About the service: Wallace House is a nursing and residential care home that can accommodate 40 people. Care is primarily provided for older people, including people who are living with dementia. At the time of this inspection 38 people were living at the service.

What life is like for people using this service: Improvements had been made to the service following our previous inspection in October 2017. The registered manager had acted to ensure that the systems for assessing and monitoring the performance of the service were effective. The provider had made significant improvements to all aspects of the environment and they were in the final stages of a full refurbishment programme.

In September 2018 the provider introduced new training programmes and over three-quarters of the staff had already completed the mandatory training using these programmes. The registered manager made sure new staff completed a full induction and all the required training. Checks were made on the ongoing competency of staff.

The registered manager and staff had developed robust risk assessments and acted appropriately to mitigate any identified risks. The provider was redesigning assessments and the care records. They recognised more refinements to these documents were needed.

The cook was very knowledgeable and it was positive to hear they had received focus on under-nutrition training. Staff were encouraging people who were under-weight to eat fortified foods. However, at times catering staff found the budget did not allow for a full range of ingredients to be purchased to make fortified foods but the registered manager worked with them to make sure action was taken to obtain the necessary ingredients.

People participated in a range of activities that met their individual choices and preferences. Staff understood the importance of this for people and provided the structured support people required. This enabled people to achieve positive outcomes and promoted a good quality of life.

Staff effectively investigated and reported any safeguarding matters. The registered manager had acted on concerns, and complaints received by the service and had taken steps to resolve these matters. They ensured that all incidents were critically analysed and from this review lessons were learnt and embedded into practice.

All the people we spoke with told us that the registered manager and staff listened to their views, acted to resolve concerns, when needed, and met people’s needs.

Rating at last inspection: Requires Improvement (report published 6 December 2017). This had been the third time the service was rated as requires improvement since July 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved and was rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected Wallace House on 21, 27 and 29 September 2017. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

At our last comprehensive inspection of this service on 19, 20 and 28 July 2016, we found the provider was in breach of four regulations related to consent to care, dealing with complaints, staffing and good governance. We rated Wallace House as ‘Requires improvement’ overall at that time. We re-visited Wallace House on 31 January 2017 and found they had rectified the breaches of regulations previously identified.

Wallace House is a care home which provides nursing and residential care for up to 40 people. Care is primarily provided for older people, including people who are living with dementia. At the time of this inspection 36 people were in receipt of care from the service.

The home has not had a registered manager in post since June 2017. 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 had recruited a manager and they had submitted an application to the Commission to become the registered manager of the service.

The provider had not ensured the systems for assessing and monitoring the performance of the service were effective which placed people at risk.

Accidents and incidents were monitored but we found improvements were needed around how the information was analysed and used to assess risks of falls and injury. We found that the provider was changing the systems they used for monitoring the service and in the transition period the systems in place had not picked up the issues we identified.

Safeguarding and whistleblowing procedures were in place. The manager was currently in the process of reviewing all aspects of the service to check that all previously raised concerns had been investigated and appropriately referred to other agencies. They were also ensuring that the Commission had been notified of these incidents.

A complaints process was in place. However people told us that, up until recently, when they raised issues they received no feedback and action was not taken to rectify their concerns. The manager was currently in the process of ensuring all complaints were identified, reviewed, complainants were responded to and action was taken to reduce the potential for these matters to reoccur.

People’s care records were cumbersome, extremely difficult to navigate and we often found it difficult to get a sense of the person’s needs. The lack of a detailed written assessment had contributed to the difficulties around developing the care records as an effective working tool. Also staff needed to ensure the risk assessments in place reflected all of the concerns.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. However, the service was reliant on using agency staff and we found the provider's central human resources team had vetted the agencies they used, but they did not always send the staff at the service the agency staff profiles or ensure the ones they did send were kept up to date. We discussed this with the manager on the first day of the inspection and found when we returned they had developed their own system for checking that agency staff remained suitable to work at the service.

The environment on the upstairs nursing unit was not user friendly and both floors were in need of refurbishment. The manager confirmed that they had taken action to rectify this and the provider was to begin a full refurbishment programme before the end of the year.

Although the domestic staff tried their best to keep the service clean, there were insu

We carried out an unannounced comprehensive inspection of this service on 19, 20 and 28 July 2016. Four breaches of legal requirements were found.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements. These related to the breaches of regulation regarding good governance, consent to care and treatment, complaints and the arrangements for ensuring staff were suitably supported by means of training and appraisal.

We undertook a focused inspection on 31 January 2017 to check they had followed their plan and to confirm that they now meet the legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wallace House on our website at www.cqc.org.uk.

