CQC report explained · a residential care home
What the CQC found at Walnut House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some aspects of safety were not reliable. Inspectors found gaps in risk information, fire safety records, infection control, staff training and the reporting of missed medicines.
- Effective?
- Good
- This key question was not inspected during this focused visit. Its rating was carried over from the previous inspection.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its rating was carried over from the previous inspection.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its rating was carried over from the previous inspection.
- Well-led?
- Requires improvement
- Management oversight was not strong enough. Audits and checks did not consistently identify or resolve risks, and action was not taken quickly enough.
What inspectors found, May 2023
Rated Requires Improvement; improvements were found, but safety and management problems remained and the home had only just left special measures.
This was a focused inspection of Safe and Well-led. It took place on 14 and 16 March 2023, with further inspection activity until 3 April. Inspectors spoke with people, staff and relatives, observed care, and checked care, medicine, staff and management records.
The home had improved since its previous inadequate rating. Staffing levels were no longer in breach, people were supported to make choices, medicines were generally managed safely, and improvements had been made to security and some parts of the building. However, some staff still lacked training for people's individual needs.
Inspectors found ongoing problems with care records, fire safety, cleaning, missed-medicine reporting and repairs. Audits had identified some risks but had not led to timely action. The home remained in breach of Regulations 12 and 17, although it was no longer rated inadequate or in special measures.
People had choices
People were observed making their own choices, and staff listened to what they wanted. Staff supported people in a kind and least restrictive way.
“People were observed making their own choices over both days of our inspection visits and staff listened to people's direction and followed their wishes.” from the report
Medicines were generally managed safely
Staff supported people to make choices about their medicines. Staff administering medicines had training and regular checks of their competence.
“We saw that all staff who were administering medicines had appropriate training in place with regular competency assessments.” from the report
Staff recruitment checks
The home had carried out relevant checks before employing staff, including DBS checks.
“Staff were recruited safely to the service, with relevant checks including Disclosure and Barring Service (DBS) checks in place” from the report
Community access
People could visit the community regularly and take part in activities they chose. Relatives were able to visit.
“People were regularly supported to participate in activities of their choosing, on both days of inspection people were observed being supported to leave the house” from the report
Incomplete risk information
seriousOne person's epilepsy care plan did not contain enough information to guide staff, especially at night. Other care records contained inconsistencies and lacked detail.
“We identified another person's care plan with epilepsy lacking required information to guide staff how to keep this person safe, especially at night.” from the report
Fire safety gaps
seriousFire records did not reflect that staff slept at night. Emergency equipment and evacuation records were missing or needed review, and fire drills were not clearly recorded.
“Records were not robust in relation to fire safety.” from the report
Repairs and cleanliness
seriousSome areas remained in disrepair. A damaged ground-floor shower room could not be cleaned properly, creating an infection control risk.
“A ground floor shower room was heavily damaged during both days of inspection, this resulted in this room not being able to adequately be cleaned to reduce risk of infection.” from the report
Staff training gaps
needs fixingSome staff had not completed mandatory training, including training for epilepsy and the Mental Capacity Act. This could affect their knowledge when supporting people.
“Not all staff had appropriate training for people's individual needs when lone working.” from the report
Weak oversight and communication
seriousAudits had not led to timely action, and management had not consistently identified problems in care records or acted on safeguarding concerns. One family also said communication had deteriorated.
“Oversight arrangements had not improved to a sufficient standard and actions taken were not timely to minimise risk and impact to people being supported.” from the report
- 01What repairs have now been completed, particularly to the ground-floor shower room and other areas of disrepair?
- 02Have all staff completed the required training for epilepsy, the Mental Capacity Act and people's individual needs?
- 03How are you checking that care plans contain complete, consistent and personalised information?
- 04What has changed to make sure missed medicines and other safeguarding concerns are reported correctly and promptly?
