Archived: Wayfarers

Wayfarers is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Wayfarers accommodates up to 33 older people requiring long or short term care, in one purpose built building. At the time of the inspection, the provider was only using one wing of the building. There were 18 people living at the service who required personal care.

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.

We inspected Wayfarers in September 2017 and the service was rated ‘Requires Improvement’ overall with three breaches of regulation. Following the last inspection, we asked the provider to complete an action plan to show how they would meet the regulations. At this inspection, we found that improvements had been made and the regulations had been met. The service was now rated Good overall.

At the last inspection, we found the registered person had failed to do all that is reasonably possible to mitigate risks to people’s health and safety. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Potential risks to people’s health, safety and welfare had been assessed. There was now detailed guidance for staff to reduce the risks and keep people safe. Checks had been completed on the environment and equipment to make sure that people were safe. Incidents and accidents were recorded and analysed for patterns and trends. Action was taken to reduce the risk of them happening again.

Previously, we found the registered person had failed to assess, monitor and improve the quality of the service and maintain accurate and complete records. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, improvements had been made the breach of regulation had been met.

At this inspection, audits had been completed consistently by senior staff and the provider to monitor the quality of the service. When shortfalls had been identified, an action plan was put in place and signed off when completed. The registered manager had oversight of the audits and the action taken to rectify the shortfalls.

At the last inspection, we found the registered person had failed to give person centred guidance to staff to meet people’s needs. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, improvements had been made the breach of regulation had been met.

Care plans now had detailed guidance for staff about people’s choices and preferences. Care plans were reviewed regularly with people, who agreed their care and support. Care plans now reflected the care being given. Staff worked with healthcare professionals to support people at the end of their lives.

The management team met with people before they moved into the service to make sure that staff could meet their needs. Staff monitored people’s health and when there were changes, people were referred to healthcare professionals. Staff followed their guidance to keep people as healthy as possible. People had access to professionals such as the dentist and optician. People were encouraged to be as active as possible and lead a healthy lifestyle. People had a choice of meals and were supported to eat a balanced diet.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible, the policies and systems in place supported this practice.

People’s dignity and privacy was respected, staff treated people with kindness and compassion. People and staff had developed warm relationships and staff had a genuine interest in people. Staff supported people to be as independent as possible and be involved in developing their care and support. People had access to activities and trips that they enjoyed.

People were protected from harm and abuse. Staff knew how to recognise signs of abuse and how to report concerns. Staff were confident that the registered manager would deal with the concerns appropriately. The registered manager had reported concerns to the local safeguarding authority and followed the guidance given.

People received their medicines safely and when they needed them. The service was clean and there were procedures in place to protect people from infection. The service was purpose built and met people’s needs.

There were enough staff to meet people’s needs, who had been recruited safely. Staff received regular supervision and yearly appraisals, to discuss their practice and development needs. Staff told us they felt supported by the management team. New staff received an induction, staff received training appropriate to their role and staff competency was checked.

The provider had a complaints policy that was displayed in the main reception. People told us they knew how to complain and were comfortable to talk to staff about any issues.

There was an open and transparent culture within the service, staff were focussed on people and maintaining their independence. People, staff and stakeholders were asked their opinions about the service and the feedback had been positive. People and staff attended regular meetings to make suggestions and discuss any concerns they may have.

The management team worked with agencies such as the local council and safeguarding authority to ensure people received effective care. The registered manager and senior team leader attended local forums and training to keep up to date and continuously improve the service.

Services that provide health and social care to people are required to inform the care Quality Commission (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in a timely manner.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. That is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall.

Wayfarers offers short and long term residential care for up to 33 older people. The service is set out on one level and is split into two units, each with a communal lounge and dining room, there is also a quiet lounge. The service is located on the outskirts of Sandwich. At the time of the inspection, one unit was closed and there were 16 people living at the service.

There was a registered manager in post, although, they were on long term sick leave at the time of the inspection. There was a recently appointed interim manager in post who was in charge of the day to day running of the service while the registered manager was absent. 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 2008 and associated Regulations about how the service is run. We were supported during the inspection by the interim manager and deputy manager.

Potential risks to people’s health and welfare had not been assessed consistently, risk assessments did not contain detailed guidance for staff to mitigate risk and keep people safe. Accidents had been recorded and action had been taken to reduce risks but there were no overall analysis to identify trends or patterns. The provider told us this had been completed since the inspection, we will follow this up at the next inspection.

Staff had completed checks on some of the environment and equipment to keep people safe, for example water temperatures were recorded to mitigate the risk of scalding. However, some areas had not been checked such as portable electrical appliance testing (PAT). Some safety certificates were not available at the time of the inspection. Following the inspection, the provider sent us records to confirm that some checks had been completed since the inspection.

