What life is like for people using this service:

People did not always feel there were enough staff to meet their needs and staff reported that they felt rushed in their work. Medicines were not consistently managed in a safe way and it was not clear if medication had been given as prescribed. Staff managed risks to keep people safe and knew how to safeguard people from abuse. There were effective infection control practices in place.

People’s needs were assessed and reviewed where required. People were given choices at mealtimes and had their dietary requirements met. People’s rights were upheld in line with the Mental Capacity Act 2005. People had access to healthcare services where required.

People were not always given choices or involved in decisions around their daily care. People felt staff were kind and caring but their interactions were limited and task focused. People were treated with dignity and were supported to maintain their independence where possible.

People were supported by staff who knew their preferences with regards to their care. Where people required end of life care, there were systems in place to ensure their individual wishes were met. There were activities available for people to take part in. People had been informed of how to complain if needed.

There were systems in place to monitor the quality of the service but these were not always effective. The registered manager had systems in place to gather feedback but this did not always reflect the findings of this inspection. People and staff spoke positively about the registered manager and they had a visible presence within the home.

Rating at last inspection: Good (Report Published 21 July 2016)

About the service: Wellesley House Nursing Home is a care home that was providing personal and nursing care to 33 people aged 65 and over at the time of the inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

We carried out an unannounced comprehensive inspection of this service on 22 June 2016. We also received information in relation to safe care and management of people’s skin care at the home in June 2016. We took account of those concerns during this inspection.

The home is registered to provide accommodation and personal care for adults who require nursing care. A maximum of 38 people can live at the home. There were 35 people living at home on the day of the inspection. There was 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.

In response to concerns raised in June 2016 the provider was working with external agencies to make changes to reduce the risk to people’s skin care. Whilst changes had been made these will need to be reviewed by the provider to ensure they improve the risks to people’s safe care and treatment.

People told us that they felt safe in the home and felt the staff helped to keep them safe. People were not concerned about the risk of potential abuse and staff told us about how they kept people safe. During our inspection staff were available for people and were able to support them by offering guidance or care that reduced people’s risks. People told us they received their medicines as prescribed and at the correct time. They also felt that if they needed extra pain relief or other medicines these were provided. People told us there were enough staff to support people at the home and they did not have to wait for care to be provided.

People told us staff knew how to look after them. Staff felt their training reflected the needs of people who lived at the home. Nursing staff had clinical supervision which they felt supported and helped them in providing care to people who lived at the home.

People were supported to eat and drink enough to keep them healthy. We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us and we saw that their privacy and dignity were respected and staff were kind to them. People received supported to have their choices and decisions respected and staff were considerate of promoting their privacy and dignity.

People had not always been involved in the planning of their care due to their capacity to make decisions. However, relatives felt they were involved in the care of their family member and were asked for their opinions and input.

People told us they had limited abilities and chose not to maintain their hobbies and interests. However, staff offered encouragement and supported people to read or join in group activities and outings.

Relatives we spoke with told us they were confident to approach the registered manager if they were not happy with their care. The provider had reviewed and responded to all concerns raised.

Management and staff had implemented recent improvements and these would need to be regularly reviewed to ensure people’s care and support needs continued to be met. The management team were approachable and visible within the home which people and relatives liked.

We spoke with five people, three relatives, four staff members and the registered manager.

We observed that people received care which met their needs. Records showed that people received care and support from other healthcare professionals in a timely manner. One person said, “I have no problems here, the staff are good.”

Arrangements were not in place to ensure the safe handling of medicines. We found that the records related to medicines were not always completed appropriately.

We found that selection and recruitment processes for staff were inconsistent. Records showed that different staff had varying levels of checks carried out before they started to work at the home.

Robust systems were not in place to monitor the quality of the service. We found that trends were not always identified to minimise risks and identify shortfalls in the home. People and their relatives we spoke with were satisfied with the quality of the home. One relative said, “I am happy with everything here.”

We found that people’s care records were not always accurate and fit for purpose. This could increase the risk of people receiving inconsistent care. Records related to the management of the home were not always accessible.

