We carried out an unannounced comprehensive inspection on 21 and 22 January 2019.

At our last inspection in October 2018 we rated the service as requires improvement. This was because the provider's governance framework, to help monitor the management and leadership of the service, and the ongoing quality and safety of the service, had not been fully implemented. In addition, some newly designed systems had not always been robust in identifying areas requiring improvement. The Commission took enforcement action and imposed a positive condition on the providers registration. This meant the provider was required to send a monthly action plan, telling us what action was being taken to help improve the service. We monitored those monthly action plans to ensure they provided the information required.

During this inspection we looked to see if improvements had been made and that the condition had been sufficiently met. The Commission was satisfied with the progress at the service, therefore the rating changed from requires improvement to good, and the condition was removed.

Waypoints Plymouth 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. The service is registered to provide residential care and accommodation for up to 64 older people who may also be living with dementia. At the time of this inspection, 53 people were living at the home.

Waypoints Plymouth is owned by Waypoints Care Group Limited. The provider also owns two other care homes in Dorset.

The service had 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.

Significant improvements had been made to the providers governance framework, meaning that checks to assess and review the ongoing quality of the service, were now imbedded. However, some small changes were still required to ensure the system was fully effective.

People had their needs assessed prior to moving into the service to help ensure the service was suitable, and had their health and social care needs met in a co-ordinated way. People had care plans in place and people’s communication needs were known, but care plans were not always accurate. The registered manager told us immediate action would be taken to update care records.

People had the opportunity to participate in social activities. However, the registered manager told us they would review social engagement for people, as we found some people did not always have stimulation.

People’s risks associated with their care were known but not always recorded. Immediate action to update people’s records was taken at the time of our inspection. People’s accidents and incidents were monitored for themes and trends and to help reduce reoccurrences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service also supported these practices. At the time of our inspection the registered manager was taking action to improve the recording of people’s mental capacity and consent in their care plans.

People told us the quality of the food was nice, with plenty choices available. People had their nutrition and hydration needs met by knowledgeable staff, and people now received support with their meals in a respectful manor.

People were looked after by staff trained to meet their needs. Nursing training and competence had now improved. People were cared for with dignity and respect at the end of their life.

People were cared for b

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures, but further improvements are still required.

We carried out an unannounced comprehensive inspection on 27 and 28 February 2017 and the service was placed into ‘special measures’.

We told the provider to make improvements to make sure people were kept safe from avoidable harm and abuse. Risks associated with people’s care were to be recorded and known by staff so they could be cared for safely, and received care that met with their needs, wishes and preferences. People’s medicines to be given as prescribed and for the environment to be free from offensive odours. In addition, we told the provider people should be treated with dignity, respect and have their privacy respected and their confidential information to be stored securely. Staff training to be embedded into practice, nursing competency improved and the culture of the service reviewed to ensure people living with dementia received personalised care. We also requested the overall management, leadership and culture of the service should be improved. That the provider learnt from mistakes and implemented recommendations from the local authority safeguarding team, to help keep people safe. Also, the provider’s monitoring processes, used to help identify when improvements were required, were inadequate in ensuring the health, safety and welfare of people. The provider had also failed to inform the Commission of serious injuries in line with their legal obligations.

Immediately after our inspection, the Commission requested the provider submit an urgent action plan to tell us how they would keep people safe and we also met with the provider. The provider told us they would stop new admissions to the service, in order for them to put things right. We also contacted the local authority safeguarding team who took prompt action to ensure people's health, safety and wellbeing. The local authority and Clinical Commissioning Group (CCG) took action to stop placing at to the service. During this inspection we looked to see if improvements had been made. We found action had been taken, but some improvements were still ongoing.

Waypoints Plymouth is owned by Waypoints Care Group Limited. The provider also owns two other care homes in Dorset. The service provides care and accommodation for up to 64 people. On the day of the inspection 52 people lived in the home. Placements by the local authority and CCG had recently re-commenced.

Since our last inspection there was a new 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.

