Inwood House

Inwood House is a care home providing accommodation and personal care for up to 20 people in one adapted building. Accommodation is provided over three floors accessed by stairs and a lift. People have their own rooms and access to communal areas such as dining rooms, lounges and a conservatory. The home had an enclosed garden accessed from the ground floor. At the time of the inspection there were 19 people living at the home.

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

Medicines were managed safely and regularly reviewed by healthcare professionals. Staff received training in medicines administration and had their competence checked. There were enough staff available to provide people with care and support in a timely way. Staff had been recruited safely.

Risks to people’s safety had been assessed and action had been taken to mitigate risks and keep them reviewed. 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 home was clean and smelt fresh. Systems were in place to make sure all areas of the home had a regular thorough clean. Staff had access to personal protective equipment (PPE) and were observed to wear it appropriately as needed. Staff had been given training and had guidance on infection prevention and control (IPC) good practice. Management carried out IPC audits regularly to monitor systems and practice.

People were being cared for by enough staff. The provider had recruited staff safely and been successful in filling gaps in staffing numbers. Staff were aware of their role in safeguarding which helped to keep people safe. Incidents and accidents had been recorded and reviewed. Any learning was shared with staff to prevent reoccurrence.

People and relatives told us people were safe at the service and they had no concerns with care provided. Relatives told us staff worked hard to meet people’s needs and kept them up to date with any changes. People were able to have visitors when they wished in any part of the service.

Meetings were held regularly, and staff had daily handovers. There were good communications amongst the team, and we were told staff morale was good. Staff felt well supported by the provider and felt able to raise any concern or share their ideas. People had regular reviews which their relatives were involved in.

There was no registered manager at the service, but a new manager had been employed. Feedback about the new manager’s approach was positive. Relatives, staff and professionals told us the manager was approachable, calm and attentive. Support was available to the manager from the provider and the owners visited regularly.

Quality monitoring systems were in place which helped to check various areas of the home. Any actions identified were carried out to make sure the service was continually improving. Following the inspection in October 2021 we imposed a condition on the provider’s registration to submit a monthly action plan to CQC. The provider had complied with this condition and we received a regular action plan. Whilst we saw improvements had been made, not all incidents had been notified to CQC. We have made one recommendation about governance systems.

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 11 February 2022) and there were breaches of regulations. At this inspection we found the provider had carried out the required improvement but further improvement was needed.

At our last inspection we recommended that the provider reviewed systems to make sure topical creams were consistently dated when opened. At this inspection we found the provider had acted on the recommendations and made the improvements to topical creams.

Why we inspected

We carried out an unannounced focused inspection of this service on 28 October 2021. Three breaches of legal requirements were found. We served the provider a Warning Notice for a breach of regulation 12, we also imposed a condition on the provider’s registration for a breach of regulation 17 and we issued a requirement notice for a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We returned on 6 January 2022 to check the provider had complied with a Warning Notice we served for a breach of regulation 12. We found they had made the improvement required and were no longer in breach of regulation 12.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. At this inspection we found the provider had carried out the improvement required to no longer be in breach of regulations.

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.

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 improved to good. 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 Inwood House on our website at www.cqc.org.uk.

Recommendations

We have made one recommendation for governance systems.

Follow up

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

Inwood House is a care home providing personal care for up to 20 people, some of whom live with dementia. Accommodation is provided over three floors accessed by stairs and a lift. People have their own rooms and access to communal areas such as dining rooms, lounges and a conservatory. The home had an enclosed garden accessed from the ground floor. At the time of the inspection there were 13 people living at the home.

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

Risk management plans were not robust and effective in mitigating risks. There was conflicting information recorded and gaps in one person's monitoring records. Some risks had not been identified and there was not always guidance available for safe ways of working.

Staff were not consistently wearing the correct personal protective equipment (PPE) and not testing for COVID-19 as required. Current safe systems of working in a care home during COVID-19 had not been identified by the provider or registered manager.

Quality monitoring was not robust or effective in assessing and mitigating risks and driving improvement. Incidents of safeguarding and one serious injury had not been notified to CQC. The provider’s governance systems had failed to identify this had not been carried out.

Whilst people had their medicines as prescribed staff had not carried out all checks required for people needing medicines covertly. We also observed topical creams had no date of opening recorded consistently. The provider’s quality monitoring systems had not identified these shortfalls. We have made a recommendation about medicines.

People and relatives told us they experienced good care provided by a team of staff who had a caring and kind approach. People and relatives told us they felt involved in their care and kept up to date with any changes.

People were being supported by enough staff who had been recruited safely. Staff had been trained in safeguarding and knew where to report any concerns. Staff were able to attend regular staff meetings and share their views. Staff felt well supported by the registered manager and the provider.

Incidents and accidents had been recorded and investigations carried out where needed. Action had been taken to prevent reoccurrence. Staff worked in partnership with the local authority, local mental health teams and GP’s to meet people’s health needs.

