We inspected Wraysbury House on 27 October and 1 November 2017. The inspection was unannounced.
Wraysbury 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.
Wraysbury House provides accommodation, nursing and personal care for up to 27 people in one adapted building. At the time of the inspection there were 24 people living in the home. People living at the home were older people with various support needs, including dementia, mental health and physical disabilities.
There was manager in post at the home who was currently in the process of applying to be a registered manager for the service. 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.
We last inspected the service on 26 April and 3 May 2016. At this inspection, we asked the provider to take action to make improvements as we found people were at risk of their care needs not being understood or met as their care planning records had not been fully completed, personalised and were not fit for purpose. We also found the provider had not ensured people’s consent to care and treatment was sought in accordance with the Mental Capacity Act (MCA) 2005. The provider sent us an action plan on 31 July 2016 outlining how they would take action to address the matters.
Since the last inspection, the provider had been sold to another company in February 2017. The new owner of the provider had retained the same registration responsibilities as the previous ownership. These included ensuring that actions on the plan sent to us on 31 July 2016 had been completed. At this inspection we checked to see if the provider had made the necessary improvements in these areas. We found people were still at risk of not having their care needs met as the provider had not been able to ensure people’s care planning records were fully completed, personalised or fit for purpose. We found the provider had taken adequate action to ensure people’s care and consent was sought in accordance with the MCA. The manager and staff understood and put into practice the principles of the MCA when supporting people. People’s care plans clearly documented that they or an appropriate person had consented to their care and this was open for review at any time.
The provider was not ensuring safe and proper management and practice when supporting people with medicines. Arrangements for managing medicines including obtaining, recording, storing, disposing and administering were not safe and people were at risk of harm due to this.
Identification, assessment and management of risks to people at the home was not always safe. We found that, although identified, there was a lack of detail and guidance in people’s risk assessments and care plans about how to manage risks safely. Equipment in place to help manage risks to people was not always functioning.
Fire alarm checks and fire drills were taking place regularly along with health and safety checks and maintenance audits. However, there was no current fire risk assessment at the home so it was not certain the premises were safe from all fire risks and there was a lack of detail in people’s personal emergency evacuation plans about how to support them safely in the event of a fire.
The provider had systems in place to audit quality and safety, but we found these systems were not effective. Identification of risks to people or areas in need of improvement was not consistent. Actions taken in response to any identified risks or improvements were not always implemented or successful.
The provider had not consistently followed safe recruitment practices. Records showed two references had not always been historically obtained for all staff before commencing their employment. The provider was now taking action to locate the missing references.
The home was not always clean and hygienic. On the first day of the inspection there were strong offensive smells of urine in the front entrance, hallway and from people’s bedrooms. Areas of the property were not clean and furniture was stained and in poor condition. Housekeeping staff were under-recruited, leading to shortfalls in maintaining an acceptable standard of cleanliness. The provider had addressed these issues on the second day of the inspection.
People were involved in decisions about their care and relatives told us they felt the home provided kind and compassionate support. We observed staff supporting people in a caring manner. Staff we spoke to showed a good understanding of the importance of treating people with respect. However, during the inspection we found people’s privacy and dignity was not always respected. We discussed this with the provider and they took immediate action to address this.
The home had enough staff to meet people’s needs. The manager logged and reviewed accident and incident forms to help identify any themes and subsequent actions needed to keep people safe. Staff received safeguarding training and showed a good understanding of their responsibilities to keep people safe.
Staff received an induction that met the Care Certificate standards and received training in subjects relevant to their role. Some staff training was missing or required updating, there was a plan in place to address this and the provider was in the process of delivering this.
The manager was proactive in arranging and maintaining links with organisations to provide on-going guidance and training to help improve support at the home. Staff received regular supervisions and appraisals to support them to understand their responsibilities.
People had support to maintain good health and had access to healthcare professionals and services. Staff had a good understanding of people’s health needs and monitored these appropriately. People had support to access sufficient food and drink and the home supported people to manage any dietary or nutritional needs. The service placed an emphasis on supporting a healthy, varied and balanced diet. Meal times were flexible and people had an active input in the menu and could choose what they wanted to eat.
The provider encouraged feedback and sharing information with people and their relatives in order to help them to respond to people’s needs quickly and effectively. People and their relatives knew how to raise a complaint and felt confident to do so. People we spoke to who had raised a complaint were happy with the response they received.
The service supported people to access a range of social activities they could choose to take part in. There was an on-site activities co-ordinator and people had support to take part in activities in the local community. People had support to develop and maintain relationships with people important to them and had support to meet their cultural and spiritual needs.
There was a positive culture at the service and staff and relatives spoke highly of the manager. There was a good level of shared understanding from all staff at the home of the vision and values of delivering high quality care. Staff and management showed a willingness to work together to overcome challenges and concerns and develop the home to realise this vision. Staff felt supported and the provider was committed to supporting the manager and the team with any necessary resources to drive improvement at the home.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and that in some areas the service was failing to meet the national standards that people should be able to expect. You can see what action we told the provider to take at the back of this report.