Wantage Nursing Home

Wantage is a residential care home providing personal and nursing care in an adapted building across two floors. At the time of the inspection 19 people aged 65 and over were living at the service and only occupying the ground floor. The service can support up to 50 people.

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

People living at Wantage received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs.

Medicines were managed safely, and people received their medicines as prescribed. The provider had made significant changes and ensured there were clear processes and procedures to manage all aspects of medicines safely.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The provider had made improvements to ensure people’s care and support was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. Records showed people’s needs were assessed before they came to live at Wantage. The provider was still in the process of improving the environment for people living with dementia in line with good practice guidance for helping people to be stimulated and orientated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and commented that food choices had improved.

The home was well-led by a registered manager who was committed to improving people's quality of life. We received positive feedback about the management of the home from people, relatives and staff. The provider and registered manager had made significant changes to the service. They had developed effective quality assurance processes which were used to improve people’s care. The service had a clear management and staffing structure in place and staff worked well as a team. Staff worked well with external social and health care professionals.

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 June 2019) and there was a breach in Regulation 17. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 24 April 2019. A breach of legal requirements was found. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wantage Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Wantage Nursing Home is a care home with nursing that offers care for up to fifty people. At the time of our inspection there were 39 people living at the home.

People’s experience of using this service:

We identified one breach of the regulations. This was in relation to the governance of the service.

Medicines management was not always based on current best practice. The systems in place to monitor the quality of service were not always effective.

There were enough staff to meet people’s needs. Staff were aware of their responsibilities to report concerns and understood how to keep people safe. We saw that risks to people's safety and well-being were managed through a risk management process.

People benefited from kind and committed staff. People complimented the support received and told us they formed meaningful, caring relationships with staff. Staff knew what was important to people and ensured people had care that met their needs and choices. People's dignity, confidentiality and privacy were respected, and their independence was promoted. 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.. People were encouraged to maintain good diet and access health services when required. People had access to a wide range of activities and were supported to avoid social isolation.

People complimented the care provided by skilled and competent staff. People, staff and relatives were involved and felt listened to. Staff and management worked well in partnership with other agencies, social and health professionals and external organisations.

Rating at last inspection: When we last inspected the service we rated it as Good (report published 17 February 2017)

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Enforcement: You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

For more details, please see the full report which is on the CQC website at ww.cqc.org.uk

Wantage Nursing Home is registered to accommodate persons who require nursing or personal care. The home offers care for up to 50 people. At the time of our inspection there were 35 people living at the Home. At the previous inspection on 17 and 18 February 2016 we found that care and treatment of service users was not always person centred. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We also found service users were not always treated with dignity and respect. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. Our findings highlighted that the provider had not acted in accordance with the principles of the mental capacity act 2005 and associated code of practice. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. Persons employed by the service provider were not appropriately supported. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We also found that records in relation to service users were not always complete or accurate and Governance systems were not always effective. These concerns were a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we found that the home had made significant improvements to address the areas of concern and bring the service up to the required standards.

The service had a registered manager. 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.

Staff understood people’s needs and preferences. Staff were knowledgeable about the support people needed. Staff were kind and respectful and treated people with dignity and respect.

People were supported by staff who had been trained in the MCA and applied it's principles in their work. Staff told us, and records confirmed they had effective support. Staff received regular supervision (one to one meetings with their manager). Staff spoke positively about the support they received from the registered manager and the provider

Records in relation to people who used the service were complete and accurate. The manager conducted regular audits to monitor the quality of service. Learning from these audits was used to make improvements.

People told us they were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities.

People received their medicines as prescribed. Staff administering medicines checked each person's identity and explained what was happening before giving people their medicine.

There were sufficient staff to meet people's needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The service sought people's views and opinions. Relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People had sufficient to eat and drink. Where people required special diets, for example, pureed or fortified meals, these were provided by kitchen staff who clearly understood the dietary needs of the people they were catering for.

