This unannounced inspection was carried on 25 September 2018.

Wey House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Wey House provides care for up to 31 people with complex neurological conditions, acquired brain injuries and/or other physical disabilities. People who live at Wey House have complex nursing and other support needs and many of them are unable to communicate verbally. At the time of the inspection there were 28 people living at the home.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good

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. People and staff commented positively about the registered manager.

Staff were aware of the risks relating to people, although not all of these had been formally assessed and recorded. Staff told us there was a culture of learning from incidents.

People’s care plans were detailed and although some aspects of them were not fully up to date, staff were aware of people’s needs. The registered manager was in the process of reviewing all of the care plans and transferring them onto a new electronic system.

People’s consent to care was in the main sought in line with legislation and guidance.

Staff knew how to recognise and report abuse and were confident any concerns would be investigated. People received safe care and support from adequate numbers of staff who had the skills and experience to meet their needs.

There were systems in place to minimise the risks of the spread of infection in the home. There were a range of checks in place to ensure the environment remained safe. The environment was suitable to meet people’s needs.

People’s health was monitored by trained nurses and they had access to other healthcare professionals to meet their individual needs. People received their medicines safely.

People’s nutritional needs were assessed and people’s weights were monitored. Where aspects of people’s care required monitoring, records were consistently completed.

People were cared for by staff who were kind and caring. One person told us, “You get to know them, you trust them.” We observed positive interactions between people and staff.

People were treated as individuals and staff supported people to make choices about their day to day lives. Staff knew people well and provided care that was personalised to their wishes and needs.

People knew how to raise concerns and could be confident these would be responded to. There were systems in place to ¿share information and seek people's views about their care and the running of the home. ¿

The service was well led by a registered manager who had the right skills and knowledge to undertake their role. There was a management structure in the home, which provided clear lines of responsibility and ¿accountability.

The quality assurance systems in place were effective at identifying shortfalls in the service and ensuring action points were completed.

Further information is in the detailed findings below

The inspection took place on 4 February 2016 and was unannounced.

At the last inspection on 12 February 2015 we found improvements were required. There was inconsistency and lack of clarity about some aspects of people’s care records and social and leisure activities were limited. At this inspection we followed this up and found improvements had been made. We found a significant improvement in the consistency and accuracy of people’s health monitoring records and people were enjoying greater staff engagement and more recreational activities.

Wey House is registered as a nursing home for up to 37 people with complex neurological conditions, acquired brain injuries and/or other physical disabilities. People who live at Wey House have complex nursing and other support needs and many of them are unable to communicate verbally. At the time of the inspection there were 20 people living at Wey House. A major refurbishment to improve the environment had recently been completed. There were now 31 modernised bedrooms available. The provider has applied to change the home’s registration accordingly, to accommodate a maximum of 31 people. The home is also equipped with assisted bathrooms, a hydrotherapy pool and other specialised rehabilitation facilities to support people’s complex mobility needs.

The previous manager of the home had left a couple of months earlier. The two new home managers had applied to the Care Quality Commission to become the registered manager for the service, on a job share basis. Their application was still in progress at the time of the 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.

People who lived in the home, their relatives, staff and external healthcare professionals all said the home’s new managers were very open, accessible and responsive. One relative said “The managers are very good and they definitely care about the residents”. A senior healthcare practitioner said “[Manager’s name] has got the place by the scruff of the neck and is driving up improvements”. All of the staff we met were highly motivated and spoke positively about the service. They said everyone worked really well together as a supportive and dedicated team.

People’s needs were fully assessed, prior to moving to the home, and regularly thereafter to ensure people’s changing care needs were met. There were always at least two qualified nurses on the day shifts to ensure people’s complex clinical needs were monitored and met. A community nurse specialist told us “There have been no recent concerns or safeguarding issues”.

People and their relatives told us the management and staff were very caring and always treated them with respect. One person who lived in the home said “I think it’s a lovely home. The staff are all genuine, friendly and kind people”. We observed numerous examples where staff demonstrated a caring and compassionate approach toward the people they were supporting. There were also examples of valuing and involving people in the running of the home. A new member of care staff informed us that one of the people who lived in the home was on their interview panel.

