Archived: Wicksteed Court Care Home

Wicksteed Court Care Home is a residential care home providing personal care to up to 25 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 17 people using the service.

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

The provider had made improvements to the service to ensure suitable staffing levels and suitable contingency measures were in place.

Staff were clear on their roles and fed back to us that staffing levels had improved, and they were supported by the registered manager.

Improvements had been made to the environment which had undergone some re-decoration and maintenance. Infection control measures were in place and being followed by staff.

Audits and checks were in place to ensure staffing levels and cleanliness were monitored, and action taken when necessary.

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 requires improvement (published 10 November 2022) when there was a breach of regulation.

Following our last inspection, we served a warning notice on the provider. We required them to be

compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 11 January 2023 .

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wicksteed Court Care Home 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.

Wicksteed Court Care Home is a residential care home providing personal care to up to 25 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 15 people using the service.

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

The provider had failed to achieve good standards within the home across multiple inspections. This service was registered with CQC on 26 October 2017 and in that time has failed to achieve a Good rating. This is the sixth consecutive inspection where the service has received a Requires Improvement rating or lower.

Contingency planning was not in place to manage a period of staff sickness within the home, leading to poor standards of care and cleanliness.

The environment had not been sufficiently cleaned. We found areas within the home which were dirty and needed cleaning, maintenance, and re-decoration.

People were not having their care needs met promptly. Staff were rushed as they had to complete extra duties with cleaning and cooking, as well as care tasks, due to staff sickness.

On the day of inspection, there was a lack of meaningful activity within the home as staff did not have the time to facilitate this. We received mixed feedback from staff about the support they received and morale within the service.

People were not always offered choice of what to eat and drink.

Staff were recruited safely in the service and received suitable induction and ongoing training. Medicines were administered safely by staff who were trained to do so.

A complaints policy and system was in place, and people knew how to use it. People’s preferences, likes and dislikes were documented within care plans, and staff knew people well. End of life information and care planning was documented for those who wished to have it.

Audits and checks were in place throughout the service. Staff and people were able to feedback their views through questionnaires and meetings.

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 (published 12 November 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We received concerns in relation to staffing levels and care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing levels , person centred care and good governance at this inspection.

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 will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wicksteed Court Care Home is a residential care home providing accommodation and personal care for up twenty-five people. At the time of inspection there were eighteen people living at the home.

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

Person centred care was impacted by limited opportunities for people to engage in, and to be supported, to follow their interests or take part in activities. Staff who were responsible for providing activities told us, there were not enough staff, or they did not have sufficient time as they had to fulfil their primary responsibility of providing personal care.

Staff shortages, for example due to staff absence meant the provider routinely used agency staff to ensure there were enough staff to keep people safe. We identified missing or incorrect information on the electronic medicine system. The registered manager submitted information following our visit to evidence the necessary changes had been made.

Improvements were needed to support decisions made to keep people safe were in their best interests. For example, best interests’ decisions had not been documented to support the use of equipment to promote people’s safety, which also had the potential to restrict people’s independence and freedom of movement. Mental capacity assessments had been carried out where it was thought people lacked capacity to make informed decisions about their care.

People living with dementia could potentially benefit to improvements within the service to support them in navigating around the service. For example, increased signage and the use of memory boxes. A programme of ongoing decoration and improvement to the service was in place.

Mixed feedback was received from staff about the management and leadership of the service, and whether staff worked well as a team to deliver good outcomes for people.

Systems and processes were in place to assess and reduce potential risk to people. People’s records provided key information for staff to support them in promoting people’s safety. Staff recruitment processes were robust, and staff undertook training in safety related topics. Infection control and prevention guidance had been implemented consistent with government guidance related to COVID-19.

People’s needs were assessed and kept under review. People were supported by staff who had the necessary skills, knowledge and experience, who were supported through ongoing supervision and monitoring. People’s health and welfare was promoted and supported by health care professionals where required. People’s care plans provided limited information as to their wishes on end of life care. People’s care plans provided clear information about their needs and were regularly reviewed, which included information as to people’s communication needs.

Systems and processes for quality monitoring were in place, which included a daily report being submitted by registered manager to the provider. A regular schedule of audits took place. Information was shared with staff through regular staff meetings. People’s views and that of their family members were sought annually through questionnaires.

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 Requires Improvement (published 29 April 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We inspected in response to receiving information of concern with regards to people’s safety, staffing numbers and the quality of care provided, and to follow up on the issues identified in previous inspections. As a result, we undertook a focused inspection to review the key questions of Safe, Effective, Responsive and Well-led. We have found evidence that the provider needs to make improvement.

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 reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect Caring. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same.

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 a breach of regulation. We found people had limited opportunities to take part in regular and scheduled recreational events and activities, which were organised and facilitated by sufficient staff to encourage and support people’s participation.

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

We will request an action plan for 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.

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

This inspection was focussed on the concerns that had been passed to us around people’s safety.

Quality assurance systems were not detailed enough to reveal shortfalls in the risk assessments around people’s care. These contained details of more than one person and therefore were not personalised.

