This unannounced inspection took place over two days on 27 and 28 November 2018. The first day of the inspection was unannounced, we carried out an announced visit on the second day.Wheatsheaf Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Wheatsheaf Court Care Home is registered to provide accommodation, nursing and personal care to up to 55 people in one adapted building. At the time of the inspection there were 34 people living in the home.
There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.
At the previous comprehensive inspection on 18, 19 and 20 September 2017, the service was rated ‘Requires Improvement’.
Systems and processes in place to assess, monitor and improve the quality and safety of the service were not always effective at identifying concerns. Areas of the home were not well maintained or clean. The impact on people of ongoing refurbishment in the home had not been adequately assessed.
Where shortfalls were identified these were not always addressed in a sufficiently timely manner. People did not always receive their care from staff who knew them well as there was a high reliance on agency staff. This also affected the amount of social interaction and activity available to people.
People were not consistently involved in planning their care and the systems in place for responding to people's feedback required strengthening. Improvements were required to ensure people received their medicines as prescribed.
The provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to the safety, maintenance, cleanliness and governance of the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.
At this comprehensive inspection, we have found that the required improvements have not been made. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
The suitability and safety of the environment needs to be addressed to ensure that the environment people live in is appropriate and safe. Risks posed by the environment have not been identified or acted upon in a timely manner and as a result have not been resolved. Where risks have been identified insufficient action has been taken to mitigate these risks. We have found that many areas of the environment are dirty and unhygienic and the principles of infection control are not consistently adhered to.
The deployment of staff is inconsistent due to a lack of permanent staff recruited and use of agency staff. People have experienced and are at risk of experiencing care that does not meet their needs as a result.
There is a lack of care delivered to meet people's individual needs and maintain their dignity.
People's dignity is not being maintained at the service. People’s personal care is not being provided in the way they wish and some people are in an unkempt state.
We have received some feedback that staff do not always communicate with people in a kind or respectful manner. This raises concerns that people have been subject to abuse and safeguarding referrals have been made as a result.
People's personal preferences in relation to their care is not always considered and people lack
stimulation and choices about how they spend their time.
People are not provided with an appetising choice of food. We have been told that the food served at mealtimes is often cold and of poor quality.
People do not feel listened to by the provider, as they have raised concerns about the service they receive but no action has been taken.
There is a lack of effective monitoring in place at the service and this has resulted in poor outcomes for people using the service. Ineffective quality monitoring systems have failed to pick up and address the failings we identified during our inspection.
We found individual staff to be caring and compassionate towards people, however, due to staffing deployment at the service they lack time to be able to spend with people. Care being delivered is often task focussed.
Staff are provided with appropriate training and support; however, do not always put the training they have received into practice.
Medicines are safely managed; regular audits are in place and medicines records are completed accurately.
People are supported to maintain good health. Staff have the knowledge and skills to support them and there is prompt access to healthcare services when needed. People’s nutritional needs are assessed and monitored.
The principles of the Mental Capacity Act 2005 are followed at the service and people have assessments and best interest decisions documented when needed.
At this inspection we have found breaches of six regulations of the Health and Social Care Act 2008 Activities) Regulations 2014. Full details regarding the actions we have taken are added to reports after any representations or appeals have been concluded.