The Care Quality Commission
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  • Care home

Archived: Wexford House Care Home

Overall: Inadequate read more about inspection ratings

44 Shakespeare Road, Worthing, West Sussex, BN11 4AS (01903) 231450

Provided and run by:
CU Care Ltd

Important: The provider of this service changed. See old profile

All Inspections

31 July 2014

During a routine inspection

We used a variety of methods to help us understand the experiences of people using the service because the people using the service had complex needs, which meant they were not able to tell us their experiences. We observed care and support being given in communal areas of the home and viewed records relating to care, staffing and the management of the home. We spoke with one relative, three members of staff, the registered manager and the owners.

We considered eleven outcomes during this inspection. These being

Outcome 1 Respect and Dignity

Outcome 2 Consent to care and treatment

Outcome 4 Care and welfare of people who use services

Outcome 5 Nutrition and Hydration

Outcome 7 Safeguarding people who use services from abuse

Outcome 8 Cleanliness and infection control

Outcome 9 Medication Management

Outcome 10 Safety and suitability of Premises

Outcome 13 Staffing

Outcome 16 Assessing and monitoring the quality of the service

Outcome 20 Notifications of Other Incidents

We considered all the evidence we had gathered under these outcomes and used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

We found the service was not safe. People did not always benefit from sufficient staff to meet their needs. We observed care being provided in the communal areas of the home and saw staff were rushed and not able to provide care at the time people wanted it. All of the people in the home had complex needs and were left unsupervised for long periods of time, while staff carried out other tasks, such as cooking. A member of staff told us 'the problem is we are all in here [the kitchen] and there is no-one out there, anything can happen but people have to eat. We still feel bad when something happens, like a fall or something as we are not with them'.

People were not protected from the risk of abuse because they were cared for by staff who did not understand what constituted abuse or when to report any concerns. The home was not a clean, hygienic environment and there were no effective systems in place to ensure appropriate guidance followed.

People's records were incomplete, inaccurate and did not contain up to date information regarding people's care needs. This applied to all aspects of their care and support. For example, one person had a visual impairment which was not recorded and another person's medication details were incorrect. People were not appropriately assessed or monitored and staff had insufficient knowledge to ensure safe care was provided.

People were at risk of inadequate nutrition and dehydration because they were not provided with a choice of suitable and nutritious food and drink; and they were not supported to be able to eat and drink sufficient amounts to meet their needs.

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. The owners, manager and staff were not aware of their responsibilities under the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

There were no effective arrangements in place to manage medicines and people were at risk of receiving inappropriate quantities of medication because staff did not always follow doctor's instructions.

Is the service effective?

We found the service was not effective. People's care plans did not follow a consistent structure and did not contain the necessary information to inform staff as to the specific care people required. Risk assessments were out of date or were not recorded in people's care plans.

Staff did not respond effectively to identified behavioural concerns. Where incidents had occurred there was no behavioural assessment completed to enable triggers for the behaviour to be identified and reoccurrences prevented. During our inspection we saw two incidents involving people displaying behaviour that may challenge others, where people started to became distressed and agitated. No staff were present during these incidents. We spoke with a member of staff who said 'This is always happening'.

Staff training was provided via a series of DVDs supported by an exam, which was externally marked. A member of staff told us 'I don't think the training is suitable and it didn't really give me the skills I need. I have had to learn on the job myself'.

Is the service caring?

We found some aspects of the service were not caring. We observed some care and support that was patient, kind and caring. However, most staff did not interact with people at a personal level. They were task focussed and appeared to be unaware of what was occurring around them.

People were not stimulated and received little social interaction. People's records did not show they had access to regular meaningful activities.

We saw a member of staff sit down nest to people at the dining table. They did not engage with the people there but sat using their mobile phone for 10 minutes. Later in the afternoon we saw other staff sitting at the table having conversations with each other and ignoring the other people sitting there.

Is the service responsive?

We found the service was not responsive. Care plans were not regularly reviewed and where people's needs had changed the care plan had not been updated. For example, we saw one person's care plan referred to them having a catheter. However, this had been removed in 2013.

There were not effective arrangements in place to respond to short term staff absences. Where agency staff were used to cover absences they were not provided with an induction into the home.

There was not an effective complaints procedure in place. We found that the owners had received a complaint from the relative of a person using the service which had not been responded to. They had also received a written letter of concerns raised by a member of staff, which had not been dealt with.

A member of staff told us they had raised concerns over infection control with the owners. We spoke with the manager about the lack of cleaning and they told us 'there just is not enough time; we know we should but we cannot'.

Is the service well-led?

We found the service was not well lead and there was a fundamental failure of leadership within the home. Neither of the owners had any experience in care and had adopted a task driven approach to managing the service. When we raised the concerns identified during the inspection the owners told us 'We know it is bad' they said they had been waiting to implement a new system and put improvements in place.

There was not a clear management structure, with a new person being brought in to work as the manager alongside the existing registered manager. Although there were procedures in place to monitor the quality of the service provided with audits, these had not been completed since May 2014.

There was no evidence that learning from incidents or investigations took place and appropriate changes were implemented. The owners were not able to show us any review of the incidents or action taken to prevent reoccurrence.

There was a staff meeting structure and we looked at copies of the previous meetings' minutes from April and May 2014. We saw these meeting were directive rather than interactive. One member of staff told us there were monthly meetings 'where we just get moaned at'.

Annual surveys were sent out to families of people using the service, staff and visiting health professionals. We saw the results of these surveys, which were all positive.

