This was an unannounced inspection which took place on 5 June 2018. This meant the staff and provider did not know we would be visiting.

We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

At the last inspection in July 2017 the service was not meeting all of the legal requirements with regard to regulation 12, safe care and treatment, regulation 18, staff training and regulation 17, governance.

Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions about is the service safe, is it effective and is it well-led to at least good.

At this inspection we found improvements had been made and the service was no longer in breach of regulations 12 and 18. Although further improvements were required as identified in the inspection report. A breach of regulation 17 was in place as further work was required in order to achieve compliance. The quality assurance processes although becoming more robust required further action in other aspects of care. You can see what action we told the provider to take at the back of the full version of the report.

Wheatfield Court is a care home. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Wheatfield Court accommodates a maximum of 60 people who require nursing care or personal care, some whom may live with dementia or a dementia related condition. This includes a separate ‘enhanced care facility’ unit run by the NHS which provides temporary care and rehabilitation to up to 20 people who have been recently discharged from hospital or care to prevent their admission to hospital. At the time of inspection 53 people were accommodated at Wheatfield Court.

A registered manager was 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 provider undertook a range of audits to check on the quality of care provided. However, we considered some improvements were required with regard to record keeping, staff deployment, staff training and to ensure previous non-compliance was actioned in a timely way.

The environment was well-maintained and there was a good standard of hygiene. Improvements were required to ensure information was accessible to keep people involved and orientated.

Training provision had been improved for staff. However, we have made a recommendation that staff receive all available training, appropriate to their role to give them more insight into people’s specific care and treatment needs. Staff were supervised and supported.

People and staff told us they felt safe and there were enough staff on duty to provide safe care to people. Staff knew people’s care and support requirements. However, record keeping required some improvements to ensure it reflected the care provided by staff.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had access to an advocate if required.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care. Care was provided with kindness and people’s dignity was respected.

Some activities and entertainment were available to keep people engaged and stimulated. Staff did not always interact and talk with people.

People were protected as staff knew how to respond to any allegation of abuse. Whe

This inspection took place on 17 July 2017 and was unannounced. A second day of inspection took place on 19 July 2017 and was announced.

Wheatfield Court is a residential home which provides nursing care, personal care, short term care and reablement (short term support usually after people are discharged from hospital) for up to 60 people. At the time of our inspection there were 57 people living at the home, some of whom were living with dementia. 34 people were receiving nursing care, three people were receiving residential care and 20 people were receiving short term care on the reablement unit which is located on the first floor. All bedrooms have en-suite facilities. Some bedrooms on the ground floor have direct access to the garden.

A registered manager was not in place at the time of our inspection. 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. The current manager has been in post since April 2017 and has applied to the Care Quality Commission to become the registered manager.

We last inspected this service on 23 March 2015 when it was rated 'good.'

During this inspection we found breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This was because: risks associated with people's care were not always identified and mitigated; essential staff training was not up to date; the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure people received appropriate care and support; and the provider had failed to notify the Commission about significant events in a timely manner.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Medicines were not always managed safely as there was a lack of guidance for staff in relation to ‘when required’ medicines. When people had their topical creams administered this was not always recorded accurately.

People we spoke with told us they felt safe living at the home. Relatives we spoke with all said they felt their family members were safe.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Each person had a personal emergency evacuation plan (PEEP) which provided staff with information about how to support them to evacuate the building in an emergency situation such as a fire or flood.

There were enough staff on duty to meet people’s needs. The provider was using agency nursing staff while they recruited to fill five nurse vacancies. Essential staff training was not up to date.

People had 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.

Fluid charts had not been completed accurately. People said the food was enjoyable.

Staff were not always caring as sometimes they concentrated more on the task rather than the individual they were supporting. People gave us positive feedback about the standard of care provided.

People had access to important information about the service, including how to complain and how to access independent advice and assistance such as an advocate.

Some car

At the time of the inspection there were sixty people who were living at Wheatfield Court. We were able to meet and speak with some of them and observe their experiences of care and support at the home. We spoke with the relatives of people who used the service, the ten staff on duty and the manager. Feedback from the people who used the service, their relatives and health professionals was very positive. One person who used the service told us, “It’s is really lovely here. I have my own key to my room,” One relative said, “The staff do their best; I can talk with them at any time. It’s not bad here”.

We were able to observe the experiences of people who used the service. For instance, we spent time with people as they had their breakfasts and lunches and observed how staff supported and encouraged them. The ten people we spoke to all told us they had a choice of hot food at mealtimes and we saw staff encouraged people to make their own choices and decisions in as many aspects of their care as possible. We saw staff understood each person’s different needs, for example, when they required additional support.

We observed that staff treated people with dignity and respect. We saw that people had freedom of movement around their home and could spend time in their bedrooms whenever they wanted. We saw that each person had their own bedroom which was personalised. We saw the provider had made suitable adaptations to meet the people’s physical needs.

Staff told us how they respected people’s privacy and knocked before they entered their rooms. We saw that the people who used the service related well with the staff. We saw that the staff communicated well and appropriately with people in a way that was easily understood. We saw that staff were attentive and interacted well with people. One relative of a person who used the service told us, “My dad is well looked after. The staff are doing a good job”. We learned more about how care and treatment was provided when we talked with staff, observed their practices and looked at the records of five people who used the service.

