Wordsworth House

Wordsworth House is a care home providing personal and nursing care to up to 78 people in one purpose built building across three floors. At the time of the inspection there were 55 people using the service, some of whom may be living with dementia.

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

People, and their relatives, told us they felt safe at Wordsworth House. Staff understood how to safeguard people form abuse and were confident any concerns would be appropriately responded to by the registered manager. Improvements had been made to infection prevention and control measures since our last inspection. Staff were very knowledgeable about PPE and wore it correctly. Measures to assess competency and monitor compliance with PPE use were in place. Risks were assessed and minimised. Medicines were managed safely. Staff worked as a team to meet people's needs and support new staff who had recently started in post. Safe recruitment practices were followed.

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.

A range of audits were used to effectively monitor and assess the service. Areas for improvement were identified and responded to in a timely manner so the service was continuously learning and developing. Everyone we spoke to said the home was well-led, and the staff were kind, caring and supportive. No concerns were raised with us during the 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

The last rating for this service was requires improvement (published 19 January 2021) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 11 and 16 November 2020. A breach of legal requirements was found. We served a warning notice in relation to infection prevention and control practices. We undertook this focused inspection to check they had made improvements and to confirm they now met legal requirements.

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.

We also received some concerns in relation to falls management and meeting people’s needs. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

This report only covers our findings in relation to the Key Questions Safe 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 requires improvement to good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wordsworth House is a 'care home' which is registered to provide personal care and accommodation to up to 78 people in one adapted building across three floors. At the time of our inspection 47 people were living at the home.

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

People were not always protected from the risk of harm. Infection prevention and control procedures did not always follow government guidance.

Systems were in place to safeguard people from the risk of abuse and a review of any accident or incident was completed. Medicines were administered to people as prescribed. There were enough staff on duty to meet people’s needs and staff were recruited safely.

Quality monitoring systems had failed to identify the shortfalls in the infection control practices staff were using. Staff were positive about the management at the service and felt supported.

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 7 February 2019).

Why we inspected

We undertook a targeted inspection as part of CQC’s response to care homes with outbreaks of coronavirus. 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 coronavirus and other infection outbreaks effectively.

We inspected and found there was a concern with infection prevention and control measures, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one breach in relation to safe care and treatment at this inspection. In particular, infection control practices.

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

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected Wordsworth House in January and February 2018 and rated the location requires improvement.

Wordsworth House 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.

Wordsworth House can accommodate 78 people in one adapted building across three floors.

The service had a registered manager, who had been in post at the last inspection. They registered with the Commission on 1 October 2018.

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 we found improvements had been made.

There were mixed views about staffing levels and we observed staff on the ground floor spent time outside of communal areas completing paperwork, whilst on the first and second floors staff sat with people chatting with them whilst completing their records. We have made a recommendation in relation to staff deployment.

People were happy with how their medicines were managed and this was done in a safe way. ‘As required’ medicines protocols lacked detail which placed people at potential risk. The registered manager and deputy manager ensured these were all re-written and a full medicine audit was completed to ensure no one had come to harm, which they hadn’t. We have made a recommendation in relation to the governance of ‘as required’ medicine protocols.

Activities were available. People living with a dementia would benefit from more involvement with the activities. Staff told us if people became anxious or distressed they weren’t always invited to the activities. We have made a recommendation about this.

Everyone we spoke with was keen to let us know that improvements had been made and they had confidence in the registered manager and the staff team. People and relatives told us they felt safe and well cared for.

Care plans and risk assessments were in place, and contained sufficient detail to enable staff to support people appropriately. The registered manager aimed to develop these further to ensure they were more person centred and individual. The nutritional needs of people were met, and there was a well balanced diet available for them to choose from.

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.

Staff told us they felt well supported and found the registered manager approachable. They felt trained to do the job. Some staff mentioned that the majority of training was now completed on line and they felt they would benefit from the opportunity to discuss their learning.

We were told there were regular resident, relatives and staff meetings which were beneficial and productive. Minutes were available and everyone was invited to contribute to the agenda.

Premises and equipment checks were completed appropriately. Wheelchairs and hoists were stored in communal hallways which may have presented a risk to people and visitors. We were assured that storage was being discussed as it had been recognised that this was a risk.