6 and 10 November 2014

During a routine inspection

Wexford House is a privately owned cared home which provides accommodation for up to 10 older people living with dementia who need support with their personal care. The accommodation is arranged over three floors with the third floor, being office accommodation. There are 10 single bedrooms set over the first two floors. The second floor is accessed via a stairway and a stair lift. At the time of our inspection there were eight people living at the home and they were joined by a new person who moved in while we were there.

The inspection was carried out over the 6 and 10 November 2014.

At the time of inspection the manager was not registered, because the previous registered manager had recently left. The new manager had started the process to become the registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered provider’s, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run.

We conducted this inspection because we had concerns about the service following a previous inspection carried out on the 31 July 2014, which had identified systemic failings by the provider. People were not protected from abuse, treated with respect and dignity and their legal rights were not protected. There was insufficient staff available with the necessary skills to meet people’s needs. People’s care and treatment was not planned and delivered in a way that ensured their safety. Their medication was not managed effectively and they were at risk of inadequate nutrition and dehydration. The home was not clean and hygienic and people were not protected against the risks from unsafe or unsuitable premises. There was no effective system to monitor the quality of service people received, or to identify, assess and manage risks. These failings had a major impact on people using the service. As a result of our findings we required the provider to put in place an improvement plan to bring the service up to the required standard.

During this inspection we found that the service had improved in respect of the standard of care provided across all of the above areas. However, there were still failings in respect of people’s care and welfare, respect and dignity, the management of medicines and an additional concern in respect of requirements relating to workers.

We observed care within the home and spoke with the families of three people using the service. The family members we spoke with told us they thought the home was now well led and the new manager had made a “big difference”. They said they did not have any concerns over the level of care provided to their relatives.

However, we found that staff did not always manage people’s health risks effectively. For example, one person had lost weight rapidly over a short period but there was no evidence that this weight loss had been investigated and there was no referral to a health professional. We did see other occasions where healthcare professionals, such as GPs, district nurses and chiropodists were involved in people’s care where necessary.

People were at risk of unsafe care because their care plans did not always contain up to date information regarding their care needs. For example one person’s care plan had not been fully updated since 2012. In another person’s care plan there were records of unexplained bruising, which had not been investigated to ensure the person’s safety and allow preventative measures to be put in place.

There was no guidance available to assist staff in understanding when to administer “as required” medicine to people. The home did not have an effective medicine stock management system in place, which meant that on occasions the number of tablets or sachets of medicine held in stock did not always correspond with the amount shown on the record.

Prior to their admission to the home people’s needs were not adequately assessed. On the day of our inspection, the home received a new admission following their discharge from hospital. They arrived at the home without any supporting documentation. The pre-assessment completed by the home did not contain sufficient information to enable staff to meet the care and support needs of the person who became distressed and agitated on arrival at the home.

The checks the provider is required to do before recruiting a new member of staff were not always completed correctly, which meant that the home may employ staff who were not of good character and suitable for the role.

The home had a safeguarding and whistleblowing policy, and the manager and the staff we spoke with told us they had received safeguarding training and could say what they would do if concerns were raised or observed. The family members we spoke with told us they felt their relatives were safe in the home. The home had also recently increased its staffing levels which meant there were enough staff available to meet people’s needs. Staff told us they felt supported by the new management regime and had regular supervisions.

We observed care being provided in the communal areas of the home and saw staff did not always interact with people in a positive way. We saw a mixture of both poor and positive interactions by staff. People’s rooms were personalised with their family photographs and memorabilia. Staff respected people’s right to privacy and dignity

The home was clean and appropriately maintained. People in the home appeared happy and well looked after.

People at the home lacked capacity to make some decisions and were subject to restrictions to their personal lives. Staff were guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. We found that capacity assessment were not readily accessible to staff. We have recommended that the service considers the current guidelines regarding record keeping and accessibility of records relating to people’s capacity assessment.

People at the home who were living with dementia. However, the home did not have decoration or signage that aided people to find their way around or to be as independent as possible. There were no dementia friendly signs to indicate toilets or to identify people’s rooms. We have recommended that the service explores the relevant guidance on how to make environments used by people with dementia more ‘dementia friendly’.

There was a complaints policy and a system to record and investigate complaints. The provider told us they had not received any complaints since our last inspection. Accidents and incidents were recorded and remedial actions identified. However, there was no evidence available to show the remedial action had been completed and people were now safe.

The provider had arranged for a series of audits to be carried out at the home by external professionals. However, there was not a structured audit process/system in place to ensure standards were maintained. The provider encouraged visitors, family members were kept fully informed, and they were open to feedback and showed a desire to improve. They had also developed links with external organisations and professionals to help enhance the staff’s and their own knowledge and experience.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.

4 November 2013

During a routine inspection

We spoke with four members of care staff, the registered manager and one of the registered providers. We saw that staff were attentive to the needs of people living in the care home. Staff provided a good choice of nutritious food and drinks creating a friendly and happy environment.

There were nine people living in the care home and conversation with them was limited due to dementia and limited memory. We observed the people who lived at the care home and saw how they were being cared for with dignity and respect by the staff. We saw evidence of high levels of quality and care delivered by conscientious members of staff. We witnessed staff working well together as a team and handing over effectively to colleagues at the end of their shifts.

The manager at the care home had put systems in place to enable staff to develop their skills and we heard how staff appreciated and benefited from this developmental approach. The manager maintained an effective quality management system and made use of regular audits to ensure that people were safe and receiving appropriate care and treatment within the home.