This inspection took place on the 10 and 11 July 2018 and the first day was unannounced. The inspection started at 7am to allow us to meet with the night staff team, be present at the staff handover and see how duties were allocated for the day.

Walmer House is a ‘care home’ without nursing, operated by Keychange Charity, who operate 10 care homes nationwide. 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 home has a Christian ethos, but people of all faiths or none were welcome to live or work there.

People living at Walmer House were older people, many living with long term health conditions or dementia. The service accommodated up to 17 people in one adapted building, with a lift to access many of the rooms on the first floor. A short stair lift was in use to access other rooms. 16 people were living at the service at the time of the inspection. Walmer House had an underpinning Christian ethos, but managers we spoke with were clear the service was open to people of all faiths or none. There was a regular communion at the service but people were free to attend this or not as they wished.

At the time of the inspection the service did not have a registered manager in post. The registered manager had left the service at the end of April 2018. A new manager had been in post for five days at the start of the inspection, and was making plans to apply for registration. Throughout the report they are described as the manager. 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 inspection of the service on 17 and 18 December 2015 the service was rated as ‘good’ in all areas. On this inspection we found the service had not maintained this and we have rated them as requires improvement overall. This was because we identified failures of management systems had led to breaches of legislation across many areas of the service.

People were not always being kept safe, because the service had not always identified or acted on concerns about risks to people’s safety. We identified concerns over risks to people from their care, healthcare needs, and risks from the environment. These included support for people to eat and drink sufficient amounts to maintain their health, and the oversight and understanding of risks from long term health conditions. Although many of these had already been identified by the service, plans to address them were either still in development or had not yet demonstrated sustained improvement.

Care plans did not always contain sufficient detail to enable staff to respond to people’s needs in a person centred way. For example staff understanding how to support them in ways that made use of known information about the person’s history. People living with specific support needs such as dementia had not always received information in formats tailored to meet their needs. Some care plans for people at most risk had been prioritised for re-writing which was being done while we were at the service. We saw this was being done with the person concerned who was encouraged to express their wishes about the plan, likes and dislikes.

People were not always supported by sufficient numbers of staff on duty to meet people’s needs and there was no formal system in use to assess how many staff were needed. Systems for the safe recruitment of staff were not robust, and recruitment files showed there had been gaps in the recruitment process that had potentially put people at risk. Immediately following the inspection the manager took action to increase the s

People told us that they enjoyed living at the home and that they feel part of a family. One person told us "it's a nice atmosphere here, I enjoy the company". Another person said " there is always good food here and plenty of it". A family member commented "I am always made welcome. It's a friendly place".

We found that people were well supported within the home and that the home worked closely with external agencies to provide a good quality service.

Records confirmed that people's needs were assessed and monitored and that all necessary steps to maintain optimum health and wellbeing were being addressed.

People who lived at the home told us that they felt safe and comfortable and that staff were competent and knowledgeable. one person told us " I feel in safe hands when they help me". this was confirmed by a family member who told us that " the staff are very kind and nothing is too much trouble for them".

The home was warm and clean with a fresh smell and comfortable atmosphere.

People who lived at the home and family members we spoke to confirmed that they knew how to raise a concern or what to do if they felt something was wrong.

People told us they were very happy living at the home and felt that they received a high standard of care. People described the home as “lovely” and the staff as “great girls”.

We found that people were being involved in making decisions about their care. We saw people were supported well and that the home were working with other agencies to ensure the support people received was as far as possible consistent across all agencies involved.

We found that people's healthcare needs were being assessed and supported well. We found that the home's staff and management understood people's needs, including communication needs where this was impaired. We found that they understood people's rights and supported them.

People using this service felt safe and were confident that staff had the skills needed to safeguard them and to meet their needs. Staff training, supervision and annual appraisals were linked to ensuring that staff had the skills to meet people’s needs.

The home was clean. However two bedrooms were malodorous.

People said they felt safe living at the home and knew how to raise any concerns or complaints.

Walmer House is a care home in Torquay which provides personal care for up to 17 older people who require care and support due to frail health or those who may be living with dementia. Nursing care is provided by the local community nursing team. The home is one of a group of 11 care homes owned and managed by Keychange Charity, a Christian organisation. The home was previously inspected in December 2013 and was found to be compliant with the regulations at that time.

This inspection took place on 17 and 18 December 2015 and was unannounced. There were 15 people living in the home at the time of the inspection.

