Wispington House Limited

Wispington House is a residential care home providing personal care for up to 26 people aged 65 years and over. At the time of the inspection, the service was supporting 22 people. The care home supports people in one adapted building. There are 2 floors with a stair lift installed.

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

There were systems and processes in place to protect people from harm. Staff were aware of their responsibilities in protecting people from abuse, and people told us they felt safe. The manager had processes in place to learn from events to reduce risks to people’s safety.

The risks to people’s safety were well managed. People were provided with care and/or equipment they needed to reduce the risks to their safety. This included regular repositioning, to reduce the risk of skin damage, or walking aids, to reduce the risk of falls and increase their independence.

People told us staff always worked to meet their needs but there were times when they were busy or short staffed, this was often due to short notice sickness. The manager worked to manage staff sickness and had been recruiting staff to allow them to meet the established numbers of staff required.

People’s medicines were managed safely. Staff had received training for safe handling of medicines and the manager’s audits of medicines were effective in maintaining safe practices and storage of medicines.

Good infection control practices were in place to reduce the risk of the spread of infection at the service.

People’s needs were assessed using nationally recognised assessment tools. People’s care was recorded on a new electronic care planning system. The provider and manager were reviewing this system to ensure going forward it would meet the needs of the service.

Staff received training to support them in their roles and people told us they were happy with the way staff supported them.

People were supported with their nutritional and health needs. People enjoyed the food they were served and told us staff were quick to deal with any health issues which required external health professionals.

People lived in an adapted building which had an ongoing refurbishment plan in place to ensure areas were updated when required. They were able to personalise their rooms.

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.

The service had a manager in post who was not yet registered with the CQC but had applied for their registration. There were quality monitoring processes in place, some required some updating but the manager was aware and was working to an action plan to ensure completion.

The provider had processes in place to ensure oversight of the service. There were plans to also further support the manager with a quality monitoring consultant visit on a monthly basis. This would also support the provider oversite.

People, relatives and staff felt the staff at the service were open, honest, and supportive. Many people spoke about the homely atmosphere at the service.

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

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.

At our last inspection on 24 March 2022 we undertook a targeted inspection to check whether the Warning Notice we previously served in relation to Regulation's 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. At that inspection we found the regulations had been met. However, the overall rating for the service did not change following this targeted inspection and remained requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Why we inspected

This focused inspection looked at the key questions, safe, effective and well led, and was carried out to provide an up-to-date rating for the service. At this inspection we found improvements found at the last inspection had been sustained and the provider was no longer in breach of regulations.

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 changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Risks associated with falls and pressures sores were identified, assessed and measures were in place to reduce harm. Fire evacuation procedures had been updated and people had individualised emergency evacuation plans in place. People's ‘as needed’ medicines were managed safely by trained and competent staff. Soft furnishings in the service had been replaced which were in good condition and wipeable. There were enough staff to meet people’s needs during the night.

Mental capacity assessments and best interests’ decisions had been completed where required for specific decisions relating to people’s care. Staff had received training in regard to safeguarding and manual handling.

The provider had a quality assurance framework in place to enable them to monitor the quality of people’s care. Shortfalls identified during the last inspection relating to medicines, risks to people, staff training and fire evacuation had been addressed. There was a new manager at the service who had systems in place to ensure oversight of quality of care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

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.

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation's 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wispington House is a residential care home providing personal care for up to 26 people aged 65 years and over. At the time of the inspection, the service was supporting 20 people.

The care home supports people in one adapted building. There are two floors with a stair lift installed.

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

Care plans did not provide enough guidance on how to keep people safe. People were not safe in the event of an emergency evacuation. Medicines were stored safely, but ‘as needed’ medicines were not managed safely.

People told us they felt safe, and staff were confident in reporting any concerns about abuse. Infection control processes were not always safe, which put people at risk of COVID-19 transmission. When incidents occurred, action was taken to reduce the risk of re-occurrence.

There was not enough staff at night to meet the needs of the people safely. Staff did not have up to date training to ensure they were skilled to support people. There was a reliance on agency staff, but there were poor quality records to guide them on how to care for people safely.

People were not supported to have maximum choice and control of their lives as detailed mental capacity assessments had not been completed. People were subjected to Deprivation of Liberty safeguards (DoLs), however there was poor oversight of this. We found doors leading outside were not always locked to meet restrictions authorised in the DoLs.

Audits were of poor quality and did not produce needed improvements. There was poor management oversight to ensure risks were identified.

Complaints were recorded and responded to and the duty of candour was met. Staff, people and relatives were consulted on the running of the service and able to make suggestions.

