Walshaw Hall

Walshaw Hall is registered to provide personal care and accommodation for up to 56 people. Accommodation is provided over three floors, each of which has separate adapted facilities. The ground and first floor provide care to people living with dementia. The top floor is designated for those people requiring residential care. At the time of the inspection there were 48 people living at the home.

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

People and their relatives told us they were well cared for, and staff treated them with dignity and respect. 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.

Systems were in place to help keep people safe. People’s prescribed medicines were managed and administered safely. Good healthcare support was provided so people’s changing needs were responded to in a timely manner.

Relevant recruitment checks were carried out prior to new staff commencing employment. Ongoing recruitment was taking place. The provider has looked at incentives to encourage recruitment and retention.

Internal and external safety checks were carried out to ensure the premises and equipment were safe. The premises were clean and well maintained.

Managers carried out audits and checks, reviewing standards across the home. Where action was identified, plans were in place to make any improvements needed. People we spoke with were confident in the management and leadership at the home.

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 20 December 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.

Walshaw Hall comprises of two properties, Walshaw Hall and The Beeches. The service is registered to provide personal care and support for up to 106 people. Prior to the inspection we were informed Walshaw Hall was to close. The Beeches provides accommodation over three floors, each of which has separate adapted facilities. The ground and first floor provide care to people living with dementia. The top floor is designated for those people requiring residential care. At the time of the inspection there were 56 people living at the home.

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

Action had been taken to address the breaches in regulation identified at the last inspection with regards to staffing arrangements, training and development, accurate care records and management and oversight.

People said they received the care and support they needed. Staff were described as kind and respectful and people felt they had a good understanding of their individual needs, wishes and preferences. People’s relatives were confident their family members were safely and effectively cared for. A range of opportunities were provided, both in and away, helping to promote people’s autonomy, choice and independence.

The provider continued to meet the regulations in relation to infection control, safeguarding and complaints, health care & nutrition, health and safety and maintenance checks.

The management and administration of people’s prescribed medicines was safe. People had access to a range of healthcare support to help maintain their health and well-being.

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’s care records were held electronically. These explored all areas of care and support including people’s goals, aspiration, preferences and wishes. Where risks to people’s health and wellbeing had been identified, these were assessed and planned for. We have recommended the provider considers the implementation of the Accessible Information Standard (AIS), which aims to make sure disabled people have access to information they understand.

Suitable arrangements were in place to meet people’s nutritional needs. The kitchen was clean, well-organised and the dietary needs of people were understood by kitchen staff.

Relevant information and checks had been completed prior to new commencing employment. From our observations and discussions with people and staff we found sufficient numbers of staff were available to support people in a timely manner. A range of training opportunities were available to help staff develop the knowledge and skills needed to meet people’s individual needs. Staff spoken with felt there was good team work and were supported in their role.

People were provided with a good standard of accommodation that was clean and well-maintained. Suitable aids and adaptations were available to aid people’s mobility and promote their safety. Consideration had been given to providing a more ‘dementia friendly’ environment to help people independently orientate themselves around the home.

The management team and staff understood their role and responsibilities. Audit and monitoring systems demonstrated clear management and oversight of the service. Areas of improvements were planned for so that on-going improvements could be made. People, their relatives and staff were able to share their views about the service.

Safe systems in place for responding and reporting safeguarding concerns and complaints. People told us they felt safe and were confident their views were listened and responded to.

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 requires improvement (published 28 December 2018) and there were multiple 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Walshaw Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Walshaw Hall comprises of two properties, Walshaw Hall and The Beeches. There were 33 people living in Walshaw Hall and 30 people living in The Beeches, a modern purpose-built building, which is designated as a specialist dementia care unit. The top floor of The Beeches was unoccupied. The home is situated in a rural area close to Tottington.

The service had a registered manager. 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.

You can see what action we told the provider to take at the back of the full version of the report.

Whilst quality monitoring systems were in place to gather information about the service, we found these were not sufficiently robust nor had findings been acted upon to ensure potential risks were mitigated. Opportunities were provided for people and their visitors to comment on their experiences.

People told us that at times they had to wait for support. Staffing levels needed to be reviewed to ensure sufficient numbers were available at core times so that people receive the support they needed in a timely manner. Staff had not received all necessary training and support to develop the knowledge and skills needed to meet the individual needs of people.

Individual care records were in place. Information reflected people’s involvement where possible and had been reviewed and updated. Improvements were needed to ensure information accurately reflected the current and changing needs of people so that staff were clearly directed in the safe and effective delivery of people’s care.

People told us that occasional activities were provided however this was not consistent. We have recommended more meaningful activities are introduced so that people’s autonomy, choice and independence is promoted.

Whilst suitable arrangements were in place to ensure peoples nutritional needs were met. We have recommended improvements are made to enhance people’s mealtime experience.