The provider had designed, but had not yet implemented their new overarching governance framework, to help monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving. This meant there was a continued risk to the ongoing quality of the service because the provider may not be alerted to when improvements are required.

The registered manager had devised some new systems and process to help monitor the quality of care people received. However, these had not always been robust in identifying areas requiring improvement, and still required embedding into culture and practice.

People’s families were being asked to complete questionnaires to help collate th

We carried out an unannounced comprehensive inspection on 27 and 28 February 2017.

Prior to our inspection the Commission had received a concern that people were being unsafely supported with their mobility and that their bedroom furniture was not always repaired. There had also been reports from the provider and local authority of a high number of safeguarding incidents involving people walking into other people’s bedrooms uninvited and of people causing harm to one another. The provider had also failed to notify us of significant events in line with their legal obligations.

Waypoints Plymouth is owned by Waypoints Care Group Limited. The provider also owns two other care homes in Dorset. The service provides care and accommodation for up to 64 people. On the day of the inspection 61 people lived in the home.

Waypoints Plymouth provides care for people with physical and mental health conditions which include people living with a diagnosis of dementia. The provider's philosophy of care was stated to be “Creating a sense of independence, normality and enjoyment” and “Supporting people with the least restrictions, ensuring their freedom, choice and control”.

At the time of our inspection the service did not have a registered manager in post. The service was being managed by a Director of Waypoints Care Group Limited. A new manager had been appointed from 20 March 2017 and we were told would be registering with the Commission. 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 our last inspection on 08 August 2016 and 09 August 2016 we asked the provider to make improvements to ensure there were sufficient numbers of staff employed to meet people’s individual needs; and to ensure people were protected from risks associated with their care. We also required the provider to improve practice in the service based on the findings of previous safeguarding investigations in order to keep people safe and free from avoidable harm and abuse. We requested the provider make sure people’s care records were accurate and people’s complaints were listened to. As well as ensuring there were effective governance systems in place to assess, monitor and improve the ongoing quality of the service.

In addition, we asked the provider to consider the ethos, management and culture of the service. This was because some relatives and staff had told us of inconsistent management approaches and poor communication. Following our inspection, the provider sent us an action plan telling us how they intended to meet the associated regulations. During this inspection we looked to see if improvements had been made. We found some action had been taken, but further improvements were required.

People were not protected avoidable harm that may affect their human rights, because people were able to freely walk into other vulnerable people’s bedrooms and cause harm. Although, this freedom of movement was the basis of the provider’s dementia care ethos, consideration had not been given to how people were protected from experiencing psychological or physical harm. Previous safeguarding alerts and investigations carried out by the local authority had also shown similar themes; that the layout of the service did not always keep people safe and protected from harm.

People told us they felt safe living at the service. However one person told us they did not feel safe because, they were worried about other people entering their bedroom. They explained they had told staff, but nothing had changed. The preventative measures which were in place to alert staff when a person entered another person’s bedroom uninvited, were not always effective and people did not always have a call be

We carried out an unannounced comprehensive inspection of this service on 8 and 9 August 2016.

At our last inspection on 30 June 2015 and 1 and 3 July 2015 we asked the provider to make improvements to how people’s care was documented, ensure medicine records were completed accurately and that social activities were meaningful and planned in line with people’s interests. During this inspection we looked to see if these improvements had been made and we found that action had been taken.

Waypoints Plymouth is owned by Waypoints Care Group Limited. The provider also owns another care home in Dorset. The service provides care and accommodation for up to 64 people. On the day of the inspection 58 people lived in the home.

Waypoints Plymouth provides care for people with physical and mental health conditions which include people living with dementia. The provider’s philosophy of care is about “creating a sense of independence, normality and enjoyment” for people living with a dementia. Supporting people with the least restrictions, ensuring their freedom, choice and control.

The service had a registered manager in post. However, at the time of our inspection the registered manager was absent due to ill health. The service was being managed by the head of care, who was supported by the provider’s operations director. 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.

