The Care Quality Commission
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Archived: Wispers Park Care Village

Overall: Requires improvement read more about inspection ratings

Wispers Lane, Haslemere, Surrey, GU27 1AD

Provided and run by:
RMH (Wispers) Care LLP

All Inspections

6 March 2015

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 22, 23 and 27 October 2014. Multiple breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified.

We undertook this focused inspection to check that they had followed their plan and to confirm that they have now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wispers Park Care Village on our website at www.cqc.org.uk.

This inspection took place on 6 March 2015 and was unannounced.

Wispers Park Care Village is a nursing home providing personal and nursing care for up to 55 older people some of who are living with dementia. At the time of our inspection 22 people were living at the home. The home is divided into separate units with two of those Oak and Willow in use at the time of inspection. The home is a modern addition to an older building which includes a bistro and communal facilities. The home is part of a larger complex which provides more independent living accommodation on the rural outskirts of Haslemere in Surrey.

At the time of our inspection the interim manager had applied to be the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

On this focused inspection we found the service had made improvements and people were now safe. The requirements of the warning notice in relation to the deficiencies in fire safety, personal evacuation plans and staff knowledge of what to do in an emergency had been met.

People told us that they now felt safe; relatives also told us they thought that their family members were safe. Staff showed a good understanding of safeguarding and what to do if they suspected abuse. Incidents and accidents were managed and reported appropriately

Medicines were stored and administered safely. There was a new electronic system used to help manage medicines safely in the home which reduced the risks to people.

Only two units, Oak and Willow, were now used. Staffing levels had been maintained and as staff were no longer covering three units this meant there were sufficient staff to meet people’s needs. Agency staff use had reduced and people told us staffing had improved however there were occasions when call bells had not been answered quickly. One person told us “I feel safe and there are enough staff at the moment”.

Staff had received some training in key areas however not all staff had received up to date training in areas which included dementia awareness and the Mental Capacity Act (MCA) 2005. Staff told us they felt supported and they had monthly supervision whilst the service made changes.

Records clearly documented what actions staff took to ensure that people‘s healthcare needs were met. Staff described the signs they looked for when people might be unwell and had a good understanding of the care needs of each person. Staff took action when it was identified that people needed medical treatment. A relative told us “My relative seems healthy and they look a lot better than when they were at home”.

People were now supported to eat and drink sufficient, varied food and drinks. Where they had special dietary requirements these were followed. However people also told us that they were not always consulted about the menus provided. Some people told us they usually enjoyed their meal, others said it was “Unappetising”. Nutritional risk assessments had been completed for those that needed it and reviewed regularly. People’s weight was checked regularly, and food and fluid intake was monitored on a daily basis.

Some staff were still not confident about the MCA and Deprivation of Liberty Safeguards (DoLS) but were aware of the importance of explaining the reason for people’s care. Staff gained people’s consent before providing support. People’s capacity had now been assessed and recorded.

The environment had been improved on the unit where people were living with dementia. This had been partially redecorated with bold colours on hand rails and there were memory boxes outside people’s rooms to help orientate people.

Staff treated people with kindness and compassion. They gave reassurance to people when needed. People told us they were treated with respect by the staff. Comments from people were that staff were “Kind” and ”Attentive”. People and their relatives told us that they felt more involved in their care. There were residents and relatives meetings which were welcomed by people.

Care records were reviewed regularly and contained information about people including preferences, likes and dislikes. These were updated where necessary to reflect any changes. Relatives had been invited to attend a review of the care provided and welcomed the opportunity for increased involvement in this.

People and relatives knew who to complain to if they needed to. One relative told us that they were unhappy with the progress of their complaint; the provider had dealt with the only other complaint appropriately.

There were now robust quality assurance processes in place. People and relatives told us they were impressed by the interim manager and the improvements that had been made. One relative told us the interim manager had “Improved the service –previously the place was in such a mess”. Residents and relatives meetings had been introduced so that people’s views could be obtained. Audits that monitored peoples’ health were completed regularly and action taken to improve peoples’ health. Staff were clear about what was expected of them.

We recommend that staffing levels are regularly reviewed to ensure that people’s needs are met in a timely way.

22, 23 and 27 October 2014

During a routine inspection

This inspection took place on the 22 and 23 October 2014 with a pharmacy specialist visiting on the 27 October 2014. The inspection was a comprehensive inspection which was brought forward due to concerns being raised about the quality of care being provided. This inspection was unannounced. The previous inspection took place on 18 June 2014 and found the home was complying with the outcomes we inspected at that time.

