We inspected Wraysbury House Limited on 26 June 2018. Wraysbury House Limited 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. Wraysbury House Limited is registered to provide care for up to 27 people, with a range of health conditions and some who were living with dementia. On the day of our inspection there were 22 people living at the service, who required varying levels of support. We previously inspected Wraysbury House Limited on 27 October and 1 November 2017 and found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and further areas of improvement were required. We asked the provider to take action to make improvements and these actions have been completed.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. However, we identified some issues in respect to recording. This had already been recognised by the registered manager and did not place people at risk.

We have made a recommendation in respect to compliance with the Accessible Information Standards (AIS).

Risks associated with people’s care, the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were cared for in a clean and hygienic environment and appropriate procedures for infection control were in place.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as the care of people living with dementia.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. Notifiable events and actions had been reported to the CQC in a timely manner.

A registered manager was 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 and associated Regulations about how the service is run.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. People’s care was enhanced by adaptations made to the service.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. Staff had received supervision meetings with their manager, and formal personal development plans, such as annual appraisals.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have ch

We inspected Wraysbury House on 27 October and 1 November 2017. The inspection was unannounced.

Wraysbury House 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.

Wraysbury House provides accommodation, nursing and personal care for up to 27 people in one adapted building. At the time of the inspection there were 24 people living in the home. People living at the home were older people with various support needs, including dementia, mental health and physical disabilities.

There was manager in post at the home who was currently in the process of applying to be a registered manager for 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.

We last inspected the service on 26 April and 3 May 2016. At this inspection, we asked the provider to take action to make improvements as we found people were at risk of their care needs not being understood or met as their care planning records had not been fully completed, personalised and were not fit for purpose. We also found the provider had not ensured people’s consent to care and treatment was sought in accordance with the Mental Capacity Act (MCA) 2005. The provider sent us an action plan on 31 July 2016 outlining how they would take action to address the matters.

Since the last inspection, the provider had been sold to another company in February 2017. The new owner of the provider had retained the same registration responsibilities as the previous ownership. These included ensuring that actions on the plan sent to us on 31 July 2016 had been completed. At this inspection we checked to see if the provider had made the necessary improvements in these areas. We found people were still at risk of not having their care needs met as the provider had not been able to ensure people’s care planning records were fully completed, personalised or fit for purpose. We found the provider had taken adequate action to ensure people’s care and consent was sought in accordance with the MCA. The manager and staff understood and put into practice the principles of the MCA when supporting people. People’s care plans clearly documented that they or an appropriate person had consented to their care and this was open for review at any time.

The provider was not ensuring safe and proper management and practice when supporting people with medicines. Arrangements for managing medicines including obtaining, recording, storing, disposing and administering were not safe and people were at risk of harm due to this.

Identification, assessment and management of risks to people at the home was not always safe. We found that, although identified, there was a lack of detail and guidance in people’s risk assessments and care plans about how to manage risks safely. Equipment in place to help manage risks to people was not always functioning.

Fire alarm checks and fire drills were taking place regularly along with health and safety checks and maintenance audits. However, there was no current fire risk assessment at the home so it was not certain the premises were safe from all fire risks and there was a lack of detail in people’s personal emergency evacuation plans about how to support them safely in the event of a fire.

The provider had systems in place to audit quality and safety, but we found these systems were not effective. Identification of risks to people or areas in need of improvement was not consistent. Actions taken in response to any identified risks or improvements were not always implemented or successful.

The prov

The inspection took place on the 26 April and 3 May 2016 and it was unannounced.

Wraysbury House Limited is registered to provide accommodation and personal care for up to 27 people. At the time of the inspection 27 older people were living at the home. People had various needs including dementia and physical disabilities.

Wraysbury House is an older styled detached property close to the centre of Worthing with easy access to shops and the seafront. Spacious communal areas include a lounge leading to a conservatory dining area which overlooks a large garden and a further sitting room. The surrounding gardens were maintained to a high standard, hanging baskets were positioned all around the building. All rooms were single occupancy apart from one which was shared. All bedrooms had en-suite facilities.

