This inspection was carried out on the 12 July 2017. Wilsmere House provides long-term nursing care and short stay care for up to 92 people. The service offers specialist support for those who have experienced a brain injury, those that are living with dementia and those that require nursing care. At the time of our inspection 84 people were living at the service two of whom were in hospital.

There was a registered manager in post on the day of the 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. On the day we were supported by the registered manager, the deputy manager and the clinical lead.

There was sufficient numbers of staff deployed at the service to meet people's at a time they needed and preferred. People told us they felt safe at the service and staff had a good understanding about the signs of abuse. Staff were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from potential risks.

Recruitment practices were safe and relevant checks had been completed before staff started work. Nurse’s professional registration was kept up to date. Medicines were managed, stored and disposed of safely. Any changes to people's medicines were prescribed by the person's GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business contingency plan that identified how the service would function in the event of an emergency and staff were knowledgeable about the procedures to take.

Staff had received appropriate supervision with their managers including clinical supervision. We found the staff team were knowledgeable about people's care needs. People told us they felt supported and staff knew what they were doing and that the training they received was effective.

Staff were up to date with current guidance to support people to make decisions. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

People had sufficient amount to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

The environment for people living with dementia was appropriate to their particular needs.

Staff involved and treated people with compassion, kindness, dignity and respect. We saw staff treat people in a caring way. People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted when personal care was undertaken.

People's needs were assessed when they entered the service and on a continuous basis to reflect changings in their needs. Care plans were detailed and provided staff with guidance on how to provide the most appropriate care.

People were encouraged to voice their concerns or complaints about the service. Concerns were used as an opportunity to learn and improve the service.

People had access to activities that were important and relevant to them. People were protected from social isolation through systems the service had in place. There were a range of activities available within the service and outside

We carried out an unannounced comprehensive inspection of this service on 4 August 2014 at which one breach of legal requirements was found. The registered provider did not deploy staff appropriately and we found that there were not a sufficient number of staff available to meet people’s needs.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on the 28 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wilsmere House on our website at www.cqc.org.uk.

Wilsmere House is a nursing home for up to 87 people some of whom have dementia, some who require nursing care and some of whom were younger adults with complex physical disabilities. During the day of our focused inspection the home had 11 vacancies.

The home has a registered manager. 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 and associated Regulations about how the service is run.

At our focused inspection on the 28 May 2015, we found that the provider had followed their plan and legal requirements had been met.

During our focused inspection on 28 May 2015 we also looked at the administration of medicines, how staff are supported and how people were supported around their nutrition and hydration. We did this as a result of various safeguarding alerts we had received in relation to the above.

We found that the provider had employed additional care and nursing staff and staff had been deployed appropriately to meet people’s needs.

We found that medicines were administered, stored and disposed of appropriately which ensured that people could be confident that the management of medicines was safe.

Staff had received a wide range of mandatory and additional specialist training to ensure that people’s complex health and physical needs were met.

Food was provided in sufficient quantities and was of a good quality and standard. People who required additional support to eat due to complex physical or health needs were supported and assessed appropriately.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Wilsmere House is part of Barchester Healthcare Homes Ltd and is a nursing home for up to 87 older people, some of whom have dementia. At this inspection there were 85 people using the service.

This was an unannounced inspection. The service was last inspected in February 2014, and was found to be meeting the regulations we inspected.

The service had a registered manager in post. 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.

People living at the home told us they felt safe living there. Staff understood how to safeguard people they supported. The registered manager and staff had received training on safeguarding adults, the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA).

The provider did not always have sufficient numbers of suitably qualified, skilled and experienced staff in order to meet the needs of people. The provider relied on agency staff and moving staff across units to cover for vacant posts and staff absences. We saw that at times agency staff did not arrive on time or did not turn up for shifts, which meant people who were on one to one care did not always receive this level of care.

Staff understood people’s needs and we saw that care was provided with kindness and compassion. People’s relatives told us staff were kind and caring, which we observed during this visit. We saw staff treated people with respect and dignity.

All staff had undertaken the required training and where necessary refresher training had been booked to keep their skills up to date and to ensure that the care provided was safe and effective to meet people’s needs.

The registered manager and staff considered families as a valuable source of information, with a role to play in care decisions. We saw from people’s care records that families were involved in people’s care where appropriate. Overall, their views were respected and acted on.

The registered manager demonstrated an understanding of their role and responsibilities, and staff told us they felt well supported. There were systems in place to monitor the safety and quality of the service provided. The manager encouraged feedback from families and other stakeholders, which they used to make improvements to the service.