People had a range of specialised equipment available to them and regular testing took place to ensure equipment was safe for people to use. However, some checks were not consistently recorded. The managers undertook to address this straight away.

Staff told us there were always sufficient staff numbers to keep people safe and to meet their needs. The number of agency staff hours had reduced by almost half since the recruitment of new permanent care staff. Current nurse vacancies were covered by block bookings of regular agency nurses to ensure co

This inspection took place on 12 February 2015 and was unannounced.

At the last inspection on 23 September 2014 we found there were breaches of legal requirements. We asked the provider to take action to make improvements to: care records, inconsistent care practices and delays in resolving previously identified concerns. We received a provider action plan stating the relevant legal requirements would be met by 29 December 2014. At this inspection we followed this up and found most of the actions had been completed although some further improvements were needed.

Wey House is registered to provide long term nursing care for up to 37 people with neurological conditions, acquired brain injury and physical disabilities.  The home is equipped with a hydrotherapy pool and other rehabilitation facilities. At the time of the inspection there were 25 people living at the home. People had complex nursing care and other support needs and many of the people were unable to communicate verbally due to their physical or mental health needs.

A new manager was recruited in September 2014 and had applied to the Care Quality Commission to become the registered manager for the service. 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 this inspection we found people were not always supported to participate in their planned recreational activities. Some people who chose not to socialise with others had little to interest them. People and their relatives told us more could be done to provide further interest and social stimulation.

Where there was a change in a person’s condition this was reported to a nurse and action was taken. However, the nurses only recorded a brief summary assessment, for example “low fluid intake” or “drank well”. Nursing notes did not record the specific actions taken, such as providing a suggested volume of fluid intake at regular intervals or reasons for the fluctuating intake. This level of detail would have provided greater assurance about the actions taken or alternatively if there were no concerns.

Repositioning of people with mobility difficulties was recorded in different ways by different staff during the day time. This inconsistency meant it was difficult for others to check whether people had been repositioned at the correct intervals. Failure to reposition people at regular intervals could result in painful pressure sores. We did not find any evidence of pressure damage but the manager undertook to ensure clearer repositioning guidelines were issued to staff.

As detailed above, some aspects of care records still required improvement. However, in general, there was a marked improvement in the accuracy of people’s health monitoring records since our last inspection.

People, relatives and staff told us they had observed an improvement in the service since the appointment of the new senior team. They said the new manager was visible, approachable and responsive. We were told people’s care and support was much more consistent and had improved overall. One person said “Things are turning around now”.

People were protected from the risk of abuse or avoidable harm through appropriate policies, procedures and staff training.  People said they felt safe and management would deal with any concerns to ensure they were protected.

There was enough staff to meet people’s needs and keep them safe. The service was making progress with filling staff vacancies although temporary agency staff were used to cover some of the shifts.               

People and their relatives told us staff were kind and compassionate and “knew what they were doing”.  People’s friends and family could visit the home without undue restrictions and they spoke with their families regularly on the telephone. Staff received regular training to make sure their skills and knowledge were up to date. People had access to a range of external healthcare professionals to help them maintain good health.

People’s views were sought and where people were unable to make certain decisions about their care the provider acted in line with current legislation and guidance to protect their rights.

People’s nutritional needs were assessed to make sure they received sufficient food and drink. People told us the food was of good quality, served at the right temperature and a choice was always available.

People received their medicines safely and on time.

The home was clean and tidy but many areas of the home were in need of refurbishment. A major redevelopment programme had commenced with a planned completion date by September 2015.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

Prior to this inspection, information of concern was received by CQC through our ''have your say” website form about staffing levels within the service. At the time of the inspection the service was the subject of a ‘whole home safeguarding process’, overseen by Somerset County Council. There had been two incidents of concern in the past four months which related to the management of epilepsy and PEG feeding (PEG feeding is used where people cannot maintain adequate nutrition with oral intake). Concerns had also been raised about pressure area management. We have chosen outcomes that relate to the concerns we received, namely the care and welfare of people using the service and staffing levels.

