The inspection took place on the 11 August 2018 and was announced. At our last inspection in September 2017 the service was rated requires improvement because not all health and safety requirements were up to date. We made two recommendations. At this inspection we found that the provider had made improvements to bring the service in line with health and safety legislation.

Wishingwell 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. The service accommodates four older people living with dementia in one adapted building.

There was no requirement to have a registered manager at this service as the registered provider ran 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 2008 and associated Regulations about how the service is run.

There were sufficient staff on duty who had been trained and had the skills and knowledge to meet people's needs. Staff recruitment was carried out safely with checks of people's background.

Maintenance of equipment was carried out and was up to date. There were now regular checks of fire safety equipment and drills. There was an emergency plan in place so that staff knew what to do in the event of an emergency situation.

People's social needs had been met and activities were part of their everyday life. Staff were respectful to people and preserved their dignity. They had a caring and compassionate approach to people.

There was a complaints policy in place but no complaints had been received by the service. People's records were stored securely.

The service was a family home and that was reflected in the way people were relaxed and happy taking part in domestic and other activities.

People's nutritional needs had been met. Food was home cooked and people's likes and dislikes were noted by staff.

Care plans were person centred and enable staff to provide care people needed.

The service had clear information in care plans about people's communication needs. They also used aids to assist in orientating people. This went some way to meeting the requirements of the Accessible Information Standard.

Audits and checks were carried out to monitor the quality of the service. There were not always written action plans which would help the manager when making sure actions were completed.

Wishingwell Residential Care Home is registered to provide accommodation with personal care and support for up to four older people, including people living with dementia. A day care service for a small number of people can also be provided. The service is situated in Dringhouses, York.

The inspection took place on the 7 September 2017. The inspection was announced. We told the provider the day before our inspection that we would be visiting because it is a small service and we needed to be sure that there would be a member of staff available to assist us with the inspection. During our last inspection of the home, in July 2015, the provider was rated Good overall and Good in each of the five key questions. At this inspection the service was rated Requires Improvement overall.

The service does not have a registered manager as it is managed and run by the registered provider. 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. Throughout this report we have referred to the registered provider as ‘the provider’.

People told us they felt safe living at Wishingwell Residential Care Home and we observed that people appeared comfortable and relaxed in the home and with staff.

There were a range of safety systems and checks in place, such as gas safety checks, a fire alarm and emergency lighting and regular servicing of equipment. However, improvement was required in relation to the systems for ensuring electrical and fire safety. Action was taken shortly after the inspection to address these issues.

Recruitment checks were in place to ensure that people were supported by staff who were safe to work with vulnerable people. However, some improvement was required to ensure that all appropriate checks and documentation were retained and we have made a recommendation about this in our report.

Quality assurance systems in place were informal. The provider regularly sought people’s views about the quality of the service and acted on these. They also took action when they identified any issues in relation to the environment or people’s care. However, the quality system in place had not been effective in identifying and addressing the issue with electrical and fire safety systems or recruitment records. Some policies did not reflect up to date legislation and guidance. There were also some minor issues identified at our last inspection which had not all been addressed. Whilst there was no evidence of any negative impact to people as a result of this, it showed that quality assurance systems could be improved to ensure they were consistently effective in driving continual improvement. We have made a recommendation about this in our report.

People and visitors spoke highly about the provider and were very satisfied with the quality of care provided at the service. They told us the provider was approachable and very responsive to people’s needs and wishes. The provider promoted a positive and person centred culture. People were cared for in a family environment and there was a friendly and relaxed atmosphere. Throughout our inspection it was very evident that people were at the forefront of everything staff did and that support was tailored around people’s individual needs, wishes and strengths.

There was a small staff team who knew people well and understood their preferences. Staff interactions with people were warm, supportive and caring. Staff respected people’s choices and opinions. People told us that staff respected their privacy and maintained their dignity at all times.

Medication systems were generally managed safely although there were some minor issues identified at our last inspection which had reoccurred.

People were complimentary about the

The inspection took place on the 15 July 2015. It was unannounced. During our last inspection of the home in June 2014, the provider was compliant with all of the regulations; however a number of improvements had been suggested. We found that the provider had taken action to address all the improvements suggested during our last visit.

The service is situated in Dringhouses, York. The service can provide personal care and support for up to four older people with dementia care needs. A day care service for a small number of people can also be provided.

The service does not have a registered manager as it is managed and run by the registered provider. 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 told us they felt safe living at Wishingwell Residential Care Home and there were policies and procedures in place to help safeguard vulnerable adults which were understood by staff.

People told us that staff knew and understood their needs. The care we observed throughout our visit demonstrated a person-centred ethos.

Staff understood individual risks to people and worked with them to minimise these risks whilst also supporting them to remain as independent as possible.

All of the people living at Wishingwell Residential Care Home spoke highly of the registered provider and of staff and we observed warm, friendly relationships between people living and working at the home. It was a family environment which was very much evident throughout our visit. This sentiment was echoed by relatives we spoke with.

Recruitment systems were robust and appropriate checks were completed before people started work. There were two staff employed and people spoke positively of them.

Medication systems were generally well managed although there were some recommendations following a pharmacy visit which had not been fully implemented at the time of our visit.

People and their relatives told us that the registered provider and staff regularly went out of their way to ensure people had things which were important to them. People’s likes, dislikes and personal preferences were very much catered for. They described the service as ‘home from home.’

