Enhanced Elderly Care Service - Wardley Gate Care Centre

We found the following examples of good practice.

• Systems were in place to help prevent people, staff and visitors from catching or spreading infection.

• The environment was clean. Additional cleaning was taking place, including of frequently touched surfaces.

• Staff wore appropriate PPE and there were sufficient supplies. The registered manager carried out weekly checks to ensure the home always had enough PPE for staff to access.

• Staff had undertaken training in putting on and taking off PPE and other COVID-19 related training. Infection control officers were in place who observed staff IPC practices and undertook COVID-19 audits.

• People and their relatives were supported to keep in contact using a range of technology and with visits to the home.

• People and staff participated in a regular testing programme.

• Appropriate vaccination status checks were in place.

Enhanced Elderly Care Service - Wardley Gate Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Enhanced Elderly Care Service - Wardley Gate Care Centre provides care and support for up to 88 people who require support with personal care, some of whom are living with dementia. At the time of the inspection there were 75 people living there.

The service had a registered manager in place. 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.

At the last comprehensive inspection in January 2017 we rated the service as ‘Requires Improvement’ overall. At the inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 14 (Meeting nutritional and hydration needs); Regulation 16 (Receiving and acting on complaints); Regulation 17 (Good governance) and Regulation 18 (Staffing). This related to robust systems not being in place to monitor nutrition and weight loss, complaints not always being handled in line with the provider’s policy, systems and processes were not established and operated to monitor service provision and insufficient staffing levels.

Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good. We then carried out a focussed inspection in August 2017 and found improvements had been made in the areas identified at the previous inspection but that the improvements needed to be sustained for a period of time and therefore the service remained ‘Requires Improvement’. At this inspection we found standards had been sustained and further developments had been made and the service had improved to ‘Good’.

There were enough staff to meet people’s needs. The registered manager assessed staffing requirements in line with people’s dependency needs. Staff continued to be recruited in a safe way with all necessary checks carried out prior to their employment.

People and their relatives told us people were safe living at the service. Staff had completed training in safeguarding people and the service raised any safeguarding alerts with the local authority in a timely way.

Risks to people’s safety and wellbeing were assessed and managed. Environmental risk assessments were also in place.

People’s medicines were administered in accordance with best practice and managed in a safe way. People continued to receive their medicines in line with prescribed instructions.

People were supported to meet their nutritional needs. People at risk of malnutrition had their weight monitored weekly as well as their food and fluid intake recorded. People accessed a range of health professionals including speech and language therapists, dieticians and doctors. Information of healthcare intervention was included in care records.

New staff completed an induction programme prior to working with people. Staff received regular training, supervisions and annual appraisals to support them in their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and relatives felt the service was caring. Staff treated people with dignity and respect when supporting them with daily tasks.

People had access to advocacy services if they wished to receive support including Independent Mental Capacity Advocates (IMCAs). No one was receiving support at the time of inspection but advocacy services had previously been involved with people in the home.

The provider had an up to date complaints procedure in place. All complaints received were dealt with in accordance with the provider’s procedure. People knew how to raise any concerns they had regarding the service.

People’s physical, mental and social needs were assessed prior to them moving into the home. Care plans were personalised, detailed and reviewed regularly and included people’s personal preferences.

There was a range of activities available for people to enjoy in the home. People were also supported, where necessary, to access activities in the local community including going for walks, visiting places and shopping.

The service had re-designed rooms in the home to further improve people’s lives and their activities. For example, one room had been made into a pub room and another was made into a vintage café style room, with fancy chairs, china cups and saucers, accessories and trinkets.

The provider had a robust audit system in place to monitor the quality and safety of the service. The views of people, relatives, staff and professionals were sought by the registered manager via surveys. The registered manager analysed all feedback received and identified improvements for the service and took appropriate action.

We undertook an unannounced focused follow up inspection on 8 August 2017 to check whether the legal requirements were being met. This report only covers our findings regarding these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Enhanced Elderly Care Service - Wardley Gate Care Centre on our website at www.cqc.org.uk.

Enhanced Elderly Care Service - Wardley Gate Care Centre is a care home for up to 88 older people, including people with dementia related conditions. Nursing care is not provided. At the time of our inspection 74 people were living at the home.

The service had a manager who had applied to become registered. 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.

We found care staffing levels had been increased, enabling people’s needs to be responded to in a timely way.

Senior management supported the manager and had a regular presence in the home. Improved systems for record-keeping and assuring the quality and safety of the service had been implemented.

Overall, we judged that the provider had made sufficient improvements to comply with the legal requirements.

We have made recommendations about making fully robust arrangements for covering staff absence and formalising observations of people’s care experiences.

This was an unannounced inspection carried out on 17, 20 and 25 January 2017.

Wardleygate Elderly Care Service provides accommodation and personal care to a maximum of 88 older people, including people who live with dementia or dementia related conditions. At the time of inspection 75 people were living at the home. Nursing care is not provided.

We last inspected Enhanced Elderly Care Service Wardleygate in January 2016. At that inspection we found the service was not meeting all its legal requirements with regard to staffing levels, meeting people’s nutritional needs, respecting people’s dignity, records and governance. At this inspection we found that sufficient action had not been taken in all the required areas to make sure the relevant legal requirements were met.

A registered manager was not in place. The previous registered manager had left in December 2016. 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.

At this inspection some improvements had been made, however efforts were needed to improve the care and experiences of people who lived at the home. People enjoyed a better dining experience, although this could still be improved. Some improvements had been made with regard to record keeping to ensure people received person centred care. People’s dignity was respected. Improvements had been made to menus and the choice of food available. However, systems needed to be improved to support and monitor people at risk of poor nutrition and weight loss.

People told us they felt safe. However, staffing levels were not sufficient to ensure people's needs were managed safely and in a person centred way at all times. Staffing levels were in the process of being increased as the result of our inspections but they needed to be consistently maintained. We saw staff did not always have time to interact and talk with people. There was an emphasis on supervision and task centred care.

A programme of activities was available but activities provision was not well-organised around the home so people had an opportunity to take part. Staff did not have time to carry out activities when the activities people were not available. We have made a recommendation about activities to ensure people remain engaged and stimulated.

Systems were in place or being introduced for managing and mitigating risk. A more critical accident and incident analysis was introduced. This needed to be maintained and regularly reviewed to identify any trends of accidents and incidents that occurred to help prevent them occurring.

Risk assessments were in place but they did not all accurately identify current risks to all people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe and timely way.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. We have made a recommendation with regard to communication to ensure all the required information is passed on to staff about people's health and well-being.

Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves.

Staff received opportunities for training to meet people's care needs and in a safe way. A system was in place for staff to receive supervision and appraisal but not all supervisions were up to date due to the management changes.

A complaints procedure was available. Improvements were required to any complaints received to ensure they were dealt with according to the home's complaints procedure.

People told us the current management team and staff were approachable. They told us they were asked their views about the service they received. A quality assurance system was in place but it needed to be more robust. The audits used to assess the quality of the service provided were not effective as they had not identified the issues that we found during the inspection.

Full information about the Care Quality Commission’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can see the action we took with regard to the non-compliance with aspects of nutrition and complaints at the back of the full report.