Care service description

Wishmoor Rest Home is a residential care home for 25 people with dementia. At the time of our inspection 25 people were living at the home.

Rating at last inspection

At our last inspection on 11 January 2016 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.

People continued to receive care in ways which helped them to remain as safe as possible. Staff understood risks to people’s safety and supported people receive their prescribed medicines safely. There was enough staff to provide support to people to meet their needs.

Staff received training which matched the needs of people who lived at the home, so they would develop the skills and knowledge to care for them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were supported by staff if they needed help making key decisions about their life. People were cared for so they had enough to eat and drink and their food preferences were met. Staff supported people to see health professionals so they would remain well.

People enjoyed spending time with the staff that cared for them and were treated with dignity and respect. Staff spoke warmly about the people they cared for and encouraged them to make their own day to day decisions and maintain their independence. People were treated with respect and dignity.

People care was planned in ways which reflected their preferences and wishes. Relatives’ and health and social care professionals’ views and suggestions were considered when people’s care was planned. People, relatives and staff were confident if any complaints were made these would be addressed. Systems were in place to manage complaints.

People were encouraged to stay active. The provider had a comprehensive activities and entertainment programme for people to join in and enjoy.

People, their relatives and staff were encouraged to make suggestions to develop the care they received further through open communication with the senior management team. The manager and provider regularly checked the quality of the care people received. Where actions were identified these were undertaken to improve people’s care further.

At our previous comprehensive inspection of this service on 13 March 2015 there was a breach of legal requirements. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to how people were able to consent to care and treatment, Regulation 11 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014

This inspection took place on 11 January 2016 and was unannounced.

The home provides accommodation for a maximum of 28 people requiring personal care. There were 24 people living at the home when we visited. A registered manager was in post when we inspected 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 and associated Regulations about how the service is run.

During our last inspection on 13 March 2015, we found areas of people’s care needed to be improved. At that inspection, we found the registered manager did not always ensure that people’s consent was correctly obtained.  At this inspection, we noted that that management team had considered our feedback and taken action on areas where improvements had been required.

People responded warmly to care staff looking after them and engaged with them in a friendly and positive manner. Relatives told us they had no concerns and that care staff knew what to do to keep them safe.

Care staff understood people’s health concerns and how to support people to ensure that their health was monitored and anything to be aware of was considered. Risks to peoples health were reviewed and updated.

Care staff recruited undertook checks of their background so that the registered provider could be made aware of all of the necessary information before employing the person.

Peoples medications and how they received them were reviewed regularly to ensure they received them as prescribed. People were positive about the support they received to take their medicines.

Care staff told us they benefitted from regular supervision meetings from their manager so that they could discuss issues that affected them. They were also able to get clarification about people’s care, if there were unsure of anything.

People were supported by care staff they liked and found approachable. People’s care needs were understood by care staff supporting them. Care staff also understood how to care for people in a respectful manner whilst ensuring their dignity was maintained.

People were involved in activities that reflected their individual interests. People’s interests were understood by care staff.

People knew the registered manager and felt able to approach and discuss issues that were important to them. The registered manager knew people living at the home and understood their individual care needs.

The management team had listened to people and the ideas and suggestions people were making to improve care at the home. Changes had also been made to how people were involved in making decisions so that peoples suggestions were gathered using a variety of methods, from meetings to questionnaires.

People understood they could complain if they needed to and understood the process to do so. Where people had approached the registered manager to raise issues they may have, these were resolved so that a workable solution could be identified.

The management team were clear in their understanding of each other’s expectations. Improvements had been made to how the monitoring of care was being reviewed by the registered provider so that any issues or areas of concerns could be identified and responded to.

This inspection took place on 13 March 2015 and was unannounced.

The service is a care home without nursing which is registered to care for 28 people. Accommodation and personal care are provided to older people requiring support with Dementia, physical disabilities and sensory impairments. There were 23 people living at the home when we visited and 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.

People were very positive about the care they received and about the staff who looked after them.

People told us that they felt that felt safe and staff were able to tell us about how they kept people safe. During our inspection we observed that staff were available to meet people’s care and social needs. People received their medicines as prescribed and at the correct time and medications were safely administered and stored.

People and families told us and we saw that privacy and dignity were respected. We saw people supported to maintain their independence and dress in a way they chose to.

The provider did not act in accordance with the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they receive. Staff and the Manager had some understanding of the law and had received training but acknowledged they did not always feel confident applying it.

We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs and families told us that they felt that further help was sought when needed.

People were supported to eat and drink enough to keep them healthy. People had access to a range of snack, drinks and fresh fruit throughout the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with training that was continually updated that helped them understand how to care for people in most areas. The registered manager told us that all staff received training and regular checks were made to ensure that everyone received the right training.

People and staff told us that they would raise concerns with senior staff, deputy manager or the registered manager and were confident that any concerns would be dealt with. The registered manager made regular checks to monitor the quality of the care that people received and continually reviewed care to ensure improvements were made where they were required.

