for staff deployment to be reviewed to ensure there were always enough staff to complete the 15-minute observations required. We saw evidence of lessons learnt where things had gone wrong.

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.

The service did not always provide sufficient choices of nutritious food for people, we saw a lack of vegetables and choice offered on the day of inspection. We recommended the service review this as well as reviewing the availability of foods to meet people’s specific dietary requirements. Pre assessments done prior to people being admitted to the home were detailed and specific. People were supported by staff who had received sufficient training and support to fulfil their roles.

The service was responsive to people’s needs and requirements. Care plans were detailed and contained person centred information and guidance for staff. The provider had assistive technologies to meet people’s specific communication needs. We saw evidence of activities and excursions for people which were planned specifically to meet their preferences and interests. Staff were trained to deliver end of life care and care plans were completed in line with these requirements.

Many of the shortfalls identified on the last inspection had been improved or rectified by the registered manager. The provider had effective audit systems in place which were driving the quality in the service. The registered manager was completing daily audits, walk arounds, and oversight in the service had improved. The provider was engaging with people, relatives and staff through a range of different methods to gain feedback on ways to improve the service. Staff told us the management team were supportive and visible on the units.

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 rating for this service was inadequate (published 1 November 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations

At our last inspection we recommended the provider reviews staffing arrangements to make sure staff are available, at all times, to meet people's needs. We also recommended the provider reviews catering arrangements to make sure people have choice in how and when they receive their meals. At this inspection we found the provider had acted on these recommendations and improvements had been made.

This service has been in Special Measures since 1 November 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 16, 21, 28 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, medicine management and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and Well led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Good. This is based on the findings 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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wykewood on our website at www.cqc.org.uk.

Wykewood is a care home providing personal and nursing care to up to 40 people. The service provides support to people living with a range of physical, neurological and mental health issues including brain injury and dementia. At the time of our inspection there were 17 people using the service occupying three of the four units of the home. The fourth unit was not being used.

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

Systems were not in place to make sure people were supported safely. Staff had failed to maintain the levels of observation required to make sure people were safe, which had resulted in serious incidents. Staff were not always sure about the level of support and observation people needed. There was a lack of effective monitoring of records relating to the observation of people with high levels of need. Managers had introduced systems to address these issues, but they had not been fully embedded at the time of the inspection. Medicines were not always managed or stored safely. Some people had missed some doses of their medicines because there was no stock available in the home. Records about medicines were not always accurate and there was a lack of information to make sure “when required” medicines or medicines to be given at a specific time, were given safely. Staffing was arranged in line with people’s dependency levels, but we were not confident there were always enough staff available to meet people’s needs effectively. The home was clean and hygienic.

We have made a recommendation the provider reviews staffing arrangements to make sure staff are available, at all times, to meet people’s needs.

Records in relation to people’s deprivation of liberty (DoLS) status were inconsistent. Staff received training appropriate to the needs of people living at the home but varied in their understanding of the Mental Capacity Act (MCA) and safeguarding. Training to address issues identified in the service had not been delivered to all staff. People raised issues about the quality and availability of food and records relating to food and fluid intake required improvement. People were supported to access healthcare professionals as needed.

We have made a recommendation the provider reviews catering arrangements to make sure people have better choice in how and when they receive their meals.

People and their relatives were complimentary of the staff and of the care they received. They were treated with respect. People’s independence was encouraged but further work was needed in this area.

Care plans were detailed and personalised, but some gave information that conflicted with other care records. People’s relatives felt involved in the care planning and review process. Further work was needed to make sure people were able to follow a programme of activities suitable to their interests and needs. Complaints to the service were managed well.

Governance systems were not sufficiently robust to ensure all aspects of the service were safe or to identify areas needing improvement. People who used the service, their relatives and staff were complimentary of the management team. They felt their opinions about the service were sought and that their feedback was important. A new manager was registered at the service during our inspection.

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

This service was registered with us on 27 May 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part by notification of an incident during which a person using the service died. This incident has been reviewed and action is being taken to investigate by the appropriate agency. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the risk of staff not following procedure in relation to levels of observation of people with high level needs. This inspection examined those risks.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.