Wentworth Grange 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. This inspection took place on 28 November and 7 December 2017 and was unannounced. We last inspected the home on 15 and 20 December 2016 and found the provider was meeting the requirements of the regulations.

Wentworth Grange accommodates 51 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia.

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 actively sought people’s and relative’s views. Feedback forms were available for people to share their views about the home and people could also attend meetings.

People and staff told us the home was a safe place to live. Staff showed a good understanding of the provider’s safeguarding and whistle blowing procedure including how to raise concerns. Staff did not raise any concerns about safety with us. One previous safeguarding concern had been dealt with and investigated appropriately.

Sufficient staff were on duty to meet people’s needs. People told us staff responded quickly when they needed assistance. Throughout our inspection we observed there was a visible staff presence at all times.

The provider had effective recruitment checks to ensure only suitable staff worked at the home.

Medicines were managed safety. Only trained staff were able to administer medicines. There were accurate records for the receipt, administration and disposal of medicines and medicines were stored safely.

Where a potential risk had been identified, a risk assessment had been completed. These had been reviewed regularly to ensure they were up to date.

Regular health and safety checks were carried out to help maintain people’s safety. The provider had up to date procedures to deal with unforeseen emergency situations.

People told us the home was clean and hygienic, we also observed this to be the case.

Incidents and accidents were logged and investigated. Where required action had been taken to keep people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Meeting nutritional needs was an area of strength at the home. The registered manager was motivated to make people’s mealtimes special with great attention to detail and quality ingredients used. Chefs were skilled at preparing and presenting special diets so that people requiring these had a good experience.

People were supported to access a range of healthcare services in line with their needs such as professionals including speech and language therapy, chiropody, opticians and mental health professionals including the behaviour support service.

The provider had adapted the environment to meet the needs of people living with dementia. This included low sheen plain flooring, good levels of lighting and contrasting toilets with flooring. The registered manager was motivated to make the home "special" whilst still meeting the needs of people living with dementia.

People's care plans were up to date, individualised and reviewed regularly. Although care plans were detailed and personalised, some of the very specific information staff were aware of was not always included in the plans. We discussed this with the registered manager who agreed to ensure care plans were deve

This inspection took place on 15 and 20 December 2016 and was unannounced. A previous inspection, undertaken in August 2016, found three breaches of legal requirements. The provider subsequently sent us an action plan of improvements they were intending to make to meet regulations.

Wentworth Grange provides accommodation and support for up to 51 older people with personal or nursing care needs. The accommodation consists of a main house, with accommodation spread over two floors, and an annex building known as Hampton House, within the grounds of the main building. Hampton House is a single storey conversion which predominantly supports people living with dementia or cognitive impairment. At the time of the inspection there were 39 people living in both areas of the home.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since October 2010. 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 a previous inspection we had found some issues with the safety of the premises, in that window restrictors in the Hampton House area did not meet current guidance and a garden area was not secured. At this inspection we found window restrictors had been fitted to vulnerable areas. On the first day of the inspection we noted the garden gate, previously unsecured, could still be potentially opened and the area exited unobserved. By the second day of the inspection this matter had been fully addressed.

We had also previously noted not all potential safeguarding issues had been referred to the local safeguarding adults team. At this inspection we found safeguarding issues and notifications had been logged, although the standard of the records meant it was sometimes difficult to track progress of matters. People told us they were safe living at the home. Staff had a good understanding of safeguarding issues and had received training in relation to protecting vulnerable adults. There was regular maintenance of the premises and fire risk and other safety checks were carried out on a regular basis. Accidents and incidents were monitored and reviewed to identify any issues or concerns.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). People and staff told us they felt there were sufficient staff to provide care and support.

At the previous inspection we had found some issues with the management of medicines at the home, including the effective administration of topical medicines. At this inspection we found new processes had been introduced to ensure all topical medicines were in date and stored appropriately. There were some minor gaps in MARs and some “as required” medicine care plans required additional detail. We have made a recommendation regarding this.

Staff told us they had access to a range of training and updating. The home had a dedicated training manager who oversaw the provision of internal and external training courses. Staff told us, and records confirmed they received annual appraisals and bimonthly supervision.

People told us, and our observations confirmed that the home was maintained in a clean and tidy manner.

People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists, district nurses and other specialist health staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw applications for DoLS had been

We found people's needs were assessed and care was planned in line with their needs. People received a high standard of care that ensured their safety and wellbeing. We spoke with people and their relatives in both parts of the service and received very positive feedback from everyone we met. One person told us, “The staff don’t take over but are there when I need them and they are very caring.” Another person said, “I have fallen on my feet coming here.” One relative told us, “The staff are always aware of what my Dad needs and they keep me fully involved.”

We were unable to speak to all of the people who used the service because of the nature of their condition. We spoke with staff and observed their practices to determine how care and support was delivered.

We found that people were provided with a choice of adequate nutrition and hydration.

The home was clean and we saw there were effective systems in place to reduce the risk and spread of infection.

We found staff recruitment procedures were in place and records showed that these were followed when new staff were appointed. We saw appropriate checks were undertaken before staff began work. One member of staff told us, “There is a high level of support and training for all the staff and it is easy to talk to the management here.”

We saw that people’s personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making decisions and consent about their care. People told us they had confidence in the service, comments included, "They (staff) always ask before they do anything" and "I feel involved." A second person said, "I know they (staff) would like me to be more involved in the social activities, but I am quite happy with my own interests, there is no pressure put on me."

People said they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said, "When the weather is better we get out and about" and "I can go and see my family."

People's safety was ensured and they were protected from harm by the provider's arrangements for safeguarding people from abuse, staff training and maintenance of the premises. People felt safe, comfortable and able to raise concerns.

