Wheatsheaf Court Care Home

Wheatsheaf Court Care Home is a care home providing personal and nursing care to up to 55 people. The service provides support to people with nursing needs, mental health needs and people living with dementia. At the time of our inspection there were 40 people using the service. The home supports people over 3 floors.

People’s experience of the service and what we found:

People did not always receive person centred care that considered their individual needs. The support provided to people at mealtimes continued to need improvement. Staff did not support people with their meals in a person centred and timely manner. Governance systems in place were not effective in identifying and taking timely actions.

People were protected from the risk of harm. Staff knew how to identify possible signs of abuse and how to escalate concerns. People received their medicines as prescribed. There were enough staff to support people safely and respond to their needs. Staff had been safely recruited. Where things went wrong action was taken to reduce the risk of reoccurrence and learn for the future.

People's needs had been assessed and care plans contained details of their wishes and preferences. Staff knew people's needs and understood their likes and dislikes. Staff had received training , however, staff did not always support people in a person centred way. Staff felt supported by the management team. People's health needs were managed with the support of external agencies.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were a variety of systems in place to monitor and assess the care provided. Where areas for action were identified during the inspection, the provider took immediate action. There was a positive culture and a commitment to continuous learning and improvement. Most areas of concern identified in the previous inspection had been addressed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 7 May 2023) and there was a breach of regulations. At this inspection we found the provider remained in breach of regulations. The service remains requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

When we last inspected Wheatsheaf Court Care Home on 7 May 2023 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

Enforcement

We have identified breaches in relation to person centred care and good governance and leadership at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wheatsheaf Court Care Home is a nursing home providing accommodation and personal care to up to 55 older people and people with dementia. At the time of inspection there were 38 people living at the service.

People’s experience of using this service and what we found

There were insufficient systems in place to assess, monitor and improve the service. The governance and oversight in place had not identified the concerns found at this inspection.

The provider failed to identify or manage risks posed by people’s health conditions. People living with insulin dependent diabetes did not receive safe care which put them at risk of harm.

Medicines were not managed safely; processes were not in place to ensure people’s medicines were safely administered.

People's care plans and risk assessments did not always reflect people's current needs.

Environmental risks and food safety needed to be addressed to ensure people were not at risk of harm. People were not always protected from the risks associated with infection because the service did not consistently implement processes to reduce the risk of infection and cross contamination.

People did not always receive person centred care that considered their individual needs. The support provided to people at mealtimes continued to need improvement. Staff did not support people with their meals in a person centred, timely way. The provider had not always ensured people were supported with visiting in line with government guidance.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People told us staff were deployed in sufficient numbers to meet their needs and they did not have to wait for their care.

Staff knew people well and understood how to protect them from abuse. There were policies covering adult safeguarding, which were accessible to all staff.

Staff felt supported within their roles and felt confident to discuss any concerns they may have with the manager.

There was a positive and inclusive culture, feedback was sought from people, relatives and staff to identify where improvements were needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 September 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. Since 2017 this service has been rated requires improvement twice and inadequate once.

Why we inspected

The inspection was prompted in part due to concerns received about staff knowledge, management of medicines, responding to people’s medical needs, person centred care and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has not changed following this focused inspection and remains requires improvement. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wheatsheaf Court Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person centred care and governance and leadership at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will work with the local authority to monitor progress.

We found the following examples of good practice.

A robust system and process was in place for screening and testing visitors on arrival to prevent the spread of infection. This included, temperature checks, declaration forms and a designated room for handwashing.

The service had Personal Protective Equipment (PPE) stock, and staff confirmed the provider ensured they had an adequate supply. Staff were observed to be using PPE correctly throughout the inspection

Regular cleaning took place throughout the home including high touch areas such as handrails and door handles. There was a system in place to ensure visiting rooms were cleaned between visits to prevent cross contamination.

People were regularly monitored for early detection of the symptoms of COVID-19 by trained staff.

Wheatsheaf Court is a care home providing personal and nursing care to people aged 65 and over. At the time of the inspection 28 were being supported.

The home can accommodate up to 55 people across three floors, two of which had their own communal areas for people to socialise.

People’s experience of using this service and what we found

Improvements had been made to the overall environment of the home and the provider had developed systems to oversee the quality and performance of the service. These needed to be embedded and sustained to ensure the service continued to improve and provide a good quality of life for people.

People's meal time experiences continued to need improving. Staff needed to be better deployed to support people who needed assistance at meal times effectively and in a timely way.