At the time of this inspection there were 29 people living at the service. We met with the majority of people and spoke with four in some depth to hear their views and experiences of living at Wey House.

We spent time observing the care and attention delivered to people and reviewed various records, including care records. We also spoke with five relatives, four health professionals, and 10 members of staff, including the registered manager.

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

Is the service safe?

All of the people spoken with told us they felt safe at the home, that staff treated them with respect and kindness and that they were happy with the level of care they received.

All five relatives we spoke with felt their family member was safe at Wey House.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found the service had a range of specialist equipment such as pressure relieving equipment, specialist wheelchairs and moving and handling aids to help reduce risks.

There were usually enough qualified, skilled and experienced staff on duty unless the service was unable to cover short notice sickness.

Is the service effective?

People's preferences and interests had been recorded and care and support was provided in accordance with people's wishes. People told us their current needs were being met by the service.

We spoke with five visiting relatives. They told us they were satisfied with the care and support their family member received. Two relatives described the improvement to their family member’s physical, emotional and psychological health since their admission to Wey House.

We spoke with a speech and language therapist (SALT) and a dietician. Both told us referrals to their service had been appropriate and that staff had recognised where people required their specialist input.

Visiting professionals told us the home communicated well with them and there was an open and friendly atmosphere.

Some people’s personal records were not always accurate or fit for purpose. Not all records could be located promptly when needed. We have judged this outcome as non-compliant. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records.

Is the service caring?

We observed staff to be friendly and polite when interacting with people and they were able to offer reassurance to people who appeared anxious or restless. At mealtimes, people were assisted in a dignified and safe manner, as described in their care plans. When assisting people with personal care staff were discreet and respectful, promoting people’s privacy and dignity.

Relatives told us they found the staff team to be caring and kind. Comments included, “We are happy with the care and attention X is getting. X loves it here”; “This is the best placement X has had…” and “I know this is a good place and we are very happy with the care”.

Visiting health professionals told us when they visited there was a “happy” and “lively” atmosphere at the home. Professionals described the support staff as, “really good”, “very knowledgeable and caring” and “very helpful”.

Is the service responsive?

Relatives and health professionals felt the service was responsive to people’s changing needs and they were informed of any changes to people’s condition appropriately.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Professionals we spoke with expressed their confidence in the manager and staff.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received the care they required.

Staff demonstrated a good understanding of the ethos of the home. Relatives and visiting health and social care professionals told us the registered manager was approachable and open and honest. This meant people using the service, relatives and professionals could raise issues and be confident they would be listened to and acted upon.

We brought forward this inspection in response to some information of concern received by CQC through our ''have your say about a service website form.'' We have chosen outcomes that relate to the anonymous concerns we received. This centred on staff attitude and possible lack of respect for people they cared for, staffing levels and a lack of recording of possible serious incidents within the home.

Two inspectors spent time at the home during the afternoon and early evening. We spoke with six people who live at Wey house and to two visiting relatives. We also spoke with seven members of staff, including care staff, nurses, and the manager. We looked at some key records including plans of care, risk assessments and records about how the home monitor behaviour that challenges the service.

People we spoke with who were positive about their experiences of living at the home . Comments included '' Staff give me a chance to do as much as I can for myself.'' ''Staff are all nice here, they help me.''

One relative said “when I leave here I am never worried. I know he is looked after properly. I trust them to do what’s right for him”.

We found that care, treatment and support was well planned. Staff understood the needs of people they cared for and told us they were well supported to do their job.

We found that all parts of the home were clean although there was a malodorous smell in some parts of the building.

Records were accurate and kept secure.

This was an unannounced inspection carried out by one inspector and a Specialist Nurse Advisor.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still on our register as a Registered Manager at the time of the inspection.

There were 27 people living in Wey House on the date of our inspection. Most of the people had cognitive and communication impairments which meant it was difficult for us to hold conversations with them. We spoke with three of the people who were able to communicate verbally with us and we observed the care provided to people who were less able to communicate. We also spoke with the relatives of three people and to eight members of care staff.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service caring?

Everyone we spoke with said the staff were very kind and caring. This was supported by our own observations. We saw staff supported people in a friendly, discreet and respectful manner. We heard staff offering people reassurance when they appeared anxious.