Wantage Nursing Home is registered to accommodate persons who require nursing or personal care. The home offers care for up to 50 people. At the time of our inspection there were 34 people living at the Home.

There was not a registered manager at the service. However, an application had been made by the current manager. 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 carried out an unannounced comprehensive inspection of this service on 17 and 18 February 2016. We found the provider was not meeting the legal requirements of five of the fundamental standards. After the comprehensive inspection, we took enforcement action and issued warning notices to require the provider to meet the legal requirements of two of the fundamental standards.

This inspection in July 2016 was to check they had met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to people’s safe care and treatment.

We also checked they had met the legal requirements of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to staffing.

This report covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wantage Nursing Home on our website at www.cqc.org.uk

Since February 2016 the provider had improved their practices in relation to mitigating the risk to people who had been assessed as being at high risk of pressure damage. People that were at high risk of pressure damage had up to date and accurate records that demonstrated they had been repositioned in line with the guidance within their care records.

Since February 2016 the provider had improved their practices in relation to infection control. People who used the service had access to appropriate equipment that was in line with the code of practice on the prevention and control of infections.

Since February 2016 the provider had improved their practices in relation to the deployment of staff. People had access to ‘call bells’ and the response time by staff in answering to peoples care needs had improved.

Wantage Nursing Home is registered to accommodate persons who require nursing or personal care. The home offers care for up to 50 people. At the time of our inspection there were 39 people using the service.

There was not a registered manager at the service, however an application had been made by the current manager. 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.

People were not safe. The service did not deploy staff effectively to meet peoples care needs. Call bells were not always responded to in a timely manner. People did not receive their medicines safely and medicines were not always secured.

People were not always protected from the risk of pressure area damage and choking, because thickeners were kept unsecured in communal areas of the home. The service had procedures in place to report incidents and accidents. However staff did not always follow these procedures. We observed poor standards in relation to infection control.

People’s care plans did not always contain information that was guided by the principles of the Mental Capacity Act 2005 (MCA). Where mental capacity assessments had been carried out records were not underpinned on how best interest’s decisions had been reached. Staff had completed training in relation to MCA but were not always able to understand the principles underpinning it.

The service had regular meetings in place for staff. However, staff told us and records confirmed that staff did not always receive effective supervision (one to one meetings with their line manager).

People were not always treated with dignity and respect. We observed that people were left in an undignified way during personal care. People's personal information was not always kept confidential.

People did not always receive personalised care. All the care plans held personal information about people including their care needs, likes, dislikes and preferences. However, guidance on peoples care needs was not always followed and records did not always reflect people’s changing care needs.

We saw evidence that the service carried out monthly reviews of peoples care’s needs. However, care records did not always contain accurate information. People told us and we observed that they did not always have access to a range of meaningful activities.

The provider had carried out quality assurance audits and had identified concerns within the home. However, the systems in place were not always effective.

The manager had visions and values for the home. However, these visions and values were not always displayed during the course of our inspection.

Staff understood the whistleblowing policy and procedures. Staff told us they felt confident speaking with management about poor practice. Staff we spoke with said they were confident they could raise concerns surrounding the day to day running of the service. However, staff did not always feel confident that their concerns would be acted on.

The adaption and design of the service did not always meet people’s needs. We observed parts of the home where people were living with dementia were not decorated or designed in a way that followed good practice guidance for helping people to be stimulated and orientated.

People did not always receive their care and support when needed as there was limited equipment to assist people to transfer from, for example, their bed to a wheelchair.

Staff told us and records confirmed they received training. However, we identified three staff members that were responsible for administrating medicines were overdue in their refresher training. Medicines administered ‘as and when required’ included protocols providing guidance for staff about when the medication should be used. Staff had an understanding of the protocols and how to use them.

People who needed assistance with eating and drinking were mainly supported appropriately. However, people who had been assessed as being at risk of becoming malnourished or dehydrated were not always supported appropriately.