People needed to be placed consistently at the heart of the service and the systems and processes to support this needed to be maintained. Work on developing more person-centred care plans needed to be completed to enable and support the staff to deliver care meeting people’s desired preferences and needs.

Recruitment of staff and maintaining staffing levels needed to be sustained. Staff needed to have the time outside delivering basic care to spend time with people to support them with their social and emotional needs. Activities needed to be developed further to provide a stimulating environment and meet people’s individual needs.

Staff received the training they required and were supported to develop their skills and knowledge. The registered manager needed to ensure that staff consistently put in to practice the training they had around infection control and maintaining people’s dignity.

People were cared for by staff who were caring and showed empathy towards them. Relatives could see the improvements that had been made over the last several months and felt their loved ones were cared for safely and their health needs were being met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service this practice. Visitors were welcome at anytime and relatives were confident if they had any concerns these would be listened to and acted upon.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was Inadequate (published 26 February 2019) and there were multiple breaches of regulation. We placed positive conditions on the provider’s registration to provide monthly reports to the Care Quality Commission (CQC) to show what actions the service had taken to address the shortfalls found.

This service has been in Special Measures since February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. however, they do remain in in breach of one Regulation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvement. Please see the Effective section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified a continued breach in relation to providing person-centred care at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wheatsheaf Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Wheatsheaf Court Care Home is registered to provide accommodation, nursing and personal care to up to 55 people in one adapted building. At the time of the inspection there were 34 people living in the home.

There was a registered manager in post. 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 the previous comprehensive inspection on 18, 19 and 20 September 2017, the service was rated ‘Requires Improvement’.

Systems and processes in place to assess, monitor and improve the quality and safety of the service were not always effective at identifying concerns. Areas of the home were not well maintained or clean. The impact on people of ongoing refurbishment in the home had not been adequately assessed.

Where shortfalls were identified these were not always addressed in a sufficiently timely manner. People did not always receive their care from staff who knew them well as there was a high reliance on agency staff. This also affected the amount of social interaction and activity available to people.

People were not consistently involved in planning their care and the systems in place for responding to people's feedback required strengthening. Improvements were required to ensure people received their medicines as prescribed.

The provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to the safety, maintenance, cleanliness and governance of the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.

At this comprehensive inspection, we have found that the required improvements have not been made. 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.

The suitability and safety of the environment needs to be addressed to ensure that the environment people live in is appropriate and safe. Risks posed by the environment have not been identified or acted upon in a timely manner and as a result have not been resolved. Where risks have been identified insufficient action has been taken to mitigate these risks. We have found that many areas of the environment are dirty and unhygienic and the principles of infection control are not consistently adhered to.

The deployment of staff is inconsistent due to a lack of permanent staff recruited and use of agency staff. People have experienced and are at risk of experiencing care that does not meet their needs as a result.

There is a lack of care delivered to meet people's individual needs and maintain their dignity.

People's dignity is not being maintained at the service. People’s personal care is not being provided in the way they wish and some people are in an unkempt state.

We have received some feedback that staff do not always communicate with people in a kind or respectful manner. This raises concerns that people have been subject to abuse and safeguarding referrals have been made as a result.

People's personal preferences in relation to their care is not always considered and people lack

stimulation and choices about how they spend their time.

People are not provided with an appetising choice of food. We have been told that the food served at mealtimes is often cold and of poor quality.

People do not feel listened to by the provider, as they have raised concerns about the service they receive but no action has been taken.

There is a lack of effective monitoring in place at the service and this has resulted in poor outcomes for people using the service. Ineffective quality monitoring systems have failed to pick up and address the failings we identified during our inspection.

We found individual staff to be caring and compassionate towards people, however, due to staffing deployment at the service they lack time to be able to spend with people. Care being delivered is often task focussed.

Staff are provided with appropriate training and support; however, do not always put the training they have received into practice.

Medicines are safely managed; regular audits are in place and medicines records are completed accurately.

People are supported to maintain good health. Staff have the knowledge and skills to support them and there is prompt access to healthcare services when needed. People’s nutritional needs are assessed and monitored.

The principles of the Mental Capacity Act 2005 are followed at the service and people have assessments and best interest decisions documented when needed.

At this inspection we have found breaches of six regulations of the Health and Social Care Act 2008 Activities) Regulations 2014. Full details regarding the actions we have taken are added to reports after any representations or appeals have been concluded.

Wheatsheaf Court Care Home is registered to provide residential and nursing care for up to 55 older people, including people with dementia care needs. At the time of this inspection there were 31 people living in the home.