Training was provided for staff although it was recommended that training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) should be completed, as staff were not clear about the legislation which is in place for people who are unable to make decisions for themselves.

People spoke highly of the food provided and told us that they received a choice.

People expressed positive comments regarding the care they received. They told us they were treated with kindness and compassion and we saw this throughout our visit. They told us that staff respected their privacy and maintained their dignity at all times. Relatives also spoke highly of the service and the way in which people were cared for.

Each person had individual care records which focused on them as a person. People told us that social opportunities were available and said they could choose how to spend their time.

The home had not received any complaints; however, there was a complaints procedure in place and people told us that they could raise concerns if they needed to.

People unanimously told us that the service was well led. This included people living at the home, relatives and staff. They spoke highly of the registered provider and staff, and there was a strong caring ethos which was evident from both feedback and observations.

There was a number of informal quality monitoring systems to review the service. It was evident throughout our visit that people living at the home remained at the forefront of everything staff did. However the registered provider did agree to try to formalise some of these systems so that they were more able to demonstrate continual improvement. Relatives, staff and those living at the home were positive about the current systems and said that their views and opinions were sought.

The summary is based on our observations during the inspection, speaking with people who used the service, speaking with the owners and staff who supported them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes. People told us that they were consulted about their care. Comments included, "I can choose what I want to do and how I spend my time. I am well cared for." The home had risk assessments in place. This helped to reduce the risks to people.

Is the service effective?

The home had informal arrangements in place for gaining people's consent. People's health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. People told us they were very happy living at Wishingwell residential care home.

Is the service caring?

People were supported by the providers. They lived as part of a family. We observed warm and caring interactions between the providers and those living at the home. The people living at the home had done so for a while so they knew each other well. People's preferences, interests, aspirations and diverse needs had been recorded and care and support was being provided in accordance with people's wishes.

Is the service responsive?

People told us that they felt able to raise any issues and that they did this informally. People also attended an annual review meeting so that their care needs could be discussed. People were confident that if any issues were raised these would be responded to by the providers. The provider may like to consider reviewing their systems to reflect more formally the way in which they consulted with people.

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Is the service well-led?

The home was run by the providers and people lived as part of a family. Some of the policies and procedures in place would benefit from review as were not based on up to date legislation or guidance. The service worked well with other agencies and services to make sure people received their care in a joined up way. All of the people we spoke with said that they felt able to raise any concerns and were confident that these would be addressed.

People we spoke with said that they were told about the service they could receive and were able to ask questions before they gave their consent to receive a service.

We saw that people had individualised care records and risk assessments in place and were looked after by the provider of the service and two other staff. This ensured that the staff knew people's needs in detail. This provided excellent support and continuity of care for people. Everyone we spoke with told us they were very happy with the care and support they received. One person said "It is another world. You have a 'real' home here.” Another said "It could not be better. I am well looked after”.

People were asked at each mealtime what they would like to eat and drink and they could have anything they liked. There was always drinks and snacks available at any time. A person said "The food is always very nice I can choose what I like." People's dietary needs were being met.

During our visit we saw there was enough skilled and experienced staff to meet people’s needs. This was confirmed by people we spoke with. A person said "I am well looked after." The manager said I always get the best staff. I interview and work with them so I know their standards of care are good."

There were systems in place to deal with any complaints. However, no complaints had been received. People we spoke with at the home had no complaints at all about any aspect of the service they received.

People who used the service told us that they had consented to receive their service. One person said “I am asked about matters that concern me”.

People receiving care and support said they received the help they needed. One person said “I signed to say I agreed with the help that was going to be provided for me”. Another person said “Staff speak to me nicely with respect. I am consulted about my care”.

People we spoke with said they were happy with the home’s environment. One person said “The home environment and garden is so nice here”. We observed everyone sitting in the garden singing and enjoying the nice weather.

People confirmed that they felt the staff were recruited using thorough methods and were trained to deliver their care and support safely. One person said “Staff have been recruited properly so they are suitable to do care work”. A representative we spoke with said “The staff are skilled at looking after people”.

People told us that their views about the service they were receiving were asked for. One person said “The proprietor asks for our opinions”. A representative said “I cannot praise the proprietor and staff enough for the service they provide. They always check if I am happy and they include me in everything even birthday parties for my relative”.

People said they were consulted about their care, treatment and support options. They told us their views were sought and acted upon about every aspect of how the home was operated so they felt they were central to all the decisions being made. One person said ‘I have agreed to the care and support that I receive’. Another person said ‘I am asked for my views about everything. My every wish is known and respected. It is a lovely little home. You could not find a better place to live’.

The people we spoke to said that they received the help and support they needed when they wanted it. One person said ‘The staff help me they know my needs’. Another person said ‘The staff encourage me to a do what I can for myself to maintain my independence’.

People we spoke to said they felt safe and felt protected by the staff who were gentle and kind. They said they knew how to raise issues if they had any concerns. One person said ‘I feel safe here with the staff they are all very nice’. Another person told us ‘I know if I had any concerns about anything the issue would be dealt with straight away’.

People said the staff had the skills they needed to be able to support them. One person said ‘The staff are excellent they really look after me very well.’ Another said ‘The staff work well as a team together’.

People confirmed they spoke to the proprietor everyday and that she asked them if everything was alright for them. One person said ‘The proprietor works very hard, she makes sure everything is just right. I could not be happier with the services provided here’. Another person said ‘The quality of the service is very good, nothing is too much trouble. We all live as one big family and it is great’.