About the service: Wombwell Hall Care Home is a residential care home that was providing personal and nursing care to up to 120 people aged 65 and over at the time of the inspection. There were 116 people living at the service at the time of inspection. The service was divided into four separate units, each accommodating up to 30 people. People required nursing care and had care needs such as, living with dementia, diabetes, seizures or recovering from a stroke. Some people were nursed in bed, some people needed help with moving around and others were able to mobilise independently.

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

People’s experience of using this service:

¿ Although the registered manager used a dependency tool to calculate the numbers of staff needed and felt assured their staffing levels were sufficient, most people we spoke with were clear there were not enough staff as they were often kept waiting to have their needs met. There were a number of agency staff used, particularly at night and people had concerns about this.

¿ People were not always supported to maintain their basic rights when they lacked capacity to make particular decisions, and were deprived of their liberty.

¿ Meaningful occupation through the day was not available to everyone, particularly those who were nursed in bed or chose to stay in their rooms.

¿ People did not always receive their medicines as prescribed as sometimes they did not receive the correct amounts of tablets.

¿ New staff were not always recruited in a safe way to make sure they were suitable to work with people living in the service.

¿ We found one area needing to improve: consideration to providing a more dementia friendly environment.

¿ Apart from the concerns about staffing, people and their relatives thought the staff were caring, friendly and worked hard.

¿ The food was described as good and people could order something different if they were not happy with what was on the menu. Qualified nurses took care of people’s health needs and referred them to other healthcare professionals when needed.

¿ Staff were well trained and supported by a clear management structure.

¿ A registered manager was in post who knew people well.

Rating at last inspection: Requires Improvement (Report published 16 March 2018). Insufficient improvements had been made to raise standards since the last inspection. This service has been rated Requires Improvement at the last two inspections.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of this report.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Requires Improvement.

The first day of the inspection was unannounced on the 29 January 2018, and the second and third days of the inspection the 30 January and 5 February 2018 were announced.

Wombwell Hall Care 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. The service comprises of four separate houses, Pickwick House, Weller House, Copperfield House and Micawber House, together with a main administration building. Each house provides residential and nursing care for up to 30 people making a total of 120 people when the service is full. There were 114 people living in Wombwell Hall Care Home at the time of our visit.

The service was run by a registered manager and they were present on the days of our visit. 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.

This is the first time the service has been rated since the change in ownership in December 2017.

People and their relatives told us staff were kind and caring and made people feel safe. They said staff had the necessary skills to respond to people’s needs, monitored their health and that people enjoyed their meals. However, we found inconsistency in care practices across the service which meant that people did not always receive the level of care expected.

Systems to monitor the quality of care were not always effective. Potential risks were not always accurately monitored and recorded and records were not always legible, accurate and up to date which could result in people receiving inappropriate staff support.

There was evidence to show that there were at times insufficient numbers of staff on duty to meet people’s needs.

Shortfalls had been identified in staff training and plans were not in place on the first day of the inspection visit, to ensure staff received relevant refresher training for their role. Not all staff felt well supported both informally and through formal processes such as staff meetings and supervisions.

Recruitment practices were robust in ensuring only suitable staff were employed at the service.

People’s needs were assessed and a plan of care was developed which included their choices and preferences. Guidance was in place for staff to follow to meet people’s needs. However the care plans were not always legible, accurate and up to date to ensure that people’s needs were met.

People’s health needs were assessed and monitored and the service worked in partnership with healthcare professionals to ensure people received appropriate care and treatment. However, there were examples where the provider had not effectively managed and responded to risk.

Medicines were on the whole managed safely and people received them as prescribed.

The views of people and their relatives were sought through meetings and an annual survey.

Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order.

Management systems were in use to minimise the risks from the spread of infection and keep the service clean, although records did not always support this.

We found four 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 this report.