Wyncroft House

Wyncroft House is a residential care home providing personal and nursing care to up to 38 people. The service provides support to people living with dementia and people living with a range of complex health care needs. At the time of our inspection there were 19 people using the service.

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

Care plans contained contradictory information about how to manage people’s wounds. Topical creams were not administered as prescribed. There were no processes in place to ensure peoples pain relief medicines were monitored to ensure they were still in situ.

Appropriate checks were not carried out to ensure staff were recruited safely. Several staff files contained gaps in employment history, and risk assessments had not been completed for staff who had used their Disclosure and Barring Service certificate from their previous employer.

There were measures in place to prevent the spread of infection.

Incidents and accidents were recorded and analysed to identify trends however, there was no process in place for the provider to check if actions were consistently followed up.

There were systems and processes in place to protect people from the risk of abuse. People and relatives told us they felt safe. There were enough staff to keep people safe.

The systems and processes in place to monitor the service were not effective and did not consistently identify where improvements were needed. We were not assured the provider had embedded a culture of continuous learning.

People told us the manager was approachable and they felt comfortable raising their concerns. The provider engaged with people using the service. Staff worked with external health care professionals to ensure people received partnership care to meet their needs.

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.

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 (09 March 2020).

At our last inspection we found breaches of the regulations in relation to safe care and treatment and good governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider remained in breach of regulations. We also identified a new breach in relation to fit and proper persons employed.

Why we inspected

We received concerns in relation to the management of people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 not changed following this inspection and remains requires improvement

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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.

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

Enforcement

We have found breaches in relation to safe care and treatment, fit and proper persons employed and good governance at this inspection.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The service was clean and effective systems were in place.

Personal Protective Equipment (PPE) stations where staff could sanitise their hands, don and doff the appropriate PPE were placed throughout the building in key areas. Staff wore gloves, masks, aprons and visors when supporting people who had tested positive for COVID-19 and were isolating.

Staff received additional Infection control training and PPE training remotely. The training materials were also sent to each staff member for reference should they need it.

There was a clear process in place to monitor vaccination status and testing for staff and people at the service.

The provider responded swiftly when people tested positive for COVID-19 and supported them to isolate immediately and ensure all areas of the home were sanitised and disinfected through a deep clean.

People were supported to maintain contact with families through visits. Staff supported people to make phone and video calls to maintain contact with family and friends between visits and when people were isolating after testing positive for COVID-19.

Wyncroft House is a care home registered to provide personal and nursing care for up to 38 people living in a converted building. The home accommodates people living with dementia at different stages in its progression and people living with a range of complex health care needs. At the time of our inspection there was 37 people living at the home.

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

Risks were not consistently managed, and systems and processes were not always effective for mitigating ongoing risk to people.

The providers quality monitoring systems and processes were not always effective at identifying where improvements were needed and action was not always taken on issues identified in a timely way. Medicine management systems were not always robust in relation to the administration of prescribed creams and the follow up on medicine management queries.

Some people told us more staff were needed to meet their needs. Staff were not always deployed in a way to ensure people’s safety was maintained. The provider acted during the inspection to improve the deployment of staff. This gave assurance about people’s safety.

There were policies and systems in place, so people would be supported to have maximum choice and control of their lives, however these had not always been implemented effectively when people were supported to make choices about their care.

People said they felt safe and were comfortable around staff. Relatives told us they felt their family members were safe. Staff received the training they needed so they had the skills and knowledge to meet people’s needs.

Staff were observed to be kind and caring. Staff spoke to people with dignity and respect and took the time to support and encourage people.

People were supported to access external healthcare professionals to maintain their health and wellbeing. People were supported to have enough to eat and drink and appropriate referrals had been made to healthcare professionals where people had specific dietary needs.

People were supported to plan for and receive appropriate end of life care. There were systems in place for people and relatives to give their feedback on the service.

The provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include, age, disability, race, religion or belief etc. Staff members we spoke with knew people they could tell us about people's individual needs and how they were supported.

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 good (published August 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to regulation 12 safe care and treatment and regulation 17 good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 return sooner.

We carried out an unannounced comprehensive inspection of this service on 20 and 21 June 2016 at which a breach of legal requirements was found. This related to there not being systems in place to show how staff were being supported and how the quality of the service was being managed and checked.

