Archived: Walnut Close

Walnut Close is a residential care home providing personal and nursing care to 31 people, aged 65 and over, at the time of the inspection. The service provided care in one adapted building split into three wings. One of the wings specialised in providing care to people living with dementia. This service can support up to 35 people.

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

We found the provider to be in breach of four regulations, these were in relation to the need for consent, premises and equipment, person-centred care and good governance.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People told us staff did not always come quickly when they used the call bell. We observed that call bells had at times been left out of reaching distance for people. This meant people were not always able to access support when they required it.

Medicines were not always stored safely. Systems for monitoring expiry dates of creams were not always effective and the service did not always monitor the storage of medicines effectively.

People and relatives told us they felt safe at the service. Staff received training in safeguarding and felt confident to raise safeguarding concerns if required.

People told us they had concerns about their bedrooms being in disrepair. We observed the service was not decorated in line with best practice guidance and areas of the home were in poor condition.

People were supported to have enough to eat and drink, however feedback we received about the quality of food was mixed.

People were assessed prior to moving into the service. These assessments were used to make personalised care plans for people. People were assisted to access other health and social care services and community provisions.

Care staff treated people kindly and with respect. People and their relatives told us they liked the care staff and were happy with the care they provided.

People told us there was not enough to do at Walnut Close, people told us this made them feel bored and isolated. The service did not restrict visiting times and relatives told us they were always made to feel welcome when they visited.

The service completed a range of audits to assess and improve quality at the service. However, several shortfalls identified on this inspection had not been picked up by these processes. The registered manager kept up to date with best practice and legislation. People and staff told us the management team were approachable.

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 31 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of four regulations, these were in relation to the need for consent, premises and equipment, person-centred care and good governance. Please see the action we have told the provider to take at the end of this report.

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.

Walnut Close provides support and personal care to up to 35 people in total, with needs arising from old age. Up to eleven people living with dementia are supported in a separate specialist unit. The service does not provide nursing care.

Rating at last inspection.

At the last inspection in November 2014, the service was rated Good.

Rating at this inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

The service had continued to develop and improve, particularly in terms of the developments in the dementia unit, which had been prioritised recently. The improvements made and planned there had significantly enhanced the experience of those living with dementia, and a range of further developments were in process.

People felt safe and well cared for and said staff were kind and attentive to their needs. Feedback from the local authority was positive and the service had worked with them to improve some records and systems. A local authority representative commented, “The staff are very person centred and from my experience during my visits are very supportive and kind to the residents.” Regarding the management of the service they said, “Management are very proactive and transparent.”

People were kept as safe as possible by the systems, policies, procedures and the training provided to staff. Health and safety and other risks were well managed.

People’s safety and wellbeing were enhanced by the changes in staffing, including additional staff at key times, piloting qualified shift leaders on night shifts and increasing management cover at weekends. The appointment of ‘champions’ in key areas also helped to drive further developments in the service.

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.

Induction improvements and an effective ongoing training programme helped ensure staff had the up to date knowledge and skills to deliver person centred care. The registered manager had taken steps to improve the frequency of ongoing staff support through supervision and had ensured staff development was encouraged through annual appraisals.

People continued to receive effective healthcare support and the service worked well with external healthcare providers. Where issues had been identified with the quality of food provided, the registered manager had taken steps to address these with the external caterers and had achieved improvements.

Staff delivered support calmly and in a timely way. They respected people’s dignity, individuality and cultural or personal needs. There was a positive rapport between people and staff. The service continued to respond promptly to people’s changing needs, feedback and complaints. Ongoing improvements had been made in the variety and individualisation of activities.

The service was well led by a competent registered manager who sought to involve people and staff in plans for future developments. The view of people, staff and external professionals had been sought and identified issues acted upon.

Some people told us that they were 'very well looked after'.

The service had made amendments to completed plans of care to show that people had agreed with them and what date any changes were made.

We found that people were well cared for in the way they preferred. People told us that they were ''very happy with their care'' and ''staff always care for me in the way I like best''. One person said, ''I am very happy living here and feel so safe and cared for''. People told us they were treated with the greatest respect and that staff always seemed to know what they needed.

We found that the home was clean and hygiene and staff knew all about infection control. People told us that that their home was always ''comfortable and clean''.

We found that the home had safe ways of giving people medication which had been prescribed for them by their doctors.

We found that staff were appropriately trained and supported to give the best possible care to the people who lived in the home. People described staff as ''absolutely brilliant'' and ''very respectful''.

The home had ways of making sure that they checked the quality of care being given to people. They listened to the views of the people who lived in the home. People said, ''the girls always ask me if things are alright and put them right if they're not''.

We found that some people's personal records were not completed properly and were not detailed enough to support good care and did not reflect the good practice we saw.