This inspection was carried out on 11 January 2017 and was unannounced. It was carried out by two adult social care inspectors.

The last inspection of the service was carried out in September 2014. No concerns were identified with the care being provided to people at that inspection.

Wessex house is a purpose built home which can accommodate a maximum of 56 people. Accommodation is arranged over three floors. Bedrooms are for single occupancy and all have the provision of en-suite toilet and shower facilities. A garden pathway is available on two sides of the home and there is ample parking. The home provides a service to older people who require nursing care. At the time of this inspection there were 37 people living at the home.

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.

The registered manager demonstrated a great deal of passion and enthusiasm and spoke of their commitment to promoting and implementing on-going improvements to the service people received. They also spoke of their commitment to empowering and valuing the staff team. One person who lived at the home said “I don’t have any worries at all. If I did, I would say. [Name of registered manager] comes to see us every day and I know for sure she would be straight on it if you were unhappy.” Another person said “Do you know [name of registered manager] comes and chats with us every day. She is so lovely.” We heard people calling out the registered manager’s name when she walked through the home and heard friendly banter and chatter.

People received care and support which was adjusted to meet their changing needs. People had access to appropriate healthcare professionals to make sure they received effective treatment when required. People received their medicines when they needed them and medicines were stored securely. Medicines were managed and administered by registered nurses or senior care staff whose skills and knowledge were regularly monitored.

Risks to people were minimised because there were effective procedures in place to identify and manage risks. These included reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin. A plan of care had been developed to minimise risks and these were understood and followed by staff.

People told us they felt safe and well cared for. One person told us “I couldn’t feel safer really. I know if I use my call bell the staff will come straight away.” Another person said “I prefer to stay in my room. The staff are always popping in to see if I am alright. If I need anything during the night I just ring my bell and they come pretty quickly.”

Risks of abuse to people were minimised because there were effective recruitment processes for all new staff. Staff had been trained and had a good understanding of how to recognise and report any signs of abuse.

People were cared for by staff who were well trained and competent in their role. There were effective systems in place to monitor the skills of staff. One person who lived at the home said “I think the training staff get must be good because they all seem to know what they are doing.” A visitor told us “All the staff are excellent. I find them friendly, professional and confident.”

People were supported to have enough to eat and drink however; views about the quality of the food provided were mixed. The registered manager was aware of this and was currently addressing. Staff knew about people’s preferences and were aware of people’s abilities and any risks associated with eating and drinking. We observed people were provided with food and drink w

An adult social care inspector carried out this inspection. We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We found the service to be safe because care and treatment was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

The people we spoke with told us they felt safe at the home and they commented on the kindness of the staff. Comments included “I feel very safe here. The staff are friendly and helpful” and “the staff would do anything you ask without a grumble.”

The provider had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.

Visitors were only able to access the home when they were let in by staff and all visitors were required to sign a visitor’s book when they arrived and left the home. This helped to provide a safe environment for people who used the service.

Is the service effective?

We found the service effective in meeting people’s physical care needs. The care plans we looked at had been regularly reviewed. This meant that people received care and support which met their up to date needs and preferences. Records showed that the home liaised with people's relatives and representatives as appropriate and that the individual was involved in the review of their care plan where appropriate.

We spoke with two visitors who were complimentary about the care their relatives received. They said “you cannot fault the general care. My X had a seizure and they got the doctor to review the medication straight away” and “my X is always clean and warm.”

The service could be more effective in meeting people’s social needs. The home employed an activity co-ordinator for 27 hours a week. We met with this person. They appeared very enthusiastic and committed to providing people with a varied programme of activities. Given the number of people and layout of the home, it was not possible for the activities co-ordinator to offer activities or one to one time to each person who lived at the home on a daily basis. Staff told us they did not have time to offer support with activities and did not have time to take people out. Following the inspection we were informed by a member of the provider's management team that there were plans to increase activity hours from 27 to 57 per week.

Is the service caring?

People told us staff were kind and caring. We observed staff interacted and supported people in a gentle and professional manner. People appeared comfortable with the staff who supported them.

People made the following comments “I think the nurses and carers are first class” and “the staff are very friendly and will do anything for you anytime.”

Is the service responsive?

People received care that was responsive to their individual needs. People’s health care needs had been monitored and appropriately responded to. Information about people’s health needs and contact with health and social care professionals had been recorded. We were informed that the service received good support from health care professionals and there were no problems obtaining their input for people when required. The manager told us that people were seen by a doctor within 48 hours of moving to the home.

Staff had up to date guidance on how to support each individual. We read five care plans. These contained assessments of need and outlined how needs would be met. The assessments were regularly reviewed to ensure that they reflected people's up to date needs. We saw people received care in line with their assessed needs. Examples included pressure area care and reducing the risk of malnutrition.

Staff had a very good knowledge of people’s healthcare needs and were able to tell us about how they monitored and treated individual needs.

The people we spoke with were generally satisfied with the care they received. However they told us they would like more quality time with staff. The staff we spoke with told us they were able to meet people’s “basic” care needs but did not have time to spend the time they would like to with people. People made the following comments “the staff are very good. They come in and wash me from head to toe every morning” and “I need to be turned every two hours and they always make sure that happens.”

Is the service well led?

There was a registered manager in post. A registered manager is a person who has been registered by the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Staff morale was low and we noted a lack of leadership on one of the floors during the lunch time period. This resulted in people having to wait for their lunch to be served. We shared this with the manager during our visit.

There had been a period of instability within the staff team and a number of staff had left employment. However, we saw the manager had communicated staffing arrangements with the staff team through staff meetings. They were in the process of interviewing for staff vacancies and we saw agency staff had been booked in advance to cover shortfalls.

Staffing rotas showed that senior staff were available to support and offer advice to less experienced staff.

There was a complaints policy in place. We saw that any complaints made were fully investigated and responded to. People we spoke with told us they would be comfortable to make a complaint if they were not happy with any aspect of their care.