Improvements continue to be made to the premises, and risk assessments had been completed and were regularly reviewed to help reduce the risks known to people. People had Personal Emergency Evacuation Plans (PEEPS) in place which reflected their current needs to ensure their safe evacuation in the event of an emergency.

Audits were in place for people's care plans and care plans were regularly reviewed, and this reflected people’s care needs. Falls, accidents and incidents were reviewed, and any lessons learnt were communicated to staff to reduce the likelihood of further incidents. Staff supervisions continue to be completed and now include direct supervision by the registered manager on staff performing caring tasks and medicine administration.

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

At our last inspection the service was rated Inadequate (published 11 May 2020) and there were multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made. However, the provider was still in breach of the regulations.

This service has been in Special Measures since 11 May 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We inspected to follow up on the issues identified in the previous inspections and to see if improvements had been made to these areas.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified a continued breach in relation to staffing numbers at this inspection.

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

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.

Wicksteed Court Care Home is a residential care home providing accommodation and personal care for up to 25 people. At the time of inspection there were nine people living at the home.

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

This inspection was focussed on the concerns that had been identified at the previous inspection and followed up on the warning notice that had been issued.

We found that the required improvements had been made.

Improvements had been made to the premises, so people were safe from identified risks. Risk assessments had been completed and were regularly reviewed to help reduce the risks known to people. People had Personal Emergency Evacuation Plans in place which reflected their needs to ensure their safety in the event of an evacuation.

Quality assurance systems had been improved. Auditing was in place for people's care plans and care plans were regularly reviewed, and this reflected people’s care needs. Falls, accidents and incidents were reviewed, and lessons were learnt to prevent further incidents. Staff supervisions were completed on a regular basis and a staff dependency tool was used to good effect to ensure there were enough staff.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

At our last inspection the service was rated Inadequate (published 11 May 2020) and there were multiple breaches of the regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in February 2020. Following this inspection, we served a Warning Notice in relation to breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the safety of the premises, insufficient risk assessments regarding peoples care and insufficient quality assurance systems.

We undertook this targeted inspection to check if the provider had made improvements and if they were now meeting the legal requirements. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

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

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

What happens next?

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.

Special Measures

The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

On 24 July 2019 the provider applied to change the name of the service from Holly House Residential Care Home to Wicksteed Court Care home. The nominated individual for the service remained the same and the service continued as Wicksteed Court Care home.

Wicksteed Court Care Home is registered to provide accommodation for persons who require personal care, for up to 26 older people in a converted building. At the time of inspection 15 people were using the service.

People’s experience of using this service

We found evidence of ineffective systems and processes regarding how the provider delivered and monitored the quality and safety within the service. This meant there was limited oversight of the safety of the service.

Known risk's to people’s safety were not always identified, assessed and managed. The provider's failure put people in the service at risk of harm.

Peoples personal emergency evacuation plans (PEEP’s) did not always contain the information required for staff to support them safely in the event of an emergency.

People did not have appropriate risk assessments for the use of equipment. This meant effective strategies were not in place to reduce the risk of harm to people using the equipment.

Safe staff recruitment processes were followed to protect people from unsuitable staff. However, staff had not received comprehensive inductions. Staff had not been suitably trained to support people safety.

There were not always enough staff to meet people's needs. People and staff told us that additional staff were needed.

Improvements were needed with infection control.

People did not always receive person centred care. People’s care files did not always contain the necessary information and staff had not read people’s care files.

People’s records were not completed fully and there were gaps in people’s repositioning charts.

Daily activities were limited and during our inspection we saw limited interactions between staff and people.

People were mostly supported to have 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.

Medicine had been given as prescribed.

People’s relatives and staff told us they knew how to make a complaint.

There were procedures in place for making compliments and complaints about 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:

The last rating for this service was requires improvement (17 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to bring the inspection forward to inspect and examine those risks.

Enforcement

We have identified breaches in relation to safe care, person centred care, staffing, staff training and oversight of the service.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service:

¿ Improvements were required to ensure people’s privacy was always protected and the service was fully compliant in relation to the use of CCTV and the requirements of General Data Protection Regulation (GDPR).

¿ The systems in place to monitor the quality and effectiveness of the service needed to be fully embedded and sustained.

¿ Information needed to be accessible to meet people’s individual communication needs.

¿ People were cared for by staff who were kind, caring and empathetic to their needs.

¿ Staff understood how to keep people safe and knew how to report any concerns.

¿ People and relatives were listened to, and actions were taken to address any shortfalls.

¿ People were protected from the risk of harm and received their prescribed medicines safely.

¿ Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs.

¿ Staff had access to the support, supervision and training that they required to work effectively in their roles.

¿ People were supported to maintain good health and nutrition.

¿ Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). The registered manager was aware of how to make referrals if people lacked capacity to consent to aspects of their care and support and were being deprived of their liberty.

¿The service met the characteristics for a rating of “good” in three of the five key questions we inspected and rating of “requires improvement” in two. Therefore, our overall rating for the service after this inspection was “requires improvement”.

More information is in the full report.

We identified a breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to dignity and respect. Action we told the provider to take is recorded at the end of the report.

Rating at last inspection: This was the first inspection since the home had been sold and purchased by a new provider in October 2017.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with the Care Quality Commission scheduling guidelines.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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