This inspection took place on 6 November 2018 and was unannounced.

Wayfarers 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.

Wayfarers accommodates up to 33 older people requiring long or short term care, in one purpose built building. At the time of the inspection, the provider was only using one wing of the building. There were 18 people living at the service who required personal care.

There was a registered manager in post. 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 inspected Wayfarers in September 2017 and the service was rated ‘Requires Improvement’ overall with three breaches of regulation. Following the last inspection, we asked the provider to complete an action plan to show how they would meet the regulations. At this inspection, we found that improvements had been made and the regulations had been met. The service was now rated Good overall.

At the last inspection, we found the registered person had failed to do all that is reasonably possible to mitigate risks to people’s health and safety. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Potential risks to people’s health, safety and welfare had been assessed. There was now detailed guidance for staff to reduce the risks and keep people safe. Checks had been completed on the environment and equipment to make sure that people were safe. Incidents and accidents were recorded and analysed for patterns and trends. Action was taken to reduce the risk of them happening again.

Previously, we found the registered person had failed to assess, monitor and improve the quality of the service and maintain accurate and complete records. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, improvements had been made the breach of regulation had been met.

At this inspection, audits had been completed consistently by senior staff and the provider to monitor the quality of the service. When shortfalls had been identified, an action plan was put in place and signed off when completed. The registered manager had oversight of the audits and the action taken to rectify the shortfalls.

At the last inspection, we found the registered person had failed to give person centred guidance to staff to meet people’s needs. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, improvements had been made the breach of regulation had been met.

Care plans now had detailed guidance for staff about people’s choices and preferences. Care plans were reviewed regularly with people, who agreed their care and support. Care plans now reflected the care being given. Staff worked with healthcare professionals to support people at the end of their lives.

The management team met with people before they moved into the service to make sure that staff could meet their needs. Staff monitored people’s health and when there were changes, people were referred to healthcare professionals. Staff followed their guidance to keep people as healthy as possible. People had access to professionals such as the dentist and optician. People were encouraged to be as active as possible and lead a healthy lifestyle. People had a choice of meals and were supported to eat a balanced diet.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive wa

This was an unannounced inspection that took place on 28 September 2017.

Wayfarers offers short and long term residential care for up to 33 older people. The service is set out on one level and is split into two units, each with a communal lounge and dining room, there is also a quiet lounge. The service is located on the outskirts of Sandwich. At the time of the inspection, one unit was closed and there were 16 people living at the service.

There was a registered manager in post, although, they were on long term sick leave at the time of the inspection. There was a recently appointed interim manager in post who was in charge of the day to day running of the service while the registered manager was absent. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were supported during the inspection by the interim manager and deputy manager.

Potential risks to people’s health and welfare had not been assessed consistently, risk assessments did not contain detailed guidance for staff to mitigate risk and keep people safe. Accidents had been recorded and action had been taken to reduce risks but there were no overall analysis to identify trends or patterns. The provider told us this had been completed since the inspection, we will follow this up at the next inspection.

Staff had completed checks on some of the environment and equipment to keep people safe, for example water temperatures were recorded to mitigate the risk of scalding. However, some areas had not been checked such as portable electrical appliance testing (PAT). Some safety certificates were not available at the time of the inspection. Following the inspection, the provider sent us records to confirm that some checks had been completed since the inspection.

Each person had a care plan that reflected their choices and preferences. The care plans had not been consistently reviewed and when people’s needs changed had not been updated to reflect people’s changing needs. The interim or deputy manager met with people before they moved to the service to make sure they were able to meet the person’s needs.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these had been agreed by the local authority as being required to protect the person from harm. At the time of the inspection no-one was deprived of their freedom or liberties and no applications were required.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack capacity to do so for themselves. The Act requires, that as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff were working within the principles of MCA, seeking consent from people before providing care and support. However, the assessment of people’s capacity had not been recorded, this was an area for improvement.

There were systems in place for monitoring the quality of the service provided, however, these had not been completed consistently or been effective in identifying shortfalls found at this inspection. Records were not accurate or complete. Quality assurance surveys had not been sent out recently, the interim manager had started to meet with people to ask for their views, but relatives and stakeholders had not been asked for their opinions about what the service did well and how it could be improved. Staff had comp

This was an unannounced inspection that took place on 12 May 2015.

Wayfarers offers short and long term residential care for up to 33 older people, some of whom may be living with dementia. Most people stay at the service on a short term respite basis after discharge from hospital. The service is set out on one level and is located on the outskirts of Sandwich. On the day of our inspection there were 20 people living at the service.

There was a registered manager in post, although they were not available on the day of our inspection because there were attending training, we were supported by the deputy manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 felt safe and told us, “They take great care of me” and “I just ask someone to help me and they do”. One person commented, “If all homes were like this, people wouldn’t be afraid of moving into these places”. Staff understood how to keep people safe and protect them from abuse. Staff had been trained in safeguarding people, understood whistle blowing procedures and knew the importance of reporting any concerns.

