Our last inspection report of this service was published on 10 January 2017 and related to an inspection that had taken place on 14 November 2016. At the inspection in November 2016 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 9, Person centred care, Regulation 10, Dignity and respect, Regulation 11, Need for consent, Regulation 12, Safe care and treatment, Regulation 13, Safeguarding service users from abuse, Regulation 17, Good governance and Regulation 18 Staffing.

We asked the provider to take action to meet regulations 9, 10, 11, 13 and 18. We took enforcement action against the provider and told them to meet regulation 12 and 17 by 24 February 2017.

The provider sent us a report of the actions they were taking to comply with Regulations 9,10, 11, 13 and 18 and they told us they would be meeting the Regulations by 10 February 2017.

We returned to carry out a comprehensive inspection on 25 and 26 April 2017. The inspection was unannounced. At this inspection we found that the provider had implemented new ways of working to address the breaches from the previous inspection which had resulted in an improvement to the service provided.

Wilmington Manor Care Home is registered to provide nursing care with accommodation for up to 50 people. There were 47 people living at the home on the day of our inspection. Most people lived in the home permanently, however, some people stayed for a planned period of respite care. For example, if they were recovering from a medical procedure or health issue or if their usual carers were having a break. People living at the home had varying nursing care needs. Some people were living with dementia and some people had complex medical conditions such as diabetes or having suffered a stroke. Some people were receiving the care needed to support them at the end of their life. Accommodation was over two floors plus a mezzanine floor. A lift was available so that people could move between floors easily.

A registered manager was not based at the service at the time of our inspection. However a new manager was in post and had made an application to register with CQC and this application was in progress. 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 were now receiving a safer service. Staff understood their responsibilities in reporting potential abuse and felt confident to raise concerns with the manager or provider. Safeguarding alerts had been raised with the local authority by the provider and the manager since the last inspection.

The management of medicines had improved although this continued to progress and some further improvement was required. We have made a recommendation about the medicines administration.

Improvements had been made to individual risk assessments which were now in place to mitigate the risks of people coming to harm when they were receiving care and support. More detailed guidance was in place to give staff the advice necessary to manage the risks faced by people.

Safer procedures were now in place when reporting accidents and incidents. The manager reviewed and signed off all incident records and logged these on to the provider’s electronic system themselves once they had completed their review.

There were suitable numbers of nurses and care staff across the service to provide the right amount of staff people required to meet their assessed needs. Staff confirmed they were not under pressure and had the time to give to people without rushing. Safe recruitment practices continued to be followed to ensure new staff were suitable to work with people whose circumstan

This inspection took place on 14 November 2016 and was unannounced. Wilmington Manor Care Home provides nursing care and accommodation for up to 50 older people. There were 42 people living at the home at the time of this inspection. When we last inspected the service on 12 May 2014 the provider was meeting the required standards. At this inspection we found that the provider was not meeting the required standards.

The home had a registered manager. 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.

Risks to people’s safety were not always safely managed by staff. People who were at risk of malnutrition, falls or developing pressure ulcers, did not have appropriate assessments carried out consistently. Risk assessments were not always developed with detailed management plans to offer guidance for staff in what steps were needed to mitigate the risks and keep people safe.

There were insufficient numbers of suitable staff available and deployed to meet people’s needs consistently across all areas of the home. Safe and effective recruitment practices were followed to make sure that staff were of good character and had the experience and qualifications necessary for the roles they performed.

Incidents or accidents were not always reported to the registered manager for review, subsequently not all were reported to the local safeguarding authority or Care Quality Commission (CQC). Not all the staff spoken with were knowledgeable about the risks of potential abuse or knew how to report concerns internally and externally to local safeguarding authorities.

People had their medicines administered by trained staff; however they did not always receive their medicines as intended by the prescriber. Staff did not always follow GP`s instructions when administering people`s medicines.

Not all the people who had a diagnosis of dementia or had a confused state of mind had mental capacity assessments in place to establish if they had capacity to understand and take informed decisions regarding the care and support they received from staff. Best interest processes were not always followed to ensure the care and support people received was in their best interest.

People told us they were not always involved in decisions about their care, they could not recall having been involved. Their consent was not always accurately reflected in their individual plans of care. Care plans were not personalised to reflect people`s likes, dislikes and preferences about the care they received. They had not identified and detailed all the care needs people had and did not offer sufficient guidance for staff to understand and deliver care and support in a personalised way. People`s care plans were not always reflective of their current needs.

