Wolfeton Manor

Wolfeton Manor is a residential care home providing personal care to up to 31 older people, aged 65 and over, some of whom are living with dementia. 29 people lived there at the time of the inspection, although one person was in hospital.

We found the following examples of good practice

People were kept safe because staff understood people’s individual risks and took steps to minimise them. Staff had a high awareness of health and safety systems and described ways to keep people safe. For example, housekeeping staff used hazard signage and cones to highlight slip/trip hazards such as wet floors.

Improvements to the environment had been made. New plumbing installed had minimised the risk of leaks. Work was underway to improve access for people in the garden by installing a raised bed area for people to make gardening easier. Where contractors were working on site, the service worked closely with them to carefully manage risks and ensure people, visitors and staff were kept safe.

We were assured the service were following safe infection prevention and control procedures to keep people safe. The service had ongoing monitoring arrangements to ensure all aspects of infection control followed best practice guidance.

People’s relatives were kept up to date about their progress. A relative wrote, ‘The home is very well managed and we are kept up to date by regular newsletters which has been very important during the pandemic.’ A counsellor was available to support people, family and friends as well as staff.

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

Rating at last inspection

The last rating for this service was Good. (report published 23 August 2018)

Why we inspected

This targeted inspection was prompted in part to follow up a health and safety incident in 2019 when a person using the service fell and sustained a serious injury whilst maintenance works were being undertaken. This incident is subject to a separate investigation. As a result, this inspection did not examine the circumstances of the incident. The purpose of the visit was to check the provider’s action plan to mitigate risks of avoidable harm and make safety improvements had been implemented.

As part of CQC’s response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes. This targeted inspection also looked at the infection control and prevention measures the provider has in place.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well Led sections of this full report.

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.

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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People felt safe. They were supported by staff with a good understanding of how to safeguard them and how to raise concerns either internally or externally if they suspected harm or abuse. There were enough staff to meet people’s needs. A dependency tool was used monthly to ensure that staffing levels continued to match the needs of the people living there. People’s individual risks were assessed and reviewed.

At the previous inspection we found people were not always protected from the risks of falling from a height likely to cause harm as not all windows in the home were restricted. At this inspection we saw that this had been resolved. At the previous inspection we found that some hot water taps did not have temperature regulators, which meant the hot water temperature was not always at a safe level for people. The Health and Safety Executive provides guidance on hot water temperatures in care homes and states hot water above 44 degrees can present a scalding risk to vulnerable people. Again, we saw that his had been resolved. These actions meant that risks to people had been reduced.

The home carried out monthly accident and near miss audits. This included a description of what had happened, the result of the investigation, and follow up action taken. This helped reduce the risk of things happening again.

People had their needs assessed to support their move to the home. This included their care needs and how they preferred to live their lives. People were supported by staff who had received an induction. This involved shadow shifts with more experienced staff and regular competency checks. People were supported to eat a balanced and healthy diet. They were given choice of what to eat and drink and could eat as much or as little as they wanted. Where people required extra support at meal times this was provided in line with guidance from health professionals.

People were supported to attend appointments to maintain their health and well-being. Where people’s health needs changed there was timely contact with relevant health professionals. People were supported by staff who understood the importance of offering choice and support in line with what they needed and wanted.

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. Where people lacked capacity to make particular decisions they were supported by staff who were trained and worked in line with the principles of the Mental Capacity Act 2005.

Staff consistently demonstrated a kind and caring approach towards people. When people were feeling upset staff knew how to support them emotionally. People’s privacy and dignity was supported at all times. They were given time and space to spend private and uninterrupted time with friends and relatives. People were encouraged to maintain their independence. One relative said that people at the home were “given space to be themselves.”

There was a wide range of activities supported at the home. These supported people to maintain their interests and develop new skills. People were supported to maintain contact with family and friends. Relatives told us they could visit freely and were always made to feel welcome. Staff were aware of people’s different communication needs and provided information in a format that was most beneficial for them. The home managed complaints in line with their policy. People and relatives expressed confidence that when issues were raised they were dealt with in a timely way and to their satisfaction.

There was a positive and open culture at the home where everybody’s views were seen as important. Staff told us they enjoyed working there and felt supported by the management. Their good work was recognised and opportunities provided for personal development. Regular team meetings were held to share information and learning. Annual surveys were used to find out where people, staff and health professionals thought improvements could be made. The home had developed good working relationships with healthcare professionals. This had resulted in pro-active in-reach services from GPs and district nurses that helped to keep people well for longer and prevent unnecessary hospital admissions.

