Archived: West Ridings Care Home

West Ridings Residential and Nursing Home is a multi-unit site providing care for up to a maximum of 180 people. The service has six units and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were five units open and 113 people who used the service.

The service had 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.

Staff had a secure understanding of safeguarding and whistleblowing procedures.

Staff’s knowledge of how to use equipment had improved since the last inspection and individual risk assessments for people were much more detailed to ensure staff had clear instructions for moving and handling people safely. People were appropriately assessed for equipment and the provider had taken steps to ensure equipment was suitable for people’s needs.

Accidents and incidents were recorded and analysed to good effect to evaluate and share where lessons may be learned and practice may be improved.

Staffing levels were sufficient to meet people’s needs and there was a reduction in the use of agency staff and staff being called from one unit to cover staff absence in another unit. Where a hostess was deployed this was positive and supportive of people’s dietary needs.

Systems were more robustly in place than at the last inspection to assess and monitor the competency of staff.

Training had improved and was more specific for staff to be effective and work safely, such as moving and handling. Staff knowledge of what was meant by people’s mental capacity and deprivation of liberty and processes they may need to follow where a person lacked capacity had been enhanced through training.

Staff were very caring and respectful in their interactions with people. People’s privacy and dignity was promoted well.

Assessment of people’s needs in care records was clearly documented.

There were many meaningful and interesting activities that supported people’s interests. The environment throughout the site had continued to improve since the last inspection and was more welcoming and homely.

There was more rigorous and regular quality monitoring throughout the site and the registered manager had a clear oversight of the strengths and areas to improve. Communication between units had improved which resulted in more cohesive teamwork at all levels.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found there was significant improvement to take the provider out of special measures.

West Ridings Residential and Nursing Home is a multi-unit site providing care for up to a maximum of 180 people. The service has six units and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were only five units open and 127 people living at the home.

The service did not have had a registered manager in post at the time of our inspection, although there was a manager who had been in post since August 2015 and whose application to register with the Care Quality Commission was in progress. 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.

Staff had a clear understanding of safeguarding and whistleblowing procedures.

Staff lacked knowledge of how to use equipment and individual risk assessments for people were not detailed enough to give staff clear instructions for moving and handling people safely. People were not sufficiently assessed for equipment and not all equipment was suitable for people’s needs. This was a continued area of concern from previous inspections.

Accidents and incidents were recorded with some analysis, although there was limited feedback given to staff or opportunities to evaluate lessons learned.

Staffing levels were variable and at times, not sufficient to meet people’s needs due to staff frequently being called from one unit to cover staff absence in another unit. The hostess role, where sufficiently deployed, was positive and supportive. Staff morale was variable and linked to staffing levels in the service.

Recruitment procedures were in place, but lacked rigour to ensure staff suitability was thoroughly determined. Where agency staff were used there were improvements in the suitability checks made. Ongoing suitability of staff was not checked thoroughly or consistently.

Infection control procedures were robustly in place and the organisation of systems to minimise the risk of infection was clear.

There was a new trainer who was enthusiastic about induction and ongoing training for staff. However, training around risk was not in place and some training was not specific enough for staff to be effective and work safely, such as moving and handling. Staff knowledge of mental capacity and deprivation of liberty was variable across the site, although training had been completed.

Staff were patient, kind and caring in their approach on the whole. People’s privacy and dignity was respected and staff gave good explanations to people about their care and support.

Assessment of people’s needs in care records lacked key detail around areas of risk, such as for equipment or support with moving and handling.

There was limited evidence of meaningful and personally engaging interesting activities that were in keeping with people’s interests. The environment for those people living with dementia had improved since the last inspection.

Systems with which to monitor and evaluate the quality of the provision showed some improvements over recent inspections, although they were disjointed and lacked consistency across the service. There were weaknesses in communication, between the units, with the manager, and with the wider organisation. Where serious failings in the service had been previously identified around the management of risk, no action was taken to improve practice and prevent future harm to people.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC is now considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

West Ridings comprises of six separate houses ' Wharfedale unit (residential); Calderdale unit (nursing dementia); Wensleydale unit (residential dementia); Airedale unit (residential); Swaledale unit (general nursing) and Kingsdale unit (nursing intermediate care). The care provided on Kingsdale unit is commissioned by The Mid Yorkshire Hospitals NHS Trust and provided in partnership with staff employed by the Trust.

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People told us they were treated with dignity and their rights were respected. People's comments included:

"It's like a 5 star hotel here."

'Staff are lovely they are very obliging.'

'Very kind.'

All the people we spoke with told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

However, we found people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate care records were not always maintained. We found care records were, in the main, difficult to navigate around and complex.

We looked at the recruitment of new staff. We saw recruitment practice was safe and all necessary pre-employment checks had been carried out.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, policies and procedures were in place and under review to ensure people's rights were protected.

Is the service effective?

People who used the service told us they were asked about their care and able to make decisions about this. However, care records did not show how people who used the service or their relatives were involved in their on-going review.