Wallace House is a care home which provides nursing and residential care for up to 40 older people, including people living with dementia. There were 35 people living in the home at the time of this inspection.

The service had a registered 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 a 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 the provider had met the assurances they had given in their action plan and were no longer in breach of the regulations.

The support given to staff had improved. The registered manager had reviewed the provision of staff training and addressed the deficits in staff training identified at the previous inspection. Compliance with training was being monitored on an on-going basis by the registered manager and action taken to schedule training for staff when required. All staff had been scheduled to receive an annual appraisal during 2017 and the registered manager was in the process of training members of the senior staff team to assist in the completion of these.

At the time of this inspection, records held where people had appointed a lasting power of attorney to act on their behalf were still not clear. We highlighted this to the registered manager who took immediate action to resolve this. Other records we reviewed showed consent to care and treatment had now been obtained from the relevant person and documented in the person’s care records.

The records held in relation to the one recent complaint the service had received were much more detailed than those seen during the previous inspection. There was evidence this complaint had been investigated by the registered manager and a full written response provided to the complainant.

The systems to assess, monitor and improve the quality of the service had been reviewed. The registered manager was receiving additional support from the provider to monitor and review the service and to make improvements. Overall we found documentation was much more accessible than during the previous inspection; records were being maintained to a higher standard and audit documentation was being completed more consistently. The provider was also in the process of introducing a new quality team who would be responsible for assisting the registered manager in reviewing and improving the quality of the service.

This inspection took place on 19, 20 and 28 July 2016 and was unannounced. This means the provider did not know we were coming. We last inspected Wallace House in November 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

Wallace House is a care home which provides nursing and residential care for up to 40 older people, including people living with dementia. There were 37 people living in the home at the time of this inspection.

The service had a registered 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 a 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 kept safe from harm. Staff were aware of the different types of abuse people might experience and of their responsibility for recognising and reporting signs of abuse. People told us they felt safe. At the time of the inspection not all staff members were up to date in relation to safeguarding training. The service had recognised and taken action to address this.

Possible risks to the health and safety of people using the service were assessed and appropriate actions were taken to minimise any risks identified. People were assisted to take their medicines safely by staff who had been appropriately trained.

Staff had not been given the on-going training they needed to keep their knowledge up to date. Nor had they been given the necessary support, in terms of annual appraisals.

People were supported to meet their health needs and access a range of healthcare services. Nutritional needs were monitored and specialist advice was sought when necessary. People were offered a varied diet with choices of meals and, where needed, were assisted with eating and drinking.

Staff were described as kind and caring and had a good understanding of people’s needs and preferences. They treated people as individuals and supported them to make choices about their care. People told us they were consulted about and involved in their care planning although we found this was not always clearly documented.

Care plans were reviewed and updated on a regular basis to reflect changes in people’s needs. Consent to care and treatment was not always formally documented.

People told us they felt staff listened to them and they felt able to raise issues with management. Formal complaints were not always properly investigated or recorded in sufficient detail.

People told us they were happy with the management of the service and knew who to contact should they have any concerns. Staff we spoke with felt supported by the registered manager and were able to easily access support when they required it. The provider had a range of systems in place for monitoring and reviewing the service, however we found these were not fully effective. Record keeping around areas such as safeguarding incidents, complaints and actions taken to resolve areas for improvement was poor.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to supporting staff; consent to care and treatment; complaints; and governance. You can see what action we told the provider to take at the back of the full version of the report.

At the time of the inspection there were thirty-one people who used the service and we were able to meet and speak with some of them and observe their experiences of care and support at Wallace House. We spoke to relatives of people who used the service, with the seven staff on duty and the manager. One person who used the service told us, “It’s really good here. I can decide what I want to do each day, every day is different”.

We were able to observe the experiences of people who used the service. For instance, we spent time with people as they had their breakfasts and lunches and observed how staff supported and encouraged them. We saw staff encouraged people to make their own choices and decisions, we saw some people preferred to have lunch in their rooms. We saw staff understood each person’s different needs, for example, when they required additional support at mealtimes.

We saw that staff supported people to make choices about how they spent their day. People told us that there had been activities in the home if they wanted to take part. On the day of our visit we observed a range of activities throughout the home which had been arranged by the activities co-ordinator.

We saw that staff treated people with dignity and respect. We saw that people had freedom of movement around their home and could spend time in their bedrooms whenever they wanted. We saw that each person had their own bedroom which was personalised. Each person had a choice to have a nameplate with a photograph and an information sheet about them on their room door. We saw the provider had made suitable adaptations to meet the people’s physical needs. We observed that staff respected people’s privacy and knocked before they entered their rooms.

We saw that the staff communicated well and appropriately with people in a way that was easily understood. We saw that staff was attentive and interacted well with people.

