Wharfedale House - Care Home Physical Disabilities 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 service is registered to provide care and support for up to 18 people with a physical disability. Nursing care is not provided. The home is situated close to local amenities in Wetherby and has good transport links. At the time of this inspection there were 18 people living at the home. Some people had additional needs, such as living with dementia.

This comprehensive inspection took place on 20 February 2018 and was unannounced. At the last inspection in August 2015 we rated the service as 'Good' overall. However, we found improvement was required for the service to be 'Effective'. This was because was staff were not adequately supported with supervision and appraisal.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Wharfedale House - Care Home Physical Disabilities on our website at www.cqc.org.uk

At this inspection we found improvements had been made to support for staff. However, we recommend the provider review the current supervision system to make sure it is effective.

There were systems in place to look at the quality of the service and these identified areas that needed improvement. provided, action was not always taken where shortfalls or risks were identified. We recommend the provider review governance systems to make sure identified areas for improvement are acted on.

Overall, the systems in place to make sure that people were supported to take medicines safely were effective. However, we recommend the provider reviews the procedure for managing the disposal of skin patches.

There was 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 responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager had good oversight of the service and there was a clear ethos of care.

People told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. Risks to people had been assessed and plans put in place to keep risks to a minimum. Improvements had been made to the environment to make it safe and this work was planned to continue.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background. Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted and they lack capacity to make their own decisions. 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.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People told us that staff were caring and that their privacy and dignity were respected. Care plans showed that individual preferences were taken into account. Care plans were up to date and gave clear directions to staff about the su

The inspection took place on 13 August 2015 and was unannounced. Wharfedale House is a care home for 18 people with physical disabilities. There are 12 en-suite bedrooms, two shared rooms with communal lounges, dining areas, kitchen, and laundry room and four self-contained flats with these facilities within them. The flats can be used by people who are working towards living independently. There were 18 people living in the service when we inspected.

A registered manager was in place at the service. 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 were positive about living at the service and told us that the staff and registered manager provided a good standard of care and support. We saw that the provider investigated concerns when these were raised.

The service was robust in following local authority guidance and policy in reporting safeguarding issues. Staff we spoke with showed a good understanding of what constituted abuse and what to do if they believed that any abuse was taking place.

Risk assessments were in place and regularly reviewed and updated. We saw that people who used the service were involved in the process of review.

We found that recruitment of staff involved appropriate checks to ensure that applicants were suitable to work with vulnerable people. People who used the service were involved in recruitment of new staff at all levels. Staffing levels were maintained at a level which enabled the service to provide appropriate support to people.

People who used the service told us that staff understood how to meet their needs and we saw that the service demonstrated a commitment to staff training. Supervision and appraisal for staff was not taking place at sufficiently regular intervals to ensure that staff were fully supported in delivering care. The registered manager had already taken action to address this.

Care plans were clear, comprehensive and personalised. We saw that they contained records which showed that people had regular input from other health professionals. People told us that they were involved in writing and reviewing their care plans.

The service maintained a well-planned programme of activities with the support of volunteers, and we saw that people who used the service were regularly consulted about the things that they wished to do.

We saw that the service had a good system in place for handling complaints and concerns. Where a person had raised concerns that could not be addressed by the registered manager we saw that the provider had taken action.

The registered manager was seen as approachable and responsive by both staff and people who used the service. Staff meetings were regularly held, giving the staff an opportunity to discuss any issues.

A number of audits were undertaken with results analysed and actions planned to ensure effective service delivery and improvement.

During our inspection we looked for the answers to five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

We spoke with seven members of staff and most told us they had recently had safeguarding training. Some members of staff had refresher training booked. One member of staff told us "The atmosphere is much better here now, people are not complaining as much." Another member of staff said, "I feel the bosses are listening to us now and I feel if there are any concerns they will take them seriously."

The provider in conjunction with people who used the service had implemented a 'Keeping Safe Protection Plan'. We spoke with seven people who used the service and most told us they thought the 'Keeping Safe Protection Plan' had helped them to feel safer. However, two people we spoke with said it had not helped at all. We saw each person had signed to say they agreed with the plan.

Two people who used the service told us they thought the atmosphere was still unpleasant sometimes. People told us they were aware a safeguarding investigation by Adult Social Care could not be continued and this had caused them concern. One person who used the service said, "I am happy here, I feel safe with the staff, it's a lovely environment." Another person said, "I like some people and others I don't, but I feel safe here. Staff are very good, if I had any concerns I would talk to them."

Is the service effective?

We did not look at this domain during our inspection.

Is the service caring?

We did not look at this domain during our inspection.

Is the service responsive?

