Wellfield House

We found the following examples of good practice.

• Current restrictions meant people were not receiving visitors. Alternative arrangements were in place for people to maintain contact with family and friends. Where visits were made by health professionals or contractors, health screening and the use of PPE was requested.

• The service followed national guidance on the use of personal protective equipment (PPE). Enough supplies of PPE were available, and staff had received relevant information and training in the safe ‘donning and doffing’ of PPE and infection control procedures.

• The testing of people and staff was completed in line with the home testing programme. Consideration had been given to people’s mental capacity to consent to testing, where necessary best interest decisions were made. Additional temperature checks were carried out on staff at the start of each shift. This meant the service could respond quickly if someone developed symptoms or had a positive test result.

• The home appeared clean with adequate ventilation. Designated housekeeping staff completed all domestic tasks which now included increased cleaning of touch areas such as handrails and door handles. This helped to reduce the risk of cross infection.

• Risk assessments were carried out to manage and minimise the risks of COVID19 to people, staff and visitors.

Further information is in the detailed findings below.

Wellfield House is registered to provide accommodation and care for up to 23 older people, some of whom are living with dementia. The home is situated in a residential area of Whalley Range, Manchester and is close to public transport and the motorway network. The home was originally four terraced house which have been converted into one detached property. At the time of this inspection, there were 20 people living at the service.

Wellfield House is a 'care home', people in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

During the last inspection of Wellfield House on the 15 March 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the premises were not as safe as they should have been because some fire exits were obstructed, window restrictors were not in place on the second-floor bathroom windows and some radiators were not protected with covers. This placed the health and safety of people at risk of harm. The service was rated as good overall and requires improvement in safe.

Following the last inspection, we asked the provider to complete an action plan to tell us what they intended to do and by when to improve the key question; is the service safe to at least good. At this inspection, we found that required improvements had been made.

We found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and on-going 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. At this inspection we found the service remained Good overall.

Why the service is rated good.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the inspection. 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.

Equipment checks were undertaken regularly and safety equipment, such as fire extinguishers and alarms. However, we found the provider did not have a risk assessment in relation to legionella to identify and assess any risks in the homes water system. During the inspection we were provided with assurances from the director that the home would ensure a legionella risk assessment would soon be in place. The registered manager showed us an email confirming the director had commissioned an external provider to complete this risk assessment in October 2018.

Staff were kind and caring and treated people with respect. We observed many positive and caring interactions throughout the inspection. Staff knew people's likes and dislikes which helped them provide individualised care for people.

People's needs were assessed before they moved to the home and care plans were in place to inform staff of their needs and how they should be met. Staff worked with other health care professionals to maintain people's health and wellbeing.

There were effective and established systems in place to safeguard people from abuse and individual risk was fully assessed and reviewed. Accidents and incidents were recorded and appropriate actions taken.

Medicines management and administration processes were reviewed during the inspection and found to be safe.

We found that staffing levels were adequate to meet people's needs. A dependency tool was used to determine staffing levels and we saw that staff responded quickly to people when they needed attention.

Recruitment practices were safe and records confirmed this. Staff received induction and on-going training to enable them to meet the needs of people they supported effectively. Staff were supported by way of regular supervision, appraisal and access to management.

People's rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

People had access to a wide range of activities which were provided seven days a week and were well supported by staff to access the community and activities further afield.

Quality assurance practices were robust and taking place regularly.

Wellfield House is a residential care home registered to provide personal care and accommodation for up to 23 older people. There were 18 people using the service at the time of the inspection. The home is situated in a residential area of Whalley Range, Manchester and is close to public transport and the motorway network. The home was originally four terraced house which have been converted into one detached property. There is limited parking in the grounds but plenty of on-road parking at the front of the home.

Bedroom accommodation is provided mainly on the ground and first floors although one person chooses to live in the one bedroom that is situated on the second floor. Access to the first floor and second floor is via a passenger lift. The communal areas of lounges, small conservatories and the dining room are situated on the ground floor.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the inspection. 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.'

We found a breach in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. We found the premises were not as safe as they should have been because some fire exits were obstructed, window restrictors were not in place on the second floor bathroom windows and some radiators were not protected with covers. This placed the health and safety of people at risk of harm.

You can see what action we have told the provider to take at the back of the full version of the report.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

The staff we spoke with had a good understanding of the care and support that people required. We saw people looked well cared for and there was enough equipment available to promote people's safety, comfort and independence.

