We inspected the service on 12 September 2018. The inspection was unannounced.

Wychdene is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Wychdene is registered to provide accommodation and personal care for 24 older people. There were 20 people living in the service at the time of our inspection visit.

There was a registered manager in post who was present on the day of the inspection. 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.

At the last inspection on 29 March 2018, the overall rating of the service was ‘Inadequate’ and the service was therefore placed in, ‘special measures’. We found four continuous and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always treated with dignity, medicines were not well managed and the environment was unsafe. Furthermore, the quality of the service was not checked to make sure risks to people were minimised and suitable staff were employed to support people.

We required the registered persons to take action to make improvements to address each of our concerns. The provider sent us monthly reports detailing how they planned to address the breaches of Regulations and they regularly updated this to evidence what had been completed. The last update was received 30 August 2018.

At this inspection on 12 September 2018, we found that the provider had make significant improvements to the service. There were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, sufficient time had not elapsed to ensure that these improvements would be sustained or that identifying and addressing shortfalls in a timely manner had been embedded as part of the culture of the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

All potential hazards which we highlighted to the provider at the last inspection had been addressed. Actions identified in the provider’s fire risk assessment of November 2017 had now been completed, and fire drills undertaken by all staff. People had access to facilities of an appropriate standard to wash their hands and staff had received training in minimising infection and put this knowledge into practice. Repairs had been made to environment and new bedroom furniture sets purchased. However, sufficient time had not elapsed to be certain that improvements would continue to be made and sustained.

Quality assurance processes had been strengthened through the introduction of a programme of audits. However, the provider had historically not acted on shortfalls which had been identified in the inspection process and insufficient time had passed to ensure these changes had been embedded at the service.

The provider had not sought advice with regards to how to adapt the environment for people living with dementia and assessed what actions to take to meet people’s individual needs.

Assessments of potential risks to people’s individual safety had been undertaken such as risk of them falling or developing pressure sores, and strategies put in place to minimise their reoccurrence. Proce

We inspected the service on 29 March 2018. The inspection was unannounced. Wychdene is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Wychdene is registered to provide accommodation and personal care for 24 older people. There were 19 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 27 and 28 July 2017 the overall rating of the service was, ‘Requires Improvement’. We found that there were five breaches of the regulations. This was because there were shortfalls in the arrangements made to manage medicines in the right way so that people reliably received safe care and treatment. Also, suitable arrangements had not been made to obtain people’s consent to the care they received. Furthermore, we noted that there were oversights in the maintenance of the accommodation. In addition, we found that people did not always receive care in a way that promoted their dignity. Lastly, we concluded that the registered persons had failed to operate quality checks to enable problems in the running of the service to quickly be put right.

We told the registered persons to take action to make improvements to address each of our concerns and they subsequently told us that this had been done. However, at the present inspection we found that only one of the breaches of regulations had been met. This referred to the arrangements made to obtain people’s consent to the care and treatment they received. The four remaining breaches had not been suitably addressed because suitable arrangements had not been made to ensure that people consistently receive safe care and treatment. Also, the accommodation was not designed, adapted and decorated in a way to meet people’s needs and expectations. In addition, people did not always receive care in way that promoted their dignity and quality checks had not been completed in a robust way to ensure the smooth running of the service.

Full information about CQC’s regulatory response to the breaches of regulations noted above will be added to our report after any representations and appeals have been concluded.

At this inspection we also found a further breach of regulations. This was because the registered persons had not completed suitable background checks before two new care staff had been appointed to assure themselves of the applicants’ previous good conduct. You can see what action we have told the registered persons to take about this shortfall at the end of the full version of this report.

As a result of these breaches of regulations the overall rating for this service is ‘Inadequate’ and the service is therefore in, ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered persons’ registration of the service, will be inspected again within six months. The expectation is that registered persons found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of ‘Inadequate’ for any key question or overall, we will take action in line wit

This was an unannounced inspection carried out on 27 and 28 July 2017.

Wychdene is a residential care home providing accommodation and personal care for up to 24 older people some of whom may be living with dementia. The service is built over three floors and has a passenger lift. Nine bedrooms are en-suite and the remainder have a hand basin in them. The service is set in large gardens edged by trees. It is a short walk from Broadstairs town centre and close to Broadstairs beach. On the day of the inspection there were 18 people living at Wychdene.