People who lived at the home had mixed views about the skills and abilities of the care staff. Staff received induction training when they started working at the home. However the provider failed to ensure that staff had yearly refresher training in key areas such as safeguarding, food hygiene, manual handling and fire training. Staff told us they had regular supervisions and felt supported by the home management team.

The quality assurance systems were not effective. The regular audits carried out by the registered manager and the provider had not identified all the issues and concerns we identified at this inspection. Care records were not up to date and were not always reflective of people`s care needs.

People were cared for in a kind and compassionate way by staff. However the care and support provided for people nearing the end of their life did not always promote their dignity and privacy.

At this inspection we found t

The inspection was conducted by one inspector. During our visit we followed up on areas of non-compliance from our last inspection on 17 October 2013. The provider sent us an action plan following that visit in which they told us about improvements they had made. During our visit we found that the shortfalls we had found had been addressed and compliance had been achieved.

There were forty seven people living in the home at the time of our visit. Some of the people were experiencing dementia. This meant they were not always able to tell us about their experiences. The report is based on our observations during the inspection, talking with people who used the service, their relatives, and staff who were working in the home, and reviewing records.

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

Is the service safe?

People told us they felt safe. There were systems in place to make sure that the manager and staff learned from events such as accidents and incidents and the risks associated with the environment.

Risks to people’s health and welfare were identified and managed to ensure people were protected from risk of harm.

People had personal emergency evacuation plans for staff to follow in the event of a fire.

Is the service effective?

People’s health and care needs were assessed with them, and they, or their representatives were involved as far as possible in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. We saw that people were comfortable with the staff who were working with them.

Staff knew people well and were able to describe people’s preferences, interests and diverse needs. This meant that care and support was provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities regularly. An activities coordinator provided a programme of activities for people to choose from. People were able to take part in outings.

Staff responded promptly when people needed support or reassurance. People who lived in the home and staff who worked there told us they were able to raise any concerns with the manager and were confident these would be dealt with.

Is the service well-led?

The service had an effective quality assurance system, records seen by us showed that identified shortfalls were addressed promptly.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The manager was accessible and approachable. We saw that people were comfortable talking with the manager during our visit. Staff told us the manager was supportive.

We found that people’s views and experiences were not taken into account in the way the service was provided and delivered in relation to their care and that people’s privacy, dignity and independence was not respected.

We found that people did not experience care, treatment and support that met their needs and protected their rights.

We found that people who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that although the provider did not have an effective system in place to assess and monitor the quality of service that people received.

We found that that the provider did not have an effective complaints system available. Comments and complaints were not responded to appropriately.

We spoke with the registered manager, three people who used the service, three members of staff and the home’s activities organiser. The people who used the service told us that they were happy with the care and support they received and said they felt safe in the home. They told us that staff offered them choice and respected their opinions, whilst encouraging them to be as independent as possible. One person living at the home told us, "I think the staff are lovely. The people we spoke with raised no concerns other than one person told us that on occasions they had to wait a long time for their call system to be responded to by staff. People told us that they were asked for their views about the service at residents and relatives meetings and their comments were taken into consideration when considering how the service was delivered. This was particularly apparent in considering peoples wishes about what food should be included or eliminated from the home’s menu plan, and activities that were to be organised both in the home and out in the local community.

The visit was carried out by one Inspector over four hours. During this time we (i.e. CQC) talked with four people living in the home, two relatives, and five staff, as well as with the manager. The manager was available throughout the visit.

People we talked with spoke positively about the home. This was in spite of a considerable upheaval due to a major refurbishment which was nearing completion. People’s comments included:

“The staff are definitely looking after us very well, even with all the work that is going on. They are so cheerful and just get on with the job.”

“I am very happy here, and very comfortable. I am very pleased with the redecorating of my room and the new curtains. My daughter helped me to choose the colours.”

“Yes, everything is fine here. The staff are very good.”

“Yes, I am happy with everything.”

A relative said that “The carers and the care here are very good.”

We viewed some recent questionnaire responses, which included these comments:

“I have no frustrations or worries. I am very happy here.”

“The staff are very helpful, we get lots of support.”

“Everyone is so nice, and they really work hard.”

“It’s a friendly place to be, and it’s warm and it’s safe.”