We found the home to be clean and tidy and maintained to a high standard. Home furnishings such as pictures, flowers and ornaments decorated communal areas. Paintings were hung within vintage frames adding to the ‘grand’ style of the home.

A registered manager had been in post since January 2016. 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.

Care records showed how people were assessed prior to receiving support from the service and how current care was planned. Care plans failed to reflect the individual needs of people living with dementia. Care plans lacked involvement from people and their relatives. Two care plans held no information about people’s personal histories, likes, dislikes and preferences. Therefore lacked the level of guidance required for staff supporting people within the home. The registered manager was able to share how improvements to care plans would be made.

Where people lacked capacity to give their consent to their care best interest meetings were held in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards legislative. However, the registered manager was unable to demonstrate that the Mental Capacity Act 2005 (MCA) had always been followed because capacity assessments had not always been completed on behalf of people.

Our observations and records confirmed there were sufficient staff on duty to keep people safe.

Staff had been trained in how to recognise signs of potential abuse and protected people from harm. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks.

Staff demonstrated how they would implement the training they received in core subject areas by providing care that met the needs of the people they supported. Staff received regular supervisions and spoke positively about the guidance they received from the registered manager.

Additional drinks and snacks were observed being offered in between meals and staff knew people’s preferences and choices of where and what they liked to eat.

Staff spoke kindly to people and respected their privacy and dignity. Staff encouraged people to be as independent as possible. Staff knew people well and had a caring approach.

People and staff told us they were happy with the activities that had been organised. The home employed an activities coordinator to help engage with people.

There was a complaints policy in place. All complaints were treated seriously and were managed in line with the complaints policy.

People and their relative’s views were obtained mainly through informal means however the registered manager had plans to develop their systems further. The registered manager met with people routinely to check on their wellbeing.

There were was a range of audits in place, overseen by the registered manage

We spoke with a range of people about the service including people who live at the home, their family members, care assistants, nurses, and the manager. We also spent time observing how care was provided in order to help us understand the experience of people who could not talk with us.

People living at the home told us that staff were kind and respectful towards them. One person said “the staff are very nice”. Relatives told us that the staff seem well trained. One relative said “the staff are good at listening to people and therefore have a good understanding of what people might want to do’’. They explained this was important when people could not express themselves easily.

People and their relatives told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations. A relative told us "the home is really nice and the manager is always open to relatives ideas and opinions”.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs.

People told us they were involved in their assessment and staff provided care according to their needs. One person said, “I am very happy with the care I am receiving”. A family member told us “I am comforted to know that my relative is well cared for”. People we spoke with said that staff discussed their care with them and provided care in a way they were happy with.

Care records we looked at showed that people’s consent had been sought regarding their care and treatment.

We found that people’s needs and wishes were recorded in a plan of care that was kept under regular review and risks to people’s safety were assessed.

We saw that people were protected from the risk of infections because the provider had infection control systems in place.

Records showed that people were supported by staff who had received training appropriate to their roles, and had been recruited appropriately.

The provider had an effective complaints system in place. We found that comments and complaints people made were responded to appropriately.

People told us that they like living at Wraysburgh House Limited and that the service meets their care needs. Reference was made to the kindness of the staff and the good relationship that the people who live at the home have with the staff.

People we spoke with were not all aware that they had a plan of care but told us that their needs were me by the staff at the home.

People said that they had no concerns about the staffing levels at the home, they told us that staff were kind and caring and that there was always someone around to provide help and support.

Comments included the following: ‘I am very happy here’, ‘I can’t fault it’, I have a nice room’ and ‘I am very comfortable’.

People said that they did not have any complaints about the service and that if they did they would speak to the staff.

The relative of one person told us that they had some concerns about the care that their relative was receiving and said that they felt that they staff were not meeting their relative’s needs. Other relatives we spoke with were happy with the care and support provided by the home.