Wykeham House

Updated 22 June 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.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by 1 inspector 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

Wykeham House 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. Wykeham House 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 27 April 2023 and ended on 04 May 2023. We visited the location’s service on 27 April 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we observed the support people received throughout the day. We spoke with 12 people who used the service about their experience of the care provided and 7 relatives of people who use the service. We gathered feedback from 1 health care professional who regularly visited the service. We spoke with 8 members of staff including the registered manager, deputy manager, care staff and kitchen staff. We reviewed a range of records. This included 5 people's care records and multiple medication records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

Updated 22 June 2023

About the service

Wykeham House is a nursing care home providing personal and nursing care to up to 76 people. The service provides support to older people, people living with dementia and mental health conditions. At the time of our inspection there were 70 people using the service. Wykeham House accommodates people across four separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

Records of the medical decision agreed with people to not attempt resuscitation when it may be clinically futile to attempt to do so were not always clear and consistent. The presence of Do Not Attempt Resuscitation (DNAR) forms did not always correspond with an easy access colour coded system and staff handover paperwork, meaning there is a risk that staff may not have the correct information in an emergency.

People and their relatives told us they had concerns about staffing levels at weekends. Feedback was given to the provider and the registered manager acknowledged there was less administrative staff and management presence at weekends, however we found during this inspection that staffing levels were satisfactory to meet the needs of people.

Incidents and accidents were investigated, and lessons learnt on an individual basis with changes made to people’s care plans to manage risk. There was a lack of oversight of trends in incidents and accidents to establish potential service wide improvements. Quality assurance processes were not always effective to provide managerial oversight of systems and drive improvements. Audits of care plans and incidents and accidents were not always thorough. It had not been identified that some care records contained inconsistencies regarding DNAR information. The registered manager told us how they would make improvements on these issues.

People told us they felt safe, and relatives told us they were confident in the care provided to people. People were supported to have choice and control of their day to day lives. Staff supported people in the least restrictive way and in their best interests. Staff, people and relatives were supported to engage with the service. People and relatives told us the management team were approachable and accessible. Staff told us they felt well supported, empowered to develop and that Wykeham House had a positive culture to work within.

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 6 November 2021).

Why we inspected

We received concerns in relation to an incident involving a person using the service and the accuracy of records relating to their care and treatment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report. The registered manager has told us they have mitigated risks. They have audited all care records and adapted processes to update changes to people’s information more promptly.

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

Enforcement

We have identified breaches in relation safety monitoring and management, and 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.