This inspection took place on 4 January 2017. It was an unannounced inspection.

Wantage Nursing Home is registered to accommodate persons who require nursing or personal care. The home offers care for up to 50 people. At the time of our inspection there were 35 people living at the Home. At the previous inspection on 17 and 18 February 2016 we found that care and treatment of service users was not always person centred. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We also found service users were not always treated with dignity and respect. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. Our findings highlighted that the provider had not acted in accordance with the principles of the mental capacity act 2005 and associated code of practice. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. Persons employed by the service provider were not appropriately supported. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We also found that records in relation to service users were not always complete or accurate and Governance systems were not always effective. These concerns were a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we found that the home had made significant improvements to address the areas of concern and bring the service up to the required standards.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood people’s needs and preferences. Staff were knowledgeable about the support people needed. Staff were kind and respectful and treated people with dignity and respect.

People were supported by staff who had been trained in the MCA and applied it's principles in their work. Staff told us, and records confirmed they had effective support. Staff received regular supervision (one to one meetings with their manager). Staff spoke positively about the support they received from the registered manager and the provider

Records in relation to people who used the service were complete and accurate. The manager conducted regular audits to monitor the quality of service. Learning from these audits was used to make improvements.

People told us they were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities.

People received their medicines as prescribed. Staff administering medicines checked each person's identity and explained what was happening before giving people their medicine.

There were sufficient staff to meet people's needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The service sought people's views and opinions. Relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People had sufficient to eat and drink. Where people required special diets, for example, pureed or fortified meals, these were provided by kitchen staff who clearly understood the dietary needs of the people they were catering for.

We inspected Wantage Nursing Home on 20 July 2016. The inspection was unannounced.

Wantage Nursing Home is registered to accommodate persons who require nursing or personal care. The home offers care for up to 50 people. At the time of our inspection there were 34 people living at the Home.

There was not a registered manager at the service. However, an application had been made by the current 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.

We carried out an unannounced comprehensive inspection of this service on 17 and 18 February 2016. We found the provider was not meeting the legal requirements of five of the fundamental standards. After the comprehensive inspection, we took enforcement action and issued warning notices to require the provider to meet the legal requirements of two of the fundamental standards.

This inspection in July 2016 was to check they had met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to people’s safe care and treatment.

We also checked they had met the legal requirements of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to staffing.

This report covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wantage Nursing Home on our website at www.cqc.org.uk

Since February 2016 the provider had improved their practices in relation to mitigating the risk to people who had been assessed as being at high risk of pressure damage. People that were at high risk of pressure damage had up to date and accurate records that demonstrated they had been repositioned in line with the guidance within their care records.

Since February 2016 the provider had improved their practices in relation to infection control. People who used the service had access to appropriate equipment that was in line with the code of practice on the prevention and control of infections.

Since February 2016 the provider had improved their practices in relation to the deployment of staff. People had access to ‘call bells’ and the response time by staff in answering to peoples care needs had improved.

This inspection took place on 17 and 18 February 2016. The inspection was unannounced.

Wantage Nursing Home is registered to accommodate persons who require nursing or personal care. The home offers care for up to 50 people. At the time of our inspection there were 39 people using the service.

There was not a registered manager at the service, however an application had been made by the current 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.

People were not safe. The service did not deploy staff effectively to meet peoples care needs. Call bells were not always responded to in a timely manner. People did not receive their medicines safely and medicines were not always secured.

People were not always protected from the risk of pressure area damage and choking, because thickeners were kept unsecured in communal areas of the home. The service had procedures in place to report incidents and accidents. However staff did not always follow these procedures. We observed poor standards in relation to infection control.

People’s care plans did not always contain information that was guided by the principles of the Mental Capacity Act 2005 (MCA). Where mental capacity assessments had been carried out records were not underpinned on how best interest’s decisions had been reached. Staff had completed training in relation to MCA but were not always able to understand the principles underpinning it.

The service had regular meetings in place for staff. However, staff told us and records confirmed that staff did not always receive effective supervision (one to one meetings with their line manager).