One person who lived at Wey House said “Everyone is very friendly”. A relative of another person said “My relative has a lovely young care worker. She really understands Z’s needs and is absolutely brilliant. It’s great to see Z so happy”. Another person’s relative said “Staff are very kind and considerate. My relative absolutely loves it here. It is the best home they have lived in”.

The provider consulted people and their relatives to obtain their views about the care and treatment received. One relative told us “We’ve just been asked to complete a satisfaction questionnaire. Overall I would rate the service eight out of 10”. Another relative said “They are good at involving me. I don’t hear a lot from them these days because my relative is fairly stable but they always contact me when they need to”.

Is the service responsive?

People and their relatives told us the managers and the care staff were very supportive and responsive to their needs.

To enable the service to understand people’s needs they carried out an assessment of people’s care and nursing requirements prior to them moving to the home. People living at Wey House had a range of diverse needs, including brain injury or mental disorder, physical rehabilitation, and end of life care. Individual care plans were developed with input from the person, to the extent they were able, relatives, staff, health and social care professionals.

Care plans contained a lot of relevant information to enable staff to meet each individual’s needs and personal preferences. This included people's preferred daily routines, communication needs, personal care, continence needs, dietary requirements, mobility and decision making abilities. Care plans identified where best interest meetings were required to make certain decisions on behalf of people who lacked the mental capacity to make those decisions.

Is the service safe?

We found there was a lack of proper information and accurate recording of people’s daily care activities. This meant people were at risk of unsafe or inappropriate care and treatment.

However, people told us they felt safe. One person said “Yes I feel safe here. Some residents can become agitated but the staff are good at sorting it out”. Another person’s relative said “I am confident they keep X safe and look after their health needs”.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards is in place to protect people’s freedom and human rights. The manager was aware when a DoLS application should be made and knew who to go to if an application was required.

Is the service effective?

The service was not always effective in providing care and treatment in line with people’s individual care plans. There was inconsistent recording of important care monitoring information. This included incomplete and missing daily repositioning charts and daily fluid intake charts.

People and their relatives told us they were generally happy with the care and treatment provided but expressed some reservations. One relative said “I’ve had concerns about staff turnover. The staff are very sweet but quite often they don’t know my relative”. Another relative said “The quality of care is very good but Z is left alone for long periods. I think they need more one to one staff time”. A third relative said “Y is very happy and I haven’t ever needed to complain. But I think they could do more activities if they had more staff”.

Staff expressed mixed views about the standard of care provided. One care worker said “The care is exceptional but the paperwork and communications is poor”. Another care worker said “I think people get OK care, it’s not great but it’s not awful”.

The Operations Manager said a large number of agency staff had been used at the home over the summer period to cover staff vacancies and absences. They had recently been successful in appointing new nurses and support workers. A new activities co-ordinator post was also being recruited.

Is the service well led?

The service had not been well led over the last year but there were some recent signs of improvement. Staff told us the series of management changes had resulted in an inconsistent approach and confusion about who was responsible for the different levels of decision making. One of the care workers said “We’ve had four different managers in the last 12 months. There’s been no consistency. The manager would say one thing, the nurse another, and the senior something else. I think this explains the position we are now in”. One of the nurses told us “Until recently the structure was very unclear. The nurse’s role is now a lot more defined”. Another care worker said “Until recently no one was listening, you might as well complain to the wall. I am very optimistic about the new manager and the new clinical lead”.

The Operations Manager told us they had taken on the manager’s role over the last three months pending the recruitment of a new permanent manager. The new manager had started the week before our inspection. The Operations Manager said “It’s still early days but real progress has been made in terms of recruitment, training and working practices”.

We found concerns identified in our previous inspections, in September 2013 and April 2014, had not been resolved. The provider’s quality monitoring systems had not been effective in promoting and implementing the necessary improvements to the service.

Relatives told us the home’s management style was very open. They said they were always made to feel welcome when they visited. One relative said “I’d be quite happy to talk with the managers about any concerns”. Another relative said “Management have responded every time I have raised something. They are very professional and talk things through with me”.