This unannounced inspection was undertaken on 11 January 2017 by one adult social care and one pharmacy inspector. The service was last inspected on 1 September 2015, when it was found to be compliant with the regulations that we looked at and an overall quality rating of ‘requires improvement’ was awarded.

Wrawby Hall is registered with the Care Quality Commission (CQC) to provide accommodation for up to 34 older people who may be living with dementia. Accommodation is provided over two floors. Secure gardens are provided at the rear of the property and a car park is available at the front. The service is situated off the main road that runs through Wrawby. People have access to local amenities. There were 30 people living at the service on the day of our inspection.

This service has 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there were some minor shortfalls in the operation of systems at the service which were addressed by the medicine fridge being reallocated to make sure staff monitored the temperature of this effectively. We made a recommendation about the medicine shortfalls that we found.

We observed the staffing levels on the day were adequate to meet people’s needs. We received some feedback from visitors and a member of staff felt staffing levels at peak times could be improved. This was discussed with the registered provider and a director who informed us they would increase the staffing levels on an afternoon by having ancillary staff or bank staff on duty. The management team assured us staffing levels provided at the service would be kept under review.

Staff received training about protecting people from harm and abuse. Safeguarding issues were reported report to the local authority and Care Quality Commission.

Staff received training, supervision and appraisals which helped to support them and develop their skills.

Health care professionals told us staff contacted them and followed their guidance appropriately to maintain people’s wellbeing.

People’s nutritional needs were assessed and monitored and their preferences and special dietary needs were catered for. Staff encouraged and assisted people to eat and drink. Advice was gained, as necessary from GP’s and dieticians to ensure people’s nutritional needs were met.

Staff supported people to make decisions for themselves. People chose how and where to spend their time. Staff reworded questions to help people living with dementia understand what was being said.

Activities were provided and visiting was encouraged at any time. People visiting the service were made welcome.

A programme of redecoration and refurbishment had taken place and further improvements were scheduled. Pictorial signage was present to help people living with dementia find the bathrooms and toilets. Bedroom doors were numbered and named and some people had pictures present to help them find their bedroom. General maintenance occurred and service contracts were in place.

There was a complaints procedure in place. This was explained to people living with dementia or to their relatives so they could raise issues if they wished. People living at the service, their relatives and staff were asked for their views. Feedback received was acted upon. This helped the management team to maintain or improve the service provided.

The registered manager and senior staff undertook a variety of audits to monitor the quality of the service. The minor issues we found with the medicine systems had not been identified by the auditing process and the staffing levels provided were to remain under review. We were sent an action plan which told us what action h

This inspection was undertaken on 1 September 2015, and was unannounced. The service was last inspected on 20 December 2013 and was found compliant with the regulations that we looked at.

Wrawby Hall is registered with the Care Quality Commission [CQC] to provide accommodation for up to 34 older people who may be living with dementia. Accommodation is provided over two floors. Secure gardens are provided at the rear of the property and a car park is available at the front. The service is situated off the main road that runs through Wrawby. People have access to local amenities.

This service has 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood they had a duty to protect people from abuse and knew they must report concerns or potential abuse to the management team, local authority or to the CQC. This helped to protect people.

We observed that the staffing levels provided on the day of our inspection were adequate to meet people’s needs. A visiting health care professional told us that staff contacted them to discuss any changes in people’s conditions or concerns they may have. They told us staff followed their guidance which helped to maintain people’s health.

Staff had undertaken training in a variety of subjects to develop and maintain their skills. Training updates were provided for staff.

People’s nutritional needs were assessed and monitored. Their preferences and special dietary needs were known and catered for. Staff encouraged and assisted people to eat and drink, where necessary. Advice from relevant health care professionals was sought to ensure that people’s nutritional needs were met.

Staff supported people to make decisions for themselves. People chose how and where to spend their time. Staff reworded questions or information to help people living with dementia to understand what was being said.

