We completed an unannounced inspection at Wilbraham House on 16 September 2016. At the last inspection on 10 March 2015, we found that the service was meeting the regulations. Wilbraham House are registered to provide accommodation with personal care for up to 33 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 32 people.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
There was a registered manager at the service. 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 identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
Risks to people’s health and wellbeing were not consistently identified, managed or followed by staff safely. We found there were not enough staff available to deliver people’s planned care or to keep people safe.
We found that medicines were not administered in a consistent and safe manner and they were not always administered as prescribed.
The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the manager and provider.
Systems in place to monitor accidents and incidents were not being followed or managed to reduce the risk of further occurrences.
People did not always get the support they needed to eat sufficient amounts. Staff were not always available to monitor people were eating sufficient amounts. This meant some people’s nutritional needs were not met.
Staff told us they received training. However, we found that some of the training they had received was not effective. There were no systems in place to ensure that staff understood and were competent to support people safely and effectively.
Advice was sought from health and social care professionals when people were unwell. However, we saw that people were not always referred to specialist health professionals to ensure their health needs were met effectively.
People told us they were treated with care and given choices. However, we saw that improvements were needed to ensure staff were available to provide care in an unrushed way that made people feel cared for.
People were not always treated with respect in an environment that protected their privacy and dignity.
Improvements were needed to ensure that people were able to access hobbies and interests that were important to them. We found that improvements were needed to ensure that staff were available to support people with hobbies and interests when the dedicated activities worker was unavailable.
People’s care records did not contain an up to date and accurate record of people’s individual needs. This meant that people were at risk of receiving inconsistent care.
People were protected from the risks of abuse because staff understood how to recognise and report possible abuse.
When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.
People knew how to complain about their care and the provider had a complaints policy available for people and their relatives.
People and staff told us that the registered manager was approachable and staff felt supported to carry out their role.