About the service: Wrottesley House is a residential care home that provides accommodation and personal care for up to 18 older people. At the time of the inspection the service was providing care to 16 older people, most of whom were living with dementia.

People’s experience of using this service:

People were not supported by effective quality assurance and governance systems. The registered manager had not identified areas of risk and improvement required within the service. People’s feedback was sought although positive action was not always taken where improvements were suggested or concerns were raised.

People were not consistently supported in a dignified way. While some interactions were kind, caring and dignified this was not always the case and some improvements were needed. People were offered choices but at times these were limited.

People had access to a limited range of leisure opportunities and activities. People were involved in planning their care where they had capacity to do so. Some improvements were required where people lacked capacity to make decisions. The provider was not always following the requirements of the Mental Capacity Act 2005.

We also some people did not receive care that met their needs and issues and concerns had not been identified and addressed sufficiently. Other people’s needs were being met and risks were managed appropriately, however, this was not always consistent. We found risks were not always reviewed following accidents and incidents.

More information on our findings at this inspection are available in the full version of this report.

Rating at last inspection: At the last inspection completed 07 June 2016 we found the service to be good in all areas. The provider was meeting the requirements of the law.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Enforcement: The provider was not meeting the requirements of the law around dignity and respect, the need for consent, safe care and treatment and good governance. Please see the action we have told the provider to take’ section towards the end of the report.

Follow up: We have met with the provider and they have been asked to send an action plan detailing how they will make the required improvements. We will check these improvements have been made at our next inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection was unannounced and took place on 7 June 2016. At the last inspection in July 2014, we found the provider was meeting all of the requirements of the regulations we reviewed.

Wrottesley House is registered to provide accommodation for up to 18 older people who require personal care and support. On the day of the inspection there were 17 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 (CQC) 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. People were supported by staff that knew how to keep them safe from harm. Staff were confident in reporting any concerns or suspected abuse. Risks to people were recorded and understood by staff. There were enough staff to meet people’s needs and provide them with care and support when they needed it. People received their medicines as prescribed.

Staff received regular training and had the skills, knowledge and experience to meet people’s care and support needs. People’s consent was sought before care was provided and appropriate assessments had been carried out around people’s capacity to make certain decisions. People enjoyed the food provided and told us they received the food and drink they required. Staff were aware of people’s preferences and people with specific dietary requirements received appropriate food. People had access to appropriate healthcare according to their needs and staff responded without delay to changes in people’s health.

Staff knew people well and treated people with kindness and respect. Staff had a good knowledge of people’s needs and preferences and where possible people were involved in making decisions about their care and support. Staff acted in a way that upheld people’s dignity. People’s relatives were welcomed when they visited the home.

People’s care was tailored to their individual needs and choices. Staff had a good understanding of people’s preferences and life histories and provided them with support that was responsive to their needs. People felt able to express their views to the registered manager. The registered manager had responded to concerns that had been raised and there was a system in place in manage complaints.

People, relatives and staff felt the home was well managed. Staff felt able to contribute ideas and told us they enjoyed working at the home. The registered manager carried out quality audits to ensure people received good quality care and was responsive to feedback from other agencies.

A single inspector carried out this inspection on 31 July 2014. During the inspection we spoke with six people who lived at Wrottesley House and three of their relatives. We also spoke with the registered manager and four members of staff. We looked at the paperwork the provider gave us.

Below is a summary of what we found. The summary is based on our observations during the inspection, observations of people using the service, the staff supporting them and from looking at records. We used the evidence we collected during our inspection to answer the five questions.

Is the service safe?

From our observations and the information we saw in care plans, policies, procedures and audits the provider's safety monitoring systems were adequate. The staff showed that they had a good understanding of their role in providing care and in safeguarding the people they supported. The staff demonstrated that they knew the people well and worked to provide a good level of care and support.

Two people we spoke with told us that they felt very comfortable and safe at the home. They said that all the staff were very polite and treated them with respect and dignity. One person said, “All the staff are marvellous. They always ask me what I want and get it for me; they are all so kind and polite.”

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) ,which applies to care homes. The registered manager told us that there was no Deprivation of Liberty Safeguard orders in place for the people who lived at Wrottesley House at the time of our inspection. The registered manager said they were in discussion with their peers and the local safeguarding team, regarding the recent changes in legislation.

The staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required, the skills and experience staff would need. The night time staffing levels and on call system showed that the provider had taken steps to ensure the staffing provision was safe.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

We saw that all records held appropriate information about each person and guidance for their support. The records were kept and stored securely.

Is the service effective?

The relatives we spoke with said that they were very satisfied with the care provided in the home and felt that people's needs were being met. One person said, "Staff are very good with my mother and with me, they are all very kind and supportive.”