We found the environment, particularly in The Beeches, did not provide a ‘dementia friendly’ environment. We have recommended the provider refers to good practice guidance about the suitability of the environment for those people living with dementia

People told us, and we observed, staff treat them with dignity and respect when offering care and support. Staff were said to be helpful and caring and understood people’s individual needs and wishes.

All relevant recruitment checks were undertaken prior to new staff commencing employment.

Relevant authorisations were in place where people were being deprived of their liberty. Care records show that capacity and consent had been considered when planning people’s care and support.

Safe systems were in place for the management and administration of people’s prescribed medicines. People had access to relevant healthcare support so that their health and well-being was maintained.

Effective systems were in place to ensure the premises and equipment were regularly serviced and safe to use. Internal maintenance checks were completed. Issues identified during the inspection were immediately acted upon so that the building was safe.

Suitable arrangement were in place to minimise the risk of cross infection.

Systems were in place for the reporting and responding to any complaints and concerns. People and their visitors said they were able to raise any issues and felt they would be listened to and acted upon.

Walshaw Hall provides accommodation for up to 50 people who have personal care needs, including those with dementia. There were 33 people living in the service on the day of our inspection.

The service had a registered manager in place at the time of our 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.

During this inspection all the people we spoke with told us they felt safe in the service. Staff had received training in safeguarding and were able to tell us how they would respond to any concerns. They were also aware of the whistleblowing policy.

Recruitment processes and systems in place within the service were robust. This meant that people who used the service were protected against the risk of unsuitable people working within the service.

Risk assessments were in place in relation to hazards in the environment. We found these were sufficiently robust to protect people.

Wheelchairs, hoists and moving and handling equipment had been serviced to ensure it was safe to use. Records showed that staff members had received training in moving and handling procedures.

The registered manager and staff members all felt there were enough staff on duty to meet the needs of people who used the service. We checked the rota which was a reflection on what we had been told on the day of our inspection.

Records we looked at showed that people had been assessed in relation to their capacity. These assessments had been undertaken by the relevant and appropriate people and had involved the person and their family. We also saw that best interest meetings had been undertaken for those people who lacked capacity to consent.

All the people we spoke with told us the food was good. We checked the kitchen and found adequate supplies of fresh, fresh, tinned and dried food was available. The service had a 5* rating from environmental health.

People who used the service told us that staff members respected their privacy and dignity and knocked on their doors before entering.

Nobody in the service was receiving end of life care, however some staff members had undertaken training in this. All the staff we spoke with were able to tell us how they would care for someone at the end of their life.

Activities on offer within the service included, pamper afternoons, bingo with sherry and nibbles, singsongs, exercise sessions, greatest inventions of the times discussions, poetry corner and high tea with strawberries on Wimbledon Finals weekend. We observed a memory quiz was being held in one of the lounges.

Some care plans contained detailed information to guide staff on the care and support to be provided. However, some care plans we looked at lacked information and direction for staff members. We spoke with the registered manager and area manager regarding this. They told us the format of the care plans was still being trialled and that they were amending them when they felt improvements needed to or could be made.

People who used the service told us they were able to make their own choices such as what they wanted to eat, what they wanted to wear and how they wanted to spend their time.

Throughout our inspection we observed the registered manager interacted with people in a friendly and personalised manner. They knew the names of all the people who used the service and were able to speak in great detail about any of them.

Staff members we spoke with told us they would be happy for one of their relatives to use the service. They told us there was a good culture and the registered manager was very supportive of them.

The service undertook regular quality audits to highlight any improvements needed. We saw policies and procedures were in place to guide and direct staff in their roles.

During our visit to the home we spoke with one of the people using the service and asked them to tell us how their medicines were managed. They told us their medicines came on time, and did not raise any concerns with us.

The provider had a satisfactory system in place for checking the quality of care the service provided.

People using the service were protected against the risk of unsafe or inappropriate care and treatment because records contained enough information to protect their safety and wellbeing.

The systems in place to help protect and safeguard vulnerable people from the risk of abuse were not adequate. Staff had not received training in the protection of vulnerable adults.

The management of medicines was unsafe. This could place people's safety, health and well being at risk.

Management had started to gather information about the quality and safety of the service provided. The systems in place however, were not robust enough to help protect people against the risks of inappropriate or unsafe care and treatment.

People's care and medication records were not always accurate or up to date, putting them at risk of receiving unsafe care and treatment.

People told us they were satisfied with the care and support they received. They said they had a choice of appetising food at each mealtime. They also said that staff asked for their consent prior to care or support being given.

There was a complaints procedure in place and people said they felt able to approach staff if they had a complaint.

We saw that assessments and monitoring of the quality of the service provided were not routinely carried out. Procedures were in place stating quality audit reports should be completed and analysed, but the manager told us they were unaware of this requirement.