Social and recreational activities were being provided and interactions between staff and the people who used the service were warm, friendly and relaxed. Staff were polite and patient when offering care and support.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. Staff were able to demonstrate their understanding of the whistle-blowing procedures (the reporting of unsafe and/or poor practice).

The system for managing medicines was safe and we saw how the staff worked in cooperation with other health and social care professionals to ensure that people received timely, appropriate care and treatment.

All areas of the home were clean and procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply.

People's care records contained enough information to guide staff on the care and support required. The care records showed that risks to people's health and well-being had been identified, such as the risk of pressure sores and poor nutrition.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

Food stocks were good, people were offered a choice of meal and the meals provided were varied and nutritionally balanced.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided and there were systems in place for receiving, handling and responding appropriately to complaints.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

There was a dedicated log book for recording accidents and incidents at the care home. We saw evidence and were told by a senior staff member, "They are reviewed every month and taken very seriously." This helped ensure the safety of people who used the service.

We saw staff members observing good infection control procedures. This included wearing gloves and aprons when providing personal care or carrying out domestic duties. The risk of cross infection was further minimised by the use of hand washing liquid, paper towels and sanitizer in the toilets and bathrooms we saw.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. On the day of our inspection, no people who used the service were subject to a DoLS.

Is the service effective?

People who used the service had undergone a pre-admission assessment. Their wishes and preferences had been recorded which helped ensure their support was provided in accordance with their care needs. This showed they had been provided with the opportunity to express their wishes.

We were shown a residents meeting room. We were told if people wanted to meet their families in private they could. Visiting times were flexible and one staff member told us, "When we get visitors, they can come in here or go to the resident`s room."

Is the service caring?

We spent time in communal areas and saw staff members caring and supporting people in a patient and unhurried manner. Several people had limited mobility and we saw staff helping them between rooms which kept them safe.

We spoke with two people who used the service and one told us, "It`s absolutely beltin (great) here and the food is lovely." Another person told us, "I have just come out of hospital and the staff have been brilliant. They have looked after me so well."

Is the service responsive?

We observed activities taking place in the afternoon which staff were involved with. People were dancing, playing cards, doing jigsaws and listening to music. The choice was theirs and we saw staff supported them with their choice.

We saw there was a complaints policy within the provider`s policies and procedures manual. A copy of the procedure was also displayed on the entrance wall. Although no formal complaints had been received recently, the last complaint received had been managed appropriately and in line with the provider`s policies and procedures.

Is the service well led?

The provider had effective procedures in place that monitored the quality of service provided to people who used the service. We saw evidence care plans, medication administration and emergency procedures were reviewed on a monthly basis.

We saw GP and professional visits had been recorded within people`s individual care plans. This showed a multi-disciplinary approach to providing care. This helped ensure people received appropriate care and support when they needed it.

People who used the service told us the care met their needs. They said: 'The best thing is that we're all looked after very well.'

And:

'I couldn't wish for anything better.'

Relatives told us 'Yes (my relative) is alright. (My relative) has moved around a few places and then here, it's the best one for (my relative).'

And:

'No questions for me'it's a good home.'

We saw that the health care and support provided met peoples assessed needs.

We found that medication in the home was well managed and we found systems in place for people who used the service to influence how the service was run.

We also found that the provider checked the quality of the service and responded to what was found.

At the previous inspection visit on 10 January 2013 we saw that the service did not fully protect the rights of people to give consent or take into account a person's ability to give consent. Previously we also found that fluids were not stored safely and some fixtures and fittings required mending. At this inspection we saw improvements in these three areas.

People who used the service told us the care provided met their needs. They said:

“It’s ok, I’m inside not outside, they keep you clean and they offer enough showers so you don’t have to ask.”

“It’s the best you can make, they treat me reasonably well - they’re very good, they care, I can’t complain.”

“I’m alright here, I’ve been here a while and I’m happy.”

People also made general statements about living at Wellfield House.

A person who used the service told us:

“I’m being looked after well, I’ve got my own private room, and I’ve got everything I need that’s the main thing. I just press the buzzer by my side.”

A relative told us:

“It’s a nice place and they respect my relatives’ wishes.”

We found the provider had made some improvements to the fixtures and fittings since the previous inspection.

We observed that people who used the service were provided with good support to meet their personal care and physical needs, however there were not enough activities on offer to meet social and recreational needs.

We found more consideration was needed in respect of people giving consent to care and we saw that not all items were stored safely.