Background to this inspection
Updated
2 May 2019
The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) 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 Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team: The inspection was carried out by two inspectors, a registered nurse and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was older people living with dementia.
Service and service type: Waltham Hall Nursing and Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a registered manager (known to the people using the service as ‘matron’) registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection: The Inspection was unannounced.
What we did:
Before inspection: The provider had completed a Provider Information Return (PIR), this is information the provider is required to send us at least annually that provides key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR and other information we held about the service such as notifications. These are events which happened in the service that the provider is required to tell us about. We sought feedback from the local authority and clinical commissioning group who monitor the care and support people received and Healthwatch Leicestershire, the local consumer champion for people using adult social care services. We used all this information to plan our inspection.
During inspection: We spoke with seven people living there and four visitors. We also spoke with the matron, the audit manager, two registered nurses, the medicine coordinator and eleven members of the staff team. We observed support being provided in the communal areas of the service. We reviewed a range of records about people's care and how the service was managed. This included five people's care records. We also looked at associated documents including risk assessments and a sample of medicine records. We looked at records of meetings, both for the staff team and the people using the service, staff training records and the recruitment checks carried out for new staff employed at the service. We also looked at a sample of the providers quality assurance audits that the management team had completed.
After inspection: The matron provided us with copies of documents requested to demonstrate compliance with the regulations.
Updated
2 May 2019
About the service: Waltham Hall Nursing and Residential Home is a care home providing personal and nursing care and accommodation for up to 81 people, some of whom have dementia. There were 52 people living at the service at the time of our inspection.
People’s experience of using this service:
•People felt safe living at Waltham Hall Residential and Nursing Home and with the staff team who supported them. The staff team were aware of their responsibilities for keeping people safe from abuse and avoidable harm.
•Risks associated with people’s care and support had been assessed, managed and regularly monitored. Checks had been carried out on the environment and equipment to ensure it was safe and fit for purpose.
•People felt that, overall, there were enough staff on duty to meet their care and support needs. However, people told us they sometimes had to wait for their call bell to be answered. The matron acknowledged this but was confident a new way of working would address this.
•People using the service were involved in the recruitment of new staff to ensure they were suitable to work there. The staff team received the training they required to meet people’s care and support needs.
•People received their medicines in a safe way.
•People were provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time on their own, or with others.
•People were supported to access healthcare services when they needed them and they were supported to eat and drink well. Food and fluids records had not always been completed accurately or totalled to show the recommended fluid levels had been met.
•People had plans of care in place and whilst some were more comprehensive than others, the staff team knew the people they were supporting well.
•People were supported to have the maximum choice and control of their lives and staff supported them in the least restrictive way possible; the polices and systems in the service supported this practice.
•People were involved in making decisions about their care and support whenever possible and their consent was always obtained.
•The matron ensured information was provided to people in a way they found accessible.
•People were treated in a kind way and their privacy and dignity were maintained and respected.
•Lessons were learned when things went wrong to improve the service provided.
•People’s personal preferences within daily living had been identified and they were supported to attend activities they enjoyed.
•People were involved in how the service was run through meetings, the use of surveys and day to day conversations with the matron and the staff team.
•People were supported with compassion and kindness at the end of their life.
•Systems were in place to monitor the quality and safety of the service being provided. A complaints process was in place and people knew who to talk to if they had a concern.
•The matron worked in partnership with others to ensure people received the safe care and support they required.
More information is in the detailed findings below.
Rating at last inspection: Good (report published 7 September 2016) all the key questions were rated Good and the service was rated as Good overall.
Rating at this inspection: The rating for this service has not changed and the service remains Good.
Why we inspected: This was a planned inspection based on the previous rating.
Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.