The inspection took place on 28 and 29 of July 2015 and was unannounced. Weald Hall Residential Home is registered to provide accommodation and personal care for up to 39 older people. The service mainly provides care to people living with dementia. There were a total of 38 people using the service at the time of the inspection.
We last inspected the service in January 2015 and we rated the service as inadequate as the provider was not meeting the legal requirements. Following the inspection the provider wrote to us to say what actions they intended to take.
The service has a registered manager, although they were not present during the inspection as they were on holiday. 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 this inspection we found that the provider had made some improvements but had not met all the requirements made at the previous inspection.
At the last inspection we found that the environment was not being properly maintained and equipment was not safe. We found that the provider had undertaken some refurbishment and had developed areas for people with dementia to use, which reflected good practice. However we found that people continued to be at risk of unsafe care as staff were not sure how to use some of the equipment provided. Moving and handling practice placed people at risk of injury. Risks were not always well managed, and there had been insufficient consideration of the least restrictive way of keeping people safe. Bedrails were in regular use but the dangers that they presented had not been fully considered.
Infection control was not well managed and this placed people at risk and the staff were not clear about the procedures to follow to protect people from the spread of infection.
At our last inspection we found that induction training and support provided was not effective as staff were not suitably skilled and knowledgeable. At this inspection we found that some training had been provided, however in areas such as infection control and moving and handling the limited skills and knowledge of staff remained an issue.
At the last inspection we found that the provider did not have appropriate arrangements in place regarding consent. We found that some improvements had been made but staff still had limited knowledge and understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).
At the last inspection we found that people were not protected from the risks of inadequate nutrition and hydration. We found that some changes had been made but the support for people with complex needs was not always effective and provided in line with professional advice. People’s health needs were not always promoted, and staff were not always clear about how they should support people with specific health conditions such as ulcers or diabetes and reducing risks of deterioration.
At the last inspection we found that people did not always have their dignity, privacy and independence promoted. At this inspection we found that some improvements had been made, but some staff continued to treat people in a way which did not promote a respectful and caring approach.
People had their care needs assessed and we saw that staff had started to compile social history’s. These were at an early stage of development and had not yet been incorporated in care plans. Plans were not person centred and did not offer clear guidance to staff about how care should be provided. Our observations were that the plans were not reflective of the care that was provided.
Complaints were not managed in a proactive way or used as a tool to develop care practice.
At the last inspection we found that the provider did not have an effective system in place monitor quality and identify, assess and manage the risks. We saw that the provider had started to develop a system but it was not fully operational and therefore we were unable to make a decision about how effective it could be. The concerns which were identified at this inspection had not been identified by the registered person.
Medicines were appropriately stored but staff were not always administering them safely or in line with how they were prescribed.
At the last inspection we found that there were not adequate arrangements in place that ensured people were engaged in stimulating activities which promoted their wellbeing. We found that improvements had been made in this area and people enjoyed the activities provided.
The Provider had systems in place to ensure that the staff they recruited were properly vetted. Staffing levels were adequate although they were busy and task orientated in their approach. Staff were clear about how they should respond to concerns and safeguarding.
We found that there were a number of breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we have told the provider to take at the back of the full version of the report.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
- Ensure that providers found to be providing inadequate care significantly improve.
- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.