We carried out a further inspection on 19 October 2016 to look at how the provider had made improvements in response to the breach of legal requirements. At this inspection we found that the provider had taken appropriate actions to ensure systems were in place for staff to be supported and the appropriate audits, checks and monitoring of the service were in place.

Wyncroft House can provide accommodation for up to 38 people who require nursing and personal care. People lived in one of two units within the home. On the day of the inspection there were 25 people living in the nursing unit and 9 people living in the residential dementia unit.

There was a registered manager 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 felt safe in the home. Staff had been safely recruited and had received the appropriate training to provide them with the skills to meet people’s needs and manage risks to them on a daily basis.

New systems were in place to ensure staff deployed across the home were able to meet people’s needs in a timely manner. People were supported to receive their medicines as prescribed by their doctor.

Staff received the training and support they required in order to meet people’s needs safely and effectively. People’s human rights were respected by staff because staff applied the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards in their work practice.

People were supported to maintain a healthy diet and have access to a variety of healthcare professionals in order to meet their needs.

Staff were kind and caring and treated people with dignity and respect. Staff helped people make choices about their care and their views were respected.

People were involved in the planning of their care to ensure staff had the information they needed to support people the way they wished to be supported.

Information was collected regarding people’s interests and how they wished to spend their day. Activity co-ordinators were in post to support people to take part in activities that were of interest to them.

Where complaints had been raised they were investigated and responded to appropriately. People were confident that if they did raise any concerns they would be listened to and acted upon.

People considered the service to be well led. Staff felt supported and listened to and were given the opportunity to make contributions to the running of the service.

People were supported by staff who were well motivated and knew what was required of them. There were a number of quality assurance audits in place to assess the ongoing quality of the service provided. Where audits identified areas for improvement, action plans were in place.

We carried out an unannounced comprehensive inspection of this service on 20 and 21 June 2016. A breach of legal requirements were found. These related to there not being systems in place to show how staff were being supported, how the quality of the service was being managed and the quality checked. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wyncroft House on our website at www.cqc.org.uk.

Wyncroft House is registered to provide accommodation and support for 38 people who may have dementia. On the day of our inspection there were 37 people living at the home. There was a registered manager 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.

The provider had taken appropriate actions to ensure systems were in place for staff to be supported. We found that supervisions, staff meetings and appraisals were now taking place.

Care plans were in place which showed how people wanted to be supported and the appropriate review documentation was in place.

Systems had been implemented so the appropriate audits, checks and monitoring of the service could be carried out by the registered manager and provider.

The provider was able to show evidence of their last questionnaire conducted to confirm how people were able to share their views on the service. We saw that meetings had been implemented so people could share their views about the service on a more regular basis.

Wyncroft House is registered to provide accommodation and support for 38 people who may have dementia. On the day of our inspection there were 36 people living at the home. There were 26 people living in the nursing unit and 10 people living in the residential dementia unit. There was a registered manager in post who was on holiday on the day of the inspection. 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 felt they were safe. Staff received the appropriate training to know how to keep people safe from harm. While people received their medicines as they wanted we found that medicines were not being stored as required. Medicines were not managed sufficiently to ensure people’s safety.

Staff were not being supported appropriately to ensure they had the right skills and knowledge to meet people’s needs. People’s consent was sought before they were supported and where they lacked capacity their human rights were protected as required within the Mental Capacity Act (2005).

We were unable to evidence how people’s support needs were identified and delivered and how changes to people’s support needs were managed. There were no assessments, care plans or review documentation in place.

Staff were kind and caring towards people. People’s privacy dignity and independence was respected.

We were unable to see how activities were planned to ensure people were able to enjoy the things they like to do. The provider had a complaints process to enable people to raise any concerns they had. However the provider had no system to log complaints received.

We were unable to see documentation to show us how the quality of the service was checked or audited by the registered manager and how the provider carried out their own checks on the service.

The provider did not ensure that all notifiable events were reported to us as required by the law.

The provider did not ensure that their rating from their last inspection was displayed as is required by the law.

The deputy manager who had started in their role on the day of our inspection was unable to provide us with much of the information we requested.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.