The inspection took place on 4 and 5 December 2017. The first day of our visit was unannounced. This meant the provider and staff did not know we would be visiting.

Wemyss Lodge 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. The home is registered to accommodate and provide nursing care to up to 60 people. People are supported through individual care planning to meet a range of needs including living with dementia, physical disabilities and health conditions requiring nursing care and support. The home is located in a residential area of Swindon. On the day of the inspection, there were 46 people living at the service.

In March 2016, a comprehensive inspection identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way and there were not always enough staff to effectively meet people's needs. In addition, quality auditing systems were not identifying shortfalls in the service. We issued three warning notices to the provider, as a result of the concerns we identified and the service was rated as inadequate. The service was placed into special measures.

In October 2016, we completed a focussed inspection to ensure improvements had been made. We found the provider had taken the immediate action necessary to improve the service as required of the warning notices, however some improvements had not been sustained and further shortfalls were identified.

When we completed the last inspection in March 2017 we found some improvements. The management of medicines had improved although there were still areas which required improvement. Some risk assessments such as the 'Personal Evacuation Plans' did not contain sufficient guidance for staff on what support each person required and people who could not use their call bell had not been risk assessed to ensure they received timely and appropriate support. Improvements were required around the implementation of the Mental Capacity Act 2005 and how care records underpinned the Act.

In March 2017, we also found care records required improvement as they were not always person centred, lacked sufficient detail and information and records were not always accurate between the electronic system and the paper records. Audits were taking place, however improvements were required to ensure that there was an overview of the audits required and checks that these audits were being completed within the timescale set by the provider. Mandatory training as set by the provider had not been completed within the timescale required of the provider. Processes and systems were fragmented and staff did not always have a clear direction of leadership.

During the inspection in March 2017 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. We imposed a condition on the provider's registration to submit monthly audits to the CQC to ensure the quality of the service was being monitored.

At this inspection in December 2017 we found improvements had been made. People using the service told us they felt safe living at Wemyss Lodge. Relatives we spoke with agreed they were safe living there. People were kept safe from avoidable harm because the staff team had received training on safeguarding and understood their responsibilities. They knew what to look out for if they suspected that someone was at risk of harm and knew who to report their concerns to.

The service had 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 resp

We carried out this inspection over three days on the 1, 2 and 8 March 2017. The first day of the inspection was unannounced.

Wemyss Lodge is registered to accommodate and provide nursing care to up to 60 people. The accommodation is in single rooms with the exception of one double room. Wemyss Lodge has bedrooms on the ground and first floors. A passenger lift is available for people with mobility difficulties. There is a communal lounge and dining area on the ground floor with a central kitchen and laundry room. People are supported through individual care planning to meet a range of needs including living with dementia, physical disabilities and health conditions requiring nursing care and support. The home is located in a residential area of Swindon.

In March 2016, a comprehensive inspection identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way and there were not always enough staff to effectively meet people's needs. In addition, quality auditing systems were not identifying shortfalls in the service. We issued three warning notices to the provider, as a result of the concerns we identified and the service was rated as inadequate. The service was placed into special measures. Special measures provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

In October 2016, we completed a focussed inspection to ensure improvements had been made. We found the provider had taken the immediate action necessary to improve the service as required of the warning notices, however at this inspection we found some of the improvements had not been sustained and further shortfalls were identified. Insufficient improvement had been made to enable the service to come out of special measures.

Following the inspection in March 2017, the registered manager who was in post at the last inspection submitted an application to de-register. A new manager was recruited in November 2016. Both the current registered manager and the new manager were available throughout the inspection and the manager was in the process of registering with the Care Quality Commission, to become the registered manager.

During this inspection, improvements had been made to the service. The management of medicines had improved although there were still areas which required improvement. Where incidents had occurred the service were now including more detail in the incident forms in order to plan preventative care. Some risk assessments such as the ‘Personal Evacuation Plans’ did not contain sufficient guidance for staff on what support each person required and people who could not use their call bell had not been risk assessed to ensure they received timely and appropriate support.

People told us they felt safe living at Wemyss Lodge. Staff were confident when explaining what constituted abuse and were aware of the procedures to follow if required. Medicines were not always being managed in a safe way.

There were sufficient staff available to meet people’s needs. The numbers of staff required during the day and night had been reviewed and amendments made. Safe recruitment practices were followed to ensure new staff were suitable to work with vulnerable people.