We learned more about how care and treatment was provided when we talked with staff, observed their practices and looked at the records of five people who used the service. One staff member told us, “I am well supported in my job. I can receive the training I need to help me.”

“It’s really lovely here. I get on well with the people, the staff are always polite to me. The food is really good.”

“I take things as they come but I am alright here.”

“I enjoy it here, it’s a very happy place to be.”

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that people who used the service had their care and welfare needs met.

We found that staff had been well supported to deliver care and treatment safely.

We found that people’s views were important and listened to. We found that there was an effective complaints system in place.

Some of the people who lived at the home had complex needs which meant they were not able to tell us their experiences. We used a number of different methods to help us understand their experiences, which included speaking to relatives, health professionals and observation. Throughout the observation we saw that staff treated people with respect and courtesy. Feedback from people, their relatives and health professionals was, on the whole, very positive. One person told us, "I like it here. It's a very nice place. Comfortable." One relative said, "The care is spot on, I can't fault it."

We reviewed four care records and saw that people's preferences and care needs had been well documented. We spoke with three members of staff. Staff were knowledgeable about the care needs of the people who used the service and what they should do to support them.

Staff received appropriate professional development and there was an effective system in place to make sure staff training was up to date so that staff could care for people safely and to an appropriate standard.

We found that the provider had made suitable arrangements to protect vulnerable people from the risk of abuse and that there was an effective system in place to monitor and assess the quality of the service.

Wallace House is a care home which provides nursing and residential care for up to 40 older people, including people who were living with dementia. There were 38 people living in the home at the time of this inspection.

This was an unannounced inspection, carried out over two days on 12 and 17 November 2014. The home was last inspected on 9 December 2013 when there were no breaches of legal requirements.

A registered manager was in post, having been registered in November 2013. 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.

Good systems were in place to protect people living in the home from harm. Staff had been given regular training in the safeguarding of vulnerable adults, and were clear about their responsibilities to recognise and immediately report any incidents of abuse. People told us they felt very safe living in the home and believed staff protected them very well.

There were enough staff on duty to meet people’s needs in a safe and timely way. Staff had time to engage with people, individually and in groups, and did not appear to be rushed. Any new staff were carefully checked before they started working in the home to make sure they were fit to work with vulnerable people.

People’s prescribed medicines were stored and administered safety, and clear records were kept of all medicines received, administered and disposed of.

People’s needs were carefully assessed before they came into the home, to ensure those needs could be met. People were encouraged to be fully involved in the assessment of their needs, and were asked for their wishes and preferences about how their care should be given. Detailed plans were drawn up to meet each person’s individual needs and wishes, and these were regularly evaluated to make sure they remained appropriate and effective. People told us they felt their care and welfare needs were consistently met, and that they received very good care.

People living in the home enjoyed a varied and nutritious diet, with plenty of choice. Any special dietary needs were met. People told us they were very happy with quality and quantity of their meals.

Staff closely monitored people’s health needs and accessed the full range of community and specialist healthcare services, where necessary, to make sure people received the healthcare they needed. People told us the staff were very good at picking up any changes in their health or demeanour and responded quickly. Health professionals who supported the home told us the home made appropriate and prompt referrals and always followed any advice they were given regarding people’s care and treatment.

There was a positive and relaxed atmosphere in the home. Many of the people, staff and visitors we spoke with commented on the ‘family’ feel to the home. We saw that staff were caring and sensitive in their approach and actions. People told us they were very well cared for, and were treated with warmth and affection by staff.

People told us they and their families were encouraged to express their views and be actively involved in their own care and in the running of the home. Frequent residents’ meetings were held to give people the opportunity to voice their opinions and ask questions. People told us they could speak to the manager whenever they wished. Information was displayed on notice boards telling people about the services and activities available to them.

People told us they were always treated with great respect by staff, and said that their privacy and dignity were protected. Regular reviews allowed people to comment on their care and ask for changes to their care plans. People told us they received their care in the ways they wanted, and that staff were flexible and responded positively to any requests.

Complaints or concerns were taken seriously by the manager, who addressed such issues promptly and appropriately. Complainants were given detailed and sensitively written responses which acknowledged failings, where relevant, and gave details of actions taken (for example, the replacement of damaged clothing).

People were given a wide range of activities and opportunities for social stimulation, both in the home and in the local community. People told us they were happy with the social activities available to them, and said that staff made every attempt to meet individual preferences, as well as providing group activities.

The registered manager demonstrated clear leadership and ensured there was an open and positive culture in the home. Staff told us they were clear about their roles; were proud of the quality of care they provided; and were happy working in the home. They said they felt supported and respected by the management team. Visiting health professionals commented very favourably on the quality of the management of the home.