17 August 2016
During a routine inspection
Waverley Lodge is a care home providing accommodation with nursing and personal care for up to 45 people. The service is primarily for older people, including people with dementia.
The service had 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 in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered manager was present and assisted us during this inspection.
People told us they felt safe and were well cared for. Staff took steps to safeguard vulnerable adults from harm and promoted their human rights. Incidents were dealt with appropriately and referred on to the appropriate authorities, which helped to keep people safe.
The building was generally safe and mostly well maintained. A small number of maintenance items were identified and some bathing and shower facilities required refurbishment. The property was purpose built as a care home and further steps had been taken to make the building suitable for the people living there, including for people living with dementia. Additional signage and control measures were used to highlight and minimise potential hazards and orientate people to the building. Risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. The home was clean throughout, although some inappropriate storage was evident in a sluice room. There was limited availability of moving and handling equipment.
We observed staff acted in a courteous, professional manner when supporting people. Further guidance was required to promote safe manual handling for some individuals. We observed most staff adhered to safe manual handling practices, but queried the use of under arm support when staff transferred people from lounge armchairs to wheel chairs.
We received mixed views regarding the adequacy of staffing levels. The provider had a robust system to ensure new staff were subject to thorough recruitment checks. Improvements had been made to the way medicines were managed although record keeping and audit arrangements required further work to ensure medicines could be well accounted for.
As Waverley Lodge Care Home is registered as a care home, 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 and the registered manager was familiar with the processes involved in the application for DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary, DoLS had been applied for, although further guidance was needed where people received their medicines covertly. We observed staff obtained people’s consent before providing care.
Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned on a regular cycle to ensure their skills and knowledge were up to date. The majority of staff told us they were well supported by the registered manager. Formal supervision meetings were conducted and staff told us they could seek guidance and advice from the registered manager and nurses on duty. Staff performance was assessed and targets set for their on-going training and development.
People’s nutritional status was assessed and plans of care put in place. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.
Staff displayed an attentive, caring and supportive attitude. We observed staff interacted positively with people. We saw that staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidentiality were maintained.
Activities were offered within the home on a group and one to one basis. Visitors were able to come and go freely. The home had a variety of communal rooms and quiet spaces which enabled people to sit in company or enjoy a quieter atmosphere. Staff understood the needs of people and we saw care plans and associated documentation were clear, up to date and person centred.
People using the service and most staff spoke well of the registered manager and they felt the service had good leadership. Some staff felt arrangements to rotate staff into different units in the home could have been more effectively managed. We fed back these comments to the registered manager. People using the service, visitors and staff said they would recommend the home to family or friends. We found there were a range of systems to assess and monitor the quality of the service, which included feedback from people receiving care and others. Some areas requiring improvements had not been fully addressed or improvements had not been sustained when the registered manager was absent.
We made recommendations regarding assessing and determining safe staffing levels and activities.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to governance (management) and safe care and treatment. You can see what action we told the provider to take at the back of the full version of this report.