This unannounced inspection took place over two days on 27 and 28 November 2018. The first day of the inspection was unannounced, we carried out an announced visit on the second day.

Wheatsheaf Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Wheatsheaf Court Care Home is registered to provide accommodation, nursing and personal care to up to 55 people in one adapted building. At the time of the inspection there were 34 people living in 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.

At the previous comprehensive inspection on 18, 19 and 20 September 2017, the service was rated ‘Requires Improvement’.

Systems and processes in place to assess, monitor and improve the quality and safety of the service were not always effective at identifying concerns. Areas of the home were not well maintained or clean. The impact on people of ongoing refurbishment in the home had not been adequately assessed.

Where shortfalls were identified these were not always addressed in a sufficiently timely manner. People did not always receive their care from staff who knew them well as there was a high reliance on agency staff. This also affected the amount of social interaction and activity available to people.

People were not consistently involved in planning their care and the systems in place for responding to people's feedback required strengthening. Improvements were required to ensure people received their medicines as prescribed.

The provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to the safety, maintenance, cleanliness and governance of the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.

At this comprehensive inspection, we have found that the required improvements have not been made. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvem

This inspection took place over three days on the 18, 19 and 20 September 2017. The first day of the inspection was unannounced; we carried out an announced visit on the second day and completed the inspection with telephone calls to relatives of people who live at the service on the 20 September.

Wheatsheaf Court Care Home is registered to provide residential and nursing care for up to 55 older people, including people with dementia care needs. At the time of this inspection there were 31 people living in the home.

At the last inspection in September 2015, the service was rated Good. At this inspection we found the service to be rated Requires Improvement.

There was a registered manager in post at the time of our inspection. 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.

Improvements were required to ensure that people were kept safe in the home. Audits failed to identify that areas of the home accessible to people were not safe; risks posed by the on-going maintenance and refurbishment of the home had not been assessed. Some areas of the environment in which people lived and equipment they used was not always maintained to a sufficient standard of cleanliness.

Systems and processes in place to assess, monitor and improve the quality and safety of the service were not always effective at identifying concerns. Areas of the home were not well maintained and completed refurbishment had not been finished to a high standard. The improvements that were required to the home had not been planned or co-ordinated to ensure minimum disruption to people and the environment; there were on-going shortfalls as a result.

Where shortfalls were identified these were not always addressed in a sufficiently timely manner. People did not always receive their care from staff who knew them well as there was a high reliance on agency staff. As a result people could not be assured that their needs would consistently be met by staff who had appropriate knowledge and skills. Regular staff had received training that was relevant to their role, however at times the skills mix and experience of staff on duty was not sufficient to meet people’s needs effectively.

The systems in place for responding to people's feedback required strengthening. People and staff had mixed views regarding how the service had responded to concerns and complaints. People were not consistently involved in planning their care and felt that there was not enough social stimulation and activity available.

Improvements were required to ensure people received their medicines as prescribed. The provider had recently introduced an electronic medicine management system; whilst this was being embedded people could not be assured that they would receive their prescribed medicines safely.

People were supported and encouraged to eat well and maintain a balanced diet. People were supported to maintain good health; there was prompt access to healthcare services when needed.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. People felt safe in the home and received care and support from staff that had a good understanding of their responsibility to protect people from abuse and ill treatment.

There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make informed decisions and encouraged people to make their own choices.

Regular staff were committed to the work they did and had good relationships with the people who lived in the home. People interacted in a relaxed way with staff, and enjoyed the time th

This unannounced inspection took place on 10 September 2015. Wheatsheaf Court Care Home provides nursing care for up to 52 older people, some of whom are living with dementia. On the day of our inspection 29 people were living at the home.

There was a registered manager in post at the time of our inspection. 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 arrangements to manage medicines safely required to be strengthened as staff were unable to explain why there was a variation in the number of medicines available for some people.

For those people that required frequent re positioning or moving to prevent the development of pressure related conditions, we noted that the records to confirm that staff had carried out this aspect of care had not been written in a timely way so we could not be assured that this aspect of care had taken place.

The service was flexible and responsive to people’s individual needs and preferences, Staff used creative ways to increase people’s sense of well-being and quality of life. People were supported by staff that knew how individual people wished their care to be given.

There were procedures in place to assess people’s ability to make decisions about their care and support. Care plans were in place detailing how people wished to be supported and where possible people were involved in making decisions about their care.