People told us they liked the food and had enough to eat and drink. There were positive comments about the quality and variety of food. Staff gave people time and interacted in a friendly, caring and attentive manner. People’s rights to privacy and dignity were maintained.

Improvements were required around the implementation of the Mental Capacity Act 2005 and how the care records underpinned the Act. People received the support of health and social care professionals and referrals were made.

Staff were

At the comprehensive inspection of this service in March 2016 we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the registered manager and provider with three warning notices and three requirements stating they must take action. We shared our concerns with the local authority safeguarding and commissioning teams.

This inspection was carried out to assess whether the provider had taken action to meet the warning notices we served. We will carry out a further unannounced comprehensive inspection to assess whether the actions taken in relation to the warning notices have been sustained, to assess whether action has been taken in relation to the three requirements and provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notices we issued and we have not changed the ratings since the inspection in March 2016. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. You can read the report

from our last comprehensive inspection by selecting the 'all reports' link for Wemyss Lodge on our website at www.cqc.org.uk.

At this inspection we found that the provider had taken action to address the issues highlighted in the warning notices. Medicines were being safely managed and people were supported to take the medicines they had been prescribed. Staff kept good records of the medicines available in the home and the medicines people had been supported to take.

Chemicals for cleaning were safely stored and staff followed good infection control procedures. This helped to minimise the risk of injury and cross contamination.

Accidents and incidents were clearly recorded and action was taken to minimise future risks.

There were enough staff available to meet people's needs. Staffing was planned following regular assessments of people’s needs and was re-evaluated as people’s needs changed. One person we spoke with said they were happy with the staffing arrangements, commenting, “They come quickly when I use the call bell. There’s sometimes a bit of a wait at busy times, but it’s never too long”. Relatives told us they had seen improvements in staffing levels and said there were sufficient staff available to provide the care and support people needed. Comments included, “There has been a noticeable increase in staffing and I am always able to find staff when needed. Staff have clearly completed training on supporting people and communication and this has had an impact on practice”; and “There are enough staff available. I’m always able to get hold of someone when needed”.

The management team completed regular checks to assess how the service was operating. Improvements were made following these assessments and there was clear communication with people, their relatives and staff about the action being taken. Comments from relatives included, “I have seen huge improvements since the last inspection. (The registered manager) has been a driver of many of the changes”; and “The managers are very visible. You can always talk to them if there are any issues”.

Staff told us the management team had been very open with them about the changes that were needed and had provided them with clear direction. Comments from staff included, “Staff morale has improved. Very open management team, with clear communication. We feel like part of a team”; and “There is good support from the management. We are able to discuss any concerns and they will take action”.

This inspection took place on 14 and 15 March 2016 and the first day was unannounced.

Wemyss Lodge provides accommodation to people who require nursing and personal care. The home is registered to accommodate up to 60 people. On the day of our inspection, there were 57 people living at the home, some of whom were living with dementia. Wemyss Lodge has bedrooms on the ground and first floor. All rooms have an en-suite toilet and two bedrooms have access to a bathroom. There are five rooms which can be used for twin occupancy. A passenger lift is available for people with mobility difficulties. There is a communal lounge, large dining room and smaller dining room on the ground floor.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 not protected against the risk of unsafe or inappropriate care and treatment. Medicines were not organised and administered in a safe and competent manner and we found errors in the recording of prescribed drugs. Staff who administered medicines did not undertake an annual competency assessment to ensure they remained safe to administer medicines.

People were not protected against the risk of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. There was a lack of information and guidance for staff on how to support people safely and consistently.

Staff used unsafe moving and handling techniques which put people at risk of injury. Equipment was not appropriately checked to ensure it remained safe for people and staff to use.

Staff did not receive on-going support through a system of supervision and some staff had not received any supervision in 2015 and 2016. This included the clinical supervision of registered nurses. Appraisals were starting to take place in 2016. The trainer confirmed that mandatory training had fallen behind and they had recruited an additional trainer to support with this. Staff reported they felt supported and valued by the management team.

People told us they felt safe living at Wemyss Lodge and told us staff were kind and caring. We observed that staff were friendly towards people and most staff spoke to people in a respectful manner; however some staff practices and the language used when referring to people was not respectful.

There was a choice of drinks, snacks and meals available and people told us they enjoyed the food. The home had employed nutritional assistants to ensure people have sufficient hydration.

There were safeguarding and whistleblowing policies and procedures in place which provided guidance on the agencies to report concerns to. Staff had received training in safeguarding and whistleblowing to protect people from abuse and training records confirmed this.

