We visited Wellfield 18,19 and 25 September 2018 to carry out an unannounced comprehensive inspection.

Wellfield is a 'care home' which is registered to provide care and accommodation for up to 29 older people. People in care homes receive accommodation and nursing care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. Nursing care is not provided at Wellfield. At the time of our inspection 24 people were using the service.

There was a registered manager who was also the provider. A registered manager is a person who has registered with the 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.

At the last inspection on 9 and 10 August 2017 the service was rated 'Good'. However, we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to a lack of robust complaints management processes. Following the inspection, the provider sent us an action plan outlining the progress to be made. At this inspection we found sufficient action had been taken to make improvements.

At this inspection we found there was one breach of regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to insufficient processes for monitoring and improving the safety and quality of the service.

We have also made recommendations on staff recruitment procedures, medicine management processes and person centred care. We also found some further improvements were needed with risks to health and wellbeing, monitoring staff deployment, the catering arrangements and the suitability of bathing facilities.

The service had a management and leadership team to direct and support the day to day running of the service. However, we found there were shortfalls in the auditing/monitoring systems and making plans for improvement in a timely way.

We found staff recruitment did not include all the required character checks for the protection of people who used the service.

Arrangements were in place to promote the safety of the premises, this included maintenance, servicing and checking systems. However, during the inspection we identified some areas were in need of attention.

There were enough staff available to provide basic care and support; people who used the service and staff had some concerns about the numbers of staff, however additional staff were being recruited.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff spoken with were aware of safeguarding and protection matters.

There were some safe processes in place to support people with their medicines, but we found improvements were needed.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service.

People made positive comments about the care and support they received from staff. They said their privacy and dignity was respected. We observed respectful and friendly interactions between people who used the service and staff.

Visiting arrangements were flexible, relatives and friends were made welcome at the service.

People said they were satisfied with the variety and quality of the meals provided at the service. However, we found there was scope for making improvements with the catering arrangements.

People were supported with their healthcare needs. Changes in people's health and well-being were monitored and responded to. Where necessary, people received appropriate medical attention.

People were supported to have maximum choice and control o

This inspection took place on 9 and 10 August 2017 and was unannounced. Wellfield provides accommodation and personal care for up to 29 older people. At the time of our visit 23 people were living there. At the last inspection on 6 May 2015, the service was rated ‘Good’. At this inspection we found the service remained 'Good' but that improvements were required in the way the service dealt with complaints. This has resulted in a breach of legal requirements. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager who was also the provider. 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 found the provider had safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Staff had access to a whistle-blowing procedure and said they would use it if they needed to. Appropriate recruitment checks were carried out before staff started working at the home and there were enough staff to meet people’s needs. Risks to people using the service were assessed, reviewed and managed appropriately. People received their medicines as prescribed by health care professionals.

All staff had completed mandatory training in line with the provider’s policy; they were receiving regular formal supervision and, where appropriate, an annual appraisal of their work performance. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and acted in accordance with this legislation. People were being supported to have a balanced diet and they had access to health care professionals when they needed them.

Staff had a good understanding of people’s care and support needs. They knew people well and had developed positive caring relationships with them. The environment was designed and adapted to meet people’s individual needs. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. They were also provided with appropriate information about the home in the form of a service user guide. People’s privacy and dignity were respected.

People’s care plans and risk assessments provided guidance for staff on how to support them with their needs. Where people’s needs had changed, their care records were being updated to reflect the changes. There was a wide range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be investigated and action taken if necessary. However, the service was not recording some issues that amounted to complaints and as such improvements are required in this area.

There were appropriate arrangements in place for monitoring the quality of the service that people received. The provider took into account the views of people using the service and relatives through meetings and surveys. The registered manager carried out unannounced visits to the home to make sure people where receiving appropriate care and support. Staff said they enjoyed working at the home and they received good support from the registered manager and senior staff.

People using the service told us that Wellfield was a very nice home and they were satisfied with the care provided. One person said, “The staff are always kind.” Another person said, “The staff are very nice, you can talk to them if you’ve got a problem and they never say they’re too busy.”

We found that the home was clean, tidy and free from offensive odours. Members of staff had received training for the prevention and control of infection.

Members of told us they received the training and support they needed in order to provide safe and appropriate care for people using the service.

We found improvements to the system for monitoring the quality of the service provided had been made. The manager regularly checked most aspects of the care and facilities provided at the home.

We saw that improvements to care planning had been made. All sections of people’s care plans were accessible to all care workers.

People using the service told us that they liked living at Wellfield and were satisfied with the care provided. One person said, “I wouldn’t want to live anywhere else.” All the people we asked told us the meals were good.

