Archived: Wansbeck Care Home

Wansbeck Care Home provides personal care and accommodation for up to 40 older people, some of whom have a dementia related condition. There were 28 people living at the home at the time of the inspection. The home was divided into four smaller ‘houses.’ Pine Tree and River Bank, the all-male house, were located on the ground floor. Sea View and Meadow View, the house for people who had a more advanced dementia related condition were situated on the first floor.

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

People were treated with kindness. People spoke positively about the caring nature of staff. One person told us, “They are kind and nice. They couldn’t be any nicer.”

Work was ongoing to increase the visibility of staff. People and relatives told us that more staff would be appreciated. Whilst we saw that people’s needs were being met by the number of staff on duty, staff were busy and due to the lay out of the home staff were not always visible. We have made a recommendation about this.

There were systems in place to protect people from the risk of abuse. Staff were knowledgeable about the action they would take if abuse were suspected. Medicines were managed safely.

A redecoration and refurbishment plan was in place which had commenced at the time of our inspection.

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 had a choice and access to sufficient food and drink. People were supported to access a range of healthcare professionals to ensure they remained healthy.

People’s social needs were met. People were supported to maintain their hobbies both within and outside of the home.

The home had been through a period of change and uncertainty which had affected the culture and morale. Several relatives told us that communication needed to improve and timely action had not always been taken when issues had been raised. A new manager was in post. Most relatives told us that action was now being taken and communication was improving since the new manager had started. They said however, that these improvements needed to be sustained.

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 22 November 2018). We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to safe care and treatment, the need for consent, good governance and staffing. We also identified a breach of the Care Quality Commission Registration Regulations 2009 Notifications of other incidents.

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 the regulations. However, further improvements were required in the well-led question.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on our inspection programme.

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.

We undertook an unannounced focused inspection on 3 September 2018. This meant that the provider did not know we would be visiting. We made a further three announced visits to the home on 7, 12 and 19 September 2018 to complete the inspection. The inspection was prompted following concerns received by the Care Quality Commission (CQC) regarding the management of medicines and concerns relating to pressure care for people. The team inspected the service against two of the five key questions we ask about services: is the service safe and well-led. Issues were identified during the inspection which resulted in the process converting to a comprehensive inspection where all five key areas were examined.

The last comprehensive inspection for the service was carried out in November 2017. At that time the overall rating for the home was good.

At this inspection we found care plans for people were inconsistent in the level of detail recorded and contained contradictory information about the needs of people. This resulted in care plans being confusing and difficult to read. Care staff knew people well and had in-depth knowledge of people’s needs but this was not always reflected in the documentation we reviewed.

There were short falls and omissions with the management of risk. In some instances, risk assessments had been re-written over making them difficult to understand. Some risk assessments were not always detailed for known risks such as pressure care.

Consent to care and treatment was not always sought in line with the Mental Capacity Act 2005 (MCA). The best interest’s decision-making process had been followed for people who lacked capacity to make certain decisions themselves. However, the provider did not have copies of Lasting Power of Attorney (LPA) documentation and could therefore not confirm if relevant people were legally able to act on behalf of people.

Audits were not detailed or robust and had failed to identify the issues found during this inspection. Quality assurance systems had not been effectively implemented to assess, monitor and improve quality at the service.

We saw positive interactions between staff and people. Most people spoke very positively about staff and thought they were kind and caring. There were limited meaningful activities available for people on the days the activity co-ordinator did not work.

Parts of the home were dirty and infection control procedures were not robust.

We received mixed feedback from staff regarding staffing levels and some staff told us they had too much to do and did not have time to spend with people. Safe recruitment procedures were in place however, omissions were noted. Selected training courses the provider had deemed mandatory were not up to date. Some staff told us they did not have time to complete all their work and were behind with paperwork.

The administration of medicines was not consistently safe.

People told us they felt safe. Safeguarding procedures were in place and staff told us about what they would do if they suspected or had concerns about harm being caused to people. However, we found that these procedures were not always followed.