Prior to our inspection the Commission had received a number of whistleblowing concerns. These included, issues relating to staffing levels, people not always being kept safe from avoidable harm or abuse, the management of accidents and incidents, poor manual handling practices, the cleanliness of the environment and that staff did not always follow policy and procedures.

We were also told staff did not always treat people with dignity and respect, follow people’s care plans and accurately record their care. Concerns had also been raised that nutrition was not effectively monitored, and people’s continence and personal care needs were not being met. We were also told there was a lack of management and structure at the service, and complaints were not listened to or taken seriously.

People, relatives and staff told us there was not enough staff to meet their individual needs. Relatives also felt there was a lack of continuity of care for people, because staff worked across the service and not specifically in one area. Some external health professionals also shared this view. People were not always protected from avoidable harm and abuse because the provider did not always learn from previous safeguarding investigations. People were not always protected from risks associated with their care, for example risk assessments were not always followed.

People were protected by good infection control practices. Overall, the service was free from odour but in some areas there was a smell of urine. Relatives also commented about this, but explained they understood the challenges staff faced in meeting some people’s needs. People’s medicines were administered safely and the provider responded when errors in practice had been identified, for example by arranging additional training.

Overall, relatives told us they felt their loved one was safe living at the service. Staff knew what action to take if they suspected someone was being abused mistreated or neglected. Staff were recruited safely to work with vulnerable people.

People were cared for by staff who had received training and support. Some external health professionals expressed concern that staff were not always adequately trained to support people with dementia. People were encouraged and supported with their nutrition. A f

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

At the time of our inspection there were 56 people who used the service. Our inspection team was made up of two inspectors. This is a summary of what we found. The summary is based on meeting with and speaking to twenty people who used the service, seven relatives of those who used the service, twelve staff supporting them, The Head of Care, the Registered Manager and from looking at records.

We, the Care Quality Commission (CQC) carried out an inspection of Waypoints in response to information of concern we had received about the service. The information we had received related to staffing levels and poor communication. We found that there was no evidence to support any of the allegations.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were systems in place to ensure staff received training which was specific to the needs of the people who lived at the home. This included dementia care training, end of life care and the protection of vulnerable adults.

There were systems in place to ensure risks to people's safety and welfare were identified and risk assessments were put in place to minimise such risks. There were systems in place to ensure appropriate procedures were in place in the event of a foreseeable emergency.

People we spoke with told us they felt safe, one person commented, “I feel safe and well looked after”.

A recent mock fire drill in conjunction with the local fire service, led the Registered Manager to comment, “The results were very impressive, none of the care staff were informed it was going to happen, and I was really impressed at how well everyone worked together to ensure people were safe”.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection two people had DoLS authorisations in place. The Registered Manager was able to demonstrate a clear knowledge of the process the home followed and evidenced where the applications had been made and reviewed.

The home had four separate units which were all interlinked. We saw the duty rota which showed the home had sufficient staff to cover all the units both days and night shifts.

Is the service effective?

People told us they were happy with the care they received. We saw from care records that people's care needs had been appropriately assessed and care plans reflected need.

People we spoke with said, “The staff here are very good”; “It’s splendid here, I can’t fault it” and “I’m very happy here, I wouldn’t entertain going anywhere else”.

Is the service caring?

People were supported by staff who displayed warmth and affection. We saw that staff showed understanding, patience and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were not rushed.

We spoke to people who used the service and their relatives. Comments included: “They have improved so much since being here”; “I can find no fault with the care, they are happy and I am happy”; and “I am well looked after, I have no complaints, the staff are very caring”.

Is the service responsive?

Guidance from health care professionals was sought to ensure best practice was applied, care plans were updated and it was evidenced and recorded that guidance was followed where appropriate to effectively meet people's needs and manage risk.

Records showed that people's preferences, interests and diverse needs had been

recorded and care and support had been provided in accordance with people's wishes.

Where the Registered Manager had identified posts could not be covered by the regularly employed staff, agency or bank staff were brought into cover these shifts.