There were robust and effective recruitment processes in place so that people were supported by staff of a suitable character.

Staffing numbers were sufficient to meet the needs of the people who used the service. Staff received regular training. Staff were knowledgeable about their roles and responsibilities and had the skills, knowledge and experience required to support people with their care and meet their needs.

People told us they felt safe, and there were clear lines of reporting safeguarding concerns to appropriate agencies and staff were knowledgeable about their responsibilities to safeguard people.

The manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

There was a suitable complaints system in place, complaints were responded to promptly.

Management audits were in place to monitor the quality of the service, and improvements had been made when required in a timely way. People and family members were encouraged to feedback about the quality of the service and changes were made as a result of this.

During our inspection of Wheatsheaf Court Care Home we set out to answer our 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, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report .

Is the service safe?

Equipment at the home had been well maintained and serviced regularly therefore not putting people at unnecessary risk. The manager compiled the staff rotas, they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met. Recruitment practice was safe and thorough which ensures that staff had the right level of knowledge and skills to care for people safely.

Is the service effective?

Specialist dietary, mobility and equipment needs had been identified in care plans where required to meet people’s individual needs. It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people that used the service and that they knew how people liked their care and support to be provided.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We spoke with visiting relatives that told us the care shown to people was very good. We found that people were encouraged to become involved in a wide range of activities from flower arranging, catching and throwing soft balls to bingo. People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People completed a range of activities. A relative told us that, “I come here nearly every day and there is always something going on for people to be involved in". We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely and action was taken where necessary.

Is the service well led?

Staff told us that they were well supported to carry out their job role, and that they had regular supervision and an annual appraisal. They told us that the management of the home was good and that the manager was approachable and supportive. One person’s visitor told us that “if there is anything wrong they always sort it out” another relative told us “I would recommend this place to anyone”.

We spoke with two people that used the service. They told us that the staff were very kind and looked after them well. One person told us “I am happy with the care here. The staff have changed, but it has all settled down and they come and spend time with me”.

Most of the people who used the service were unable to tell us what they thought of the service due to their dementia or frailty. We spoke with five relatives of people who used the service. They all told us that they were happy with the care their relatives received. All of the relatives told us they had seen improvements in the service in the last month. One person told us “staff come and change dad’s incontinence pads regularly, whereas before we would have to ask”. Another relative told us “It has changed, now it is more homely, staff will come and talk with the residents quite often”. Two relatives told us that their relatives always wore their own clothes which were clean.

We found that there had been a change in management and care staff. We saw that there had been improvements in the care that people received. Staff were more aware of their role in the safeguarding of vulnerable adults. We saw that record keeping was organised.

We had concerns about the providers recruitment process, training of staff and the system for making complaints.

We spoke with the relatives of three people who use the service who told us that they were happy with the home, and the people were well looked after. One person said “the staff are welcoming and there is a lovely atmosphere”, another said “I would recommend this home to anyone” and “my mother has always received excellent care from the staff”.

However we spoke with the relatives of three other people who had contrasting views. One person said “there are not enough activities to keep people stimulated, especially at weekends” and another said “I am not kept updated on mum’s care” and “we have made complaints, but we are not listened to”.

We found that risks were assessed and care plans were written for people to reflect the risks identified. However, we found concerns with the level of pressure area care and monitoring of drinks.

We found that there was not an effective complaints system in place, and that record keeping was not accurate or fit for purpose.

We also found concerns with staff’s understanding of safeguarding of the people who used the service. We found that the staff had not received adequate training to meet the needs of the people who use the service, and the staff were not supervised or supported in their role.

Many of the people living at Wheatsheaf Court had a diagnosis of dementia; as such their ability to recall their experiences and express their views was limited. In order to obtain information about peoples’ experiences of living at Wheatsheaf Court and assess how their needs were being met by the staff, we spent time observing people’s engagement, demeanour and body language.

We saw that staff were attentive, sensitive to people’s individual needs and involved them in conversation and decisions about aspects of their daily lives.

We spoke with three relatives and they told us that they were kept up to date about their relative's well being and that they were involved in decision making relating to the care that their relative received. All of the relatives that we spoke with confirmed that visiting times were flexible and that they knew how to raise any concerns with the management should they need to do so.

One person told us they felt safe living at Wheatsheaf Court and that the staff were nice to them. They also told us they felt well cared for, that staff responded promptly and had the skills to care for them appropriately. They told us they knew how to raise any concerns should they need to do so.