Wispers Park Care Village is a nursing home providing personal and nursing care for up to 55 older people. At the time of our inspection 26 people were living at the home. The home is divided into separate units with three of these, Oak, Beech and Willow in use at the time of inspection. The home is a modern addition to an older building which includes a bistro and communal facilities. The home is part of a larger complex of buildings which provides more independent living accommodation on the rural outskirts of Haslemere in Surrey. At the time of our inspection there was no registered manager at the home. A management team and acting manager were in place whilst a new manager was being recruited and applying to register.

A registered manager is a person who has registered with the Care Quality Commission (CQC)  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.

During the inspection we spoke with 10 people, five relatives and 10 members of staff. We also spoke with the acting manager and other representatives from the provider’s organisation.  Before the inspection we reviewed the information we hold about the service and took into account cocnerns we had received. We spoke with social workers and nurses who had visited the home as representatives of health authority.

People expressed contradictory views about how safe they felt at the home. Whilst some people felt very safe, others said they felt unsafe and that the staff did not always protect them from harm. Staff did not always know how to protect people from harm or the risk of harm.  Staff had not acted to identify and respond to possible abuse. This is a breach of Regulation 11 (1) (a) (b) (3) (d) of the HSCA 2008 (Regulated Activities) Regulations 2010 Safeguarding people who use services from abuse.

Some people said their movement was restricted because of safety measures such as key pad locks in some areas of the home. When these restrictions were in place people had not had their ability to make their own decisions or their best interests considered. People and their relatives had not been consulted about their care. Their consent to their care and treatment had not been sought or recorded. This meant that people could not be assured that the staff were acting according to their wishes. These are breaches of Regulation 18 of the HSCA 2008 (Regulated Activities) Regulations 2010 Consent to care and treatment.

The home did not have suitable quantities of staff with the required skills and experience. People told us they had to wait for help with their personal care. People also said there were not enough staff to help them go out as often as they would have liked. Not all the staff knew about people’s care or their individual needs. Staff training and supervision was inconsistent which led to some staff not receiving appropriate training to care safely for people. This is a breach of Regulation 22 of the HSCA 2008 (Regulated Activities) Regulations 2010 Staffing.

Incidents and accidents had not always been responded to in a way that meant the staff could take actions to prevent them happening again.

People had not always been properly assessed, had their care planned or delivered to meet their individual needs. The staff did not always have access to the most up to date information about people’s needs. This meant people were at risk of receiving inappropriate or unsafe care.

People were at potential risk in the event of a fire because the provider had failed to act on the requirements of two fire authority reports. The staff had not been trained to protect people in the event of a fire.

The examples above are breaches of Regulation 9 (1) (a) (b) (i) (ii) (2) of the HSCA 2008 Regulations (Regulated Activities) Regulations 2010 Care and welfare of people who use services.

People were not having their nutritional needs met. Staff did not always know people’s dietary needs or offer people suitable choices. People were not always being assisted to eat and drink and their food and fluid intake was not effectively monitored which put them at risk of malnutrition and dehydration. This is a breach of Regulation 14 (1) (a) (c) HSCA 2008 (Regulated Activities) Regulations 2010 Meeting nutritional needs.

Medicines were not managed safely, we found medicines stored incorrectly. It was not always clear from the records whether people had the medicines they were prescribed at the right times or in the right doses. The arrangements for treating people with the correct doses of medicine for their diabetes were inconsistent. Several people told us they had been given their medicines much later than the prescribed times.  This is a breach of Regulation 13 of the HSCA 2008 (Regulated Activities) Regulations 2010 Management of Medicines.

Where people had complained the provider had not dealt with these according to the complaints procedures. People, their relatives and staff had not been asked their views about the quality of the care or about improvements they would like to see.

The provider had not managed the risks to people that had been identified. When people were losing weight the staff had not taken action to ensure they had the care and treatment they needed to prevent their health deteriorating further.

The provider had known there had been deterioration in the service and care provided for some time but had failed to take robust and effective action until the two weeks prior to this inspection and during the inspection.  The examples above are breaches of Regulation 10 (1) (a) (b) (d) (i) (ii) (iii) HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of the service provision.

People had contradictory views about how caring the staff were. People said sometimes the care they received depended on the staff available to care for them. We observed and were told about instances where staff did not treat people respectfully or in a caring manner.

