This inspection took place on the 12, 13 and 16 March and 15 and 24 April 2018 and was unannounced.Weston Park was previously inspected on 3, 4 and 5 October 2017. During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: staffing; training; recruitment of staff; safeguarding service users from abuse and improper treatment; records; medicine management; seeking consent in accordance with the Mental Capacity Act 2005; providing person centred care and governance arrangements. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the registered person had not always notified the Commission of incidents or allegations of abuse.
We took enforcement action and we rated the service as 'Inadequate' and placed it into Special Measures. Following the inspection, the provider formulated an action plan and sent us updates in response to the breaches and concerns we had identified. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. At this inspection the overall rating for the service is ‘Requires Improvement’
At this inspection, we found that the provider was taking action to address the previous concerns we had raised. Further improvements were still required and the provider remained in breach of Regulations 12, 13 and 17 of The Health and Social Care Act 2008 (Regulated Activity) Regulations 2014 in relation to management of risk, safeguarding and good governance. We considered however, that sufficient action had been taken to meet the further breaches identified at the last inspection.
Weston Park 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.
Weston Park accommodates up to 103 people across four separate units, each of which have separate adapted facilities. Two of the units had been temporarily closed and there were 58 people living at the home during the inspection.
At the time of the inspection there was no registered manager in place. 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. A new manager had been appointed in January 2018 and had made an application to register with CQC.
Overall people, relatives and staff told us that they had seen improvements to the service. People were generally positive about the support they received.
There remained some concerns that staff did not always follow safeguarding procedures in a robust manner. We found that some improvements were being made to manage risks more safely, however there remained some gaps in the effective implementation and evaluation of risk assessments.
At this inspection we found that the usage of agency staff had reduced significantly. There had been a period of recruitment including a new chef, head housekeeper, a nurse and care staff. Managers had taken a lead on recruitment, which focussed on quality to fill staffing gaps and was on-going. There were sufficient staff to meet people's needs and provide personalised care and support with activities. There was a new management team in place including the home manager, quality assurance manager and two unit leads. There had been a focus on the organisation and allocation of roles within the staff team, however there remained some inconsistencies in the oversight of staff skill mix.
Recruitment and selection of staff was carried out safely with appropriate checks made before new staff started working in the home.
We saw that accidents and incidents, along with any pressure ulcers and weight loss or gain were monitored. At this inspection we made observations and saw that call bells were accessible to people. We saw other examples where equipment had been used to help manage potential risks such as sensor beams, low beds and crash mats.
There were no records of fire drills carried out at the service. The provider assured us that fire drills and evacuations incorporating night staff would be undertaken as soon as possible and a system was implemented to ensure that the management team had oversight of these drills.
We found that staff needed further guidance to ensure that The Mental Capacity Act 2005 (MCA) was applied robustly. Improvements had been made and staff now carried out mental capacity assessments and these were decision specific. However, we found some examples where the principles of the MCA had not been followed.
Since our last inspection, the provider had focused on staff training and had updated training records to evidence the training completed by staff. There was a significant improvement in the number of staff who had undertaken mandatory e-learning. A new training induction had been introduced. We received assurances from the provider and manager that this was work in progress which they would continue to focus on. Staff supervisions and appraisals was being implemented but needed to be embedded.
The provider had employed a new chef, who was knowledgeable about people’s dietary needs. We saw that she took time to speak with people to seek feedback about the food and choices available. We found that people's nutritional needs were being monitored. However, we noted that whilst there had been some improvements in the recording within daily charts, there remained inconsistencies and charts had not always been fully completed.
We found that the new management team were focused on the quality of the care provided. We saw examples where the management team had tackled and addressed areas of concern and this was an on-going process. People were complimentary about the way they were treated by staff and told us they were treated with dignity and respect.
The service had received a number of compliments. We reviewed relatives’ comments received within letters, about the improvement of the home. During the inspection a number of relatives actively sought out inspectors to share their positive feedback about the service.
Previously we found that daily charts had not always been completed in accordance with people's care plans. On this inspection we found that staff were aware of the importance of accurate and up to date record keeping but identified gaps in recording that could put people at risk. We were advised that nurses and unit leaders were actively monitoring the completion of charts on a daily basis, however we found that this remained insufficient.
Since our last inspection we saw that a significant number of the care plans had been re-written. Overall we found improvements to the information recorded, which in most cases was detailed and person centred. We saw that people’s wishes and preferences were respected.
The home had two activities coordinators, one on each of the units. There was an activities programme and entertainment available. They explained to us that under the new management there was now a bigger focus on activities.
The provider had a complaints policy and procedure in place, which was on display in the reception at the home. At our last inspection we found that the system for recording and responding to complaints was insufficient. At this inspection we found that improvements had been made.
Quality assurance systems needed to be more robust. Whilst the management team advised us that a schedule of audits was in the process of being embedded to help monitor and improve the quality and safety of the service provided, the systems needed to be strengthened further
We found that improvements had been made to the leadership of the service. The provider had recruited a new management team including a quality assurance manager and had also employed the services of a specialist consultancy agency with a view to making the necessary required improvements.
Staff commented on improvements and their confidence in managers, unit leads and seniors. A schedule of audits was in the process of being embedded to help monitor and improve the quality and safety of the services provided.