At the last inspection in September 2015, the service was rated Good. At this inspection we found the service to be rated Requires Improvement.

There was a registered manager in post at the time of our 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.

Improvements were required to ensure that people were kept safe in the home. Audits failed to identify that areas of the home accessible to people were not safe; risks posed by the on-going maintenance and refurbishment of the home had not been assessed. Some areas of the environment in which people lived and equipment they used was not always maintained to a sufficient standard of cleanliness.

Systems and processes in place to assess, monitor and improve the quality and safety of the service were not always effective at identifying concerns. Areas of the home were not well maintained and completed refurbishment had not been finished to a high standard. The improvements that were required to the home had not been planned or co-ordinated to ensure minimum disruption to people and the environment; there were on-going shortfalls as a result.

Where shortfalls were identified these were not always addressed in a sufficiently timely manner. People did not always receive their care from staff who knew them well as there was a high reliance on agency staff. As a result people could not be assured that their needs would consistently be met by staff who had appropriate knowledge and skills. Regular staff had received training that was relevant to their role, however at times the skills mix and experience of staff on duty was not sufficient to meet people’s needs effectively.

The systems in place for responding to people's feedback required strengthening. People and staff had mixed views regarding how the service had responded to concerns and complaints. People were not consistently involved in planning their care and felt that there was not enough social stimulation and activity available.

Improvements were required to ensure people received their medicines as prescribed. The provider had recently introduced an electronic medicine management system; whilst this was being embedded people could not be assured that they would receive their prescribed medicines safely.

People were supported and encouraged to eat well and maintain a balanced diet. People were supported to maintain good health; there was prompt access to healthcare services when needed.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. People felt safe in the home and received care and support from staff that had a good understanding of their responsibility to protect people from abuse and ill treatment.

There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make informed decisions and encouraged people to make their own choices.

Regular staff were committed to the work they did and had good relationships with the people who lived in the home. People interacted in a relaxed way with staff, and enjoyed the time they spent with them.

Following the inspection, concerns were raised with us about the standard of care and support provided to some people. In response to these concerns a safeguarding referral has been raised with the local safeguarding authority; this is currently under investigation.

At this inspection we found the service to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report .

Is the service safe?

Equipment at the home had been well maintained and serviced regularly therefore not putting people at unnecessary risk. The manager compiled the staff rotas, they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met. Recruitment practice was safe and thorough which ensures that staff had the right level of knowledge and skills to care for people safely.

Is the service effective?

Specialist dietary, mobility and equipment needs had been identified in care plans where required to meet people’s individual needs. It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people that used the service and that they knew how people liked their care and support to be provided.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We spoke with visiting relatives that told us the care shown to people was very good. We found that people were encouraged to become involved in a wide range of activities from flower arranging, catching and throwing soft balls to bingo. People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People completed a range of activities. A relative told us that, “I come here nearly every day and there is always something going on for people to be involved in". We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely and action was taken where necessary.

Is the service well led?

Staff told us that they were well supported to carry out their job role, and that they had regular supervision and an annual appraisal. They told us that the management of the home was good and that the manager was approachable and supportive. One person’s visitor told us that “if there is anything wrong they always sort it out” another relative told us “I would recommend this place to anyone”.

Most of the people who used the service were unable to tell us what they thought of the service due to their dementia or frailty. We spoke with five relatives of people who used the service. They all told us that they were happy with the care their relatives received. All of the relatives told us they had seen improvements in the service in the last month. One person told us “staff come and change dad’s incontinence pads regularly, whereas before we would have to ask”. Another relative told us “It has changed, now it is more homely, staff will come and talk with the residents quite often”. Two relatives told us that their relatives always wore their own clothes which were clean.

We found that there had been a change in management and care staff. We saw that there had been improvements in the care that people received. Staff were more aware of their role in the safeguarding of vulnerable adults. We saw that record keeping was organised.

We had concerns about the providers recruitment process, training of staff and the system for making complaints.

However we spoke with the relatives of three other people who had contrasting views. One person said 'there are not enough activities to keep people stimulated, especially at weekends' and another said 'I am not kept updated on mum's care' and 'we have made complaints, but we are not listened to'.

We found that risks were assessed and care plans were written for people to reflect the risks identified. However, we found concerns with the level of pressure area care and monitoring of drinks.

We found that there was not an effective complaints system in place, and that record keeping was not accurate or fit for purpose.

We also found concerns with staff's understanding of safeguarding of the people who used the service. We found that the staff had not received adequate training to meet the needs of the people who use the service, and the staff were not supervised or supported in their role.