We last inspected Wordsworth House on 23 and 25 August 2017 and found the provider had breached a number of regulations we inspected against. We rated the location inadequate, placing it in special measures and imposed a condition to prevent admissions. Specifically the provider had breached Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Specifically, care and treatment was not provided in a safe way. The provider had failed to assess risks to the health and safety of people and failed to do all that was reasonably practicable to mitigate such risks.

There was a failure to ensure staff providing care or treatment had the qualifications and competence to do so safely. There was a failure to ensure sufficient numbers of suitably qualified, competent, skilled and experienced staff were deployed in order to meet people’s needs and that staff received appropriate support, training, professional development, supervision and appraisal.

The premises and equipment were not safe to use for its intended purpose. And the provider had failed to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activities. At this inspection we found that improvements had been made

Wordsworth House 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.

Wordsworth House can accommodate 78 people in one adapted building across three floors. At the time of the inspection 52 people were using the service, some of whom were living with a dementia.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. The service has been rated requires improvement overall as there are still improvements to be made. Systems and processes needed to be embedded to ensure consistent good practice over time

The service did not have a registered manager. The current manager had been in post since October 2017 and had made an application to register with the Commission. 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.

The head of business improvement was driving improvements alongside the manager and a peripatetic support team which included a support manager, team leader and clinical lead. Everyone we spoke with had confidence in the manager to continue to make improvements and ensure stability within the service. However some relatives and staff were concerned over the when the peripatetic support team would be pulled out of Wordsworth House. We received assurances that although this would happen it would not be instant and measures would be in place to ensure appropriate monitoring continued.

Care plans had improved, however we found some further improvements were needed to ensure consistency and relevance when people’s needs changed. Where risks had been identified assessments had been completed and measures were in place to minimise and manage the risk.

The management team identified training as being an area where further improvement was needed. Not all staff had attended training identified as mandatory by the provider. A training plan was in place for the whole of 2018 which was being implemented. Senior care staff and nursing staff were attending additional training to develop and enhance their clinical skills and knowledge.

Team meetings were held, however minutes were not always available. Resident and relatives’ meetings were monthly and the minutes were shared following the meetings. Relatives were particularly positive about this meeting as it had provided them with regular updates on actions being taken and improvements made.

Personal emergency evacuation plans were in place and detailed the support people would need in the event of an evacuation. Staff had completed competency assessments in relation to fire safety and evacuation. Where appropriate some people had also completed an assessment to support them to evacuate safely should the need arise.

The nurse call sounder had been repaired. A handyman was based at Wordsworth House and was responsible for day to day repairs and maintenance. Specialised equipment, such as hoists and slings had been increased and renewed.

Health and safety checks had been completed and all staff had been trained in how to check bed rails to ensure they were safe. Bed rail risk assessments were in place and were regularly reviewed and evaluated.

People’s nutritional and hydration needs were being met. Where risks had been identified support was sought form external professionals, their guidance was being followed and monitoring was in place.

People, relatives and staff commented that they thought there were enough staff to meet people’s needs. Some staff commented that at busy times like lunch time additional staffing was needed. Safe recruitment practices were followed.

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.

Medicines were administered safely, audits had identified that some improvements were needed in relation to the management of medicines. A new system was being introduced which staff had attended training on.

Safeguarding concerns, complaints, accidents and incidents were all recorded, investigated and analysed. Lessons had been learnt and improvements made, for example to increase staff knowledge and competency, ensure documentation was more effective and provide additional equipment. Appropriate procedures had been followed in relation to staff performance were relevant.

Governance and quality assurance systems had been introduced and were being used effectively to drive improvements.

We found care staff had warm, caring relationships with people and people were treated with dignity and respect. People told us they felt safe and well cared for.

Within our last inspection report we said that two service users had sustained serious injury at Wordsworth House and the incidents were subject to a criminal investigation. Since the inspection report was published we have concluded our review of the incidents and have closed our enquiries with no further action.

Before the inspection we received notifications of incidents following which two service users sustained a serious injury. These incidents are subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of falls from beds and scalding. This inspection examined those risks.

We last inspected Wordsworth House on 29 February 2016 and found it was meeting all legal requirements we inspected against. We rated Wordsworth House outstanding in the caring domain and good in all other domains.