Staff described how they met and monitored people's health needs. Care records showed that people had regular contact with health and other professionals.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Training records showed that most staff in the home had completed mandatory training and other appropriate training to meet people's care and support needs. This included dementia care. We were told that further training was planned in end of life care and emergency aid.

Is the service caring?

Throughout our observations we saw staff treated people with kindness and courtesy. We saw staff were kind, patient and encouraging when giving support to people who used the service.

People's comments included:

'I'm very happy living here.'

'Would rather be at home but I couldn't wish for a better place.'

'Staff are lovely they are very obliging.'

'I can't thank them enough.'

'I can't grumble about the care and treatment. The staff are very good.'

Overall, people's family members were complimentary of the staff and care and support their relative received. One said, 'I have never, ever heard anyone speak to a resident in anything other than a very nice way.' They said the staff were quick to inform them of any significant changes in their relative's general health and they were always made to feel very welcome when they visited.

Is the service responsive?

We spoke with people who lived in the home about activities. Most people said they had enough to do and enjoyed the activities on offer. However, a number of people said they would like to go out more. The Manager of the service said they had identified the need for a mini-bus but did not at this point know if they would get one.

We saw people who used the service were responded to promptly when they asked for any support or assistance. However, we noted on Kingsdale unit that people had long waits for their lunch time meal.

People knew how to make a complaint if they were unhappy. We looked at complaints records to see how they were dealt with. We found they had been investigated thoroughly and people were responded to in a timely manner.

Is the service well led?

Staff said they felt the service was well managed and the management team were supportive. They said they had confidence any issues brought to their attention were always dealt with properly and thoroughly.

The provider had systems in place to identify and assess risks to the health, safety and welfare of people using the service.

Senior managers from the organisation carried out a monthly audit to check standards and the quality of care being provided. We saw there were action plans developed when any shortfalls were identified.

This inspection was carried out to check compliance actions had been completed following our inspection in August 2013. During the inspection we spent time on all six units in the home. We spoke with sixteen people who were staying in the home, ten relatives, fifteen staff, the registered manager and other senior managers.

We found improvements had been made in five of the houses we visited. People were involved in their care and staff respected their wishes and preferences. We found people's privacy, dignity and rights were respected in these houses. Comments from people who were staying on these units included:

'The staff are helpful and I always feel they treat me properly. If I say I don't want something they respect that and if I need help, they help me'.

'It's good here, it's not like when I was at home, but it's good'.

'I can get up and go to bed when I choose. Staff are very good like that'.

However, on Kingsdale unit we observed practices which showed people's rights were not promoted or respected and their wishes were not considered.

We found improvements had been made in the care documentation and care delivery in five of the houses. People told us they were satisfied with the care they received. One person told us: 'I feel safe and well cared for. The manager is very good and always has time for you and deals with things'.

However, on Kingsdale unit we found there was a lack of management and leadership which meant people did not always receive the care and support they required.

There were effective systems in place to keep people safe by preventing and controlling the spread of infection.

We found there were safe systems in place which ensured people received their medicines when they needed them.

There were effective systems in place to monitor the quality of service people received.

Overall improvements were found across the site in relation to infection control, the management of medicines and quality assurance processes. In five of the houses we found people's privacy, dignity and rights were respected and they were receiving the care and support they needed. However, on Kingsdale unit there remained shortfalls in the provision and quality of care people received, which we considered was due to a lack of effective management and leadership in the unit. Following the inspection the provider took immediate action and transferred an experienced manager and senior nurse onto the unit.

We spent time on all six units in the home. We spoke with twenty eight people who used the service, ten relatives, sixteen staff, the registered manager and the regional manager.

We found inconsistencies across the home in how people's privacy, dignity and choices were respected. We saw people were offered some choices such as what they would like to eat and drink. However we also saw people who wanted to lie on their beds in the afternoon were not able to as their beds had not been made. We found there were some activities taking place, however a number of people told us they were bored.

We found people were generally well cared for but found shortfalls in the care documentation which we considered could impact on the care people received.

We found there were not effective systems in place to keep people safe by preventing and controlling the spread of infection.

We found people received their medicines in a safe way but medicine records were not always accurate and complete.

We found there were sufficient staff to meet people's needs. However feedback from people who used the service and staff suggested there were times when staffing levels were not sufficient.

We found there were not effective systems in place to monitor the quality of service people received.

We spoke with the relatives of two people. Both gave positive feedback; one person said 'We are very happy with care provided, people are well cared for.'

We spoke with two people who live in Swaledale, one of the units within the home, they told us that they had been included in decisions about what care and support they received and when this would be available. One person said 'The staff are wonderful." Another person said 'I have no complaints, If you can't live at home this is the next best thing'. When we asked people about raising concerns one person said 'I feel any concerns would be listened to and resolved.'

We spoke with seven members of staff who were able to demonstrate a good understanding of the needs of the people who lived at the home. They commented that they were well supported by managers of the home.

We had some concerns about the availability of staff to provide occupation and activities for people. We spoke with the manager about this and she told us similar feedback had been made in a recent satisfaction survey. She said they were in the process of looking at ways to address this.