The Wedge Residential Home

We found the following examples of good practice.

People were supported to keep in touch with families. Visits were planned and well organised to reduce risk and avoid the potential spread of infection. Alternative forms of maintaining social contact were used for friends and relatives. For example, keeping in touch using telephones, regular e-mails to family members and video calling for meetings.

Visits were by appointment and staggered to minimise visitor numbers. The home had designed, and built, an enclosed structure to enable socially distanced visits. The structure had separate entrances with a clear partition separating people from their visitors to reduce risks. There were soft furnishings and PPE stations to ensure both people and visitors were safe and comfortable. The structure could be used all year-round.

Measures were in place, and clearly communicated, to prevent relatives, professionals and others visiting from spreading infection on entering the premises. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home.

A testing scheme for all staff and residents had been implemented, known as ‘whole home testing’. The provider had tests for regular 'whole home testing' as well as tests for any suspected or symptomatic residents or staff. People and staff had individual risk assessments in place, and adjustments had been made.

Staff were trained and knew how to immediately instigate full infection control measures to care for people with symptoms of COVID-19 to avoid the virus spreading to other people and staff members. Staff had received training from an infection, prevention and control (IPC) specialist. Arrangements were in place so staff could appropriately socially distance during breaks, handovers and meetings.

The provider had strengthened their community links during the pandemic. For example, the local GP surgery had implemented regular and consistent contact with the service to ensure people continued to have their needs met.

Further information is in the detailed findings below.

The Wedge Residential Home is a residential care home providing accommodation and personal care for up to 21 people, some of whom may be living with dementia or have a physical disability. Accommodation is arranged over two floors with lift and stair lift access to the second floor. At the time of our inspection 21 people lived at the home, one of whom moved into the home during the inspection.

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

People were safe and supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service mostly supported this practice. We have made a recommendation about the electronic recording in relation to best interest decisions.

People and their relatives told us that they thought the home was well led and spoke positively about the registered manager. The registered manager carried out numerous audits to ensure the service was effective. However, these were not always effective. We have made a recommendation in relation to the provider’s quality assurance systems.

The home had a consistent staff team who understood the needs of people well. We saw staff upheld and promoted people's rights relating to equality and diversity. Safe recruitment procedures were mostly followed.

We saw evidence of people's and their relative's involvement in care assessments. Risks to people were recorded in their care plans and staff demonstrated they had a good knowledge of people. People received their medicines safely.

People and their relatives were very positive about the food. People were encouraged to maintain a healthy, balanced diet, based on their individual needs and had access to food and drink whenever they wanted.

People and their relatives were positive about the quality of care and support people received. Staff identified what was important to people and endeavoured to provide meaningful experiences and lasting happy memories.

The registered manager was proactive in ensuring they had a visible presence within the home and operated an open-door policy ensuring that any low-level concerns were dealt with promptly preventing escalation.

The service was well-led by a management team whose passion and drive to deliver a good service, leading by example, was evident.

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 20 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 this unannounced comprehensive inspection on the 30 March 2017 to check the registered provider had met all the legal requirements. We found they had taken action and were now compliant with these regulations.

The Wedge Residential Home is registered to provide accommodation and personal care for up to 21 older people. Accommodation is arranged over two floors with lift and stair lift access to the second floor. At the time of our inspection 20 people lived at the home.

A registered manager was in post. 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 were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff available to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Medicines were administered, stored and ordered in a safe and effective way.

Risks associated with people’s care were identified. Staff had a very good understanding of these risks and how to ensure the safety and welfare of people. Incidents and accidents were clearly documented and investigated. Actions and learning were identified from these and shared with all staff.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People received nutritious meals in line with their needs and preferences, in an environment which provided a calm and relaxing dining experience for them.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. People and their relatives met with staff to discuss the planning of their care, any concerns they may have and developments in the service provided at the home.

Care plans in place reflected people’s identified needs and the associated risks.

Staff were caring and compassionate and knew people in the home well. External health and social care professionals spoke highly of the care and support people received at the home.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The registered manager was visible in the service and available to provide support and guidance for people, staff and their relatives.

A robust system of audits was in place at the home to ensure the safety and welfare of people and actions from these were completed.

The Wedge Residential home is a care home that does not provide nursing. It provides support to up to 20 older people, some of whom are living with dementia. At the time of inspection 20 people were living at the home.

A registered manager was 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.

The registered manager was unable to demonstrate that all medicines were stored safely and in line with the requirements of law. Records of people’s care were not always accurate and reflective of people’s needs. Systems to monitor the quality of care plans and medicines were not in place to drive improvements.

