Archived: Well House

Updated 8 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 06 July 2017 and was unannounced. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

As part of the inspection we reviewed the information we held about the service. We looked to see if the provider had sent statutory notifications. A statutory notification contains information about important events which the provider is required to send to us by law. We sought information and views from the local authority. We also reviewed information that had been sent to us by the public. We used this information to help us plan our inspection.

During our inspection we spoke with ten people, six visiting relatives, the registered manager, a member of the housekeeping team and seven care staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We also spent time observing day to day life and the support people were offered. We reviewed a range of records about peoples' care and how the service was managed. These included the care records for seven people and medicine administration record (MAR) sheets. We also looked at records relating to the management of the service, including recruitment records, complaints and quality assurance records.

Updated 8 September 2017

We inspected Well House on 06 July 2017. This was an unannounced inspection. At the last inspection completed on 30 September 2015, we found the service was meeting all of the legal requirements we looked at. We provided an overall rating for this service of 'good'.

Well House provides accommodation and personal care for up to 43 older people who may also be living with dementia. The service does not provide nursing care. At the time of our inspection there were 32 people using the service.

At this inspection, we found four breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

The service had a registered manager in post who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The registered provider had not ensured effective medicine management systems were in place at the service. There were no protocols in place for medicines that are prescribed as and when needed. We found discrepancies in stock levels of medicines.

The registered manager had not done all that was required to reduce risk. Moving and handling risk assessments were not being updated and bedrails were in place without an appropriate risk assessment.

The provider had not ensured that the building was well maintained. We found that windows were in a poor condition, and two bathrooms had been condemned and were not in use. Some refurbishment works had been started but other works did not have specific dates of completion.

The provider had not worked in line with the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) as mental capacity assessments and best interest information was not recorded when people's freedom of movement was restricted. There was no overview in place for deprivation of liberty safeguard authorisations, which meant the registered manager did not have oversight of authorisations in place or whether people still required them. We saw that people were supported with making decisions around their care. Staff sought people's consent before providing them with care and support.

There were gaps in staff training. We requested a revised training record which showed there were many staff who required updates in mandatory training subjects such as health and safety and fire training. Some training, such as safeguarding adults had been updated but other subjects still required updating.

Arrangements were in place for the provision of meaningful activities and stimulation. However, these arrangements were not consistent or always available for people that used the service. More opportunities are required particularly for people living with dementia. We have identified this as an area of practice that needs improvement.

People could not be assured that they would receive the support they required as care plans did not always contain accurate, up to date information.

Quality checks had not reliably identified and resolved shortfalls in some aspects of the quality and safety of the service provided.

Appropriate recruitment checks took place before staff started work. Sufficient staffing levels were being maintained.

Staff spoke positively about wanting to provide people with a high standard of care. People were supported by staff that knew them well. People were treated with kindness and compassion in their day-to-day care. People and their relatives spoke highly of the staff and the care and support they provided.

People were happy with the food and drinks provided. The chef had a good knowledge of people's likes and dislikes. People also had good access to drinks and snacks.

The above concerns in relation to the quality and safety of the service resulted in us finding breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.