People's care needs had been assessed and detailed care plans were in place. There was evidence that people and their families were involved in the assessments of their needs and care plan reviews as much as possible.

The support plans we reviewed included information on people’s daily living activities and gave information on people's levels of ability to make their own decisions. This gave guidance to staff about each person’s ability to indicated consent.

The registered manager told us about the activities and we saw that people were supported to participate in activities they enjoyed. All care, activity plans and risk assessment were reviewed regularly. We saw evidence in care plans that the care provided was constantly adapted to meet people’s needs.

We saw evidence that people were supported by a wide range of health and social care professional. This meant their health and welfare needs were being met.

Is the service caring?

We observed that the staff supported each person in a way which met their individual needs. The staff showed warmth and consideration. The staff showed respect and ensured people’s dignity was maintained at all times.

During our inspection, we saw that there was good interaction between staff and people who used the service. The staff were visible in the lounges and dining rooms talking with people and assisting them when needed. People looked well cared. The atmosphere in the home was relaxed and people seemed to be doing what they wanted to do.

The staff we spoke with told us they were committed to provide a good caring service to support and look after people so they could have a good life. They demonstrated that they were aware of potential risks, people's rights and their responsibilities.

Is the service responsive?

We saw the care plans were focused on the needs of the individual and contained detailed information about people's choices and preferences. We saw in care notes that each person was supported in an individual way which was adapted regularly to meet their changing needs. We saw that people’s health and support plans were regularly updated to reflect people’s changing health care needs.

There was evidence of regular support provided from external social care and health professionals. This meant that people’s health and welfare was regularly reviewed and monitored.

The staff we spoke with said if they had any concerns, they could always talk with the senior staff, they would always listen and address anything they raised.

The staff said they received regular training which was very good and equipped them with the knowledge to meet people’s support needs.

Is the service well-led?

The home had a clear management structure in place. The registered manager and the staff we spoke with were knowledgeable about the people who used the service, changes to legislation and developments in care provision.

We saw on staff rotas that senior staff were always around to give advice and support. There were systems in place to provide feedback to staff about changes and developments.

The staff we spoke with said they understood their responsibilities around safeguarding people’s welfare. They all said that if they witnessed poor practice they would report their concerns. They had worked with the people who lived at the home for some time and really enjoyed their work. They said that they felt they were supported and involved in the development of the service.

On the day of the inspection, there were 16 people living at the home. We spoke with six people, two staff members, the home manager and the home owner.

People were complimentary about the care that they received. We found that people had access to other healthcare professionals in a timely manner. One person said, “I am well looked after and cared for.”

We found that systems were in place to ensure that the home was clean and tidy. People we spoke with told us that they satisfied with the level of cleanliness.

Arrangements were in place to ensure the safe handling of medicines. One person told us, “They are red hot with medicines.”

Systems were in place to monitor the quality of the service. People’s comments were taken seriously.

Records needed to be improved to ensure that consistent care was being delivered. People’s care plans required more detail and information.

We carried out this inspection to check on the care and welfare of people. On the day of the inspection visit there were 17 people living at the home. This was an unannounced inspection, which meant that nobody was aware that we would be visiting. We spoke with five people, one relative, one visiting health professional, three staff, and the manager.

There was a pleasant and friendly atmosphere in the home. One relative said, “The atmosphere is nice as soon as you walk in.” We saw that staff reassured people and explained care processes before carrying them out throughout the day. This meant that people were involved in processes relating to their care. One person said, “We get to choose what to do and what to eat, the food is good especially the pork lunch.”

We saw that staff were attentive to people’s needs and that they delivered care to meet people’s individual requirements. We found that risks related to care were managed and minimised by staff throughout the day. One person told us, “I am happy here, I sit outside when I like and staff come and check on me.”

We found that arrangements were in place to ensure that any allegation of abuse was identified, managed, and reported appropriately. We saw that efficient systems were in place to ensure people’s finances were safeguarded.

People we spoke with were complimentary about the staff. One person said, “Staff are lovely, you can’t fault them.” We found that staff were supported through supervision, appraisals, training and staff meetings.

People we spoke with and one visiting relative told us they did not have any complaints to make, although they were aware of the complaints procedure. We found that there were effective systems to assess the quality of the service.

Some people were unable to tell us how they found life at the home, but we observed them to be looking comfortable and at ease in their surroundings.

The people who did speak with us said that they were satisfied with the accommodation, they were warm and comfortable. One person stating that the bedroom was adequate; they didn’t mind this as they liked to spend time in the lounge where they could watch television and see the birds in the garden.

People commented that the food was good, they had enough to eat and could have an alternative if they so wished.

One person said that they liked to attend the monthly religious service as now they are unable to get to their own church each week.

People said the staff are very friendly and nice.