Wordsworth House is a 78 bed care home that provides personal and nursing care to older people, some of whom were living with a dementia. Accommodation is provided over three floors.

At the time of the inspection there were 63 people using the service.

The service did not have a registered manager. The management of Wordsworth House was being overseen by the quality and compliance manager who had been based at the home two days prior to the inspection. The previously registered manager had left their post in May 2017 but had not cancelled their registration until August 2017. Since May 2017 there had been a further two managers overseeing the home, one of whom was a regional 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.

During this inspection we found the registered provider had breached regulations in relation to safe care and treatment, staffing, good governance, safeguarding people from abuse and improper treatment and receiving and acting on complaints.

Not all the people living at Wordsworth House had a personal emergency evacuation plan to support their evacuation in the event of an emergency. A fire risk assessment was not evident at the time of the inspection and was scheduled to take place the week after the inspection. We received confirmation that this had been completed.

A nurse call bell sounder was not working. This had been reported on 4 August 2017 but staff said it had been out of action for two to three months with no risk assessment in place to manage the situation to ensure people received care and support in a timely manner.

Monthly profile bed checks had been completed from June 2017 onwards however the checks had failed to identify that several mattresses did not meet the providers own safety requirements. Not all the people who used bed rails had a bed rails risk assessment completed and there were gaps in the recording of mental capacity assessments, best interest decisions and care plans in relation to the use of bed rails.

The quality and compliance manager could not assure us that appropriate Deprivation of Liberty Safeguards (DoLS) had been considered for people who lacked capacity. This meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did support this practice.

Individual risk assessments contained contradictory information, and lacked the appropriate level of detail and strategies to ensure risks were minimised. For some risks, risk assessments had not been completed or were over two years old. Care documentation also lacked detail, had not always been updated in response to changing needs and reviews were often meaningless.

There were concerns with some people’s fluid intake and no action had been taken to minimise the risk of dehydration.

Everyone we spoke with raised concerns about staffing levels and observations supported this. On four occasions inspectors intervened and physically sought staff out in response to hearing nurse call bells going unanswered and hearing people shouting for help.

Medicines were administered safely, however there were some concerns about appropriate storage and recording. We have made a recommendation about medicines.

The provider had not ensured staff had access to the appropriate training, support, supervision and appraisal they needed to ensure people’s needs were appropriately met.

Safeguarding concerns, accidents, incidents and complaints were logged but there was no evidence of internal investigations or analysis to identify patterns or improvements that were needed.

The provider had failed to ensure an effective system of governance and quality assurance was in place to identify concerns and action to be taken to make required improvements. Everyone we spoke with told us Wordsworth House lacked leadership, management and direction.

We found permanent care and nursing staff treated people with dignity and respect. People were complimentary of the care they received however, the provider was not ensuring appropriate systems were in place to support and develop a culture that was caring and compassionate.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

This service was last inspected in January 2014, and it was meeting all the legal requirements in place at that time.

Wordsworth House is a care home which provides accommodation and personal care to older people, some of whom have a dementia-related condition. It provides nursing care. It has 78 beds, and at the time of this inspection there were 69 people living in the home.

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.

People told us they felt they were safe in the service. They said that staff listened and responded to any concerns they had. Systems were in place to protect people living in the home from harm. Staff had been given training in how to recognise and respond appropriately to any suspicion of abuse. They were fully aware of their responsibility to keep people safe. Risks to people had been assessed and actions taken to reduce the likelihood of them being harmed. Improved systems had been introduced for the safe management of people’s medicines.

The service had enough staff on duty to allow them to meet people’s care and treatment needs promptly. We saw staff had the time to talk to people, as well as meet their needs. New staff had been carefully checked to make sure they were suitable to work with vulnerable people.

The staff team were experienced and skilled, and had been given the training they needed to meet people’s care needs. They received appropriate support to carry out their roles by means of supervision and appraisal. Staff morale was high, and they felt involved in the development of the service.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place. The registered manager was familiar with the processes involved in the application for a DoLS, and had made the necessary applications to the authorising authority.

People’s routine health needs were carefully monitored and they had full access to the normal range of health care available in the community. Any specialist needs identified were quickly referred to the appropriate services. People were offered a nutritious and varied diet. Any individual dietary needs were assessed and met, following the advice of the relevant professionals.

