This inspection took place on 20 and 28 November 2018 and was unannounced.

At the last inspection we found that the Wimbledon House Residential Care Home was 'Good' in all domains. However, we found the service is now rated requires improvement.

Wimbledon House Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Wimbledon House Residential Care Home provides accommodation and support for up to 34 people living with mental health issues. At the time of inspection there were 28 people living at the service. The care home is located close to the centre of Herne Bay and a short walk to the sea front.

There was a registered manager 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.

Risks to people were not always fully assessed and mitigated. Management did not learn from incidents which may have prevented harm. In addition, management failed to assess people's mental capacity when their mental and physical health fluctuated.

People were not always given medicine safely. Audits identified continued medicine administration errors, which persisted despite being raised in staff meetings and through staff notices. In addition, protocols around 'as needed' medicines (PRN), such as; cold medicine or sedatives were not specific to each person. Therefore, there was a risk that people could be given antipsychotic PRN medicine without less restrictive options considered first. We discussed this with the management who took action to rectify the concerns, by changing the medicine administration process and by seeking advice from a local pharmacist.

The quality of information recorded about people varied. Some care plans were thorough and contained information on people's likes, dislikes and preferences, whilst others were very basic local authority care plans that had not been reviewed. People had reviews to ensure that people could discuss how they wanted to be supported by staff. However, reviews did not always take place when accidents and incidents occurred or when people's needs changed.

Systems to monitor and assess the quality of the service were not always effective. Although the provider and registered manager undertook regular audits, shortfalls idenitifed were not always addressed, and areas of concern were not always recognised.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC requirements.

People felt safe living at Wimbledon House Residential Care Home. People told us that they would feel confident raising concerns and complaints with the managers. They also felt confident raising issues in resident's meetings and when talking to their keyworker. People told us that staff cared for them and respected their views and beliefs. Some people went to church and church services took place at the service which people attended. Staff supported people to take part in activities that interested them. However, some people felt activities at Wimbledon House Residential Care Home could be improved. This had been raised to management and they had recently hired an activities coordinator.

Staff knew what to do if they witnessed or suspected abuse and there was a safeguarding and whistleblowing policy that staff were aware of. Staff also attended annual safegua

Care service description

Wimbledon House can provide accommodation and personal care for 34 people who have mental health conditions. The accommodation is on two floors. There were communal lounges, a dining room, smoking room and well maintained gardens. A stair lift was available to help people who had mobility difficulties and one bathroom was fitted with a bath hoist. The service had its own vehicle to make sure people were able to access facilities in the local area and pursue a variety of activities.

Rating at last inspection

At the last inspection, the service was rated good and requires improvement in the ‘safe’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 April 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment. We undertook this focused inspection 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 those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wimbledon House Residential Care Home on our website at www.cqc.org.uk

At this inspection we found the service remained good and is now rated good in the ‘safe’ domain.

Why the service is rated Good

The service had improved since the last inspection. Potential risks to people were now identified and there was guidance on how to safely manage the risks. People received the interventions they needed to keep them as safe as possible. Risk assessments were designed to keep risks to minimum without restricting their activities or their life styles and promoting their independence, privacy and dignity.

Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

Safeguarding procedures were in place to keep people safe from harm. These procedures had been followed by the registered manager when necessary. Staff had been trained in safeguarding adults and they knew what action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the registered manager, or outside agencies.

Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

There was enough staff on duty to keep people safe and give them the care and support that they needed.

People received their medicines safely and when they needed them.

Wimbledon House can provide accommodation and personal care for 34 people who have mental health problems. The accommodation is on two floors. There were communal lounges, a dining room, smoking room and well maintained gardens. A stair lift was available to help people who had mobility difficulties and one bathroom was fitted with a bath hoist. The service had its own vehicle to make sure people were able to access facilities in the local area and pursue a variety of activities.

At the time of the inspection there were 33 people living at the service. The care and support needs of the people varied greatly.

There was a registered manager working at the service. 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 registered manager, deputy manager and staff supported us throughout the inspection.

The registered manager provided leadership to the staff and had oversight of all areas of the service. There was a culture of continuous improvement, so that people would feel increasingly well cared for. Staff were motivated and felt supported by the registered manager and senior staff.

The staff understood the vision and values of the service, such as person centred care, treating people with respect and maintaining their privacy and dignity. Staff told us the registered manager was approachable and they were confident they would not hesitate to raise any issues if they had any concerns. Safeguarding procedures were in place to keep people safe from harm. On one occasion these procedures had not been followed by the registered manager. They had not consulted with the local authority safeguarding team when the incident had occurred, which they should have done as part of those procedures. Staff had been trained in safeguarding adults and they knew what action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the registered manager, or outside agencies if necessary.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure they would be able to offer them the care that they needed. The care and support needs of each person were different and each person had a care plan which was personal to them. Some care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. However, some parts of the care plans did not accurately record the information needed. People had regular reviews of their care and support when they were able to discuss any concerns or aspirations and goals they wanted to achieve.

Potential risks to people were identified but guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. On the whole, there was guidance in place for staff on how to care for people effectively and safely. Risk assessments were designed to keep most risks to minimum without restricting their activities or their life styles and promoting their independence, privacy and dignity.

People had an allocated keyworker who was involved in their assessments and reviews. A key worker was a member of staff who takes a key role in co-ordinating a person’s care and support and promotes continuity. Throughout the inspection people were treated with kindness and respect. Staff were attentive and the atmosphere in the service was calm, and people were comfortable in their surroundings. People were involved in activities which they enjoyed. Contact with people’s family and friends who were important to them was supported by staff.

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The health and social care needs of people that used the service had been assessed, monitored and reviewed in keeping with the carrying out of personalised care, treatment and support plans. People who used the service benefited from one that valued and respected their privacy and dignity and helped them to make informed decisions. People that used the service benfited from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

The service checked the suitabilty of staff before allowing them to provide direct care to people that used the service. Staff had been supported to gain qualifications, skills and experience in line with meeting the needs of these people.

We spoke to eight people that used the service. One of them told us, "They are brilliant here. I would not know what to do without them". Others said that the staff were, "marvellous", "wonderful", and that the home was a good place to live. We spoke to three health care professionals that were involved in the lives of people who used the service. "One of the best", was a term used by one of these people.

We spoke with eight people about their experiences of the service and most told use that they were happy with the care and support they received. One person said ‘the staff are always there when you need them’ and ‘they are friendly and responsive’. Other people said that they ‘always knock on my door before entering’ and ‘I always receive the care and support I need’.

People said that they were involved in the decisions made about them and that there were a lot of choices about day time and evening activities. People felt happy about raising any issues of concern with the staff on duty.

We spoke to five members of staff who all gave examples of how they treated people with dignity and respect.

We found evidence of activities being planned to help promote choice, independence and participation in the wider community

We saw how care was provided safely, in accordance with people’s preferences and by staff who had the right skills and experience.

We found that there were good quality assurance systems in place to minimise the risk of harm to people who use services. Staff, people who use services and partners were asked their views regularly through surveys. There was evidence that the manager implements actions to improve the service as a result of these surveys.

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home. One person said, 'the place is okay for me, I've no complaints about it'.