An adult social care inspector carried out this inspection. As part of the inspection we spoke with four people who used the service, and a family member of one other. We also spoke with the registered manager and three members of staff. We reviewed the records relating to the management of the home. This included six care records, six staff personnel records, policies and procedures, and minutes of meetings.

Wishmoor Rest Home is registered to provide accommodation for 25 people who require personal care. On the day of our visit there were 22 people using the service.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People told us that they felt safe. One person told us, “I feel safe and protected”. Individual risk assessments were well completed and actions to minimise the risks identified were reflected in care plans. Service wide risk assessments, together with the actions to reduce those risks, were reviewed regularly.

The provider had a Mental Capacity Act 2005 policy but this was not fully applied in practice. We have asked the provider to take action to improve this.

The provider had systems and processes in place to ensure that medicines were obtained, administered and disposed of safely. This ensured that people were protected from the risks associated with the unsafe use and management of medicines.

The provider had effective recruitment and selection policies and procedures that were applied in practice.

Is the service effective?

People we spoke with told us that they had consented for the care that was detailed in their care plan. This was documented in their care records. Staff asked for people’s consent before they carried out any personal care.

People's needs were assessed and care plans developed. Care plans reflected both the needs and wishes of people. Staff had a good knowledge of people’s care needs

Policies and procedures were appropriate, up to date, and reflected current research and guidance.

Is the service caring?

People told us that the staff were kind and friendly. One person told us, “The staff are all very kind and caring”. The relative of one person told us, “The staff take very good care of (name).” We observed staff treating people in a friendly and caring way. People told us that the staff had time to spend talking with them. We saw that there was time scheduled within the day for activities. However, not all the people we spoke with were aware of what activities were available.

Is the service responsive?

People who used the service and staff were clear about the complaints process. People told us they were confident that any issue raised, or complaint made, would be thoroughly investigated and acted upon.

People told us that they were not aware of being asked to complete satisfaction surveys. The registered manager told us that surveys had been sent to people but they had not received any responses. The provider agreed to look at further ways in which feedback from the people who use the service and their families could be gained.

Is the service well-led?

Staff we spoke with told us they felt well supported by their manager. Staff said they were able to raise issues with their manager at any time and were confident they would be acted upon. Staff had opportunities to raise and discuss issues at staff meetings and at supervision sessions.

A range of audits were undertaken and the results used to improve the service. Action plans clearly identified who was responsible for implementing any change required.

Lessons learnt from complaints and incidents were analysed, shared with staff, and actions agreed and monitored.

We spoke with two people who used the service. We found people had been involved in making decisions about their care and treatment.

People expressed their views on how they wanted to maintain their independence. Care workers we spoke with told us how they supported people in their choice and how they promoted people’s privacy and dignity.

People were complimentary about the care and support they received. One person told us: “I like it here, I was lucky to come here”. Another person said: “It’s nice here, it feels relaxed”.

People were supported and cared for in an environment that was safe, secure and clean.

People who used the service were supported by care workers who were suitably trained and qualified to meet people’s needs.

The provider made sure they carried out regular supervisions and encouraged care workers to participate in team meetings and supervisions.

The provider had some systems in place to regularly assess and monitor the quality of service that people received, however on occasions did not complete follow up action to minimise the risks.

We last inspected the service on 19 April 2012 and found that care workers were not adequately trained and care plans had not been updated to reflect people’s current needs. During this inspection we found some improvements had been made.

We saw that people who lived in the home appeared comfortable in the environment and responded positively to contact with care staff.

We spoke with two people who lived in the home and they spoke positively about the care they received. They told us they felt safe and that the staff were very good to them. The atmosphere within the home was very calm and relaxed and staff were observed interacting with people in a warm and friendly manner.

We observed staff respecting people’s privacy and dignity and we saw people moving about the home making choices about where and how they wanted to spend their time.

People’s rooms were personalised and we could see that they had been able to bring in personal items of their choosing. One person showed us their room and spoke to us about the items they had decided to bring in with them.

When we spoke with staff we found that they had a good understanding of the people they cared for and knew any specific likes and dislikes people may have.

One relative was also positive about the care provided by staff and told us that there had been an improvement in their relative’s well being since they had lived in the home.

They spoke positively about the way in which staff actively engaged the person in everyday activities such as washing up, preparing vegetables and laying tables. They made reference to the fact that staff supported the person’s individual needs but at the same time encouraged their independence.

We spoke with three visitors during our visit. One person described the home as being ‘a little tired around the edges’. All three people said the home was always clean and warm when they visited.

They spoke positively about the Registered Manager and said that when they visit they usually see the manager who they felt was very approachable. They felt confident to raise any concerns with either the Registered Manager or their Deputy.

We received positive feedback from them about the staff working in the home. Two people told us that although staff were often very busy they could always find staff to assist them when necessary.