Each person had a care plan that reflected their choices and preferences. The care plans had not been consistently reviewed and when people’s needs changed had not been updated to reflect people’s changing needs. The interim or deputy manager met with people before they moved to the service to make sure they were able to meet the person’s needs.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these had been agreed by the local authority as being required to protect the person from harm. At the time of the inspection no-one was deprived of their freedom or liberties and no applications were required.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack capacity to do so for themselves. The Act requires, that as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff were working within the principles of MCA, seeking consent from people before providing care and support. However, the assessment of people’s capacity had not been recorded, this was an area for improvement.

There were systems in place for monitoring the quality of the service provided, however, these had not been completed consistently or been effective in identifying shortfalls found at this inspection. Records were not accurate or complete. Quality assurance surveys had not been sent out recently, the interim manager had started to meet with people to ask for their views, but relatives and stakeholders had not been asked for their opinions about what the service did well and how it could be improved. Staff had completed a survey for all staff working with Kent County Council and did not show the results relating to Wayfarers.

There were sufficient staff to meet people’s needs and keep them safe. Staff were recruited safely and received training to ensure they were able to provide safe and effective care. Staff told us that they felt supported and received one to one supervision from the interim and deputy manager to discuss their practice and development needs. Regular staff meetings were held, staff were able to raise any concerns or suggestions they may have.

People received their medicines safely and when they needed them. Some people were prescribed inhalers to be taken when needed to help their breathing, they had their inhalers with them and took them when they needed to. There were no checks by staff to make sure people were taking the inhaler as prescribed. This was an area for improvement. Following the inspection, the provider sent us updated risk assessments to give staff guidance on how to check people had taken their inhalers as prescribed.

People told us they felt safe living at Wayfarers and staff were kind and caring. Staff treated people with dignity and were genuinely interested in what people had to say. People were asked their thoughts and opinions about the service and encouraged to be involved in developing their plan of care. People told us that the staff helped them to remain independent and offered support in a discreet way.

People enjoyed a choice of healthy meals and told us they had enough to eat and drink. Relatives were invited to eat meals with their loved ones. People’s health was assessed and monitored. Staff took prompt action when they noticed any changes or decline in people’s health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

There were limited planned activities, however, staff asked people what they would like to do each day and provided the activity requested. People told us that they enjoyed the activities especially the day trips to local parks and pubs. There was an accessible complaints procedure and people and their relatives knew how to raise concerns. People told us they did not have any complaints.

People were protected from the risks of abuse, discrimination and avoidable harm. People told us they felt safe and would not hesitate to speak with staff if they were worried about anything. Staff knew how to report any concerns, who to report them to and felt confident that action would be taken.

Staff understood their roles and responsibilities. People, relatives and staff told us that the management team were approachable and listened to suggestions and opinions. There was an open and person centred culture within the service.

The interim manager had submitted notifications about important events that happened at the service to CQC in an appropriate and timely manner and in line with guidance.

It is a legal requirement that a provider’s latest CQC report rating is displayed at the service where a rating is given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating in the reception and on their website.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our visit out of the 17 people in residence we spoke with three people living there. We also spoke with five staff members and the visiting hairdresser. One person told us, 'I love living here, I have been here five years and wouldn't want to be anywhere else'. Another said. 'I love talking to the staff and feel at home'.

The provider had reduced staffing due to less people living in the home, but still had sufficient staff available to meet the needs of the people remaining. All staff spoken with confirmed that they received good training and were supported by the manager and the provider. All staff spoken with showed a very good understanding and knowledge of those in their care. Staff were observed to have good relationships with people residing at the home, there was a pleasant warm atmosphere throughout. Care staff were seen to have been involved in the care planning for their key people showing they were aware of their specific needs.

People told us that the service responded to their health needs quickly and that they were looked after well. They said: "The staff are excellent". "I could not wish to live in a better place". "This is a 'tip top' home".

Relatives and visitors said: "I have no complaints, my relative settled here very quickly". "The home keeps residents involved in the service; they do a lot of activities, have social gatherings and enjoy outings in the better weather".

We saw that staff knew how to care for the people using the service and responded quickly when people needed support. Staff spent time with and empathised with people by responding to them respectfully and positively.

We found records to show how people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being. We saw that people were encouraged to express their views and make or participate in making decisions relating to their care and treatment. The staff rota showed sufficient numbers of staff on duty including the use of agency staff to make sure people's needs were being met. People told us they knew how to complain but did not have any concerns or issues at the time of the visit.