This responsive inspection took place on 5 November 2018 and was unannounced.

Signature of Wimbledon 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.

Signature of Wimbledon is a large purpose-built building split over three floors, in the London Borough of Wimbledon, for up to 79 older people. At the time of the inspection there were 43 people using the service.

The service was previously known as Kingsmere Retirement Home, registered to provider Avery Homes (Wimbledon) Limited. This provider organisation was acquired by Signature and Kingsmere Retirement Home became Signature of Wimbledon in May 2018. The service was previously inspected in February 2018 and rated ‘good’ overall, however we rated the key question ‘is this service effective?’ as ‘requires improvement’ as staff were not always supported through appropriate training and supervision.

At the time of this inspection, in November 2018, there was not a registered manager in post. The manager had applied to the Commission 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.

People were not protected against identified risks, as risk management plans were not always in place and staff did not always have up to date guidance to mitigate those risks. Incidents and accidents that took place at Signature of Wimbledon were not always clearly documented, reviewed and audited in such a way as to ensure lessons were learnt. We shared our concerns with the manager who sent us an updated action plan and copy of a completed risk management plan.

People’s medicines were not always managed in line with good practice as PRN (as and when) medicines protocols were not always in place and dosages of medicines were not always recorded. The newly appointed manager had identified issues around safe medicines management and was implementing new systems to ensure improvements were made.

People received care and support from staff that had undergone robust pre-employment checks to ensure their suitability for the role. Staffing levels did not always afford staff ample time to develop meaningful relationships with people.

People were protected against the risk of abuse as staff knew how to identify, report and escalate suspected abuse. Staff confirmed they would be confident in whistleblowing should the manager not address suspected abuse in a timely manner.

The provider had adequate systems and processes in place to minimise the risk of cross contamination through effective infection control management.

Audits carried out by the service did not always identify issues in a timely manner and action taken to address these did not always take place swiftly. We raised our concerns with the manager who sent us an action plan to address our concerns.

People were not always aware of the management structure within the service and felt communication could be improved. People’s views were sought, through regular house and relative meetings and comments boxes.

The manager sought partnership working with other healthcare professionals to drive improvements.

This inspection took place on 27 February 2018 and was unannounced. This was the provider’s first inspection since their registration.

Kingsmere Retirement 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.

Kingsmere Retirement Home accommodates up to 79 people in one adapted building. At the time of our inspection 34 people were using the service. The home provides support to older people with personal care needs and those living with dementia. This was the home’s first inspection since registering with CQC in September 2016.

A registered manager was in place at the time of our inspection. 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.

The provider did not always ensure that staff were supported through regular supervision. Training for staff was not always updated regularly to ensure that staff were fully trained to carry out their roles effectively. We have made a recommendation about the provider ensuring training and supervision are kept up to date.

We have also made a recommendation about the home's environment and design not being as dementia 'friendly' as it could be. Although the provider was in the process of resourcing life story memory boards we found that the environment could be improved. The colour schemes of communal areas were neutral and social spaces did not always have clear definition and pictorial signage. This lack of definition could lead to disorientation for those with dementia whose ability to see colours and contrasts may be diminished.

People and staff were not clear on the management structure and leadership of the service. We have made a recommendation about the ways in which this is communicated.

People and their relatives spoke highly of the care that they received at the home and we saw that staff approached people with a kind and caring demeanour. Interactions were friendly and reflected that staff had developed positive relationships with people. Staff treated people with dignity and respect and knew the people they supported well. People were actively supported to express their views and feedback was encouraged.

People were kept safe from the risk of harm and abuse. Staff were aware of the different types of abuse and how to report any concerns. Appropriate risk assessments were in place and reviewed regularly to support people to stay safe. Staffing levels were appropriate to meet the needs of the people living at the home and we found the premises to be clean and well-presented throughout. Medicines were administered and managed to ensure people received them at the time that they needed them.

People’s care needs were assessed and regularly reviewed to ensure that their needs were met. People were supported to have enough to eat and drink to maintain a healthy diet and were supported to access healthcare professionals when required. Staff supported people in the least restrictive way possible.

Each person had a personalised support plan in place to reflect how best to meet their needs. Staff knew the people they supported well and understood their preferences. A range of activities were on offer to encourage people to engage with leisure activities and maintain relationships with the people that mattered to them.

People were comfortable in raising any issues they had with staff and management. Complaints were managed and responded to in a timely manner. The provider completed regular audits in order to review and drive improvement across the service.