We inspected Wellcross Grange Care Home on 19 December 2018. Wellcross Grange Care 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. Wellcross Grange Care Home is registered to provide care for up to 45 people, with a range of health conditions and some who were living with dementia. On the day of our inspection there were 34 people living at the service, who required varying levels of support. We previously inspected Wellcross Grange Care Home on 8 and 9 November 2017 and found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, caring and well led to at least good. At this inspection we saw that they provider had followed their action plan and improvements had been made.

A registered manager was 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 and associated Regulations about how the service is run.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were treated with dignity and respect and felt well looked after and supported. We observed friendly relationships had developed between people and staff.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and palliative care (end of life). Staff had received both supervision meetings with their manager, and formal personal development plans were in place.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, bingo, exercise, quizzes and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

Care plans described people’s preferen

This inspection took place on the 8 and 9 November 2017. The first visit was unannounced and started at 07:30am. This was to allow us to meet with the night staff and see how staff duties were allocated for the day. The second visit was by appointment.

Wellcross Grange Care Home 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. People living at Wellcross Grange Care Home were older people, living with physical health conditions and physical frailty. Some people were living with early dementia. However the service is not a specialist service offering support to people to whom dementia is their main need for care. The service accommodates up to 45 people in one adapted building, divided into two separate wings with their own staffing complement and shared spaces.

The home 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. The registered manager was not available on the days of the inspection, so this was carried out with the clinical lead nurse and operations manager for the provider organisation.

The last inspection of Wellcross Grange Care Home took place on 11 June 2015, when the service was rated as good in all areas. On this inspection although we found some good practice, we identified some areas of concern and the service was rated as requires improvement.

Immediately after the inspection the operations manager from the provider organisation gave us an action plan detailing what actions they were taking to address the concerns.

Systems had not always been operated effectively to assess, monitor and improve the quality and safety of the services provided, or mitigate the risks. During the inspection we identified areas of concern about the environment and people’s care. For example information was not always sufficient to ensure risks to people from poor hydration could be properly assessed. Recent information of concern had not been acted upon immediately, which could have left people at risk of poor care. We asked the service to make a safeguarding referral about this incident during the inspection.

We identified systems to analyse accidents and incidents were not robust enough to identify learning to prevent a potential re-occurrence. Accident forms had been collated but these did not contain a management review or records of what changes were made as a result of the incident or actions taken. Bruising was not always investigated or included on incident forms.

We found staff were not always using positive or respectful language when supporting or describing people and their care. We also saw people being supported in ways which did not demonstrate their dignity was respected. The operations director told us they would be reviewing this immediately.

We received positive feedback about the staff and service. People told us the registered manager was approachable and fair. They told us there was a positive atmosphere, and the service worked well with other agencies to support people’s needs. Staff were attentive to people’s needs, making sure they were well presented and attention had been paid to cleaning spectacles and helping people co-ordinate clothing. The organisation had a set of positive and person centred values, which the operations manager was taking action to ensure were well understood and shared across the staff group. We found the service had an open culture, and saw staff working well as teams, to ensure people’s needs were met. The service had a clear organisational structure where people’s responsib

We inspected Wellcross Grange Care Home on the 11 June 2015. This was an unannounced inspection. The service was registered to provide accommodation and care, including nursing care for up to 45 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, dementia, Parkinson’s Disease and cancer. On the day of our inspection there were 35 people living in the care home.

During the previous inspection on 14 April 2014 we found breaches of Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010, (corresponding to Regulation 9 HSCA (RA) Regulations 2014) in relation to inconsistent recording and reviewing of care plans and a lack of personalised care and activities; Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 (corresponding to Regulation 17 HSCA (RA) Regulations 2014) in relation to staffing and Regulation 22 HSCA 2008 (Regulated Activities) (corresponding to Regulation 18 HSCA (RA) Regulations 2014) in relation to quality monitoring systems.. Following that inspection, the provider had sent us an action plan detailing how they intended to address the shortfalls. On the day of our inspection, it was clear that the manager and staff had worked hard to improve the situation, they had thoroughly addressed all the issues and no concerns were identified.

A registered manager was in post and present on the day of the 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.

People were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff had also received both one-to-one supervision meetings with their manager, and formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans we looked at were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There was a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

The inspection team was made up of two inspectors. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

On the day of our inspection we noted there were periods of time where people were left unattended in communal areas. Several people were sitting in wheelchairs. They had been left without call bells and were, therefore, unable to summon assistance if they needed to.