People were not always treated with dignity and respect. We observed that people were left in an undignified way during personal care. People's personal information was not always kept confidential.

People did not always receive personalised care. All the care plans held personal information about people including their care needs, likes, dislikes and preferences. However, guidance on peoples care needs was not always followed and records did not always reflect people’s changing care needs.

We saw evidence that the service carried out monthly reviews of peoples care’s needs. However, care records did not always contain accurate information. People told us and we observed that they did not always have access to a range of meaningful activities.

The provider had carried out quality assurance audits and had identified concerns within the home. However, the systems in place were not always effective.

The manager had visions and values for the home. However, these visions and values were not always displayed during the course of our inspection.

Staff understood the whistleblowing policy and procedures. Staff told us they felt confident speaking with management about poor practice. Staff we spoke with said they were confident they could raise concerns surrounding the day to day running of the service. However, staff did not always feel confident that their concerns would be acted on.

The adaption and design of the service did not always meet people’s needs. We observed parts of the home where people were living with dementia were not decorated or designed in a way that followed good practice guidance for helping people to be stimulated and orientated.

People did not always receive their care and support when needed as there was limited equipment to assist people to transfer from, for example, their bed to a wheelchair.

Staff told us and records confirmed they received training. However, we identified three staff members that were responsible for administrating medicines were overdue in their refresher training. Medicines administered ‘as a

We spoke with nine people and two people's relatives. We also spoke with six care workers and one nurse. At the time of our inspection there were 46 people at the home.

We looked at six people’s care files and saw that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. For example, where people were at risk of falls, risk assessments were alongside care plans to ensure peoples safety. During our SOFI we observed that people with dementia benefited from meaningful engagement and were being supported in line with their care plans.

We found that a number of choices were offered at mealtimes, which included a vegetarian option. People’s dietary requirements were also well known to staff and recorded clearly in peoples files. People and their relatives were complimentary about the food and drink people were provided. One person told us, “I am eating good food and I weigh what I should, you can’t ask much more than that can you”.

People and people’s relatives we spoke with told us they felt able to raise concerns. One relative told us, “they are very approachable and interested in what we have to say”. We observed the manager and senior management were regularly auditing the safety and quality of their service and acting upon their findings. For example, where people had requested more day trips this had been arranged and where relatives requested a list of staff supporting their relatives in the home this was done.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained and kept securely. Records we asked to see could also be located promptly.

People told us they were always treated with respect by all care workers. We observed care workers knocking on doors and waiting to be invited in and we observed people being given a choice and time to respond. One person told us "the staff are very respectful of my cultural and religious needs and are very sensitive when attending to my personal care". Another person told us "I'm pleased with the carers that I have"

We looked at seven care files including care plans, risk assessments and daily records. All were signed and dated by the person or their relative. Where a person was unable to give consent then a best interest meeting had taken place and had been documented.

We observed people being assisted to eat their lunch in both dining rooms and some people eating in their rooms. The home had protected mealtimes, so all staff were available to assist people with their meals. We observed nursing and care workers assisting people in a discreet and dignified manner.

The provider did not have suitable systems in place to assess and monitor the quality of service that people received. There was a risk that people would be exposed to poor care due to lack of monitoring. The provider did not protect people from the risk of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

The home was non compliance in relation to safeguarding, assessing quality and notifications as well as some records.

We previously inspected Wantage Nursing Home in October 2012 and found them non compliant with two outcomes. Since then the manager and deputy had both left the home. The new manager started work in December 2012 and the new deputy manager, in March 2013.

When we inspected this time to monitor the home’s progress towards becoming compliant, we found that progress had been made in some areas but the provider was still non compliant with both outcomes.

Limited progress had been made in bringing care plans and related records up to an acceptable standard. The views and wishes of people in the home and their representatives were still not sufficiently integrated into care plans. The pace of improvement had been very slow despite ongoing monitoring by the provider. We saw from files that people’s identified needs were not always recorded and if recorded, were not always effectively met. There was limited evidence of coordination between risk assessments identified needs and care plans. Some care records were not consistently completed.

