CQC report explained · a nursing home
What the CQC found at The Wells Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, May 2023
The Wells Nursing Home was rated Requires Improvement; inspectors found kind and responsive care, but concerns about consent, risk assessments and staffing remained.
This was an unannounced follow-up inspection on 31 January and 1 February 2023. Two inspectors visited for two days, with an expert by experience for one day. They spoke with people, relatives and staff, observed care, and checked care, medicine, recruitment and management records.
The home was rated Good for Caring and Responsive. Inspectors saw kind and respectful staff, support for people's independence, activities, family visits and care that usually reflected people's needs. Medicines were managed safely and staff worked with health professionals.
The home was rated Requires Improvement for Safe, Effective and Well-led. Some risk assessments were incomplete or lacked clear instructions. Mental capacity checks were not always completed before decisions or some Deprivation of Liberty Safeguards referrals. Staffing levels and parts of the building also needed attention.
The overall rating remains Requires Improvement. The home improved enough to no longer breach the good governance regulation, but it breached Regulation 11 about consent. The report says the home has been rated Requires Improvement or Inadequate for the last four inspections.
Kind and respectful care
Inspectors saw staff speaking kindly to people and supporting their privacy, dignity and independence.
“Staff were caring, and people were treated with kindness and respect.” from the report
Safe medicines support
Medicines were stored and administered safely. Nurses had their competence checked, and people received prescribed medicines on time.
“Medicines were observed being administered in an unhurried manner and people were given the support they needed.” from the report
Activities and social contact
The home had two activities coordinators working across seven days. They spent one-to-one time with people who could not get out of bed and planned activities around people's interests.
“There was a monthly activities programme and a monthly review of what people had been doing with photos circulated to people and their relatives.” from the report
Family access
Visitors were welcome at different times of day, with no visiting restrictions in place during the inspection.
“Visitors were welcome at the home to visit whenever they liked.” from the report
Partnership working
Staff worked with health and social care professionals, including occupational therapists, physiotherapists, speech and language specialists and mental health teams.
“The management and staff worked closely with health and social care professionals such as Occupational Therapists, Physiotherapists, Speech and Language Team and Mental Health team.” from the report
Incomplete risk assessments
needs fixingSome assessments, including for bed rails and nutrition, had not been completed. Others did not explain clearly what staff should do.
“Some specific risk assessments such as bed rails and nutrition had not been completed.” from the report
Mental capacity and consent
seriousThe home did not consistently assess people's capacity for specific decisions. It had not assessed every person before making a Deprivation of Liberty Safeguards referral. This led to a breach of Regulation 11.
“We found the service had not assessed every person's Mental Capacity before completing the DoLS referral.” from the report
Staffing levels
needs fixingThere was mixed feedback about staffing, including delays in answering call bells. The rotas did not show the promised two clinical staff at weekends.
“It takes them 15 – 30 minutes to answer my call bell.” from the report
Building repairs
minorSome bathrooms, doors, chairs and carpets were worn or damaged. Inspectors said this made some areas harder to keep clean and could increase contamination risk.
“Some areas of the building were worn or damaged which meant they were difficult to keep clean and presented a higher risk of contamination.” from the report
- 01How do you now complete and record mental capacity assessments before decisions about bed rails, nutrition or Deprivation of Liberty Safeguards referrals?
- 02What staffing levels are guaranteed on weekday and weekend shifts, and how do you monitor call-bell response times?
- 03Which risk assessments were incomplete at the inspection, and how do you check that they now give staff clear instructions?
- 04What work has been completed on the worn bathrooms, doors, chairs and carpets, and what remains on the improvement plan?
- 05How do you check that care plans reflect each person's preferences, including preferred times to get up and preferred sex of carer?
This was an unannounced follow-up inspection of the previous concerns, with infection prevention and control also checked; inspectors assessed and rated all five key questions. This explanation was written from the published report of 11 May 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2022
The Wells Nursing Home was rated Requires Improvement; inspectors found risks with care planning, staffing and quality checks, although medicines were managed safely.
This was a focused inspection on 7 and 10 March 2022. Inspectors spoke with eight people, 14 relatives and 12 staff. They observed care, reviewed seven care records and checked medicines, recruitment and management records.
The home was not always safe or responsive. Some people did not have call bells, bedrails were not always used as assessed, and two people did not always receive suitable continence care. Staff deployment and the mix of skills did not always ensure people got the support they needed.
Care plans were more detailed than at the previous inspection, but people and relatives were not always involved in reviewing them. Personalised end of life care plans were also not in place. Activities had improved, and the home was clean.
The home was rated Requires Improvement overall, and for Safe, Responsive and Well-led. The other two questions were not inspected at this visit, so their previous ratings were used in the overall rating.
Medicines
Inspectors found that medicines were managed safely. People received their prescribed medicines safely and on time.
“People received their prescribed medicines safely and on time.” from the report
Safeguarding
The home had systems to protect people from abuse. Staff received training and knew what to do if they suspected abuse.
“There were suitable systems to help safeguard people from abuse.” from the report
Activities
A new activity worker had spoken with everyone about their interests and provided group activities and one-to-one time. Inspectors saw people engaged in activities and appearing happy.
“The activity person also joined people in the dining room at lunchtime, encouraged conversations and helped create a happy atmosphere.” from the report
Care plans improved
Care plans had been reviewed and were more detailed than at the earlier inspection. The provider was no longer in breach of the previous person-centred care regulation.
“Since the last inspection improvements had been made in people's care plans; they had been reviewed, were more detailed and contained information to guide staff.” from the report
Clean environment
The home was clean and free from odours.
“The service was clean and free from odours.” from the report
Call bells and bedrails
seriousStaff did not always follow people's risk assessments. Some people lacked call bells, and bedrails were not always fitted or used as assessed, creating a risk of falls or delayed help.
“However, staff were not always following people's risk assessments, for example not all bedrails had protectors on, people did not have both rails put up when they had been assessed as requiring them both.” from the report
Quality checks
seriousThe provider's audits had failed to identify several care and safety problems. This was a breach of Regulation 17.
“The provider's quality monitoring systems were not effective and had not identified some areas of poor quality and safety of care being provided to people.” from the report
Staffing and supervision
needs fixingThe mix of staff skills and their deployment across the two floors was not always balanced. Some newer staff had limited experienced staff support and were not always clear about people's needs.
“This resulted in some staff not being clear about the support people required.” from the report
Continence care
needs fixingInspectors found that two people did not always receive appropriate continence care. The manager said staff would receive further guidance.
“We identified that two people did not always receive appropriate continence care.” from the report
- 01How do you now check that every person who needs a call bell or pendant has one within reach?
- 02What has changed in staffing across both floors, and how are newer staff supervised by experienced staff?
- 03How do you check that bedrails are being used exactly as each person's risk assessment requires?
- 04How are residents and relatives involved in care plan reviews and decisions about end of life care?
- 05What action plan was sent to CQC after the Regulation 17 breach, and what evidence shows that the changes are working?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were used in the overall rating. This explanation was written from the published report of 11 May 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Wells Nursing Home
7 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- May 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2022Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2020Requires improvementup from InadequateSafe: Requires improvementWell-led: Requires improvement
- April 2020Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- February 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2015Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 1 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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