Visiting was being facilitated and safely managed. All visitors had to complete a Lateral Flow Test prior to entering the home. Staff checked visitors’ temperatures and provided PPE to be worn. People were being tested regularly for COVID-19 following government guidance.

The home was clean, and staff had schedules to complete to ensure all areas were routinely sanitised. Where possible windows were open to increase ventilation.

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 15 November 2019) and there were two breaches of regulations 12 and 17. We carried out a targeted inspection on the 13 January 2021 and found enough improvement had been made for the breach of regulation 12. We did not check at that inspection if enough improvement had been made for the breach of regulation 17. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulation 17. We also found the provider was in breach of regulation 12 again and we identified another breach of regulation.

The service remains rated requires improvement for the second consecutive rated inspection.

Why we inspected

The inspection was prompted in part due to concerns received about safety of the premises and unexplained injuries. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. 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 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. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Inwood 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 in relation to safe care and treatment, good governance and failing to notify CQC of incidents 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 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.

Inwood House is a care home in Salisbury providing personal care for up to 20 people, some of whom live with dementia. People have their own rooms and access to communal areas such as dining rooms, lounges and a conservatory. The home had an enclosed garden accessed from the ground floor. At the time of the inspection there were 12 people living at the home.

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

This was a targeted inspection to follow up on a Warning Notice served following the last inspection. At the last inspection we found the provider had not assessed and mitigated risks and there were concerns about some aspects of infection prevention and control. At this inspection we found the required improvement had been carried out.

Staff were observed to be wearing the appropriate personal protective equipment (PPE). We observed PPE was available around the home and staff had been trained on how to use it safely. Systems had been put in place to make sure staff tested for COVID-19 as per the government guidance.

The provider had an up to date infection prevention and control policy which included working safely during COVID-19. The registered manager had signed up to receive updates from the government if any guidance changed.

We observed there was signage by the front door to guide visitors on what PPE to wear and informing them they needed to carry out a Lateral Flow Test (LFT) prior to entry. Only visitors with a negative LFT were permitted entry.

The home was clean and there were cleaning schedules in place for staff to follow. This made sure all areas of the home were being cleaned regularly. The local authority environmental health team had visited the home on 16 November 2021 and rated the kitchen a ‘5’. This meant they had very good standards of hygiene.

Risks to people’s safety had been assessed and where needed a behaviour support plan was in place to give staff guidance. Where people needed additional monitoring to help mitigate risks the provider had devised new forms to record the monitoring effectively. Staff told us they shared health monitoring information with healthcare professionals to review.

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 6 December 2021). 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 undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 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.

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 do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

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.

Inwood House is a care home providing accommodation and personal care for up to 20 older people. 16 people were living in the home at the time of the inspection. Some people using the service were living with dementia.

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

People received support to take their medicines safely. Improvements had been made to medicines management systems since the last inspection. The provider had ensured medicines were stored safely and staff kept accurate records of the support they provided to people. There was clear information for staff about the support people needed to take their medicines.

The home was clean, and the provider had taken additional infection prevention and control measures as a result of the COVID-19 pandemic. Staff had completed additional training to ensure they understood how to implement these measures.

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 15 November 2019).

Why we inspected

We undertook this targeted inspection to check infection prevention and control due to a number of COVID-19 cases in the home. An overall rating for the service has not been given following this targeted inspection.

CQC have introduced targeted inspections 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 do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found the provider had taken action to manage the risk of harm to people. Please see the safe section of this full 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.

Inwood House is a care home providing personal care to 18 people aged 65 and over at the time of the inspection. The service can support up to 20 people in one adapted building.

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

Systems to manage medicines were not safe. People did not always receive support to take the medicines they were prescribed and medicines were not stored or recorded correctly.

The registered manager had not always notified us of important incidents in the home, as they are required to.

The systems for checking how the service was operating did not always identify shortfalls. Checks had been completed but did not identify medicines issues or that notifications had not been submitted.

Risks to people’s well-being and safety were assessed and recorded. Staff were aware of these risks and the support people needed.

The registered manager provided good support for staff.

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 1 May 2019)

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service sustained an injury as a result of a fall. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only. We found that risks relating to falls had been well managed.

We reviewed the information we held about the service. 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.

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

We have identified breaches of the regulations in relation to safe care and treatment and good governance 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 Inwood House on our website at www.cqc.org.uk.

Follow up

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:

• We made recommendations about the management of some medicines.

• People told us they liked living at Inwood house and relatives told us that they knew their relatives were receiving good quality care.

• People told us they felt safe at Inwood House.

• Staff were safely recruited, they knew how to keep people safe from avoidable harm and there were enough staff available to meet people’s needs.

• Accidents and incidents were analysed to prevent re-occurrence.

• The premises was clean and followed infection control guidelines.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• People were very positive about staff and management and felt confident that concerns would be listened to.

• People were supported to pursue their hobbies and interests.

• People were supported to maintain relationships with those important to them, and develop new friendships with other people.

• People told us that staff were caring and always willing to support people.