The manager was unable to demonstrate how staffing levels were calculated to ensure they were sufficient to meet the needs of people accommodated. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection the manager informed us no one accommodated was subject to a DoLS application.

There was a system in place to calculate how many accidents or incidents had taken place over a given period. The manager was unable to demonstrate how they had been analysed to make sure that the manager and staff learned from such events. This increased the risk of harm to people and failed to prevent such incidents from occurring in the future. A compliance action has been set in relation to this. The provider must tell us how they plan to improve the system to reduce the risk of accidents or incidents recurring.

Is the service effective?

People told us that they were happy with the care that they had received and it had met their needs. One person told us, "I believe I am well looked after. I think Wellcross Grange is quite pleasant. It is quite a good place to live". A relative told us, "I am quite happy with the way the home is run. Overall, it ticks all the boxes".

It was clear from our observations and from speaking with staff who worked in Wellcross Grange that they had a good understanding of people's care and support needs and that they knew them well.

People's health and care needs had been assessed, but some people’s care plans had not been reviewed for over a year. This meant they did not provide up to date information for staff to follow to ensure they met people's current needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience, were attentive and gave encouragement when supporting people. People that we spoke with confirmed this. One person who was confined to bed told us, "I am well cared for. I could not ask for anything more." Our observations also confirmed this. For example, we noted that lunch time was well paced and allowed people the time they needed to eat their meal. People were provided with protective aprons to ensure they did not dirty their clothes if they spilled any food. We observed good interactions between people and staff. Care staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence.

People’s preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people’s wishes. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Two people told us that they had made a complaint but were not satisfied with the outcomes. We also found that the minutes of a relatives' meeting, that had taken place in October 2013 recorded some concerns about the service. We looked at how these complaints had been dealt with, and found that none had been recorded. This meant that the manager was unable to demonstrate that responses to complaints had been open, thorough, and timely.

Is the service well-led?

Since our last inspection we found that improvements had been made in relation to meeting people’s nutritional needs. We noted staff were present in dining rooms to provide support to people who needed help with eating their meal.

The service had a quality assurance system. However the manager was unable to demonstrate that identified shortfalls were addressed promptly. Satisfaction surveys had been completed and returned by people and their relatives. The results had been summarised but an action plan had not been drawn up to identify the actions that need to be taken, by whom and with an agreed timescale for completion. As a result the system was not sufficiently robust to ensure the quality of the service had been continuously improved. A compliance action has been set in relation to this and the provider must tell us what they plan to do to improve.

There were 38 people living at the home at the time of our inspection. We spoke with three people who lived at the service and also three relatives. Everyone told us they were happy with the care provided. One relative said that “Overall, I would recommend the home".

We looked at peoples care plans. The care plans showed that people's ability to make choices and decisions for themselves had been assessed, and guidance was in place to inform staff as to how to support people with this.

We also spent time observing the interactions between staff and people. We found that people were not always supported to be able to eat and drink sufficient amounts to meet their needs.

We saw that people’s complaints were investigated and resolved, where possible, to their satisfaction.

We spoke with eight of the 38 people who lived at the service. Everyone told us that they were happy with the care and support they received. One person told us, "The care is very good. They try their best to satisfy your needs". People told us that staff were kind and understood their needs. Of the eight people we spoke with six said that they were satisfied with the meals provided at the service. People confirmed that they were offered a choice of hot and cold meals everyday. Comments regarding meals included "meals are nice" "what they offer is good" and "I don't think they are quite as good as they were". People also expressed satisfaction with the support they received with medicines. They told us nurses always appeared to understand their responsibilities with regard to giving people their medicines safely. Our evidence gathered during this inspection supports the comments made by people who were receiving a service.

The people who live in Wellcross Grange Care Home told us they were happy in the home. They said the home’s regular staff looked after them very well. There were concerns raised about some of the agency staff with comments such as “They were very young” and “the agency staff don’t seem to know what they are doing”.

We spoke to relatives of people staying in the home. They told us that the home had been very cold for a few weeks due to ongoing problems with the heating in the home. This had been fixed the day before our visit. They told us that the regular staff were always friendly and they had no concerns about their relative’s care.