We saw the '2013/2014 customer survey' was available to people and where required included action plans. We saw people had been asked questions for example, 'How happy are you with the way you are treated by staff and volunteers?'. The majority of people said they were 'very happy'. People were asked 'Do you feel safe in the service?' with the exception of one person everyone who completed the survey said 'always'. Where people had asked for changes to be made we saw an action plan which included for example, a better internet connection, we saw this was being installed shortly after our visit. People had said there were problems with their clothing being shrunk in the drier; the action was for staff to read clothing labels and to ask if people wanted their clothing to go in the drier.

We asked to see a log of complaints since our last visit and we were told there had not been any formal complaints. We spoke with a person who used the service who told us they had complained directly to a senior manager and this complaint was still to be resolved.

Is the service well led?

During our last inspection some staff told us they did not feel supported by the senior management team at Leonard Cheshire Disability. As a result of this a risk assessment had been completed which looked at areas causing staff stress. We saw the 'risk assessment' which included 'additional risk control actions'. We spoke with seven members of staff including the manager, their comments included;

"It's become more comfortable to work here."

"We all work as a team."

"I've seen a big change, I now feel supported, they help us."

We saw the minutes of five meetings with residents since our last inspection which covered various issues. We saw three of these meetings had been attended by the provider's senior managers. We also saw there had been three staff meetings.

During our inspection we looked for the answers to five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they did not always feel safe. Safeguarding policies and procedures were robust but these were not always followed.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

People told us they felt their rights and dignity were mostly respected.

Is the service effective?

People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in their person centred plans where required. One person told us, "It's absolutely excellent here, I'm really spoilt."

Is the service caring?

Care staff were attentive and spent time talking with people and making sure their needs were being met. People commented, "It's nice here, we have a laugh, we get on with all the staff." People who used the service had completed satisfaction surveys in March 2014. We were told the results were currently being collated by the provider.

Is the service responsive?

People who used the service told us they knew how to complain and felt confident in some cases their concerns would be listened to and action would be taken to resolve them.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff did not feel supported by the senior management team at Leonard Cheshire Disability. Staff told us there had been ongoing problems at Wharfedale House which had led to several people resigning. One member of staff we spoke with said, "I don't think anyone is listening to us, we have got no help."

Everyone we spoke with said they thought the manager at Wharfedale House was very good. A person who used the service commented, "She's a wonderful manager." and a staff member said, "I have never worked for a manager like her, she is so dedicated and so professional."

People were complimentary about the staff and the manager. They said, “This is the best home I have seen or lived in” and “I like the staff. I like the manager she has good standards.”

People were appropriately dressed, in clothes of their own choice. The staff responded to people’s needs and spoke to them in a caring and supportive way.

People told us the staff understood how to support them. One person said, “The staff that look after me know me pretty well, we have an understanding.”

People had individual care plans. The plans were well organised and included an index to each section. There were personal profiles, details of what was important to people and what others admired about them. People told us they had been involved in writing their care plans and had their own copies to refer to. One person said, “I have mine in my bedroom and it is reviewed every month with my key worker.”

There were effective systems in place to reduce the risk and spread of infection. However, we noticed some of the bathrooms and toilets were in need of repair and difficult to keep clean.

There were effective recruitment and selection processes in place. One person told us, “I do the interviews for new staff which really helps to know who is coming to care for me.”

People who used the service were asked for their views about their care and treatment and they were acted on. One person told us the new manager had asked them how they would like their room to be decorated. They said, “I went out for the day and when I came back it was done in the colours I wanted, I love it.”

We spoke with five people who used the service and they told us they were involved in making decisions about their care. One person told us they had recently sat with staff and decided what they wanted to include in their person centred plan. They said they had been asked about their ‘goals’. Another person said they had attended person centred planning training so they could understand how it works.

People talked about resident meetings which were chaired by a person who used the service and held monthly. One person who used the service told us they talked about what they wanted to do.

People we spoke with said they were treated with respect. Staff were described as ‘friendly’, ‘polite’, ‘helpful’, ‘kind’ and ‘caring’. People told us that staff respected their privacy and only entered their room when invited.

People we spoke with said they were happy with the care they received. One person said, “This is by far the best care I’ve ever received.” Another person said, “They know what is important to me and help me achieve what I want.”

People said they were encouraged and supported to be independent, and encouraged to use the local community, and had lots of opportunities to do different things. Two people said they often went out independently but also got staff support to do things when they needed assistance. One person said they did not go out on their own but went out with staff when they wanted.

People who used the service and staff were very complimentary about the manager. They said she promoted very good standards of care. Staff said they had received training that helped them understand how to provide good care.