People’s dignity and privacy were not always being protected. Staff entered people’s room without knocking and waiting for people to respond. People were not always receiving the personal care they needed to maintain their dignity. People or their relatives had not been enabled or included in making decisions about their own care. They had not been encouraged to express their views about what was important to them. The examples above are breaches of Regulation 17 (1) (a) (b) (2) (a) (b) (c) (I) (ii) (d) (f) HSCA 2008 (Regulated Activities) Regulations 2010 Respecting and involving people who use services.

The home had not been designed or adapted to meet the needs of everyone who had been admitted, especially people who were living with dementia. There were no adapted signs indicating where people could find the toilet for example. This is a breach of Regulation 15 (1) (a) HSCA 2008 (Regulated Activities) Regulations 2010 Safety and suitability of premises.

Some people made comments about how kind the staff were and how the staff response to their call bells was usually ‘excellent’. We observed some very kind interactions when staff assisted people with their needs in a caring and thoughtful way.  

The new management team had started to identify the shortfalls in the care and service and had begun to take actions to address these. However, at the time of this inspection there were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We recommend that the service considers how they could improve the activities provision to suit the individual needs of the people living at the home.

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

18 June 2014

During an inspection in response to concerns

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

' Is the service safe?

People told us that they enjoyed living at the home and that they felt comfortable, safe and well cared for. One person said, 'It's very friendly here. I got a lovely welcome when I arrived and I settled in very quickly' and another told us, 'It's an absolute haven for me. I feel part of a community here.'

Prior to this inspection, CQC received information of concern about standards of health and safety in the home. We checked health and safety records and spoke with the manager and maintenance officer about health, safety and maintenance in the home. We found that the manager and maintenance officer were aware of the shortfalls in health and safety and had begun to address them.

' Is the service effective?

Prior to this inspection, CQC received information of concern about staffing levels in the home. We were also told that there was an over-reliance on agency staff and that some agency staff did not speak English well enough to communicate effectively with the people they supported.

During our inspection we observed that there were sufficient staff on duty to meet people's needs. The people we spoke with told us that staff were always available when they needed them. They said that staff arrived promptly when they used their call bells.

We found that the home was using a significant number of agency staff but that this was necessary to cover vacancies on the permanent staff team. The provider was actively recruiting permanent care staff at the time of our inspection and considering ways in which recruitment strategies could be improved. The manager told us that, until the permanent vacancies were filled, the home had identified an agency able to supply regular staff, which meant that people received consistent care and support.

The manager was aware of the concerns about some agency workers' language skills and had raised the issue with the agency, who responded by supplying staff who possessed a good command of the English language. The agency staff we spoke with during our inspection had appropriate language skills and we observed that they communicated effectively with the people they supported.

' Is the service caring?

People told us that staff were polite and treated them with respect. We observed that staff engaged positively with the people they supported and communicated effectively with them.

People said that staff knew their needs well and that they provided the care they needed in the way they preferred. One person told us, 'They know how I like things done' and another said, 'The staff are first class. I can't fault them.'

' Is the service responsive?

People told us that their views were listened to and that any concerns they raised had always been dealt with satisfactorily. One person said, 'I've always been able to talk to someone if I've had a problem. Whatever I've brought up has always been put right.'

We found that measures had recently been introduced to improve opportunities for people to have their say about how the home was run. For example a residents' food committee had been established to ensure that that the menu reflected people's tastes and preferences.

' Is the service well-led?

Prior to this inspection, CQC received information of concern about the support and leadership provided to staff. During this inspection we spoke with staff at all levels of responsibility about the support they received to do their jobs.

All the staff we spoke with told us that they had access to good support and appropriate training. They said that they had regular opportunities to discuss their professional development and training needs. One member of staff told us, 'The support I've had since I started has been really good. I've learned a lot since I've been here.' Staff told us that the manager adopted an inclusive approach and encouraged their input into improving standards. One member of staff said, 'He tries to involve the whole team; he takes everybody's views on board.'

11 December 2013

During a routine inspection

At this inspection the home had seven people living there. We spoke with four people who used the service, three staff and the manager. We spent time observing the interactions between people and staff who were on duty. We found that people's care needs were assessed and in most instances planned for and that staff provided support in a sensitive and safe way.

Everyone expressed satisfaction with the service provided. For example, one person told us, "I am very happy here. The staff are lovely and very helpful."

The provider's recruitment practices were generally robust and protected people however they did not always have information available on the agency staff used.

Everyone that we spoke with said that they felt confident that issues or concerns they had would be resolved if raised with management of the service. One person said, "The manager is good at his job, I find him very approachable".