Is the service well-led?

There was a clear staffing structure which ensured that there were clear lines of accountability and responsibility. The staff confirmed that the Registered Manager and qualified staff were available on call whenever needed. Staff told us that they received regular supervision sessions and staff meetings. One staff member said, “We all support each other” and “We meet on a one to one regularly”.

We found that learning from incidents and investigations took place and appropriate changes were implemented. Complaints and comments were taken into account to improve the service. One person commented, “My tap wasn’t working, I saw the handyman and told him about it, it was fixed the same day” and another said, ‘I really do feel that you (The Registered Manager) listen, I have observed real improvements’.

Quality assurance processes were in place in the home. We saw evidence of people and their relatives being asked for feedback and this being responded to and acted on.

We (the Care Quality Commission) carried out this inspection as part of our planned review of inspections.

Waypoints was opened in August 2012 and this was the first inspection by the CQC.

We talked with eight people who lived at the home, nine members of staff and four visitors to the home. They all told us that they were happy with the care provided at Waypoints. People told us “The staff are great” and “Staff can’t do enough for you”.

One relative said “We are very happy with the care our relative receives, we are kept updated by the manager ”. Another relative told us “This home is five star”.

People told us that at all times staff treated them with kindness and respected them. They said they thought their needs were being met. Records relating to people’s care needed further detail to ensure that all staff would be aware of people’s care needs.

People were cared for by staff who had received training to provide them with the skills to meet their role, this included staff trained in how to keep people safe. People and staff at the home said that there were enough staff available on each shift to meet people’s needs.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Systems were in place for monitoring the quality and risks associated with the service to ensure that improvements identified were identified and addressed.

The inspection took place on 30 June 2015 and 1 and 3 July 2015 and was unannounced.

Waypoints Plymouth provides care and accommodation for up to 64 people. On the day of the inspection 60 people lived in the home. Waypoints Plymouth provides care for people with physical and mental health conditions which include people living with dementia.

The service had 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.

People had not had their medicines managed safely. Medicines administration records were all in place, but had not all been correctly completed. An action plan had been put in place to address all the issues found. Processes had been changed and fed back to staff. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, speech and language therapists and pharmacists.

People’s risks were managed and monitored. People were not consistently promoted to live full and active lives or supported to go out in the community. Activities did not meaningfully reflect people’s interests or individual hobbies. The registered manager had already identified this as an area that required improvement. Several plans had been put in place to address this issue and help ensure people’s needs were met.

There were quality assurance systems in place. Audits were carried out in line with policies and procedures. However, where areas of concern had been identified, changes had not always been made to help ensure quality of care was maintained. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.

Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. However, care plans were not always updated to reflect people’s current needs.

People or where appropriate those who mattered to them told us they felt safe. People’s safety and liberty was promoted. All staff had undertaken training on safeguarding vulnerable adults from abuse. They displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. The registered manager had made several changes to address the number of safeguarding incidents that had taken place within the service. These changes were ongoing, however, changes to date evidenced that incidents had significantly reduced.

People and staff were relaxed throughout our inspection. There was a calm and pleasant atmosphere. People were often seen laughing, singing and joking. Where able people told us they enjoyed living in the home. Comments included; “It’s good here, I feel like I’ve fallen on my feet” and “I’m very happy here, it’s lovely”. A relative said, “This is an excellent place”.

People as much as they were able to or, where appropriate those acting on their behalf, spoke highly about the care and support they received. One relative said, “I can’t praise the staff highly enough, they are so caring; just brilliant”.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. A staff member said: “The training is really good, can’t fault it”.

Staff described the management to be supportive and approachable. Staff talked positively about their jobs. Comments included: “I just love working here”, “I get praised for my work, that makes me feel good” and “I love my job, so rewarding”.

People and those who mattered to them knew how to raise concerns and make complaints. People told us concerns raised had been dealt with promptly and satisfactorily. Any complaints made were thoroughly investigated and recorded in line with Waypoints own policy.