The inspection took place on the 13 November 2018 and was unannounced.

At our last inspection on the 24 March 2016 we rated the service ‘Good’. At this inspection we found improvements needed to be made to ensure a consistent quality of care and the rating is now ‘Requires Improvement’. We found quality assurance audits were not effective in identifying areas for improvement. For example, a window was not secure enough to ensure there was not a potential risk of people falling from the window and staff did not always administer medicines as prescribed.

Wordsley Hall is registered to provide accommodation and support for up to 41 people who have conditions related to old age and/or dementia. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of our inspection there were 36 people living at the home.

There was a registered manager in post. 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.

The service was rated ‘Requires Improvement’ for the ‘safe’ question at this inspection. While staff received training so they knew how to keep people safe from harm. Medicines were not always administered to people as it was prescribed. There was sufficient staff employed to support people safely and the provider had safe recruitment procedures.

People continued to receive an effective service. People’s needs were assessed so their preferences, likes and dislikes could be met. Staff had access to support so they had the skills and knowledge to meet people’s needs. The provider followed the principles of the Mental Capacity Act 2005. People could eat and drink sufficient amounts to ensure they maintained good health.

People continued to receive support from staff that was kind and caring. People were supported to make choices and decisions about the support they received. People’s privacy, dignity and independence was respected.

People continued to receive a responsive service. People were involved in the assessment and care planning process. People could take part in activities that met their individual preferences and hobbies. The provider had a complaints process in place to people could share concerns when needed.

The service was rated ‘Requires Improvement’ for the ‘well led’ question at this inspection. The quality assurance systems and audits were not always effective in identifying areas of concern.

People could share their views by completing a provider questionnaire.

Further information is in the detailed findings below.

Wordsley Hall is registered to provide accommodation and personal care for up to 41 people, who are mainly older people with dementia. At the time of our inspection 38 people were using the service. Our inspection was unannounced and took place on 24 March 2016. The service was last inspected on the 11 September 2013 where we found that the provider was meeting the regulations we assessed associated with the Health and Social Care Act 2008.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Medicines were given appropriately, however they were not kept as they should be, with some people’s medicines becoming mixed up and being stored in the wrong boxes. A very small number of medicines were also missing without explanation. Medicines were disposed of as expected.

A suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs and people told us that this made them feel safe.

People were able to raise any concerns they had and felt confident they would be acted upon. People and their relatives understood the complaints procedure and felt that they would be listened to should they need to complain.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. Staff interacted with people in a positive manner and their consent was sought where possible.

People were supported to take sufficient food and the food was healthy and well balanced. Drinks were given when required and people were well hydrated and their health needs were met.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective.

Quality assurance audits were undertaken regularly and the provider gave the registered manager support.

Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to.

During our inspection we spoke with eight people and one relative, the manager and six members of staff.

All of the people we spoke with said they were very happy with the service they were receiving and how their needs were being met. One person said, “I’m quite happy, they’re very good.”

There was a good choice of food which was prepared freshly on the premises. All of the people we spoke with said that they enjoyed the food. If people did not want what was on the menu they could choose something else. Where people were at risk of not eating or drinking sufficient amounts, their food and drink intake were monitored.

Appropriate arrangements were in place for all aspects of medicines management. Those included procedures for obtaining, storing, administering and monitoring people’s medicines. We found that systems were followed by staff which ensured people’s medicines were handled safely.

During our inspection we saw that there were sufficient numbers of staff on duty to fulfil the needs of the people they were caring for. We did not witness anybody having to wait to have their needs catered for. One person said, “They are lovely.”

We found that people we spoke with knew how to raise a complaint or a concern and were confident that should they do so, that action would be taken to address them.

We saw that staff spent time with people and gave them individual attention. We saw positive relationships between staff and people living at the home. We saw that some community based and in-house activities were offered to suit people's individual needs and choices. People's care and treatment was being delivered in a way that ensured people's safety and welfare.

We saw that people's needs were being planned, delivered and met by staff who had the relevant skills to look after people safely. We saw examples where staff supported people to take their medication. We heard staff giving reassurance and people responded to this positively.

There was effective recruitment and selection processes in place to ensure that peoples needs were being meet by a skilled workforce. We saw that people's views were sought and listened to and there were systems in place to monitor how the home was run to ensure people received a quality service.