- 05How are management audits now identifying risks and making sure actions are completed on time?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried over from the previous inspection. This explanation was written from the published report of 10 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, January 2023
Walnut House is rated Inadequate and in special measures; inspectors found people were not safe and leadership had widespread shortfalls.
This was an unannounced inspection over two visits on 29 November and 5 December 2022. Inspectors spoke with people, staff and relatives. They observed care and checked care records, medicines records, staff files and management records.
The home was rated Inadequate for Safe and Well-led. Inspectors found risks were not managed properly, including risks from the building, medicines, infection control, staffing and people leaving without staff knowledge. Care records were sometimes out of date or contradictory, and staff training and supervision were not always completed.
Inspectors also found poor management oversight. Audits did not identify important problems, incidents were not always reported, and lessons were not being learned. The previous rating was Good, published in July 2019, but inspectors found the service had deteriorated.
Community activities
Everyone living at the home took part in community activities. One person had also been supported to secure employment.
“Each person living at the service was involved in community-based activities, and one person had been supported to secure employment.” from the report
Visits and social contact
People could receive regular visits from relatives and friends and attend meetings and social events in the local community.
“People were able to receive regular visits from relatives and friends within the service, as well as having meetings and attending social events out in the local community.” from the report
Safe recruitment
The home had completed relevant recruitment checks, including DBS checks, for staff.
“Staff were recruited safely to the service, with relevant checks including Disclosure and Barring Service (DBS) checks in place” from the report
Positive views from some relatives
People and relatives told inspectors they felt safe. Relatives spoke positively about regular care staff and their familiarity with people's needs.
“People and their relatives told us they felt safe and liked living at the service.” from the report
Risks and environment
seriousSecurity was poor and people could leave the home or wider site without staff knowing. The building was in poor repair, and knives and cleaning products were accessible without supervision.
“Security arrangements in place at the service were found to be poor, this placed people at risk of leaving the service, and wider site without staff knowledge.” from the report
Medicines
seriousInspectors found a medicine error, poor records for medicines returned to the pharmacy, unsafe storage of creams and overdue medicine competency checks.
“We identified a medicine error, where medicine had been given to a person incorrectly, but this incident had not been treated as an error” from the report
Staffing and training
seriousThere were times when staffing levels and staff skills were not enough to keep people safe. Mandatory training, including autism and epilepsy training, was not completed properly.
“Sufficient levels of suitably trained staff were not always in place to keep people safe.” from the report
Infection control
seriousStaff did not always use suitable protective equipment. Damaged and stained areas could not be cleaned properly, increasing infection control concerns.
“We were not assured that the provider was using Personal Protective Equipment (PPE) effectively and safely.” from the report
Management oversight
seriousAudits did not identify important risks and incidents were not always reported to the local authority or CQC. The provider did not take action after inspectors gave feedback between visits.
“Quality audits were not identifying risks and shortfalls in the service, including areas of concern identified as an outcome of this inspection.” from the report
Mental Capacity Act practice
needs fixingSome capacity assessments were out of date and restrictive practices were not always supported by the required assessments. DoLS applications had not been authorised and were not kept under regular review.
“We found the service was not always working within the principles of the MCA as some of people's capacity assessments were out of date, and not being reviewed” from the report
- 01What has been done to repair the damaged and stained areas of the home, and how is cleanliness now checked?
- 02How are medicines being stored, recorded, returned to the pharmacy and checked for errors?
- 03How many staff are on each shift, and how do you ensure agency staff understand each person's risks and support needs?
- 04Which mandatory training and medicine competency checks are now complete, especially for autism, epilepsy and the Mental Capacity Act?
- 05How are accidents, safeguarding incidents and other risks now reported, reviewed and used to prevent them happening again?
This focused inspection rated Safe and Well-led only; Effective, Caring and Responsive were not rated in this report. This explanation was written from the published report of 25 January 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.
Every inspection of Walnut House
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- May 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2023Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- July 2019Goodstayed GoodSafe: GoodWell-led: Good
- October 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 30 November 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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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.