A range of professionals were involved in assessing, planning, implementing and evaluating people’s care and treatment. These included GPs, district nurses, speech and language therapists (SALT) and other professionals from the Care Home Support Team. The service worked in partnership with visiting agencies. During our inspection we observed positive interactions with visiting healthcare professionals.

The service sought people’s opinions through a yearly satisfaction survey and a quality assurance questionnaire.

People and relatives were complimentary about the staff and told us staff were caring. People were cared for by staff who were knowledgeable about the care they required and the things that were important to them in their lives. We observed some kind and caring interactions.

Staff we spoke with had knowledge of types of abuse, signs of possible abuse. Staff were aware of how to report safeguarding concerns internally and externally. Records relating to the recruitment of new staff showed relevant checks had been completed before staff worked unsupervised at the home.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. The registered manager of the home had informed the CQC of reportable events.

We found seven 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 this report.

We looked at six people’s care files and saw that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. For example, where people were at risk of falls, risk assessments were alongside care plans to ensure peoples safety. During our SOFI we observed that people with dementia benefited from meaningful engagement and were being supported in line with their care plans.

We found that a number of choices were offered at mealtimes, which included a vegetarian option. People’s dietary requirements were also well known to staff and recorded clearly in peoples files. People and their relatives were complimentary about the food and drink people were provided. One person told us, “I am eating good food and I weigh what I should, you can’t ask much more than that can you”.

People and people’s relatives we spoke with told us they felt able to raise concerns. One relative told us, “they are very approachable and interested in what we have to say”. We observed the manager and senior management were regularly auditing the safety and quality of their service and acting upon their findings. For example, where people had requested more day trips this had been arranged and where relatives requested a list of staff supporting their relatives in the home this was done.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained and kept securely. Records we asked to see could also be located promptly.

We looked at seven care files including care plans, risk assessments and daily records. All were signed and dated by the person or their relative. Where a person was unable to give consent then a best interest meeting had taken place and had been documented.

We observed people being assisted to eat their lunch in both dining rooms and some people eating in their rooms. The home had protected mealtimes, so all staff were available to assist people with their meals. We observed nursing and care workers assisting people in a discreet and dignified manner.

The provider did not have suitable systems in place to assess and monitor the quality of service that people received. There was a risk that people would be exposed to poor care due to lack of monitoring. The provider did not protect people from the risk of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

The home was non compliance in relation to safeguarding, assessing quality and notifications as well as some records.

When we inspected this time to monitor the home's progress towards becoming compliant, we found that progress had been made in some areas but the provider was still non compliant with both outcomes.

Limited progress had been made in bringing care plans and related records up to an acceptable standard. The views and wishes of people in the home and their representatives were still not sufficiently integrated into care plans. The pace of improvement had been very slow despite ongoing monitoring by the provider. We saw from files that people's identified needs were not always recorded and if recorded, were not always effectively met. There was limited evidence of coordination between risk assessments identified needs and care plans. Some care records were not consistently completed.

Improvements had been made in the level of activities provided with the appointment of additional activities staff.

Feedback from people in the home and relatives remained negative about staffing levels, communication and morale. Staffing levels had improved with recent recruitment. However, the provider had yet to complete a dependency assessment to identify appropriate staffing levels. Staff morale and communication issues remained.

We saw that a compliance audit had been completed monthiy, this included checking records relating to personalised treatment and support. In October 2012 five care plans were examined and all were incomplete.

People told us that they were satisfied with the care provided by the two local GP surgeries, one of which visits the home on a weekly basis, other healthcare professionals visit as appropriate. We were told that regular resident and relatives meetings took place, this could not be evidenced.

We observed staff assisting people with their meal in a discreet and dignified manner.

We spoke with several members of staff, who had a good understanding about safeguarding adults and how to report them appropriately.

We saw evidence of regular audits undertaken and management of medication was fully compliant.

Staff that we spoke with said that there were not sufficient staff on each shift, a high percentage of people require two staff to provide hoisting, at least eight people on the general nursing unit, which meant that other people did not receive care when needed.