• Rating at last inspection: This service was rated Good at the last inspection (published 22 December 2016).

Why we inspected: This inspection was scheduled based on the rating at the last inspection.

Follow up: We will continue to monitor this service to ensure people using this service receive high quality care.

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

This inspection took place on 8 November 2016 and was unannounced.

There was a registered manager in post at 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 and associated Regulations about how the service is run.

People who use the service were positive about the care they received and praised the quality of the staff and management. Comments from people included, “Staff are very kind, they do things in the right way”, “I feel safe here and that is very important for me” and “The girls are lovely, there’s always someone available when you need them”.

People told us they felt safe when receiving care and were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were providing care for. People told us staff provided care with kindness and compassion.

Staff were appropriately trained and skilled. They received a thorough induction when they started working at the home. They demonstrated a good understanding of their role and responsibilities. Staff had completed training relevant to their role and people’s feedback demonstrated staff put this training into practice.

The service was responsive to people’s needs and wishes. People had regular group and individual meetings to provide feedback about their care and there was an effective complaints procedure. One person told us, “I would speak to (the registered manager) if I had a problem, they would sort it out”.

The provider regularly assessed and monitored the quality of care provided at Inwood House. Feedback was encouraged and was used to make improvements to the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with eight people using the service and receiving written comments from eight people using the service. We spoke with five staff, the manager and a director of the home. We reviewed six care plans and other relevant records.

Is the service safe?

Care plans instructed staff how to meet people's needs in a way which did not always clearly describe how to minimise risks for the individual. They were not always detailed enough to ensure staff cared for people in the safest way.

We found that unexplained injuries or bruising were not fully investigated and it was not clear what action if any had been taken to minimise the risk of recurrence.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home understood when a DoLS referral should be made. The home had not made any DoLS referrals in 2014.

We found that medication was administered and recorded in a way which kept people as safe as possible. Staff were properly trained and their competence to administer medicines was checked.

The environment was suitably designed and well maintained. There were hand rails fitted throughout the building and enough space for people to use wheelchairs and other walking aids. Alarm bells were always available within people's reach.

The home had enough trained staff to enable them to work safely with the people who lived in the home. People told us: 'bells are always answered quickly' and 'if anything goes wrong the staff are there to help you.'

Systems were in place to make sure that the manager and staff continually monitored the quality and safety of care offered to people.

Health and safety was taken seriously by the home and most of the appropriate safety checks had been completed. This reduced the risks to the people who lived in the home, staff and visitors.

People told us they felt very safe in the home. One person reflected the comments of everyone spoken with when they said: 'I feel very safe, nobody's ever nasty or unpleasant to you and I love it here'.

Is the service effective?

People's health and care needs were assessed with them, and/or their relatives, as appropriate. Care plans were detailed and clearly identified people's needs and how they should be met. They were reviewed regularly and changes were made to meet people's changing needs. We saw that staff gave support as described in individuals' care plans.

We observed staff meeting people's needs. Daily notes were detailed and of good quality, they described how staff met people's needs effectively.

The home offered people a comfortable environment in which to live.

Is the service caring?

People were supported by kind, caring and patient staff. We saw that care staff were attentive, encouraging and positive. Staff communicated with people and encouraged interactions between people using the service. People described staff as: 'good company'.

People's diversity, values and human rights were respected. Care plans were individualised and person-centred. We saw that people were always treated with respect and dignity by the staff team. We saw that people's choices and preferences were respected and their independence was supported.

Is the service responsive?

We saw that health care was sought in a timely way and the home co-operated with other health care professionals to make sure their healthcare needs were met. However, records of continued healthcare and appointments were not always properly recorded. It was not always possible to see if on-going healthcare was provided by the home.

The home had made changes and improvements as a result of ideas and discussions with people who lived in the home and their relatives.

We saw that the people were confident to approach any of the staff team or the manager if they had any concerns about their care. One person said: 'I could talk to anyone, I trust them all'.

The home demonstrated that they learnt from accident and falls investigations which they completed.

Is the service well led?

We saw that staff were well trained and meeting the needs of people was a priority of the staff team. We saw that communication amongst the staff team was good. Staff told us they all felt part of a strong staff team, whatever their role. They told us they felt: 'valued' and felt their views were listened to.

The service had a quality assurance system which was generally effective. We saw records which showed that identified shortfalls and ideas people put forward were addressed. As a result the quality of the service was being maintained or improved.

Staff were caring and respectful in their interactions with people.

People looked well cared for and their rights to privacy and dignity were maintained.

People were encouraged to make decisions in their daily lives.

A comprehensive range of social and leisure opportunities were offered to people, both in-house and within the local community.

People felt safe within the home. Staff were aware of their responsibilities to recognise and respond appropriately to any suspicion or allegation of abuse.

Staff were given a range of opportunities to develop their knowledge and skills in a way which met their individual needs.

Staff were fully supported and worked well as a team.

People were encouraged to give their views about the service and its development. A clear auditing system was in place to monitor the on going quality of the service provided.