Archived: Wells House Nursing Home

Wells House Nursing Home is registered to provide accommodation, nursing and personal care for 21 older people. There were 18 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. During the inspection visit the company was represented by one their senior managers who was the Care Quality Director. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 26 and 27 April 2017 the overall rating of the service was, ‘Requires Improvement’. We found a breach of regulations because sufficient numbers of suitably qualified care staff had not always been deployed in the service.

We told the registered persons to send us an action plan stating what improvements they intended to make to address our concerns. After the inspection the registered persons told us that they had made the necessary improvements.

At the present inspection we found that sufficient progress had been achieved to meet the breach of regulations. This was because enough nurses and care staff had been deployed to enable people to promptly be given all of the assistance they needed and wanted to receive.

Our other findings were as follows: People were safeguarded from situations in which they may experience abuse including financial mistreatment. People had been helped to avoid preventable accidents while their freedom was respected. Medicines were managed safely and background checks had been completed before new care staff had been appointed. Suitable arrangements were in place to prevent and control infection. Lessons had been learned when things had gone wrong.

Care was delivered in a way that promoted positive outcomes for people and care staff had the knowledge and skills they needed to provide support in line with legislation and guidance. This included respecting people’s citizenship rights under the Equality Act 2010. People were supported to eat and drink enough to have a balanced diet to promote their good health. Suitable steps had been taken to ensure that people received coordinated care when they used or moved between different services. People had been supported to access any healthcare services they needed. The accommodation was designed, adapted and decorated to meet people’s needs and expectations.

People were supported to have maximum choice and control of their lives. In addition, the registered persons had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible.

People were treated with kindness and they had been given emotional support when needed. They had also been helped to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received person-centred care that promoted their independence. This included them having access to information that was presented to them in an accessible way. People were given opportunities to pursue their hobbies and interests. The registered manager and care staff recognised the importance of promoting equality and diversity. This included appropriately supporting people if they adopted gay, lesbian, bisexual, transgender and intersex life-course identities. Suitable arrangements were in place to resolve complaints in order to improve the quality of care. People were supported at the end of their life to have a comfortable, dignified and pain-free death.

There was a registered manager who had promoted a person-centred culture in the service and had made the arrangements necessary to ensure that regulatory requirements were met. People who lived in the service and members of staff were actively engaged in developing the service. There were systems and procedures to enable the service to learn, improve and assure its sustainability. The registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Wells House Nursing Home is a large detached house with accommodation spread over three floors accessible by stairs and a passenger lift. Although the service provides a communal lounge/dining area and a seating area, most people were too frail to use these areas and received bed care. Nine bedrooms had ensuite facilities. There was a large garden which some people could access.

A registered manager was in post, although they were not present during the inspection. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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.

Although a long established service, this is the first time that Wells House Nursing Home has been inspected while under the ownership of the Victoria Nursing Group Limited. This inspection highlighted some areas where regulations were not met and other aspects which required improvement.

We found some aspects that were not safe and required improvement to address them.

The method used to assess people’s needs against the number of staff needed to meet those needs was not meaningful and had not been reviewed for over six months. Particularly at night, some people told us staff had not come when they needed support.

A survey of people living in the service found they felt safe. People received medicines safely and how and when they were supposed to.

Assessments had been made about environmental risks to people and actions had been taken to minimise them. Staff knew how to recognise signs of abuse and how to report it.

Proper pre-employment checks had taken place to ensure that staff were suitable for their roles.

Staff had received training in a wide range of topics and this had been regularly refreshed. Supervisions and appraisals had taken place to make sure staff were performing to the required standard and to identify developmental needs.

People’s rights had been protected by assessments made under the Mental Capacity Act (MCA). Staff understood about restrictions and applications had been made to deprive people of their liberty when this was deemed necessary.

Healthcare needs had been assessed and addressed. People had regular appointments with GPs, health and social care specialists, opticians, dentists, chiropodists and podiatrists to help them maintain their health and well-being.

Staff treated people with kindness and respect. Staff knew people well and remembered the things that were important to them so that they received person-centred care. People and relatives gave mainly positive feedback about the service.

People had been involved in their care planning and care plans recorded the ways in which they liked their support to be given. Bedrooms were personalised and people’s preferences were respected. Independence was encouraged so that people were able to help themselves as much as possible.

Staff felt that there was a culture or openness and honesty in the service and said that they enjoyed working there. This created a comfortable and relaxed environment for people to live in.

Systems were in place to encourage feedback from people, relatives and staff and were subject to continuous review.

People’s safety had been protected through cleanliness and robust maintenance of the premises. Fire safety checks had been routinely undertaken and equipment had been serviced regularly.

People enjoyed their meals; any risks of malnutrition had been adequately addressed. There were a range of activities.

The registered manager was widely praised by people, relatives and staff for their commitment to improving the service. There was an open, transparent culture amongst staff and management.

People knew how to complain if they needed to; most complaints were addressed in line with the services’ policy.

We found a number of breaches of Regulation. You can see what action we told the provider to take at the back of the full version of the report.

We have also made the following recommendations:

We have made a recommendation that the service fully review the operation, checks and use of the staff call system.

We have made a recommendation about the prioritisation and completion of all personal emergency evacuation plans.

We have made a recommendation about the guidance for staff to support effective hydration of people.

We have made a recommendation about updating some contact details in the complaint handling information.

We have made a recommendation about putting in place a robust audit tool to ensure the numbers of staff on duty is reflective and responsive to people's needs.