People and their relatives spoke very highly of the quality of the care they received. They told us they were treated as individuals and that the staff approach was affectionate and considerate. People told us they were treated with respect at all times. They said their privacy and dignity were protected by the staff team, and they were encouraged to be as independent as they able to be. We found staff took an imaginative, innovative and person-centred approach to people’s care, and took great pains to protect and enhance people’s well-being.

People’s needs were assessed and their wishes and views were taken into account in decisions about how those needs should be met. People’s care plans were kept under constant review and updated where necessary. People were asked to give their views about their care and the running of the home in residents’ meetings and in their individual care reviews. There were regular surveys of the views of people and their relatives, and the registered manager acted on their feedback. Complaints were taken seriously and responded to appropriately.

There was an open, positive and inclusive culture in the service. The registered manager was visible around the home and fully engaged with people and their visitors. The registered manager demonstrated good values and set high standards for the staff team. Staff told us they were well-managed; were treated with respect; and were listened to.

A range of systems were in place to monitor the quality of the service, and the registered manager took positive action to address any shortfalls. Feedback from people, relatives and staff was encouraged and welcomed as an opportunity to improve the service.

We saw that the home was aware of the latest National Institute for Clinical Excellence (NICE) standards in dementia care, and was at the early stages of incorporating those standards to improve its practice. A plan to train all nursing, care and ancillary staff in dementia care was well advanced. However, it had yet to clearly define its strategy for meeting the NICE standards in dementia care.

We spoke with 14 people living in the home, some with varying degrees of dementia, eight family members and seven staff. The feedback we received was very positive about the quality of the care given to people with dementia. One person told us, 'I have always received excellent care from wonderful, dedicated, friendly staff, who have shown me kindness and understanding at all times.' Another person said, 'Our privacy and dignity is respected, and this home is safe and the care is of a high quality and compassionate.'

Relatives were equally positive about the home. Relatives we spoke with confirmed that they were fully involved in discussing and agreeing the person's plan of care. One relative said, 'The carers are great and they treat my mother with the utmost dignity.'

We looked at the care records of people living in the home. We found people's needs were properly assessed and met, through the use of personalised care plans. People's needs were regularly re-assessed and care plans updated to reflect any changes in needs or wishes.

People with dementia were given the same access to health and social services as other people living in the home, and we found no evidence of any unnecessary admissions to hospital of people with dementia. The home ensured that appropriate information was passed to the hospital, when a person was admitted from Wordsworth House. It did not always receive the same level of information on the person's discharge back to the home from hospital.

Staff on the unit for people with dementia were very positive about their work, and had had appropriate training in the care of people with dementia. Senior staff on the unit were being given more advanced training in dementia care to further develop the quality of the care and treatment offered to people with dementia. Staff demonstrated good attitudes, values and skills in their work.

We observed the care of people with dementia. We saw no inappropriate interventions from any staff. All the staff interactions we saw with people were positive and reflected good training. The staff showed genuine care and compassion, and were sensitive and appropriate in their approaches to people with dementia.

We examined some of the systems in place for maintaining appropriate standards of care, and found they were working well. The manager took account of all feedback about the service, and treated any complaints or concerns received seriously. Staff and relatives confirmed they could speak to the manager whenever they had a problem.

People also told us they were happy with their care and their comments included, 'I'm well settled and properly cared for. I have no worries'; and, 'Everything's perfect, the staff and everything. Honestly and truly, I couldn't fault a single thing'. Visiting relatives agreed. One said, 'The quality of the care is good. The manager and staff are very caring".

We saw that people's needs had been properly assessed, and that their care was clearly planned and given in an individual and non-discriminatory way. People's care was also planned and given in ways that kept them safe from avoidable harm.

People living in the home told us they feel safe there and had confidence that the staff protected them from harm. One said, 'You needn't worry about this home, we're fine'. Relatives agreed, with no one we spoke with having ever seen anything remiss in the home.

Staff in the home were receiving appropriate levels of supervision and appraisal of their work, and were being given regular training opportunities.

Systems were in place to obtain the views of people in the home, and of their relatives, and feedback was generally good. Safety systems were in place and were frequently checked.