There were effective communication systems and staff shared appropriate information about the people they were caring for. Staff had up to date information about people’s needs. Risks were managed and staff had guidance about how to support people safely. Staff supported people to walk safely so reducing the potential for someone to have a fall. Care plans were kept up to date and reviewed when people’s needs changed. Care plans gave staff instructions about promoted people’s independence and recorded what people’s likes, dislikes and preferences were.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. When anyone had been assessed as having their liberty restricted, applications were made to the DoLS office at the local authority. The management team and staff understood the principles of the Mental Capacity Act 2005 (MCA). When people lacked the mental capacity to make decisions the staff were guided by the principles of the MCA to ensure any decisions were made in the person’s best interests.

People felt staff were kind and caring. One person said, “Brilliant. Comfortable, brilliant, decent, kind and caring staff. They really bother about you here”. Staff treated people with dignity and respect and listened to what people had to say. People told us staff helped them remain independent and offered support in an unobtrusive manner.

People and their relatives felt they were involved and able to contribute to the service and have a say about the way it was run. Relatives felt the service met their expectations, was run in people’s best interests and staff communicated well with them. People told us they were always listened to. Staff said that the service was well led, had an open culture and they understood the visions and value of the service.

People had their medicines when they needed them. Any risks associated with medicines were assessed and managed so people had their medicines safely. Some people chose to manage their own medicines and were supported to do this. People received appropriate health care support and were referred to health care professionals if any concerns were identified. People were provided with a choice of healthy food and drinks which ensured that their nutritional needs were met.

People were given information about resources and groups they could access if they wanted further support when they left the service. The design and layout of the building met people’s needs and was safe. People liked their rooms and enjoyed spending time in the communal areas. The atmosphere was calm, happy and relaxed. Activities were provided and people could choose what they wanted to take part in. People were able to go out on their own if they wanted to and some people were supported by staff to go out. People’s religious and cultural needs were taken into account and supported.

Recruitment procedures were followed to ensure that new members of staff were suitable to work at the service. There were enough skilled and experienced members of staff on duty at all times. Staff received the training they needed to provide safe and effective care. People felt there was ‘always a member of staff around’ and that staff ‘knew what they were doing’. Staff were given support and supervision and told us they received the support they needed.

There was an accessible complaints procedure and people and their relatives knew who they could raise any concerns with. Everyone we spoke with told us that they did not have any complaints.

There were systems in place for monitoring the quality of the service provided and actions were taken to address any shortfalls. The registered manager, deputy manager and staff learned from events such as accidents and incidents. The provider understood their responsibilities with regard to registration with CQC and submitted notifications to CQC in a timely manner and in line with CQC guidelines.

At the time of our inspection Wayfarers had reduced the number of people residing there from 33 to 17 to accommodate a major refurbishment. This had allowed the home to move people from wing to wing whilst work was being carried out. All people living at the home, their families and care managers had had the situation explained, all were in agreement. The work include radiators replaced with cool surface ones, upgrade to shower rooms and bathrooms, all pipework boxed in and new carpet and decoration where required.

During our visit out of the 17 people in residence we spoke with three people living there. We also spoke with five staff members and the visiting hairdresser. One person told us, 'I love living here, I have been here five years and wouldn't want to be anywhere else'. Another said. 'I love talking to the staff and feel at home'.

The provider had reduced staffing due to less people living in the home, but still had sufficient staff available to meet the needs of the people remaining. All staff spoken with confirmed that they received good training and were supported by the manager and the provider. All staff spoken with showed a very good understanding and knowledge of those in their care. Staff were observed to have good relationships with people residing at the home, there was a pleasant warm atmosphere throughout. Care staff were seen to have been involved in the care planning for their key people showing they were aware of their specific needs.

People told us that they were happy with the care and support they received. They said that the staff treated them with respect, listened to them and supported them to remain as independent as possible.

People told us that the service responded to their health needs quickly and that they were looked after well. They said: "The staff are excellent". "I could not wish to live in a better place". "This is a 'tip top' home".

Relatives and visitors said: "I have no complaints, my relative settled here very quickly". "The home keeps residents involved in the service; they do a lot of activities, have social gatherings and enjoy outings in the better weather".

We saw that staff knew how to care for the people using the service and responded quickly when people needed support. Staff spent time with and empathised with people by responding to them respectfully and positively.

We found records to show how people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being. We saw that people were encouraged to express their views and make or participate in making decisions relating to their care and treatment. The staff rota showed sufficient numbers of staff on duty including the use of agency staff to make sure people's needs were being met. People told us they knew how to complain but did not have any concerns or issues at the time of the visit.

People told us that they were happy with the care and support they were receiving and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.