There were 34 people living there on the day of our inspection. We spoke with three people and four nursing and care staff to find out their views about the service provided. People told us positive things about the service, one person told us, "The staff are very kind to me and take good care of us”. Some people were unable to tell us about their care experiences due to their medical conditions. We saw that staff spent time with people making sure they were comfortable.

People's needs had been assessed by a range of health professionals which meant their health care needs had been monitored and met. People who needed it had appropriate support with their eating and drinking.

Staff knew how to recognise and report any concerns they had about people’s safety.

Staff knew how to meet people's care and nursing needs and had the support and training to do so.

There was an ‘open door’ policy and people told us they were confident their complaints would be listened to.

We spoke with some people using the service they told us that they were comfortable and satisfied with the care and support they received. Some people told us that staff discuss their care with them and that they were supported with their individual needs. Some people were unable to remember if this had happened but told us they were “alright”. People told us they were able to go to bed and get up in the morning when they wished to do so and that the staff supported them in the way that they prefer.

People said the food was varied, they had a choice and enough eat. One person said that they get what they are given but again told us “that is alright” and they had “no complaints”.

Some people were unable to express an opinion of the care and support they were receiving due to being very frail. We spoke with two visitors who told us they had no concerns with the care or the service being provided and were fully satisfied with the home.

We carried out an inspection on the 26 January 2014 and found that the provider was not meeting standards relating to medication, recruitment of staff, quality assurance and records. The provider wrote to us and told us what actions they were going to take to improve. During our latest inspection, we looked to see what actions had been taken.

We checked to see that people’s health and well-being was being promoted by the home and what improvements had been made since our previous inspection.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with four people using the service, three visiting relatives, five members of staff, and the registered manager. We also looked at six people’s care records, three staff files and other records related to the running of the service.

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

Is the service safe?

People told us they felt safe and secure. A relative told us, “I feel she is safe”.

The staff that we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

We saw that there was sufficient staff on duty to meet people’s needs throughout the day. People told us they received a consistent and safe level of support. One relative told us, “There are always enough staff around”.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

We saw that recruitment practices had improved and ensured that new staff were safe to work with vulnerable people.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation which protects persons who lack capacity, and sets out how decisions should be made in their best interests. Although no DoLS applications had been made the manager was able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

All people whose records we looked at had an individual care plan which set out their care needs. Some people told us they had been involved in the assessment of their health and care needs and had contributed to developing their or their relative’s care plan.

Assessments included information about people’s specific health care needs and what was needed to support them, for example, mobility aids and specialist dietary requirements. A relative told us, “The manager visited the previous home and assessed X and their care plan was drawn up the week before they moved in”.

People had access to a range of health care professionals some of which visited the home. One person told us “I can see the doctor, I ask the manager and they come the same day”.

This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People commented, “I am happy here and the staff are kind” and, “They are kind, they treat me well”. A relative told us, “I feel the staff are caring”.

Staff were aware of people’s preferences, interests, aspirations and diverse needs. Our observations of the care provided, and discussions with people and records we looked at told us that people’s wishes for care and support were taken into account and respected.

Is the service responsive?

People told us that they were able to participate in a range of activities both in the home and in the local community. The activities provided included ones people could enjoy as a group and others that meet their individual interests. People also told us they were able to observe their religions. One person told us, “They have a priest come every month. They administer communion”.

People told us that staff were responsive to their needs. A relative told us, “I know if there was a problem they would ring me straight away”. Another relative said, “They are very flexible”.

People knew how to make a complaint if they were unhappy. People and relatives said they had raised issues and they were satisfied with the outcomes. People told us the service took complaints seriously and looked into them quickly.

Is the service well-led?

We were told that people and relatives had access to the manager and felt that they managed the home well. A relative told us, “Everyone knows what their role is, it’s very homely and [the manager] keeps us informed”.

We saw that the manager had made improvements to ensure that systems were in place to assure that any risks to people were identified and the quality of the service was maintained. We saw that action had been taken to improve the service or put right any shortfalls we found at our previous inspection.

The recording of people’s personal care records, and other records kept in the home had improved, and there were plans to improve these further.