We saw that people lived in clean and comfortable surroundings. People were encouraged to make their rooms more homely with personal items such as photographs, ornaments and pictures for the wall.

We noted that recruitment procedures were thorough and members of staff received the training they needed in order to provide safe and appropriate care for people using the service.

We found that some improvements to the monitoring of the quality of the service had been made. However, the system did not cover all aspects of the care and facilities provided at the home.

We saw that people’s individual care plans lacked clear guidance for staff to follow in order to ensure that identified risks were effectively managed. Care records stored electronically were inaccessible to care workers.

Since our last inspection the required improvements in the way medicines were managed have been made.

People using the service told us they liked living at Wellfield House and were satisfied with the care provided. They said their rooms were kept tidy and were always warm.

People were treated with respect and told us the staff team were very nice and friendly. One person said, “The carers are nice to talk to.” Another person said she didn’t have to wait long when she pressed the call bell for assistance.

The home owner and assistant manager regularly spent time chatting to people so that people had the opportunity to express their views and any concerns.

Visitors were welcomed into the home at anytime and offered refreshments.

All the people we asked told us they enjoyed the meals. One person said, “The meals are good and we have a choice.”

However, we found some problems in the way in which the quality of the service was monitored. This meant that any issues such as those with the management of medication had not been identified and addressed.

We carried out an inspection of Wellfield on 6 and 8 May 2015. The first day was unannounced. We last inspected Wellfield on 7 June 2013 and found the service was meeting the current regulations.

Wellfield is registered to provide accommodation and personal care for 29 older people. The home is located on Whalley Road and is on a main bus route to all areas of Hyndburn. The property is Victorian and set in well maintained gardens with outdoor seating areas.

The home was managed by 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.

People we spoke with told us they were very happy living at Wellfield and staff treated them well. They told us they felt safe and there was enough staff to attend to their needs when they needed them. People said, “It’s wonderful here. There are no rules or regulations. The staff are wonderful too”, “I’m very happy here” and “I can definitely say we are looked after well.” Routines were seen to be flexible to accommodate people’s varying needs and there were no institutional practices observed.

When we looked at people’s records we saw that risks to people’s health and welfare were identified. However these were not always kept under review and we have recommended the service takes action to address this.

People were cared for by staff that had been recruited safely and were both trained and receiving training to support them in their duties. We heard some positive comments about the staff and we observed staff were respectful to people and treated them with kindness in their day to day care. One person said, “I’ve lived here over twelve months now and I have no complaints whatsoever. I always find when you treat people with respect they will respect you. That’s how it is here, a mutual respect for each other. That makes you feel wanted and cared for.”

People had their medicines when they needed them. Medicines were managed safely. We found accurate records and appropriate processes were in place for the ordering, receipt, storage, administration and disposal of medicines.

The home was warm, clean and hygienic in all areas and people were satisfied with their bedrooms and living arrangements.

Staff were kept up to date with changes in people’s needs and circumstances and new staff were mentored by senior staff. Staff told us they were confident to take action if they witnessed or suspected any abusive or neglectful practice. Most staff had a basic understanding of The Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and the principles behind it. The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care.

Each person had an individual care plan and staff said they read these. Staff discussed people’s needs on a daily basis and following any changes in people’s needs. Staff we spoke with had a good understanding of people’s personal values and needs. People were given additional support when they required this. Referrals had been made to the relevant health professionals for advice and support when people’s needs had changed.

A variety of activities were provided. The activity co-ordinator engaged with people who preferred to or benefitted from having one to one activity sessions. Visiting arrangements were good.

People told us they enjoyed their meals. Fresh produce was used and choices were offered with drinks and snacks being offered between meals. One person told us, “It’s a bit like being at home with different days for different things. We have a roast meal on Tuesday and Sunday and bacon and egg on Monday. There is a choice and if we don’t want what is on offer we can have something else to eat.” People’s nutritional need was being monitored and support was provided when problems were identified.

People told us they knew how to make a complaint and felt confident any issue they raised as a complaint or concern would be dealt with promptly. They told us the management of the service was good and they were given as much choice and control as possible into how the service was run for them. They were given surveys to complete and those we saw showed that people were pleased with the standard of service they received. Where suggestions for improvement had been noted, these had been addressed.

Staff told us they were happy with their working conditions. “We all work very well together. I think (Registered Manager) definitely has our welfare at heart. We get plenty of training” and, “We help one another and we are all working with one aim and that is the residents being happy. (Registered Manager) wouldn’t have it any other way. The residents are well looked after.”

The service had achieved the Investors In People (IIP) award. This is an external accredited award for providers who strive for excellence, which recognises achievement and values people.