This inspection took place on 19 and 29 September 2017 and was unannounced.

The last inspection was carried out in May 2016. The overall rating for the service was Requires Improvement. During our comprehensive inspection in September 2017 the service demonstrated to us that improvements had been made.

Wellesley Road Care Home is part of the Shaw Healthcare (Group) Limited. It provides accommodation, nursing and personal care for a maximum of 60 older people, most of whom have dementia. On the day of inspection there were 56 people using the service.

At the previous inspection in May 2016, the home did not have a registered manager. At this inspection we found a registered manager was now 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.

At our last inspection in May 2016, there were concerns around the amount of agency staff that were being used at the home. At this inspection we saw that the service had reduced the amount of agency staff. There was a continuous recruitment programme in place to employ more permanent staff. At the time of this inspection, the service had employed 34 permanent staff. There were three more vacancies to be filled. We saw that people’s needs were being met.

A safe recruitment and selection process was in place. This ensured staff had the right skills and experience to support people. The provider carried out necessary checks prior to new staff commencing employment.

There were systems in place for the safe management of medicines. People received their medicines as prescribed. All prescribed medicines were available at the home and were stored securely. People told us they received their medicines when they needed.

We found that the registered provider had made improvements in their quality monitoring systems. The home had developed a range of ways to monitor the quality of the service in order to make improvements. A range of audits were carried out, including medicines, environmental, infection control and care plan audits. Where improvements had been recommended we saw that action had been taken.

Risks to people had been identified, assessed and reviewed. People receiving care told us they felt safe living at the home. There was a range of risk assessments, which covered the following areas: falls; skin integrity; and weight loss. There were control measures in place, which described how to keep people safe. The service had taken swift action to address issues we had identified with pressure mattresses.

The service met the legal requirements of the Mental Capacity Act 2005 in supporting people. We saw that staff sought and obtained people's consent before they offered help. People's mental capacity was assessed for particular decisions. Best interest meetings had been held with relatives and relevant health and care professionals where necessary.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw evidence that appropriate applications to restrict people's freedom had been submitted and the least restrictive options had been considered.

People were supported to meet their nutritional needs. They were able to make choices about the meals and drinks they wanted. We saw that alternative meals were provided.

People were supported to meet their health care needs and had access to a range of external health and care professionals. Healthcare professionals told us that people were referred to them in a timely manner so that people’s needs were met.

People’s privacy and dignity were respected. Staff cared for people in ways which recognised people's rights to make their own decisions.

Wellesley Road is registered to provide accommodation, nursing and personal care for a maximum of 60 older people, most of whom have dementia. On the day of inspection there were 59 people using the service.

At the last inspection of this service on 25, 26 and 31 May 2016 we found that some aspects of medicines management were not safe and there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to the serious nature of the breach we took enforcement action against the registered provider.

At the time of this focused inspection, 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 undertook this unannounced focused inspection on 13 February 2017 to check that the most significant breach of legal requirements in relation to Regulation 12, concerning medicines, which had resulted in enforcement action, had been addressed. During this inspection we found that the medicines were being managed safely and the breaches of the regulations identified in the warning notice had been met.

This report only 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 Wellesley Road Care Home on our website at www.cqc.org.uk.

We will undertake another unannounced inspection to check on all other outstanding legal breaches identified for this service.

This inspection took place over three days on 25, 26 and 31 May 2016 and was unannounced. At our last inspection on 28 and 29 July 2015 we found that the provider was not meeting two of the regulations that we inspected against. We found breaches in regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care plans were not adequate and did not contain enough information to enable staff to care for people appropriately. At this inspection we found that the provider had addressed this issue. The home was not adequately auditing people’s medicines to ensure the safe management of medicines. At this inspection we found that this issue had not been adequately addressed.

Wellesley Road is registered to provide accommodation, nursing and personal care for a maximum of 60 older people, most of whom have dementia. On the day of inspection there were 56 people using the service.

