This was an unannounced inspection that took place on 7 and 8 August 2018.

Wimbledon Beaumont is a ‘care home’. People in care homes receive accommodation and nursing or 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. Wimbledon Beaumont provides care for up to 49 people including people with dementia and is located in the Raynes Park area of west London.

This responsive inspection was prompted by concerns raised by relatives, health care professionals and current and former staff.

The home did not have 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.

The home was covered by the registered manager of another home within the organisation since mid-May 2018. Staff did not think the acting manager and organisation provided good support, that enabled them to do their jobs effectively. Many people and seven of eight relatives we spoke with said they did not find the acting manager approachable or responsive and they did not encourage negative feedback from people. People and their relatives said that they did not feel listened to. The registered manager who left in September 2017 had been in post for 11 years, since they left there had been inconsistent management and oversight of the service, with another manager leaving after only a very short period.

At the last inspection in June 2017 the key questions of effective, responsive, caring and well-led were rated "Good" and safe "Requires improvement". The safe key question required improvement because staff were not following corporate policy in using separate slings for people who required the use of lifting equipment to transfer. The overall rating was "Good". At this inspection staff were following the corporate policy.

Some people and their relatives that we spoke with said they were happy with the care and support provided by the home and way it was delivered, whilst others told us it was not of the quality they expected. All the people said that the staff were caring and did their best, however they felt there were too few staff to safely meet people’s needs. There was also a high turnover of key staffing and management roles over the previous two months. Some relatives told us they felt staff did not have the experience, training or received the managerial support to carry out senior roles competently. A new experienced deputy manager was recently appointed.

Medicine was not safely administered and medicine records were not complete and up to date.

Other records such as activity care plans were not fully completed.

The Mental Capacity Act and DoLS required the provider to submit applications to a ‘Supervisory body’ for authority. Not all appropriate applications had been submitted by the provider or applications under DoLS been authorised, and the provider was not complying with the conditions applied to the authorisation. They were aware of this and endeavouring to complete the required outstanding applications.

The home’s quality assurance system failed to identify short-comings in the service provided in a timely manner and did not consistently monitor and assess the quality of the service provided. The acting manager had picked up some of the areas in which the home was not performing well and was addressing them.

People and their relatives were encouraged to discuss health needs and they had access to community based health professionals as well as nursing and care staff. People had balanced diets that also met their likes, dislikes and preferences and protected them from nutrition and hydration associated risks. People and their relatives

This inspection took place on 15 and 20 June 2017 and was unannounced. At the last inspection of the service on 3 March 2015 we found the service was rated ‘Good’ in all key questions and overall.

Wimbledon Beaumont provides accommodation for up to 49 people who require nursing and personal care. People using the service had a wide range of healthcare and medical needs. The home specialises in caring for older people with dementia and physical disabilities. They also provided care to people with end of life care needs. At the time of our inspection there were 38 people living at the home.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the service continued to be rated ‘Good’.

Risks to people and the premises were generally managed well. However, staff were not following corporate policy in using separate slings for individuals during hoist transfers. This meant people were at increased risk of falls and the provider was not always managing risks relating to infection control well.

Access to the home was unmonitored for short times such as when there were no staff on reception and the front door was unlocked. However, the provider was aware of this and was actively considering solutions to increase the security of the building to reduce risks to people as soon as possible.

People felt safe and staff understood how to keep people safe from abuse. Staff were recruited through robust procedures and there were enough staff to care for people appropriately. Medicines management was safe.

Staff received the right support to care for people with training, support, supervision and appraisal. 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.

Staff were kind and caring and treated people with dignity and respect. Staff knew the people they cared for well and involved them in their care, giving information and explanations when required. The provider supported people to plan how they would like to be cared for at the end of their lives.

People were provided with a range of activities they were interested in. People’s care plans were current and staff generally followed them in providing care. People were involved in their care reviews. The provider investigated and responded to complaints appropriately.

The service was well led with visible leadership and people were supported by staff who enjoyed and felt motivated in their work. The provider encouraged open communication with people, their relatives and staff. A range of suitable audits were in place to assess and monitor the quality of service delivery.

Further information is in the detailed findings section of the report.

This inspection took place on 3 March 2015 and was unannounced. At the last inspection of the service on 17 December 2013 we found the service was meeting the regulations we looked at.

Wimbledon Beaumont provides accommodation for up to 49 people who require nursing and personal care. People using the service had a wide range of healthcare and medical needs. The home specialises in caring for older people with dementia and physical disabilities. They also provided care to people with end of life care needs. At the time of our inspection there were 45 people living at the home.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they felt safe at Wimbledon Beaumont. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Where risks to people’s health, safety and welfare had been identified, there were appropriate plans in place to ensure these were minimised to keep people safe from harm or injury in the home.

