The inspection took place on 11, 15 and 20 June 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be coming.

Enhanced Elderly Care Service - Wardley Gate Care Centre 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. Enhanced Elderly Care Service - Wardley Gate Care Centre provides care and support for up to 88 people who require support with personal care, some of whom are living with dementia. At the time of the inspection there were 75 people living there.

The service had a registered manager in place. 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 last comprehensive inspection in January 2017 we rated the service as ‘Requires Improvement’ overall. At the inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 14 (Meeting nutritional and hydration needs); Regulation 16 (Receiving and acting on complaints); Regulation 17 (Good governance) and Regulation 18 (Staffing). This related to robust systems not being in place to monitor nutrition and weight loss, complaints not always being handled in line with the provider’s policy, systems and processes were not established and operated to monitor service provision and insufficient staffing levels.

Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good. We then carried out a focussed inspection in August 2017 and found improvements had been made in the areas identified at the previous inspection but that the improvements needed to be sustained for a period of time and therefore the service remained ‘Requires Improvement’. At this inspection we found standards had been sustained and further developments had been made and the service had improved to ‘Good’.

There were enough staff to meet people’s needs. The registered manager assessed staffing requirements in line with people’s dependency needs. Staff continued to be recruited in a safe way with all necessary checks carried out prior to their employment.

People and their relatives told us people were safe living at the service. Staff had completed training in safeguarding people and the service raised any safeguarding alerts with the local authority in a timely way.

Risks to people’s safety and wellbeing were assessed and managed. Environmental risk assessments were also in place.

People’s medicines were administered in accordance with best practice and managed in a safe way. People continued to receive their medicines in line with prescribed instructions.

People were supported to meet their nutritional needs. People at risk of malnutrition had their weight monitored weekly as well as their food and fluid intake recorded. People accessed a range of health professionals including speech and language therapists, dieticians and doctors. Information of healthcare intervention was included in care records.

New staff completed an induction programme prior to working with people. Staff received regular training, supervisions and annual appraisals to support them in their roles.

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 supported this practice.

People and relatives felt the service was caring. Staff treated people with dignity and respect when supporting them with daily

We carried out a comprehensive inspection of Enhanced Elderly Care Service - Wardley Gate Care Centre in January 2017. We found breaches of legal requirements and took enforcement action against the provider in relation to staffing and the governance of the service.

We undertook an unannounced focused follow up inspection on 8 August 2017 to check whether the legal requirements were being met. This report only covers our findings regarding these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Enhanced Elderly Care Service - Wardley Gate Care Centre on our website at www.cqc.org.uk.

Enhanced Elderly Care Service - Wardley Gate Care Centre is a care home for up to 88 older people, including people with dementia related conditions. Nursing care is not provided. At the time of our inspection 74 people were living at the home.

The service had a manager who had applied to become registered. 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.

We found care staffing levels had been increased, enabling people’s needs to be responded to in a timely way.

Senior management supported the manager and had a regular presence in the home. Improved systems for record-keeping and assuring the quality and safety of the service had been implemented.

Overall, we judged that the provider had made sufficient improvements to comply with the legal requirements.

We have made recommendations about making fully robust arrangements for covering staff absence and formalising observations of people’s care experiences.

This was an unannounced inspection carried out on 17, 20 and 25 January 2017.

Wardleygate Elderly Care Service provides accommodation and personal care to a maximum of 88 older people, including people who live with dementia or dementia related conditions. At the time of inspection 75 people were living at the home. Nursing care is not provided.

We last inspected Enhanced Elderly Care Service Wardleygate in January 2016. At that inspection we found the service was not meeting all its legal requirements with regard to staffing levels, meeting people’s nutritional needs, respecting people’s dignity, records and governance. At this inspection we found that sufficient action had not been taken in all the required areas to make sure the relevant legal requirements were met.

A registered manager was not in place. The previous registered manager had left in December 2016. 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 some improvements had been made, however efforts were needed to improve the care and experiences of people who lived at the home. People enjoyed a better dining experience, although this could still be improved. Some improvements had been made with regard to record keeping to ensure people received person centred care. People’s dignity was respected. Improvements had been made to menus and the choice of food available. However, systems needed to be improved to support and monitor people at risk of poor nutrition and weight loss.

People told us they felt safe. However, staffing levels were not sufficient to ensure people's needs were managed safely and in a person centred way at all times. Staffing levels were in the process of being increased as the result of our inspections but they needed to be consistently maintained. We saw staff did not always have time to interact and talk with people. There was an emphasis on supervision and task centred care.

A programme of activities was available but activities provision was not well-organised around the home so people had an opportunity to take part. Staff did not have time to carry out activities when the activities people were not available. We have made a recommendation about activities to ensure people remain engaged and stimulated.

Systems were in place or being introduced for managing and mitigating risk. A more critical accident and incident analysis was introduced. This needed to be maintained and regularly reviewed to identify any trends of accidents and incidents that occurred to help prevent them occurring.

Risk assessments were in place but they did not all accurately identify current risks to all people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe and timely way.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. We have made a recommendation with regard to communication to ensure all the required information is passed on to staff about people's health and well-being.

Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves.

Staff received opportunities for training to meet people's care needs and in a safe way. A system was in place for staff to receive supervision and appraisal but not all supervisions were up to date due to the management changes.

This was an unannounced inspection carried out on 17 December 2015 and 21 January 2016.

This was the first inspection of Wardley Gate Care Centre since it was registered with the Care Quality Quality Commission in March 2015.

Wardley Gate Care Centre is a 92 bed care home that provides personal care to older people, including people who live with dementia or a dementia related condition. Nursing care is not provided.

A registered manager was in place. 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.

There were not always enough staff on duty to provide individual care and support to people and to keep them safe as staffing levels were not maintained.

People said they were safe and staff were kind and approachable. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Systems were in place for people to receive their medicines in a safe way. However, they did not received their medicines in a timely way when staff were busy. People had access to health care professionals to make sure they received appropriate care and treatment. Appropriate training was provided and staff received regular supervision and support.

Wardley Gate was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Best interest decisions were made appropriately on behalf of people, when they were unable to give consent to their care and treatment as staff knew people well. However, written information was not available for staff with regard to people’s capacity to make every day decisions.

People did not always receive an adequate and varied diet that suited their requirements.

We found there was not an ethos from management to encourage staff to ensure people maintained some control in their lives. Records did not contain information to ensure that people were helped to make choices and to be involved in every day decision making. People’s dignity was not always respected.

A programme of activities was available but activities provision was not well-organised around the home so people had an opportunity to take part. Staff did not have time to carry out activities when the activities people were not available.

A complaints procedure was available. Most people told us they would feel confident to speak to staff about any concerns if they needed to. Although we received positive comments about the staff and management, some people did comment they did not find the manager to be always approachable.

People had some limited opportunities to give their views about the service. The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection with regard to activities, food ordering systems, staffing levels and record keeping.

You can see what action we told the provider to take at the back of the full version of the report.