Improvements had been made in the level of activities provided with the appointment of additional activities staff.

Feedback from people in the home and relatives remained negative about staffing levels, communication and morale. Staffing levels had improved with recent recruitment. However, the provider had yet to complete a dependency assessment to identify appropriate staffing levels. Staff morale and communication issues remained.

Comments made by relative's included "very good home","mum has put on weight and has made friends","very supportive staff","care staff are very good","communication could be better, messages are not always passed on","some staff are better than others" and "hopefully things will improve when the new manager is here".

We saw that a compliance audit had been completed monthiy, this included checking records relating to personalised treatment and support. In October 2012 five care plans were examined and all were incomplete.

People told us that they were satisfied with the care provided by the two local GP surgeries, one of which visits the home on a weekly basis, other healthcare professionals visit as appropriate. We were told that regular resident and relatives meetings took place, this could not be evidenced.

We observed staff assisting people with their meal in a discreet and dignified manner.

We spoke with several members of staff, who had a good understanding about safeguarding adults and how to report them appropriately.

We saw evidence of regular audits undertaken and management of medication was fully compliant.

Staff that we spoke with said that there were not sufficient staff on each shift, a high percentage of people require two staff to provide hoisting, at least eight people on the general nursing unit, which meant that other people did not receive care when needed.

People told us that it was a good place to live. Some people described it as an excellent and a perfect place to live. People told us that they were very comfortable and well looked after.

Wantage Nursing Home provides nursing care and support for up to 50 older people including those living with dementia. At the time of our inspection there were 47 people living at the home.

Wantage Nursing Home has 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.

This unannounced inspection took place on the 26 February 2015 with an announced second visit on the 4 March 2015. At our last inspection of Wantage Nursing Home in November 2013 we found the home met all the regulations assessed.

There was significant dissatisfaction with the quality of the food.

People were positive about their safety and security. Potential risks to people’s safety were identified within their care plans. For example, from falls. Action was taken to address this, falls risk assessments identified the number of staff and equipment required to move the person safely.

The interaction between staff and people living in the home was polite, respectful and friendly. There was a very relaxed atmosphere throughout the home and staff had time to talk informally to people in lounges and dining areas.

People had different opinions about staffing levels. Some people said there were always sufficient staff available others said that at times there were not. We checked staffing rotas on the days we visited and found they agreed with the set staffing structure. The provider told us they kept staffing under review and adjusted staffing levels according to the number and dependency levels of people. However, some people told us they did not feel the dependency level was always appropriately reflected in staffing levels. There was very little recent staff turnover which helped provide consistency of care for people.

Staff confirmed they received regular training to enable them to meet people’s care needs. Domestic support staff confirmed they had received infection control training and training about the safe use and storage of chemical products.

Staff confirmed there was a mixture of formal and informal supervision, together with an annual appraisal. There were staff meetings and staff felt able to discuss any issues with their line manager or the registered manager.

Staff had received safeguarding adults training and this was confirmed from training records. There was safeguarding information and contact details displayed prominently in the home for staff and others to refer to. Staff gave us examples of what kinds of abuse they might see and how they would recognise it. They were able to describe the action they would take to protect people and how they would report any suspected abuse.

Care plans included evidence of pre-admission assessments to identify individuals’ care needs. This enabled, for example, any specific equipment required to be put in place before the person moved in and ensured their needs could be met from the outset. Staff followed any advice and recommendations given by healthcare professionals involved with the service, for example GPs and specialist nurses. Care plans were kept under review and care staff were aware of the relevant details and acted upon them.

Medicines were administered safely. Routine checks were carried out to monitor records and practice to make sure people received safe and effective support when they needed help with their medicines.

Relatives confirmed they had completed annual questionnaires and could also meet informally with the registered manager to discuss their relative’s care and provide feedback.

Staff had a good understanding of the implications for them and their practice of the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make specific decisions at a given time. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after them safely.