This inspection took place on 11 and 12 July 2017 by one adult social care inspector. The first day was unannounced.The home was last inspected in April 2015 when it was rated as 'Good' overall.
Widecombe House is a residential home in Torquay, Devon providing accommodation and care for up to 18 people. People living at the home are older people, some of whom were living with dementia or a physical disability. On the day of the inspection, 18 people were living at the home.
The home was managed by a manager. The manager was in the process of applying to become the 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 and associated Regulations about how the service is run.
The home was extremely caring. We observed a range of warm and affectionate interactions during our inspection, with people and staff sharing jokes and laughter. Staff were kind and caring and had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. They supported people to enable them to remain as independent as possible. Staff showed that they understood how to assist people living with dementia through the use of good moving and handling techniques when they supported people to move about the home. They communicated clearly with people in a caring and supportive manner.
We found that people’s end of life care was exceptional. Staff supported people compassionately, sensitively and with love in a familiar environment as they approached the end of their lives. One visiting healthcare professional told us, "Staff have gone above and beyond, particularly with regard to end of life care. They managed that really well and staff take the time to understand people's end of life wishes. People at the end of their lives receive one to one care at Widecombe and that is truly exceptional."
People we spoke with and their relatives were unanimous in their praise of the caring attitudes of staff. We found the atmosphere to be extremely relaxed, calm and welcoming and all relatives we spoke with told us this was the case whenever they visited. We saw people were treated in a dignified manner with regard to personal interactions with staff, as well as having their rights upheld, such as the right to choose where they spent their time.
People, relatives and staff felt the home was well–led. People and staff described the manager as approachable, available and supportive. Staff talked positively about their jobs and took pride in their work.
The manager was inspiring and dedicated to providing care which met the highest of standards. They strived for excellence and were passionate and dedicated to providing outstanding care to people and a loving family home. They led with a dynamic approach and continually reflected on how to improve the home further. They demonstrated a strong and supportive leadership style, seeking feedback in order to further improve what was offered. The provider's vision and values were understood and shared across the staff team, and they were fully supportive of development plans.
People told us they felt safe living at Widecombe House and staff knew how to safeguard people from the risk of abuse or poor practice. Staff knew what actions to take if they had any concerns for people's wellbeing. The manager knew what action to take if concerns regarding people's safety were brought to their attention.
The home had robust quality assurance processes in place. People's opinions were sought formally and informally. Feedback was sought from people and their relatives to assess the quality of the service provided. Audits were conducted to ensure the quality of care and environmental issues were identified promptly. Accidents were investigated and, where there were areas for improvement, these were shared for learning.
Staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and people’s right to make decisions about their care and treatment and to say how and where they wished to be supported. Staff confirmed a number people living at the home lacked the capacity to make decisions about their care. Care plans showed evidence of capacity assessments and best interests decision outcomes. Staff supported and encouraged people to make individual choices in how they lived their lives. For people who lacked capacity to make certain decisions, staff prompted and offered people choices which were made in their best interests.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection applications had been submitted to the supervisory body (local authority), some were currently waiting approval and four had been authorised.
There were sufficient staff on duty at any one time to meet people's needs safely. People were protected by safe recruitment procedures. Staff were supported with an induction and an on going training programme to develop their skills and staff competency was regularly assessed. Staff received training in dementia care to support people living with dementia. Staff displayed a sound understanding of all aspects of care we asked them about during the inspection and we found care to be delivered extremely effectively.
Staff ensured people received a nutritious, balanced diet and people who required it were supported to eat their meals. People were very happy with the quality of their meals and said they were given enough to eat and drink.
People had their health needs met. People received visits from healthcare professionals, for example GPs and community nurses, to ensure they received appropriate care and treatment to meet their health care needs. Professionals confirmed staff followed the guidance they provided. This ensured people received the care they needed to remain safe and well.
People's medicines were managed, stored, and disposed of safely. Senior staff administered medicines and had received training and confirmed they understood the importance of safe administration and management of medicines.
Where possible people were involved in their care planning. Care records were personalised, comprehensive and detailed people's preferences. Staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.
People's risks were considered, well-managed and regularly reviewed to keep people safe. Where possible, people had choice and control over their lives and were supported to engage in a wide range of varied activities within the home. Records were updated to reflect people's changing needs.
There were quality assurance systems in place which enabled the provider and manager to assess, monitor and improve the quality and safety of the service people received. Procedures were in place for the manager to monitor, investigate and respond to complaints in a timely manner.