People received enough food and drink. People were usually supported if they had swallowing difficulties. However, sometimes untrained domestic staff supported mealtimes. This risked unskilled staff not being able to respond appropriately to people's care needs. The provider has since responded to these concerns stating untrained domestic staff stopped supporting mealtimes in May 2021

We described our concerns to the provider. They created an action plan, and informed us that they intend to make the required improvements. We will assess the impact of this action plan at our next inspection.

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 14 September 2019).

Why we inspected

The inspection was prompted due to concerns we had received about unsafe staffing levels and an unsafe environment. A decision was made for us to inspect and examine those risks.

Due to the concerns received, we undertook a focused inspection to review the key questions of ‘safe’ and ‘well-led’. When we arrived, we also had concerns about areas covered by the ‘effective’ domain. We decided to include this ‘effective’ domain in our inspection. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We also 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.

We have found evidence that the provider needs to make improvements. We informed the provider of our most urgent concerns and they advised they would take action to mitigate these risks.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included a breach of regulation 12 (safe care and treatment), regulation 11 (consent), regulation 18 (staffing) and regulation 17 (good governance).

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We have requested 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 inspect sooner.

Wispington House is a residential care home providing care and support for up to 26 older people, some of whom live with dementia. At the time of this inspection 22 people were living at the home.

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

People continued to receive safe care. There were enough staff to support people and people received their prescribed medicines safely. The registered provider completed checks on staff as they were recruited to ensure they were suitable to work at the service. Lessons were learned when mistakes happened.

People’s needs were assessed before they went to live at the service. Assessments covered key aspects of people’s health, care and well-being and reflected the requirements of the Equalities Act. Staff had been trained in areas relevant to people’s needs and their competence was checked.

People received food and drink to meet their nutrition and hydration choices and needs. Staff worked with other healthcare professionals to ensure people’s care needs were met effectively, including support for when people were required to attend hospital appointments.

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.

People received caring support from staff who respected their dignity and privacy. People were encouraged to be independent and the environment was kept under review and adapted to meet people's changing needs.

Staff understood people's needs well and how to care for them in a personalised way. People were supported to choose and engage in a range of meaningful activities.

The registered manager was approachable and there were opportunities in place which encouraged people and staff to give their feedback and to contribute to the on-going development of the home. People and relatives knew how to raise any concerns they had and how to make a formal complaint.

The registered manager worked well with other professionals and looked to identify learning to contribute towards improving care for people. Regular monitoring of the home ensured that quality of care was regularly reviewed, and measures were put in place quickly when improvements were identified as needed.

Rating at last inspection

The last rating for this service was Good (published 17 January 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Wispington House Limited is situated in the village of Saxilby in Lincolnshire. The home provides residential care and support for up to 26 older people, some of whom live with memory loss associated with conditions such as dementia. There were 24 people living in the home at the time of this inspection.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission (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.

People were safe living at the home. Staff understood how to identify, report and manage any concerns related to people’s safety and welfare.

The registered provider had robust recruitment processes in place and background checks had been completed before new staff were appointed to ensure they were safe to work at the home.

Staff were well supported and had received training in order to enable them to provide care in a way which ensured people’s individual needs were met.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of this inspection two people who lived in the home had their freedom restricted and a further seven people were awaiting the outcomes of their assessments for a DoLS authorisation. The registered persons had acted in accordance with the MCA and DoLS guidance to ensure people had their rights protected.

There was a warm, friendly and caring atmosphere in the home throughout the visit. People were treated with kindness and compassion. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity.

Staff knew how to manage and minimise any identified risks and provided the care needed as described in each person’s care record. Care was supported through staff having access to a range of visiting health and social care professionals when they required both routine and more specialist help. Clear arrangements were also in place for ordering, storing, administering and disposing of any unused medicines which were no longer needed.

Staff worked closely with people and their families to ensure each person was supported to maintain and further develop their individual interests and hobbies and to have a meaningful and enjoyable life. In addition staff provided a varied programme of communal activities for those who wished to participate in them.

People also received a range of nutritious foods and drinks that met their assessed needs as well as their choices and preferences.

There was a positive culture within the home which was based on openness and inclusion. People, their relatives and staff members were encouraged to express their views. The provider and registered manager listened and took action to resolve any issues or concerns identified. More formal systems were also in place for handling and resolving complaints.

The provider and registered manager worked together consistently and maintained regular communication in order to regularly assess and monitor the quality of all the services provided. This approach ensured that any shortfalls in quality could be quickly identified and actions taken to keep improving and developing the service.