This inspection took place on 5 December 2017 and was unannounced.At our last comprehensive inspection on 27 October 2016 the overall rating of the service was, ‘Requires Improvement’. This summary rating was the result of us rating the key questions ‘safe’, ‘responsive’ and ‘well led’ as, ‘Requires Improvement’. In relation to the key question ‘responsive’ and ‘well led’, we found that there was a breach of regulations. This was because the registered manager had not ensured everyone had a care plan which met their needs at all times. We also found the registered manager had failed to maintain accurate and complete care records in respect of each person.
At our last inspection for the key question, ‘is the service safe?’ we found peoples risk assessments did not include enough detail to ensure people were supported safely. For example, we saw 'repositioning' charts were in place but there was not detailed information or guidance on the risk assessment to say how this was to be managed. Another person had been identified to be at risk of choking. There was no risk assessment in place to provide guidance to staff on how to manage this. We also found one staff member not following good hygiene procedures. Whilst supporting people to take their medication they used their hands to give it to them instead of using an appropriate hygienic method such as a spoon. They did not wash their hands in between each person's administration. This put people at risk of cross contamination.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question’s ‘safe’, ‘responsive’ and ‘well led’ to at least good. At this inspection the overall rating of the service was changed to, ‘Good’. We found significant improvements had been maintained and we rated each of our key questions as being, ‘Good’.
Wyndham House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.
Wyndham House accommodates 44 people in one adapted building. There were 37 people living in the service at the time of our inspection visit.
There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations.
There were systems, processes and practices to safeguard people from situations in which they may experience abuse. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, the necessary provision had been made to ensure that medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service to support people to stay safe and meet their needs. Background checks had been completed before care staff had been appointed. People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong.
Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.
Care staff had been supported to deliver care in line with current best practice guidance. People enjoyed their meals and were supported to eat and drink enough to maintain a balanced diet. In addition, people had been enabled to receive coordinated and person-centred care when they used or moved between different services. As part of this people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations.
People were treated with kindness, respect and compassion and they were given emotional support when needed. They were also supported to express their views and be actively involved in making decisions about their care as far as possible. Confidential information was kept private.
People received personalised care that was responsive to their needs. Care staff had promoted positive outcomes for people who lived with dementia including occasions on which they became distressed. People’s concerns and complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.
There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a management framework to ensure that staff understood their responsibilities so that risks and regulatory requirements were met. The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made. Quality checks had been completed to ensure people benefited from the service being able to quickly put problems right and to innovate so that people consistently received safe care. Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the registered manager worked in partnership with other agencies to support the development of joined-up care.