Archived: Wexford House Care Home

Updated 28 April 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 was unannounced and was carried out on 6 and 10 November 2014. The inspection team consisted of an adult social care inspector and for the first day a specialist advisor. A specialist advisor is someone who has clinical experience and knowledge of working in the field of frail older people and in particular those living with dementia.

Before this inspection, we reviewed the information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send tell us about by law. We also gathered information from the West Sussex Local Authority Adult Services team.

We met with the eight people who used the service and a resident to the home, all of whom had complex needs, dementia related condition and were not able to fully verbally communicate with us. We observed care and support being delivered in communal areas. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with three family members, four members of the care staff, the cleaner, the manager and the provider. We made detailed checks of records of two people using the service from the start of them using the service. We looked at care plans and associated records for eight people using the service, staff duty rota records, five staff recruitment files, records of complaints, accidents and incidents, policies and procedures, and quality assurance records.

Updated 28 April 2015

Wexford House is a privately owned cared home which provides accommodation for up to 10 older people living with dementia who need support with their personal care. The accommodation is arranged over three floors with the third floor, being office accommodation. There are 10 single bedrooms set over the first two floors. The second floor is accessed via a stairway and a stair lift. At the time of our inspection there were eight people living at the home and they were joined by a new person who moved in while we were there.

The inspection was carried out over the 6 and 10 November 2014.

At the time of inspection the manager was not registered, because the previous registered manager had recently left. The new manager had started the process to become the registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered provider’s, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run.

We conducted this inspection because we had concerns about the service following a previous inspection carried out on the 31 July 2014, which had identified systemic failings by the provider. People were not protected from abuse, treated with respect and dignity and their legal rights were not protected. There was insufficient staff available with the necessary skills to meet people’s needs. People’s care and treatment was not planned and delivered in a way that ensured their safety. Their medication was not managed effectively and they were at risk of inadequate nutrition and dehydration. The home was not clean and hygienic and people were not protected against the risks from unsafe or unsuitable premises. There was no effective system to monitor the quality of service people received, or to identify, assess and manage risks. These failings had a major impact on people using the service. As a result of our findings we required the provider to put in place an improvement plan to bring the service up to the required standard.

During this inspection we found that the service had improved in respect of the standard of care provided across all of the above areas. However, there were still failings in respect of people’s care and welfare, respect and dignity, the management of medicines and an additional concern in respect of requirements relating to workers.

We observed care within the home and spoke with the families of three people using the service. The family members we spoke with told us they thought the home was now well led and the new manager had made a “big difference”. They said they did not have any concerns over the level of care provided to their relatives.

However, we found that staff did not always manage people’s health risks effectively. For example, one person had lost weight rapidly over a short period but there was no evidence that this weight loss had been investigated and there was no referral to a health professional. We did see other occasions where healthcare professionals, such as GPs, district nurses and chiropodists were involved in people’s care where necessary.

People were at risk of unsafe care because their care plans did not always contain up to date information regarding their care needs. For example one person’s care plan had not been fully updated since 2012. In another person’s care plan there were records of unexplained bruising, which had not been investigated to ensure the person’s safety and allow preventative measures to be put in place.

There was no guidance available to assist staff in understanding when to administer “as required” medicine to people. The home did not have an effective medicine stock management system in place, which meant that on occasions the number of tablets or sachets of medicine held in stock did not always correspond with the amount shown on the record.

Prior to their admission to the home people’s needs were not adequately assessed. On the day of our inspection, the home received a new admission following their discharge from hospital. They arrived at the home without any supporting documentation. The pre-assessment completed by the home did not contain sufficient information to enable staff to meet the care and support needs of the person who became distressed and agitated on arrival at the home.

The checks the provider is required to do before recruiting a new member of staff were not always completed correctly, which meant that the home may employ staff who were not of good character and suitable for the role.

The home had a safeguarding and whistleblowing policy, and the manager and the staff we spoke with told us they had received safeguarding training and could say what they would do if concerns were raised or observed. The family members we spoke with told us they felt their relatives were safe in the home. The home had also recently increased its staffing levels which meant there were enough staff available to meet people’s needs. Staff told us they felt supported by the new management regime and had regular supervisions.

We observed care being provided in the communal areas of the home and saw staff did not always interact with people in a positive way. We saw a mixture of both poor and positive interactions by staff. People’s rooms were personalised with their family photographs and memorabilia. Staff respected people’s right to privacy and dignity

The home was clean and appropriately maintained. People in the home appeared happy and well looked after.

People at the home lacked capacity to make some decisions and were subject to restrictions to their personal lives. Staff were guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. We found that capacity assessment were not readily accessible to staff. We have recommended that the service considers the current guidelines regarding record keeping and accessibility of records relating to people’s capacity assessment.

People at the home who were living with dementia. However, the home did not have decoration or signage that aided people to find their way around or to be as independent as possible. There were no dementia friendly signs to indicate toilets or to identify people’s rooms. We have recommended that the service explores the relevant guidance on how to make environments used by people with dementia more ‘dementia friendly’.

There was a complaints policy and a system to record and investigate complaints. The provider told us they had not received any complaints since our last inspection. Accidents and incidents were recorded and remedial actions identified. However, there was no evidence available to show the remedial action had been completed and people were now safe.

The provider had arranged for a series of audits to be carried out at the home by external professionals. However, there was not a structured audit process/system in place to ensure standards were maintained. The provider encouraged visitors, family members were kept fully informed, and they were open to feedback and showed a desire to improve. They had also developed links with external organisations and professionals to help enhance the staff’s and their own knowledge and experience.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.