About the service:

Wilbraham House is a residential care home that was providing personal care to 31 people at the time of the inspection.

People’s experience of using this service:

¿ The provider’s governance systems were not effective at identifying and acting upon all necessary improvements.

¿ This is the fifth consecutive inspection where the provider has failed to ensure a rating of good at the home.

¿ The provider had failed to properly maintain the home’s bathrooms and toilets. As a result these areas were not able to be kept clean and hygienic. The provider had no cleaning schedules in place and this increased infection control risks.

¿ Although improved, people’s risk assessments were not always up to date.

¿ People’s care records did not always show the actions staff had taken to provide effective and responsive care.

¿ Staff understanding of when to report incidents as abuse had improved, but we found two incidents which had not been reported as such.

¿ Although redecoration of the home had started, further work was needed to ensure it met people’s needs.

¿ There were safe systems for the management and administration of people's prescribed medicines.

¿ People were supported by adequate numbers of staff who gave support in a timely manner.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff understood the importance of ensuring people's rights were understood and protected.

¿ People were supported by staff who knew them well, had good relationships with them and involved them in the planning of their care.

¿ People were happy with the care and support they received and gave positive comments about the staff at the home.

Rating at last inspection:

At the previous inspection the service was rated requires improvement (report published 27 March 2018).

Why we inspected:

This was a planned inspection to check the provider had made the require improvements since our previous inspection.

At our previous inspection in December 2017 we found four breaches in regulation. These breaches were because the provider did not have effective quality systems in place, did not always safeguard people from abuse and did not always assess or monitor risks to people. They also had not notified us of important events they are required to tell us about by law. After the inspection we issued the provider with a warning notice. At this inspection we found the provider had failed to achieve compliance in accordance with the warning notice.

Enforcement:

Action we told provider to take is at the end of the full report.

Follow up:

We will continue to monitor the provider and report on our findings.

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

We completed an unannounced inspection at Wilbraham House on 5 and 6 December 2017. At the last inspection on 6 February 2017, we found a breach in regulation11 because people’s ability to consent to their care was not always assessed. We asked the provider to take action to make improvements and we found that there had been an improvement in this area. However, we identified further breaches in regulations and improvements were still needed to ensure that people received a good standard of care.

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

Wilbraham House accommodates up to 33 people in one adapted building. At the time of the inspection there were 29 people who were being provided with a service. People who used the service predominately had physical disabilities and/or mental health needs such as a learning disability or dementia.

There was an application in process for a registered manager at 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 the time of the inspection our records showed the previous registered manager’s name was still against the service. We spoke with the provider who stated that they had requested the previous registered manager to de-register with us (CQC).

We found that the provider had not sustained all the improvements from previous inspections and the systems in place to monitor and manage the service were ineffective. This meant that areas of poor practice had not always been identified.

The provider had not notified the commission of incidents and events without delay as required by law.

Improvements were needed to ensure that records contained accurate and up to date information.

People’s risks were not always planned for, which meant people were at risk of unsafe and inappropriate support.

People were not always safeguarded from abuse because staff had not always recognised possible abuse and therefore these incidents had not been reported as required.

Improvements were needed to ensure that people’s cultural and diverse needs were considered in the assessment of their needs to enable effective planning and individualised care provision that met people’s preferences.

Improvements were needed to the quality of the lunchtime meal to ensure they suited people’s individual preferences.

We found improvements were needed to ensure that staff understood the training they had received and how this needed to be carried out as part of their role.

People told us staff were caring towards them. However, provider had not always ensured that people were cared for in a way that protected their dignity and and kept them safe from potential harm.

Improvements were needed to ensure that the provider’s complaints policy was up to date and accessible to all people who used the service.

There were enough suitably recruited staff available to meet people’s needs in a timely manner.

People received their medicines as prescribed and infection control measures were in place to protect people from potential infection risks.

People were supported to consent to their care and there were systems in place to ensure that decisions were made in people’s best interests and in the least restrictive way.

People’s health was monitored and health professionals input was sought where needed.

The environment was adapted to promoted people’s needs and independence and there were plans in place to make further improvements to the environment.

People’s choices were promoted and respected by staff in a way tha

We completed an unannounced inspection at Wilbraham House on 8 February 2017. At the last inspection on 16 September 2016 we found breaches of the regulations. After the last inspection, the provider wrote to us to say what they would do to meet the legal requirements. We undertook this focused inspection to check that they had followed their plan and to confirm that they 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 Wilbraham House on our website at www.cqc.org.uk.

As a result of our last inspection, this provider was placed into special measures by CQC. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Wilbraham House are registered to provide accommodation with personal care for up to 33 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 29 people.

There was a registered manager at 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 identified a new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 were not always followed. We were unable to ascertain if people had capacity to make certain decisions and if people were unable to consent we could not always be assured decisions were made in their best interests.

We found that improvements had been made to the number of staff available at the service. However, we found that further improvements were needed to ensure staff were deployed across the service.

The provider had made improvements to the systems in place to assess, monitor and improve the quality of care. However, some further improvements were needed to ensure all areas of care were assessed and monitored to mitigate potential risks to people.