The home had a registered manager who was appointed in August 2015 and who registered with the Care Quality Commission in December 2015. They were also the registered manager of one other of the organisation’s homes, also in Torquay. 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.

Keychange Charity’s philosophy is described on their website as “inspired by the Christian ethos to give loving care of the highest standard to each person in our care.” While the home is owned and managed by a Christian charity, the registered manager confirmed the home was not exclusively for people who followed the Christian faith and people of other religions, or no religion, were welcome in the home.

The newly appointed registered manager was also the registered manager of another of Keychange Charity’s homes in Torquay. As they had responsibly for the management of two care homes, the management structure within the home had been reviewed and as a result two new management posts had been created: a deputy manager and ‘head of care’. Staff told us these changes had been managed well and they felt supported. People and their relatives also told us they had confidence in the management of the home. The registered manager had reviewed many of the care and management systems. They had developed and introduced audits of care planning, medicine management, food and menu planning, and reviewed leisure and social activities and how well staff were supervised and supported. The registered manager was hopeful these audits and reviews would make the assessment of the quality of the support and services provided easier.

People spoke highly of the care they received. They told us they felt safe and were supported by kind and caring staff. One person said, “I’m very well cared for, they help me so well every day.” For those people who were unable to share their experiences with us, we saw staff were kind and patient. People were smiling and appeared relaxed in their company, indicating they felt safe. Staff understood their responsibilities to protect people from abuse and how and to whom they should report any concerns.

Recruitment practices were safe and there were enough staff on duty to care for people well. Regular training ensured staff had the knowledge to understand and meet people’s care needs. Plans were in place to provide staff with regular supervision and performance reviews.

Risks to people’s health, safety and well-being were assessed. Management plans were in place to mitigate these risks, although not all the steps staff were taking to protect people were recorded. For those people who required the use of aids to assist them with their mobility, we saw staff using this equipment safely.

Staff were knowledgeable about the people they were caring for. They described people’s past histories, their preferences and how they wished to be supported. Each person had a care plan detailing their care needs; however some of these were cumbersome with documents no longer in use still being held in the current care file. Some information was not recorded in sufficient detail to demonstrate what people could do for themselves, how staff should support their independence and how, when people required assistance, this should be provided. The registered manager said they had arranged for the senior staff team to review and rewrite all of the care plans to ensure they contained full descriptions of people’s current care needs. In addition, a document entitled “This is me” was to be introduced which would be used to record information important to people. This would provide staff with more insight into people’s past history, their interests and preferred routines.

People’s capacity to make decisions had been assessed but these were general assessments rather than relating to a specific decision. The registered manager confirmed these assessments would be reviewed when people’s care plans were rewritten. Where people lacked capacity to make decisions about their care and treatment, decisions were made in people’s best interests in line with the code of practice in the Mental Capacity Act 2005

People’s medicines were managed safely and people had prompt access to health care professionals, such as the GP and community nursing service, when needed. A healthcare professional told us they had confidence in the staff team to meet people’s care needs. They said staff contacted them promptly when they needed advice about a person’s care

People told they enjoyed the meals provided by the home and they could have drinks and snacks whenever they wished. People’s food preferences were known to staff and the cook, and these were recorded in their care plans. People at risk of not eating and drinking enough to maintain their health had their food and fluid intake monitored. We found the fluid intake records were not completed in sufficient detail and had not been reviewed during the day to ascertain how much people were drinking.

The home had recently employed a member of staff to support people to be involved in leisure and social activities during the weekday afternoons. A number of activities were planned throughout the month and these were identified on the noticeboard by the dining room. However, it was not clear from the records whether those people who were being cared for in their rooms received attention from staff at times other than when receiving assistance with personal care or eating and drinking. The registered manager described the home would be working with an organisation that provided training for staff to provide meaningful, person-centred engagement for people.

People and the relatives we spoke with were aware of how to make a complaint and all felt they would have no problem raising any issues. The home had received one complaint since the appointment of the registered manager. This was recorded and addressed in line with the home’s policy and the concerns were discussed at a staff meeting to ensure all staff were aware.

As part of a larger organisation, the registered manager met regularly with senior managers to share information and ideas about developing the service. They also attended local care conferences and forums with other providers to share good practice about caring for older people and those living with dementia.

The home was clean, fresh and well maintained.  Equipment was maintained in safe working order and checks had been carried out in relation to the safety of fire, gas and electrical installation.