The home, and the equipment within it, was checked and maintained regularly to ensure it was safe. The home was kept free from clutter to enable people to move around safely. There were enough staff to meet the needs of people using the service. The provider made sure there were appropriate checks to care for and support people using the service.

People received their medicines as prescribed and these were stored safely in the home.

Staff received appropriate training and support to meet the needs of people using the service. The registered manager and provider monitored training to ensure staff skills and knowledge were kept up to date. Staff were well supported by the registered manager and other senior staff and were enabled to discuss any issues or concerns they had. They demonstrated a good understanding and awareness of people’s needs and how these should be met.

Staff encouraged people to stay healthy and well by ensuring they ate and drank sufficient amounts. Staff monitored people’s general health and wellbeing on a regular basis. Where they had any issues or concerns about an individual’s health, staff ensured they received prompt care and attention from appropriate healthcare professionals such as the GP.

Care plans were in place which were personalised and reflective of people’s individual choices and preferences for how they received care. People’s relatives and other healthcare professionals were involved in supporting them to make decisions about their care needs. Where people were unable to make complex decisions about their care and support, staff followed appropriate procedures to make sure decisions were made in people’s best interests.

The provider had procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had received training to understand when an application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

We received many positive comments during the inspection about the kind and caring nature of the majority of staff at the home. However, people also said there were a minority of staff that were not as kind and caring as others. We witnessed many caring and positive interactions between people and staff. However we also observed two instances where staff were not as kind and caring as they should be. We discussed our findings with the regional director who said these issues would be discussed with senior managers and appropriate action would be taken to address these.

Despite what we observed, people said staff ensured their privacy and dignity was respected and maintained. The home was welcoming to visitors who told us there were no restrictions on them visiting with people using the service. People were encouraged and supported to maintain relationships that were important to them. People and their relatives felt comfortable raising any issues or concerns they had directly with staff and knew how to make a complaint if needed. People and their relatives were confident that any complaints they made would be dealt with appropriately.

People and their relatives told us the registered manager was approachable and proactive in getting things done. Their views were sought in developing and improving the service.

The provider was committed to improving the quality of care people experienced. This was embedded in the vision and values for the service. There was a well-established quality assurance programme which checked care was being provided to an acceptable standard. Where improvements were needed, the registered manager took action to ensure these were made. They encouraged an open and inclusive environment within the home which enabled people, their relatives and staff to speak honestly about their experiences.

On the day of our inspection there were forty five people living at Wimbledon Beaumont. Some people had complex needs which meant they were unable to tell us their experiences. We did however speak to seven people using the service and a visiting relative and asked them for their views about the care and support they received. The majority of people we spoke with were positive about their experiences. One person told us they were “very happy and settled” and “the nurses are all lovely.” Another person said, “It’s important to know and you need to understand what they are doing and why and they are very good at doing this.” People spoke positively about staff. A visiting relative told us, “The best aspect of the service is the staff.” All of the people we spoke with told us senior managers were approachable and felt confident that if they had any issues they would be dealt with promptly. If people were unhappy information was available to them about how to make a complaint about the service.

We saw evidence staff were given guidance and instructions on the importance of gaining people’s consent before carrying out any care or support. People’s records showed their care and support needs had been assessed and plans were in place to meet these needs. Risks to their health and wellbeing had been identified and plans were in place to manage these to keep them safe. Where people were unable to make decisions about their care, their families and representatives had been involved in planning and developing their care and support needs. We noted information about people was reviewed and updated regularly so staff had up to date information about people’s current care and support needs.

Records we looked at showed medicines were administered appropriately and stored safely in the home.

There were effective procedures in place to recruit and appoint staff and appropriate checks were made about their suitability to work for the service. The competency of new staff was assessed to ensure they had the appropriate skills and knowledge to care for and support people using the service.

We spoke with 8 people using the service. People told us staff were nice, kind and helpful. One person said they would give staff ‘top marks’. We observed that staff treated people with care and respect. People we spoke with told us there were activities for them to take part in every day if they wanted to. We looked at people’s records and saw that people using the service were asked for their views and preferences about how they wanted to be looked after. We also saw that people’s representatives were encouraged to take part in reviews of people’s care plans. Where they were not able to staff shared information and gave updates about their relative on a regular basis. Staff who look after people using the service undertook regular training to keep their skills and knowledge refreshed and up to date. They are aware about what they should do to protect people who may be at risk of abuse, harm or neglect. We saw senior staff regularly reviewed and assessed the quality of service provided. We also saw people using the service were asked for their views about the quality of service provided. We saw senior staff had taken action to make changes and improvements that people using the service said were needed.