During our inspection on 26 November 2013 we found the provider non-compliant with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because people who used the service and observations made during this inspection told us that there was a lack of stimulating activities and community based outings chosen by people.

The provider sent us an action plan informing the us, that action had been taken to ensure people using the service had more opportunities to participate in in-house and community based activities. We carried out an inspection on 12 February 2014 and assessed the new procedures and activities implemented by the provider. We saw a wide range of new activities implemented, both in-house and community based, and systems enabling people using the service and relatives to comment on what activities they would like to take part and see at Wilsmere House.

We received information from a whistleblower, alleging that equipment provided by the home was unsuitable and unsafe to use. During our inspection on 12 February 2014 we spoke to people who used the service and viewed documentation in regards to the equipment provided by the home and found suitable equipment checks had been carried out and people who used the service did not raise any concerns about the equipment provided.

We found the home to be clean, welcoming and free of offensive odours. People told us that they were spoken to politely and treated with respect by the staff. The staff were aware of the need to ensure that people's dignity was maintained and we saw good interactions between staff and people who used the service.

People were free to move around the home but we noticed that there was a lack of activities for people to engage in. People we spoke with told us, "There's not much to do around here" and, "There aren't many activities available". We spoke with the staff and one staff member said, "There could be more in terms of activities as there is not much available".

We saw that consent was obtained from people before care and treatment took place. People received care and treatment in line with their individual care plan but there was little information about people's likes, dislikes, preferences and life history.This meant that the care was not always centred around the person. We saw that the provider had a plan to address these issues.

The provider had appropriate arrangements in place to ensure that medicines were recorded and administered correctly.

There were sufficient numbers of suitably qualified and experienced staff to meets people's care needs, and that the staff received appropriate supervision and training.

The provider had taken appropriate steps to ensure that information was kept securely, was accurate and fit for purpose.

We spoke with people who use the service, relatives and staff and found that people were cared for according to their individual needs and requirements. People were involved in a range of social activities which they had chosen. The staff treated people with dignity and respect and called people by their preferred name.

Some of the things that people who used the service told us were, "the Staff are great" and "it's ok". Relatives said, "the physiotherapy here is excellent".

Staff told us that people who used the service were treated according to their individual needs and we saw evidence that confirmed this.

We spoke with staff who were unable to explain what was meant by safeguarding and were unsure how to raise safeguarding concerns. We did not see appropriate information displayed about safeguarding procedures. Therefore there was a risk that people who used the service, relatives, visitors and staff were not made aware how they could raise concerns.

The staff told us that they did not receive appropriate supervision or appraisals. There was no evidence that adequate supervision or appraisals took place.

People said that staff asked their views and consulted them to gain their consent before providing care and support to them. They told us that they attended meetings that were arranged for them and they had the opportunity to listen to other people and to share their views about the services provided.

People told us that there were enough staff on duty to care and support them appropriately. They reported that they did not have to wait for a long time for help and support before staff attended to them.

We visited the home just after lunch and we observed that staff had the time to talk and to engage with people appropriately. People were alert and engaged in activities that were provided for them.

People who use the service or their representatives told us that they receive enough information about the service that is offered in the home to enable them make choices about their lifestyles. Their choices are ascertained and respected by staff. They reported that they are able to give consent on a day to day basis but some do not remember having had care plans and risk assessments discussed and reviewed with them, so that they could agree and consent to the care being given to them.

People were given the opportunity to contribute to the running of the home by attending and taking part in residents’ and relatives’ meetings. A few said that they have not had a meeting regularly every three months, at the frequency that these should be held.

Most people thought that the home offers enough opportunities for leisure and recreational activities to keep them occupied. A few people believed that the amount of outings that were provided by the home had decreased recently, most likely linked to a shortage of staff that were available to escort them out on trips to shops or in the community.

People said that they liked the meals that were offered in the home and they thought that there was enough variety and choices to meet their needs. They were also happy with the standard of care, treatment and support that they received in the home and with the fact that the home had access to a number of healthcare professionals that were available to support the home’s staff in meeting the health and care needs of people living in the home. People reported that management listened to their complaints and took these seriously.

Most people thought that, the home’s staff were competent and skilled in meeting their needs. Many people also believed that shortages of staff at times prevented all their needs from being met in a timely manner. They said that the fact that the home did not use agency staff to cover the absences or sickness of staff, made this situation worst.

All people praised the quality of the environment and the standard of hygiene and cleanliness in the home.