There was some discreet signage in place to help people find their way to toilets and bathrooms. Where necessary, staff helped to guide people to where they wished to go. The lounge and dining room used by people living with dementia was about to be redecorated to make it more dementia friendly. General maintenance occurred and service contracts were in place to maintain equipment so it remained safe to use. Work is being undertaken in October 2015 to ensure fire exits open freely in an emergency. A risk assessment is in place for this issue and staff are aware of the action they must take in the event of an emergency to protect people’s health and safety.

A complaints procedure was in place. This was explained to people living with dementia or to their relatives so that they were informed. People’s views were asked for informally by staff and through surveys. Feedback received was acted upon to help people remain satisfied with the service they received.

The registered manager undertook a variety of audits to help them monitor the quality of the service. However, the issues we found with the environment and regarding two people’s medicine at the time of our inspection had not been identified by the auditing process.

People who used the service said that staff involved them in decisions about their support and that they were, “Comfortable and very happy.” We observed staff talked with people with kindness and consideration about their personal wishes and preferences for support. We saw that staff demonstrated sensitivity for people’s individual needs and provided care and compassion to ensure their dignity was promoted.

We saw that people looked comfortable, well cared for and that staff interacted with them in a friendly and supportive manner. We observed staff providing gentle reassurance to people, to ensure their individual wishes and feelings were met.

People told us they felt safe and had confidence appropriate action would be taken to resolve issues where this was required.

We observed staff demonstrated a commitment to their work and were friendly and approachable. We saw staff worked in a calm and professional way and there was evidence that training on a variety of courses was delivered, to ensure staff had the right skills to perform their work.

We saw that systems were in place to enable risks to people to be monitored and analysed. We saw these included incidents and accidents, the medication system, care plans and complaints to ensure action was taken to mitigate identified trends.

We spoke with the manager, three members of staff and two people who lived at the home on the day of the inspection. They told us that they were happy with the care they received. They said that staff respected their privacy by knocking on doors before entering and assisting them with personal care tasks in a sensitive manner. One person said “Staff have never made me feel embarrassed or uncomfortable” and another said, “We have lovely staff – they are polite and respectful”.

We saw that care plans included sufficient information to guide staff on the level of support each person needed and that they were being kept up to date by staff. People told us that they felt safe living at the home and that they trusted staff to support them and look after them.

We found the home to be clean, hygienic and maintained in a safe condition. Staff were following robust hygiene practices and there were maintenance certificates in place to show that gas and electrical installations were safe and that lifts and hoists had been serviced.

Staff had received appropriate training opportunities, including induction training when they first started to work at the home. We also found that there were sufficient staff on duty to meet the needs of people who lived at the home.

There was a complaints policy and procedure in place and we saw that any complaints made had been dealt with professionally.

People we spoke with were satisfied with arrangements for medications in the home. One person who took pain killers told us that they were comfortable and they always received their medications on time. Another person said ” No problems with my medications, the staff are very good about that”.

During our visit we spoke to people who lived in the home. Comments were very positive and included ‘I am very well cared for’, ‘the staff are usually available when I need them’, ‘its ok here and the food is very good’, ‘I have a shower in my room and staff assist me to shower every day’, ‘I am very happy’, ‘they have enough staff on duty, sometimes they have agency staff but not often though and they seem to know how to care for you’, ‘I am able to choose what time to get up’ and ‘the home is spotlessly clean’.

People also told us they felt safe living in the home.

There were some varied comments about the activities on offer in the home. Comments included ‘there are not many activities going on but I enjoy reading’, ‘I am content to watch the TV and read a book; they sometimes do games and they always ask you if you want to join in, they don’t do trips out or go to the shops which I would like but personally I am happy with what is going on.’ and ‘they do a lot of dancing here’.

A visitor to the home told us ‘the staff put a lot of effort in and are attentive to peoples needs and there is good communication with the family’.