People told us they felt safe at the home and staff had a good understanding of their roles and responsibilities in protecting people from abuse. They knew what to look for and the action to take if they were concerned. Staff were aware of risks associated with people’s care and knew the action to take if the risks presented.

Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Staff received training and supervision to make sure they had the skills and knowledge to support people.

Staff were aware of the need to gain people’s consent and to respect the decision they made. Where people lacked capacity to make certain decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests, although records of this were not clear. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs. People were supported to access healthcare services as they needed.

People had developed good relationships with staff who were kind and caring in their approach. People were treated with dignity and respect. Staff actions promoted and encouraged people’s independence. They were encouraged and supported to be involved in making decisions about their care and day to day life.

The home had an open, friendly atmosphere in which people were encouraged to make their views and opinions known. The manager operated an open door policy and encouraged staff and people to make suggestions or discuss any issues of concerns. No complaints had been made but everyone knew how to raise one if needed and were confident they would be taken seriously.

We found breaches in three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people who used the service, the relatives and staff told us, what we observed and the records we looked at.

If you'd like to see the evidence that supports our summary you can read the full report.

Is the service safe?

We saw that people were assisted to move safely and with the appropriate equipment. People received medication from appropriately qualified staff who had followed the correct procedures for storing and preparing medicines. Staff we spoke with demonstrated a good level of knowledge regarding safeguarding procedures. The home had an adequate number of experienced staff on duty to cater for people's needs and people knew the staff well.

We spoke with four people living in the home, all of whom told us they were protected from avoidable harm. One person told us, "I've been here two years. I love it here and the staff are rarely off sick".

Is the service effective?

We saw that people were able to make choices about how they spent their time. People had the opportunity to join in a range of activities, such as chair aerobics, if they wanted to. People's care plans took account of their interests and routines. The staff who worked in the home encouraged people to maintain their independence, for example with their mobility.

One person explained how they spent some of their time reading and knitting. They told us, "I do knitting for charity. It goes to Africa". Another person told us, "I can do whatever I want".

Is the service caring?

We saw staff treated people with dignity and respect. Staff were experienced, knowledgeable and knew people's needs well. People, relatives and staff told us the manager was very approachable.

People we spoke with told us the staff were kind and helpful. One person told us the night staff had been "awful" in the last home they lived in but they were very good in this home. One relative told us, "I can't fault this one. The last home used loads of agency staff".

Is the service responsive?

We found the home responded well to the needs of people who lived there. Prompt action was taken when people were ill or needed treatment and information from health care professionals who visited was disseminated effectively.

We spoke with a health care professional who visited on the day of our visit. They told us they were always called promptly, when necessary. One person told us, "I had a chest infection a while ago and the doctor came the same day".

Is the service well-led?

We saw that people's views were sought in a variety of ways such as from a visible presence by the manager and in completing surveys. People, staff and relatives told us they could talk to the manager about anything. Regular audits, to help ensure the smooth running of the home, were carried out in accordance with the law.

All four people we spoke with told us the manager was very good. One relative told us the home had been recommended to them and they, in turn, had recommended it to someone else. One relative said, "We get questionnaires annually and quite a few changes have happened as a result".

We saw that the home was clean and well maintained. Care was provided over two floors with single occupancy rooms. Most rooms were en suite. People were able to personalise their rooms with their own possessions and accessed their rooms whenever they chose. There were three communal lounge or dining areas available for people to use.

We saw that a wide variety of foods were on offer to people living at this home. A four week rota of menus was used to offer a choice of meals

The home offered a wide variety of activities for people to enjoy if they chose. Two staff members were employed to ensure activity sessions were available for people most days. We saw that people enjoyed watching television, reading, listening to music and participating in crafts in their rooms.

We saw that clear care plans were in place to support people who lived in this home. However some short term care plans were incomplete. We saw that staff treated people in a kind and gentle manner and respected their dignity. People had their care discussed and agreed with them or their representative.

People told us they were happy living at this home. One relative told us, 'The staff are angels in disguise. I could not wish for a nicer place for my Mum to live.'

During the visit we spoke with eight people who use the service. People said they felt they were treated well by staff, who listened to their requests. People said they received the care they needed in the way that they wanted it to be provided. People told us staff generally responded promptly when they used their call bells and helped them with what they needed

People we spoke with said they felt safe in the home and said they were confident that staff would respond appropriately to any concerns they raised. People told us the manager regularly asked them how things were.

We spoke with one person visiting the home to see their relative. They said "the staff are like an extended family". "I would recommend this home to anyone".

The staff we spoke to had a good knowledge of peoples histories, needs, likes and dislikes. This showed that they had read and understood the care plans. Staff told us that "we support each other, coming in and covering when we are short staffed", "I love working her, it is home from home".