There was a lack of audits in place used to assess, monitor and improve the quality, safety and welfare of people. Required audits such as in controlled medicines and infection control were not carried out. Gaps and shortfalls in the service provision were not identified. The registered manager did not have an overview of how the home was being managed and who had responsibility for various elements of this.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2015. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that this service has been placed into ‘Special measures’ by CQC. The purpose of special measures is to: Ensure that providers found to be providing inadequate care significantly

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

We spoke with the registered manager, deputy manager, deputy matron, training officer and four care and/or nursing staff. We spoke with five people who use the service and the relatives of four people. We reviewed six people's care plans and records related to the management of the service, including staffing and quality assurance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. People's care plans included information about any risks to people's health, safety and welfare. Records showed risks were assessed and actions identified and carried out to minimise risk. The registered manager reviewed incidents in the home and took action to prevent reoccurrence. The premises were safe, well maintained and suitable for the needs of people being supported.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications submitted by the provider followed the correct procedures and were properly authorised. At the time of our inspection the provider was in contact with the local authority DoLS service to discuss changes in response to a recent Supreme Court judgment. We were assured a review of people's needs would be completed following our inspection to ascertain if other applications were required. This meant the provider was taking appropriate action to ensure the human rights of people using the service were protected.

Is the service effective?

People told us they were satisfied with the care they received and felt their needs had been met by sufficient numbers of staff. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs. One relative told us how their relative had been supported to make improvements in their health. Another relative said: "It's hard to entrust a loved one to care, I have peace of mind because they take great care of my relative and they do an excellent job I couldn't wish for a better home". A person said: "I think it's brilliant, I am cared for very well". Staff received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw staff were patient and gave encouragement and reassurance when supporting people with care and when distressed. A relative said: "When I am not here I have peace of mind because I know my relative is well looked after, they genuinely care". A person said: "staff are very nice and I feel I can talk to them." People confirmed they were offered choices and involved in their care and treatment.

Is the service responsive?

People’s needs had been assessed before they moved into the home and care was reviewed and adapted to meet their changed needs. Records confirmed people’s preferences and abilities had been recorded and care and support had been provided that met their wishes. People's healthcare needs were met by trained nurses in the home and by other healthcare providers as required. Complaints were responded to and people told us staff listened to them. One relative said: "When you ask them something they get back to you straight away."

Is the service well led?

Quality assurance processes were in place. This helped to ensure that people received a good quality service. Staff we spoke with told us they were well supported by their managers and senior staff. A staff member said: "I can talk to any of the managers if there is a problem they sort it out straight away, they take care of residents and staff safety". Records showed people and their relatives were asked for their feedback on the service and their comments were acted on. Staff views were taken into consideration in the quality of the service and people's care and treatment.

People who lived in the home we spoke with told us they were well cared for and treated with respect by the staff. We were told the nursing and care staff were professional and friendly. Relatives we spoke with were also very positive about the staff team.

The home provided a varied and nutritious diet and promoted choice. The home took steps to monitor health issues and were thorough in their management of pressure care.

All staff were required to complete training on adult protection and were made aware of their responsibility to report concerns. People who lived in the home and relatives we spoke with told us they thought the home was a safe place to live.

Staff were provided with regular training.

The home ensured that all equipment in use was correctly serviced and maintained which promoted peoples safety.

People who lived in the home we spoke with told us they were well treated by the staff and were happy with the care and support they received. We were told it was a safe place to live and that they felt confident to raise issues or concerns if they arose. We were told the staff were friendly and treated people with dignity and respect.

People said they enjoyed the activities that were organised and had a choice as to whether to participate or not.

We found that the home was clean and hygienic throughout and that there were systems in place for maintaining these standards.

We found that the home had safe and effective procedures in place to recruit staff.

The home had the correct procedures in place to safely store and administer medication. Appropriate training in this area was provided for staff.

People who lived in the home told us they felt safe and were treated with respect by the staff. We were told that staff were polite, respected their privacy and carried out personal care in a competent and unhurried manner.

People said staff responded promptly to call bells and listened to any concerns they had. We were told that a good variety of activities were organised in the home as well as trips out into the community.

People who lived in the home and their relatives told us the home was always clean and well maintained.

Relatives told us that the home communicated well and kept them informed of concerns or issues if and when they arose. People said they were always made to feel welcome in the home and were free to visit at any time.

Staff said they were well supported by the senior staff and undertook regular training that was well organised and appropriate to their roles.