Archived: Wickwar

Updated 5 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection was carried out by one inspector for adult social care. An expert by experience joined us on the first day of our inspection. An expert by experience is a person who has used this type of service in the past.

Prior to the inspection we looked at information we had about the service. This information included the statutory notifications that the provider had sent to CQC. A notification is information about important events, which the service is required to send us by law.

During our visit, we observed people living in the home and we spoke individually with 10 people. One relative was happy to speak with us and share their thoughts about the home. We spent time with the manager, a clinical nurse lead and a nurse. We spoke individually with seven care staff, the housekeeper, two domestics and the chef. Two healthcare professionals had contacted us prior to the inspection. In addition, we had received information of concern from a family and an anonymous whistle-blower.

We looked at five people's care records, together with other records relating to their care and the running of the service. This included four staff employment records, policies and procedures, audits and quality assurance reports.

Updated 5 January 2019

This inspection took place on 14 and 16 November and was unannounced. The nursing home is registered to provide a service for up to 39 people. At the time of our visits there were 22 people living at the service.

At our last inspection we rated the service good. At this inspection we found evidence that this was no longer the case and that the service required improvement. We brought this inspection forward because we had received information that suggested standards had deteriorated. Two visiting health care professionals had contacted us with their concerns and told us some staff who worked at the home did not think the service was meeting the current rating of Good awarded in December 2017. In addition, we received information from a whistle-blower and relatives who also expressed concerns. This inspection report will evidence and focus on areas that compromise the safety and quality for people who use the service.

The manager in post had worked at the home since April 2018 and had applied to CQC to be the registered manager. Their application was being processed by CQC registration at the time of this inspection.

Why the service was rated Requires Improvement.

A number of improvements were required to ensure people were kept safe and received quality care. The arrangements in place to ensure the service was well led from provider level down were unsatisfactory. Monitoring the quality of the service was not robust enough to ensure quality and safety. The manager lacked knowledge and understanding about their legal obligations.

We could not be satisfied that staffing levels and routines would keep people safe. Medicines were not always managed safely. People were not protected from the risk of cross infection. This was because appropriate guidance had not been followed. People were not cared for in a clean, hygienic environment. Parts of the environment still required improvement. We could not be satisfied that induction for new staff was effective.

People did not consistently receive person centred care and respect and dignity was not always promoted and practiced. Activities and people’s emotional and psychological well-being required improvement. Staff were knowledgeable about people's lives before they started using the service. Improvements were required to enhance this knowledge so that their life experiences remained meaningful.

Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Staff received supervision and training required to meet people’s needs.

Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice.

We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from them was positive. Those people who used the service spoke well of all staff.

Further information is in the detailed findings below.