Due to their needs, some people could not offer direct comments about the care they received. Others expressed satisfaction with the care and comments included: “the staff look after us very well and I am quite happy living here” and “the staff are very nice and kind”.

During the day we spoke to a number of people living in the main building of Wentworth Grange. Comments included: `I feel safe and comfortable in my bedroom and cannot think of anything that could be improved'. `I am very happy how staff look after me`. `They knock on my bedroom door before coming in and they listen to me`. 'I was told how to make a complaint`.

Visitors to the Wentworth Grange told us they were more than happy with the home and the care given. One of the visitors said `dad does not like the food, but we put this down to him being a fussy eater`. We know the food is good because we have had our lunch here`. Another said `we have not been disappointed with the choice of home for our father` `If we have any issues we can speak to the registered manager and it will be sorted out`.

Three of the people spoken to said that they were aware that they had a care plan because it was in their room for people to read. They told us that they were happy with the way that the staff discussed the contents with them when any changes were made. People living in the home were asked about the food and the responses were "It's lovely and I get to choose what I want" another said "its fine" and another "I like the home cooked stuff". People said that the care staff always made sure that any concerns were passed on to the senior staff members if they cannot resolve it easily themselves. We were not able to ask the people in Hampton House about their experiences of living there because of their diminished level of capacity.

Wentworth Grange provides accommodation and support for up to 51 older people with personal or nursing care needs. The accommodation consists of a main house with two floors and a renovated building, referred to as ‘Hampton House’, within the grounds of the home. At the time of our inspection there were 45 people living at the home and in receipt of care. Some of these people were living with dementia, or some form of cognitive impairment, and they were accommodated in Hampton House.

This inspection took place on 17 and 18 August and was unannounced.

Our last inspection of this service took place in February 2013 where the provider was found to be meeting the legal requirements of each of the regulations that we looked at.

At the time of our inspection a registered manager was in post who had been formally registered with the Care Quality Commission (CQC) since October 2010, in line with this service’s conditions of registration. A registered manager is a person who has registered with the Care Quality Commission (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.

Concerns were identified in respect of the safety and suitability of the premises. The garden area of Hampton House was not always secure. Appropriate window restrictors were not in place, where people living with dementia and cognitive impairment were accommodated, and therefore they were at risk of falling from height and injuring themselves. The registered manager told us that they would address this immediately.

Medicines were not managed appropriately. Some topical medicines were out of date and were still being applied to people’s skin. The storage of medicines was not secure and access to the medicines room was not restricted to those staff with the responsibility for administering medicines, in line with best practice guidance. In addition, there were some gaps in the recording of the administration of medicines and a lack of individualised instructions about when to give people any of their medicines prescribed on an ‘as required’ basis.

Staff had been trained in safeguarding and were aware of what constituted abuse or improper treatment. However, the provider had not identified and reported all safeguarding matters to the local authority safeguarding team for investigation in line with their own policies and procedures.

Staffing levels were appropriate to people’s needs on the days that we inspected however, both people and staff stated that they felt there was not enough staff. Qualified nursing staff said they were regularly asked to cover shifts at short notice. The registered manager told us that new staff had been recruited and were due to start working at the service very soon which would hopefully ease staffing levels. Recruitment processes were robust.

Risks that people were exposed to had been assessed and most environmental risks. Accidents and incidents were recorded and reviewed although action taken as a result of such analysis was not clearly recorded. Some elements of fire safety had not been addressed and some staff needed training in this area. Fire drills were not being carried out in line with the requirements of fire safety regulations. The registered manager told us that this would be addressed.

People received care that was appropriate to their needs and where they needed input into their care from external healthcare professionals this was arranged. People were supported to meet their nutritional needs and monitoring of their food and fluid intake took place where there were concerns about people’s weight.

Staff displayed kind and caring attitudes towards people and people told us that they enjoyed positive relationships with staff. Explanations about care were given to people before care was delivered. People were supported to be as independent as possible and they told us that their privacy was maintained. Nobody living at the home currently needed an independent advocate acting on their behalf.

Staff received appropriate training and supervision. They had a basic understanding of the Mental Capacity Act 2005 (MCA) and people’s capacity levels were considered in respect of the delivery of their care. Paperwork related to decisions made in people’s best interests was sometimes out of date or not appropriately maintained although we were satisfied that the provider followed the principles of the MCA in practice.

The environment in Hampton House, where people with dementia were accommodated, had not been adapted in line with best practice guidelines.

We recommend the provider researches relevant best practice guidelines about how to make environments used by people with dementia more appropriate to their dementia care needs.

Records related to people’s care were individualised and appropriately maintained overall. Some information could have been improved.

People were offered choices and an activities programme was in place. People told us they would appreciate more outings. Feedback about the service was obtained from people and staff via meetings and questionnaires that were issued periodically. A complaints policy and procedure was in place. The registered manager told us that there had only been one complaint in the service in the last 12 months and this was not related to a care delivery matter.

Records related to the operation of the service were disorganised and could not always be located when we asked for them. Office space was limited and the medication room was also being used as an office. Quality assurance systems were limited and it was not always clear how matters were identified and then subsequently addressed to drive through improvements within the service.

Staff told us that the registered manager was not always available for staff to approach about day to day matters in the running of the home and they would appreciate more direction and guidance at times. The registered manager told us that he was aiming to develop an ‘open door’ culture within the service where staff could come to him at any time.

The provider had not notified us of all incidents that they should have in line with the requirements of the CQC (Registration) Regulations 2009. We discussed this with the registered manager who told us that he would familiarise himself with the requirements of the aforementioned regulation. This matter is being dealt with outside of the inspection process.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were related to ‘Safe care and treatment’, ‘Safeguarding service users from abuse and improper treatment’ and ‘Good governance’. You can see the action we told the provider to take at the end of the full version of this report.