The overall rating for this service has deteriorated from good to requires improvement.

During this inspection, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of the Care Quality Commission Registration Regulations 2009. Notifications of other incidents. You can see what action we have told the provider to take at the back of the full version of the report.

Wansbeck Care Home is a ‘care home’. People in care homes receive accommodation and 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. Wansbeck Care Home accommodates up to 40 people across four separate units, each of which have separate adapted facilities. Three of the units specialise in providing care to people living with dementia. At the time of this inspection 39 people were in receipt of care from the service.

At the last inspection in August 2015 we found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Wansbeck Care Home as ‘Good’ overall and ‘Good’ in four domains. We rated the service as ‘Outstanding’ in one domain, namely 'Caring’.

The registered manager had been in post since April 2017 and was registered in September 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 we found staff remained exceptionally caring and dedicated to ensuring people experienced high quality care. We saw that staff treated people very much as individuals and ensured people continued to follow their preferred routines. We heard how the activity coordinator had worked hard to create a sense of community within the home and developed links with local organisations. Relatives told us that visiting the service was just like popping in to visit people in their own home. People told us that staff made everyone feel welcome and at ease.

We found staff were passionate about providing a vibrant service that gave all equitable choices and experiences. The registered manager and staff were absolutely committed to delivering a service that focused on delivering a personalised service. The team worked collaboratively with people and their relatives to ensure the care provided met each person's needs. However, we discussed with the manager how the assessments could be enhanced, as the provider only supplied pre-assessment templates and therefore there were no documents for staff to use to assess the current position.

We found the registered manager’s leadership style had led to people and staff feeling that they were integral partners in the operation and enhancement of the service. Staff supported people to make decisions for themselves and spoke with people about their wishes and preferences. The registered manager, staff and activity coordinator regularly sought peoples’ views and acted upon their comments.

Each year the activity coordinator organised a relatives meeting in a local restaurant so people could enjoy a meal, network and gain support from others in the same position and in a relaxed atmosphere discuss what improvements could be made to the service. It was evident that people’s voice was heard. Following feedback from people, decisions were made about trips that were scheduled and activities were organised. People were encouraged to discuss events or activities they had always wanted to do and the staff organised these, for example, one person had always wanted to go to a factory that made teddy bears. They told us it had been a ‘dream come true’ when staff surprised them with a trip to a local factory.

Staff received supervision on a monthly basis and they received annual appraisals. Staff were respected within the organisation and were provided with comprehensive training including specialist training. We found there was a culture within the organisation of striving for excellence and assisting all to reach their maximum potential. Staff were supported to constantly develop their roles and all the staff discussed the wide range of specialist training they had been able to complete and the registered manager always looked for new courses they could attend.

Recruitment checks were carried out. People and relatives told us there were sufficient staff deployed to meet people’s needs. We noted the provider’s tool did not recognise the layout of the service so did not ensure staff were able to readily cover peak times. The registered manager undertook to review arrangements for the deployment of staff throughout the day.

People’s care needs were risk assessed with risk management plans in place and support for staff when they needed it. The registered manager was aware of risks within the service and was undertaking an analysis of risks. The service had emergency plans in place and took action when they became aware someone was at risk. The registered manager and staff critically reviewed all incidents to determine if lessons could be learnt. We found staff had an understanding of safeguarding and how to raised concerns.

People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. Staff safely managed medications. A large proportion of the staff had worked at the service for many years, which provided consistency for people using the service.

Staff knew the people they were supporting well. Care plans were personalised and had been regularly reviewed, to ensure they reflected people’s current needs and preferences. However, the provider does not have a separate assessment process so staff had to go through the whole care file to find out detailed information about individual’s physical and mental health conditions and any changes to their health.

People were supported to be as independent as possible and could access advocacy services if needed. Procedures were in place to investigate and respond to complaints.

People, relatives and staff described the registered manager as being an effective leader who ensured the service consistently delivered a good service. Staff told us they could contribute their ideas about how to make improvements at the service and they were listened to. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found:

Is the service safe?