Further information is in the detailed findings below

Wolfeton Manor provides residential care for up to 31 older people. There were 27 people living in the home at the time of our visit, some of whom were living with dementia.

There was 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.

People were not always protected from the risks of falling from a height likely to cause harm. Not all windows in the home were restricted to reduce the risks of people falling from height. Windows in three people’s bedrooms on the first floor were unrestricted which meant they opened wide enough for a person to fall or climb out. The provider had completed a risk assessment which was repeated during our inspection. The risk assessment concluded the risk of a person coming to harm by falling out of an unrestricted window was “unlikely.” However during our inspection we saw one bedroom was unoccupied and the window was open. This meant anyone in the home had access to the open window.

Some hot water taps did not have temperature regulators, which meant the hot water temperature was not always at a safe level for people. The Health and Safety Executive provides guidance on hot water temperatures in care homes and states hot water above 44 degrees can present a scalding risk to vulnerable people. The provider made checks on water temperatures and the hot water in one room was recorded at 70 degrees, other hot water temperatures were recorded over 44 degrees. We spoke with the regional manager and staff completed a risk assessment for unregulated hot water. The likelihood of people being scalded was assessed by staff as ‘possible’. The provider identified what actions they would take to reduce the risk of people being scalded and indicated actions would be completed within seven days.

People were offered a choice of how they spent their day and had personalised care plans which were tailored to their individual needs. People were treated with kindness and respect and one person described to us how staff respected their privacy and dignity. There was a relaxed atmosphere within the home and people appeared comfortable in each other’s company and with staff.

People had access to healthcare when they needed it and recommendations from healthcare professionals were carried out.

People were involved in decisions about their care; they were asked if they disliked anything about the home. We saw people’s comments were acknowledged for example changes were made to one person’s care plan after they had said they did not like eating in the dining room. There was a monthly meeting and people were invited to offer suggestions about the home, such as which activities to organise.

The provider was meeting the requirements of the Mental Capacity Act 2005. One person was subject to a Deprivation of Liberty Safeguard (DoLs), their care plan had been updated to reflect the conditions of the DoLs and staff had an understanding of their responsibilities relating to it. People told us staff respected their rights to make decisions for themselves.

Staff told us they had enough training and support to carry out their jobs. There were systems in place to provide staff with regular supervision and staff had an annual appraisal.

There were processes in place to ensure the quality of the service was regularly reviewed and improvements made. The registered manager had introduced a new system for recording people’s care plans and daily records.

The home catered for older people, most of whom had made a positive choice to live in the home. One person we spoke with told us ' I knew what it was like before I moved in, it met my expectations'.

We observed that people appeared to enjoy meeting together in the communal areas and that there was a restful and calm atmosphere throughout the home. The dining area was well attended at lunchtime and people appeared to enjoy their meals and eating together. One person we spoke with told us ' I wouldn't like to go anywhere else, everybody is very helpful.' We observed staff members readily responding to requests for assistance and that they treated people with respect. One person told us ' there is an atmosphere of relaxation here, there are no silly rules'.

Another person we spoke with told us 'they look after you well and they feed you well.' One person told us ' they (the staff) are varied, it is as good as anywhere else, I like the outlook'. Another person told us ' they do very well for us here, communion is once per week. That is well organised.. I think there should be more spiritual guidance for people'.

We found that the service had safe systems for the management of medication. We found evidence that the service was well staffed to meet the needs of people who use the service.

People experienced care and support that met their needs and protected their rights. One person told us 'It's very good here and the staff are lovely'. Another said 'This home is different. It has things money can't buy. It's full of fun and happiness'.

We spoke with four family members who were visiting people who used the service. All said they were made welcome by staff and that they felt involved with the care of their relative. Two community nurses and a local authority trainer told us this was a good service.

From reviewing arrangements for staff training and care plans and talking to staff we found that people were protected because the provider had taken reasonable steps to minimise the risk of abuse.

Reviewing records and talking with staff demonstrated that people were safe and their needs were met by a competent staff team who were well supported.

The provider had in place systems that sought people's views, took account of complaints and comments and learnt from investigations into accidents and incidents. This meant the provider had an effective system to assess and monitor the quality of service.