Records were stored safely to protect people’s confidential information. Some improvements were needed to ensure all records contained detailed and up to date guidance for staff to follow.

Risks to people’s health and wellbeing were identified, managed and followed by staff safely.

Improvements had been made to the systems in place to monitor accidents and action had been taken by the registered manager to reduce the risks of further occurrences.

People were supported with their nutritional needs and monitoring was in place to ensure people ate and drank sufficient amounts.

Advice was sought from health and social care professionals when people were unwell. We found that this advice had been documented and was being followed by staff to maintain and support people's physical and emotional wellbeing.

People were protected from the risks of abuse because staff understood how to recognise and report possible abuse.

We found that medicines were administered and managed in a way that protected people from the risk of harm.

The provider followed safe recruitment practices to ensure that people were supported by sufficiently trained staff that were of a suitable character to provide support

We completed an unannounced inspection at Wilbraham House on 16 September 2016. At the last inspection on 10 March 2015, we found that the service was meeting the regulations.

Wilbraham House are registered to provide accommodation with personal care for up to 33 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 32 people.

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.

There was a registered manager at 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 identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people’s health and wellbeing were not consistently identified, managed or followed by staff safely. We found there were not enough staff available to deliver people’s planned care or to keep people safe.

We found that medicines were not administered in a consistent and safe manner and they were not always administered as prescribed.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the manager and provider.

Systems in place to monitor accidents and incidents were not being followed or managed to reduce the risk of further occurrences.

People did not always get the support they needed to eat sufficient amounts. Staff were not always available to monitor people were eating sufficient amounts. This meant some people’s nutritional needs were not met.

Staff told us they received training. However, we found that some of the training they had received was not effective. There were no systems in place to ensure that staff understood and were competent to support people safely and effectively.

Advice was sought from health and social care professionals when people were unwell. However, we saw that people were not always referred to specialist he

We inspected Wilbraham House on 10 March 2015. The inspection was unannounced.

The provider is registered to provide accommodation and personal for up to 33 people. This includes care for people with physical needs and dementia care needs. At the time of our inspection, 32 people used the service.

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 and associated Regulations about how the service is run.

At our last inspection of the service on 22 September 2014, the provider was compliant against the Regulations we inspected against.

The provider did not have suitable arrangements in place to effectively support people who lived with dementia.

People were not always supported to engage in activities and hobbies of interest. The provider did not always ensure that people were engaged in activities they enjoyed.

People were protected from the risks of abuse because staff understood what constituted abuse and took action when people were at risk of abuse. There were appropriate numbers of staff employed to meet people’s needs. People’s care needs was planned and reviewed regularly to meet their needs.

People were cared for by staff that had the knowledge and skills required to care and support them. Staff had received training to enable them to provide care safely, and received regular supervisions to support them to carry out their roles and responsibilities effectively.

Legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) were followed when people were unable to make certain decisions about their care. This meant that people’s liberties were not restricted inappropriately. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate; decisions are made in people’s best interest.

People told us they liked the food and were supported to eat and drink adequate amounts. We saw that people were offered a choice of food during meals. Other health care professionals visited the service regularly to provide additional healthcare services to people. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People were cared for and supported by staff who knew them. People told us the staff were kind and treated them with dignity and respect. People’s care was tailored to meet their individual needs. Care plans detailed how people wished to be cared for and supported.

People who used the service, their relatives and the staff were very complimentary about the registered manager of the service. They told us the registered manager was always available and was approachable. They were encouraged and supported to provide feedback on the service. The provider had effective systems in place to review the quality of the service provided.

This inspection was carried out by a CQC inspector. We spoke with six people who used the service, five relatives, four members of staff and the registered manager. We also reviewed records relating to the management of the home which included three care records, medication records, staff training records and minutes of meetings for staff and people who used the service. We used the information to answer the five questions we always ask:

Is the service safe?

Each person had signed their care records indicating they agreed to the care, treatment and support they were to receive. If people were unable to make more complex decisions, such as moving to another service, the provider had followed the principles of the Mental Capacity Act and involved relatives and advocates in making decisions that were in the person's best interests.

Care records contained detailed information about people's health and support needs. Information included risk assessments relating to daily living and the measures in place to reduce those risks. This provided a current profile of people's needs and risks. This meant that staff had appropriate information to keep people safe.

People received effective and safe support to take medicines they had been prescribed because detailed and accurate records had been kept and evaluated by senior staff. Staff had regular assessments of their competency to administer medicines. This meant people were protected against the unsafe use and management of medicines.

People at risk of poor nutrition had been referred to health care professionals. Daily food and fluid intake records had been established to monitor people's intake. Staff completed the records and they were reviewed daily. We noted that eight people had monitoring records, but there had been no record of people being offered or receiving fluids when awake at night time. The manager intended to raise this urgently with night staff.