The inspection team consisted of three inspectors. The majority of people were unable to communicate with us verbally because of their dementia. Therefore we spoke with their relatives and observed staff practices to determine how care and treatment was provided.

We spoke with six people who were able to communicate verbally and five relatives to find out their opinions. We also consulted with two local authority care managers; a local authority contracts officer, safeguarding officer, dietetic assistant and an infection prevention and control practitioner from the local hospital Trust to find out their views. We also spoke with eight members of staff.

The care home was divided into four smaller areas. Staff explained that these were called 'houses' and not units since they were people's homes. All areas of the care home were safe, clean and well maintained. Staff had started to decorate the home to help orientate and stimulate the senses of people who lived there.

We found that there were now enough domestic staff employed to ensure that relevant standards such as those relating to infection control and the environment were met.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Following a recent court ruling concerning the deprivation of liberty in care settings, the provider may wish to review people's living arrangements. This could identify circumstances which may amount to a deprivation of liberty according to the revised definition.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

We discovered that equipment was in good working order and was being used correctly. We saw that overlay pressure relieving mattresses used to support pressure care were now correctly positioned over existing mattresses. We observed that some people had adjustable beds in their rooms which could be raised or lowered to help them get in and out of bed safely.

Is the service caring?

We noticed that care workers showed patience and gave encouragement when supporting people. One relative informed us, 'My relative doesn't say much but he smiles at the staff so I know he's being well looked after.' People looked well cared for.

Is the service responsive?

One relative told us, 'The care is good here. They do cater for people with dementia.'

Systems were in place to make sure that lessons were learnt from events such as

accidents, incidents, complaints and concerns. These processes reduced the risk to people and helped the service continually improve.

Is the service well led

A manager was in place who was not currently registered with the Care Quality Commission (CQC). A registered manager is a person who is registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The previous registered manager had left on the 4 November 2013. This meant that they had been without a manager who was registered with CQC for over seven months. The manager submitted her application to register on the day of our inspection which CQC has received but not yet processed.

People spoke positively about the manager. One person described her as 'brilliant'. He also commented, 'Out of 100, I'd give it 101. I've no complaints.'

We found that a variety of checks were carried out to monitor the quality of the service. These included audits on care plans, health and safety, medication and dining. The regional manager carried out a monthly audit of all systems and procedures at the home. Meetings were held for people and their relatives.

Staff told us they were clear about their roles and responsibilities. They informed us that regular meetings were held and this was confirmed by minutes of meetings. Staff explained that morale had improved within the home. One care worker said, 'The morale has totally lifted. The home feels a lot better.'

We were assisted during our inspection by the manager who had been in post since December 2013. Her name does not appear within this report, because she is not yet registered with the Care Quality Commission.

Some people who lived there were not able to communicate with us verbally because of their condition. We spoke with three people who informed us that staff looked after them well and the home was kept clean.

However, we had concerns about infection control and the cleanliness of the home. In addition, we found that maintenance had not always been carried out in a timely manner. Paint was peeling off in certain areas of the home and some of the ceiling tiles were stained.

We had not planned to look at staffing levels or equipment at the home. However we had concerns about these two essential standards. We considered that there were not enough domestic staff on duty to ensure that relevant standards such as those relating to infection control and the environment were met. We also found that some equipment was used inappropriately, broken or out of use.

We passed our concerns to the local authority contracts and commissioning team, safeguarding team, environmental health and the fire safety officer.

In addition, we spoke with a member of the local authority's Contracts and Commissioning team who informed us that they did not have any concerns about the service. We also spoke with a member of the NHS challenging behaviour team who described the care as "excellent."

We found before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan and we found that there were enough qualified, skilled and experienced staff to meet people's needs.

People who used the service and their representatives were asked for their views about the care and treatment and they were acted on. We found that people's personal records and records which related to staff and the management of the service were fit for purpose.