The home had a registered manager who is also registered for another 60 bedded care home which is located nearby and run by the same provider. The registered manager spends most of her time at the other care home. The provider had employed a manager, as of February 2016, who is working full time at Wellesley Road and has applied to be registered for this home.

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 home completed some audits of people’s medicines. However, there were not enough people’s medicines checked to ensure a robust auditing system and identify medicines errors.

Stock control of medicines was not always checked or documented. Some people received covert medicines; there was no documented Mental Capacity Act (MCA) assessment for people around providing covert medicines.

Staff did not always receive regular documented supervision and support. The home did not provide adequate support and guidance for staff or identify individuals learning and development needs.

The home was compliant with applications for the Deprivation of Liberty Safeguards (DoLS). However, management failed to notify the Care Quality commission (CQC) when an application had been granted.

There were concerns raised by staff and relatives around the amount of agency staff that were being used in the home. The home completed 48 hour diaries, documenting the amount of care required, when a person’s needs changed. This was discussed with the local authority and staffing allocated according to identified need.

Food looked and smelt appetising. People told us that the food provided by the home was good. People were asked what they would like to eat the day before so that the kitchen could prepare the meals. This included alternative meals. However, on the day, people were not consulted as to whether this was still the meal that they wanted and an alternative was not offered. Some people were unable to remember what they had chosen the day before.

People told us that they felt safe within the home and were well supported by staff. Relatives also said that they felt their family members were safe within the home. We saw positive and friendly interactions between staff and people.

Staff understood people’s individual needs in relation to their care. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report abuse to if people were at risk of harm.

Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Where people were not able to have input in to making decisi

This inspection took place on 28 and 30 July 2015 and was unannounced. This was the first inspection of this service since it was registered with the Care Quality Commission in June 2015.

We undertook the inspection at this time because we received concerning information regarding the home.

Wellesley Road Care Home provides accommodation, nursing and personal care for up to 60 older people most of whom have dementia. The home has 60 bedrooms over three floors and six units, each containing 10 bedrooms. The home has been newly built as part of a relocation of two existing care homes for older people, run by Camden Council, which have now closed. People were moved from the two Camden Council run homes to Wellesley Road Care Home in June 2015.

The home had a registered manager who is also registered for another 60 bedded care home located nearby run by the same provider. The registered manager spends most of her time at the other care home and the provider has employed a manager who is working full time at Wellesley Road and has applied to be registered for this home.

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.

People told us they felt safe and comfortable with the staff who supported them.

We observed kind and positive interactions between staff and people using the service. However, we observed that staff were very busy throughout the two days of the inspection. This meant that staff had little time to meet the more holistic needs of people at the home as most of staff time was taken up on trying to meet people’s basic personal care tasks. People using the service, their relatives and staff working at the home, told us they had concerns about staffing levels.

We saw that staff sickness levels were high and presented a challenge for the management of the home. This had led to a high use of agency staff as well as moving existing staff around the units to provide enough cover. This had a negative effect on the continuity of care that some people received because staff were not always familiar with the care needs of people they were supporting.

Procedures in relation to the management of medicines needed to be reviewed as this was putting people at risk of harm due to possible medicine errors.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment.

We met with the local doctor who was visiting the home on the day of our inspection. They were positive about the staff at the home.

Care planning was only recently been implemented. Care planning remained underway but had not yet been completed in respect of all people who use the service. People’s individual care needs were not always known by staff due to staff shortages and subsequent deployment on different floors at the home.

Food looked and smelt appetising and the cook was aware of any special diets people required either as a result of a clinical need or a cultural preference.

People told us they liked the staff who supported them and that staff listened to them and respected their choices and decisions.

People’s privacy was not always being respected and there were problems with ensuring that people’s confidential information was kept safe.

The culture within the home needed improvement. There was a lack of trust between staff and management. Communication between management and staff was not always effective and we saw examples where essential information was not communicated between staff and management. Staff understood the principles of how to “whistle-blow”, but said they did not feel confident in raising their concerns with management.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the management of medicines and good governance. You can see what action we told the provider to take at the back of the full version of the report.