When people's needs changed records including risk assessments had been updated. Monthly reviews had been monitored by senior staff to ensure care plans contained the changes identified in the reviews.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. This usually involves a restriction in a person's liberty to ensure their safety or the safety or others. Authorisation has to be sought from the local authority that may authorise the DoLS. We saw that no DoLS authorisations were in place at the time of our inspection. Five applications had been submitted for approval to the local authority.

Is the service effective?

People's health care needs were recorded in care records. Where people's needs changed timely referrals had been made to a range of health professionals. We spoke with a visiting GP and health professional who both confirmed they had no concerns about the standards of care provided by the service.

People told us that they were happy with the care they received and felt their needs were being met. There was a relaxed and positive atmosphere in the home. We observed good engagement and relationships between staff and all people using the service. A relative told us, "I have no concerns about the quality of care that X receives. I would quickly say if that was not the case."

Is the service caring?

We observed natural and relaxed conversations and interactions between staff and people who used the service. We saw that staff had a good understanding of how people were feeling and were able to respond to what they needed.

We asked three people who used the service for their opinions about staff and the support they received. Feedback was positive. One person told us, "The staff are really good to me they are friendly and helpful. I am happy with everything. I like living here."

We saw from questionnaires sent to people and their relatives that there was a high level of satisfaction with the service. Comments relating to staff and care contained particularly positive comments about staff commitment and satisfaction with the quality of care and support provided."

Is the service responsive?

When people's health care needs changed external health professionals were contacted. Their actions and recommendations had been recorded in care information and acted upon.

We saw from minutes of meetings with people using the service that people's views had been sought about a range of matters including activities, food and ideas or suggestions about any aspect of the service. We saw that suggestions made had been acted upon.

People and their relatives were aware of how to make a complaint. A relative told us they had not had the opportunity to raise some areas of dissatisfaction with the service. We spoke with the registered manager who arranged to meet the family and investigate their concerns under the complaints procedures of the service. We saw that complaints made since our last visit had been responded to swiftly. Examples we saw included compensation for loss of a ring and damage to a picture frame. The service had apologised where there had been shortfalls relating to daily checks concerning an aspect of personal care.

Is the service well-led?

Staff were clear about their responsibilities. They told us that they felt supported by managers. A staff member told us they felt that they were listened to and could approach managers at any time. This included on-call arrangements out of hours. This helped to ensure that people received a good quality service at all times.

The provider had a quality assurance system of checks and audits in place. The manager reported weekly to the providers and also had a weekly meeting with them when each person's progress was discussed and any concerns were raised and discussed. At least two of the directors visited the home three times each week. Relatives had been invited to meet the providers to raise any matters for discussion. Providers were easily accessible to people who used the service, relatives, visitors and staff. People were listened to. The manager and providers worked closely together to identify any shortfalls. As a result the quality of the service was continuously improving.

During the last inspection on 30 October 2012 we found that the provider was not meeting some of the essential standards of quality and care. At this inspection we found that there had been improvements made to ensure that people who used the service received the correct standard of care.

We spoke with people who used the service and their relatives who told us they were happy with the care they received. One person told us, "I like living here”. Another person told us, “Staff are kind and do anything I ask”. Staff we spoke with were aware of the individual needs of people and the care plans we viewed contained people's choices in how they wanted to receive their care.

Staff we spoke with were able to explain the actions they would take if they felt people were at risk of harm. People who used the service told us that they felt safe.

The provider had made improvements to ensure that there were sufficient staff available to support people who used the service.

We saw that staff had received an induction before they provided support to people. Staff told us that they felt supported by management.

The provider had made some improvements to the quality and accuracy of the records used in the service. Further improvements were required to ensure that documentation contained an accurate reflection of people’s needs.

The home did not know we were coming to complete our inspection. We spoke with nine people living at the home and two visitors. We spoke with seven staff. We reviewed care records and other documents, and observed how people were supported to make decisions, choices and live their life.

People living at the home expressed that they were happy with life at the home. One person told us that, “I like it here. The staff are lovely." We observed that staff treated people with respect, communicating in a way that maximised people’s involvement in their day to day care. Visitors were also complimentary about the home. One relative said, “If they have got to be in a home, then this is where they should be.”

The home was comfortable and homel but in need of general updating and repair. At the time of our inspection, the home was going through a programme of redecoration and general improvement.

People were provided with a choice of suitable and nutritious food which reflected their food preferences and respected individual religious and cultural preferences. We found that people’s care needs had been assessed and care plans had been put in place to support these. Risk management plans also were in place to ensure care staff had clear information to keep people safe. People’s health needs were included in their plans of care and any changes in their health needs responded to. A relative told us,” They are always quick to respond if mum becomes ill. They pick it up early and contact the doctor and inform me straight away”.

The planning of care staff did not ensure that people would always receive the right care, at the right time. On the day of the inspection, people with limited mobility and independence were left unsupervised in communal areas for significant periods of time. There was no protection of care staff time with people at lunch time to supervise everyone who needed support to eat and drink.

We found that the general quality and accuracy of records used in the home needed to improve. The information recorded in people’s care documentation and medication records sometimes meant it was difficult to check that care provided was in line with people’s plans of care and met people's needs.