The manager had carried out a survey of people who used the service and their relatives. In the survey everyone said that the care at the home was very good and the people who used the service felt safe.

“It’s very nice here. The food is very good. I like to have my breakfast in my room.”

“The staff are very good, I have a lovely room.”

“I just ask when I need anything. I am in control of everything.”

We found that people were encouraged and supported to make their own choices and found there was detailed care and support information in place for people using the service.

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service had their care and welfare needs met.

We found that staff had been well supported to deliver care and treatment safely.

We found that people’s views were important and listened to. We found that there was an effective complaints system in place.

This inspection was a themed inspection focussing on dignity and nutrition.

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 choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “expert by experience”; people who have experience of using services and who can provide that perspective.

To help us to understand the experiences patients have we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how patients spend their time, the type of support they get and whether they have positive experiences.

We did a SOFI observation of the lunch meal time in one of the three dining rooms. It was evident, that carers and people who used services interacted very well with each other. Carers and nurses ensured people were able to contribute to choosing what they wanted to eat. All people were given the opportunity to voice their views and opinions and staff assisted people sensitively and at a pace suitable to the individual.

During this themed inspection visit, we spoke to nine people who used the service and three relatives. This is what they told us: People who used the service said they were given appropriate information and support regarding their care or treatment. Each person had a written contract and a statement of their terms and conditions with the provider. No-one had moved into the home without having had their personal needs assessed and had been assured by the senior staff these would be met.

People told us they had been involved and had contributed to the pre-admission assessment. People told us their privacy and dignity was upheld by staff working in the home.

The nine people we spoke with said they had a choice of at least two hot meals each day. People said portion sizes were good, sometimes too big. They said second helping were always available if they wanted more.

One person said “We get three large meals each day, and we are offered snacks between meals. Sometimes this is too much, but the food always very good.”

People told us they felt safe living here. They said they could express themselves freely and without fear. People told us they would know who to speak to if they had any concerns at all.

People told us they were well supported by the staff team and were happy with the care, treatment and support they received.

We spoke with three visitors, and without exception, they all told us the care their relatives received was excellent. They said staff kept them fully informed and were very knowledgeable about their relatives support needs.

One relative told us the nursing staff were very good at keeping her informed about her relative’s health and wellbeing. She said “She could see from the care records her relative was receiving the care she needed.”

This inspection took place on 23 and 24 March 2015 and was unannounced.

The last inspection of this service took place in December 2013, when we found the service to compliant with all the areas inspected.

Wheatfield Court is a care home providing accommodation for older people requiring nursing or personal care. It has sixty beds.

The service has had a registered manager in post since 2009. 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.

Systems were in place to protect people from harm and abuse. Staff had been given appropriate training in safeguarding vulnerable people and were well aware of their responsibilities to protect the people in their care. People told us they felt very safe living in the home.

There were enough staff on duty to meet people’s needs in a safe and timely way. Staff were able to engage with people in a calm and unhurried way. New staff were carefully checked before they started working in the home to make sure they were fit to work with vulnerable people.

People’s prescribed medicines were stored and administered safety, and clear records were kept of all medicines received, administered and disposed of.

People’s needs were carefully assessed before they came into the home, to make sure all their needs could be met by the service. People were encouraged to be involved in the assessment of their needs, and their wishes and preferences about how their care should be given were recorded. Detailed care plans were drawn up to meet each person’s individual needs and wishes, and these plans were regularly evaluated to make sure they remained appropriate and effective. People told us they felt their care and welfare needs were consistently met, and that they received very good care.

People enjoyed a varied and nutritious diet, with plenty of choice. Any special dietary needs were met, as were any religious or cultural diets. People told us they were very happy with quality and quantity of their meals.

Staff closely monitored people’s health needs and accessed the full range of community and specialist healthcare services, where necessary, to make sure people received the healthcare they needed. People told us the staff were quick to pick up any changes in their health or demeanour and responded appropriately. Relatives told us the staff made prompt referrals to GPs and followed any advice they were given by health professionals regarding people’s care and treatment.

People and their relatives told us the care they received was very good, and that all their needs were met. They spoke highly of the warmth and caring attitude of the manager and the staff team and said they were treated with respect and dignity. The atmosphere in the home was calm and relaxed. Interactions between people and staff members were positive, respectful and affectionate. A number of people, visitors and staff told us the home was like a “big family.”

People were encouraged to be as independent as possible, and enjoyed a good range of activities and social stimulation. They were also supported to make as many choices as possible about their care and their daily lives. Relatives were made welcome in the home and there were good links with the local community, including churches and schools.

People were given opportunities to express their views about their care and about the running of the home. There were regular meetings with people and their relatives to review their care, and resident/relatives meetings were also held. The registered manager had an open-door policy and was always available to discuss any concerns. Complaints were taken seriously and responded to appropriately.

Staff told us the registered manager provided clear and positive leadership, and was very supportive to the staff team. They said the registered manager led by example and demonstrated good person-centred values. Staff told us they were clear about their roles and what was expected of them. They demonstrated a genuine pride in the quality of care they provided and told us they enjoyed working in the home.

Effective systems were in place to monitor the quality of the service, and feedback was welcomed as an opportunity to improve the service.