The service was run by a registered manager. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. Having a registered manager is a condition of the registration of the service. The registered manager was not present on the days of the inspection. The provider and care manager were present. The registered manager resigned after the inspection.

We carried out an unannounced comprehensive inspection of Wychdene in June 2016; the service was rated ‘requires improvement’. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 and we asked the provider to take action to make improvements. We issued requirement notices relating to failing to have a registered manager in post, failing to effectively monitor and assess the quality of the service, failing to complete relevant checks to make sure staff were safe to work with people and failing to ensure staff received the appropriate support and training. The provider sent us an action plan. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and some of the breaches met. However, we found three new breaches and one continued breach of Regulations.

Risks to people were assessed, identified and monitored. However, not all pressure relieving equipment was set correctly placing people at risk of developing pressure areas. Medicines were stored, and disposed of safely. Staff had not consistently completed the medicines records.

People told us there were generally sufficient staff during the day. However, contingency plans were not in place in the event of an emergency. On the second day of the inspection there was an unexpected shortage of staff. The provider took immediate action to bring in another member of staff and increased the numbers of staff on duty from then on.

The service was tatty and some areas of the service smelled strongly of urine. Some carpets and flooring needed to be replaced. Staff wore personal protective equipment, such as, aprons and gloves when supporting people with their personal care.

The provider had recruitment and selection processes in place, which were followed, to make sure that staff employed were of good character. Staff completed training and had one to one supervision meetings with the registered manager or care manager. There were some gaps in staff training and refresher courses had been booked to cover these.

Staff knew the importance of giving people choices and gaining people’s consent. However, records about people’s capacity were inconsistent and contradictory. Staff understood the requirements of the Deprivation of Liberty Safeguards and applications for DoLS had been made in line with guidance.

People were not consistently treated with kindness, dignity and respect. Records did not always contain appropriate language. Staff knew people well including their likes and dislikes and knew their relatives well. People were encouraged to be as independent as possible.

People took part in a variety of activities within the service. However, people’s views on the quality of the

This was an unannounced inspection carried out on 16 June 2016.

Wychdene is a residential care home providing accommodation and personal care for up to 24 older people some of whom may be living with dementia. The service is built over three floors and has a passenger lift. Nine bedrooms are en-suite and the remainder have a hand basin in them. The service is set in large gardens edged by trees. It is a short walk from Broadstairs town centre and close to Broadstairs beach. On the day of the inspection there were 22 people living at Wychdene.

The service is run by a manager who had been in post since 4th May 2016. They had applied to be registered with the Care Quality Commission (CQC) but they had not yet completed the process. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. Having a registered manager is a condition of the registration of the service.

Risks to people’s safety were identified, assessed and managed. Assessments identified people’s specific needs, and showed how risks could be minimised. There was not consistent guidance for staff of what to do if an incident happened, for example, if someone at risk of choking choked. Accidents and incidents were recorded, analysed and discussed with staff to reduce the risks of them happening again.

Recruitment processes were in place to check that staff were of good character and safe to work with people. These processes had not been consistently followed, for example, references had not always been requested and not all staff files had an application form.

There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided. There were some staff who had not completed essential training, such as moving and handling, to ensure they knew how to move people safely. The manager did not coach and mentor staff through regular one to one supervision.

There was no robust auditing process to assess, monitor and improve the quality of service being provided at Wychdene.

People said they felt safe living at the service. Staff understood how to protect people from the risk of abuse and the action they needed to take keep people safe. Staff were confident to whistle blow to the manager or other organisations if they had any concerns and were confident that the appropriate action would be taken.

People were consistently supported by sufficient numbers of staff who knew them well. People received their medicines safely and people told us they received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The manager had sent applications to the local authority in line with guidance.

People felt informed about, and involved in, their healthcare and told us they had as much choice and control as possible. People were able to make choices about how they lived their lives, including how they spent their time. Staff had received training on the MCA and understood the key requirements of the MCA and how it impacted on the people they supported. They put these into practice effectively, and ensured that people’s hu

We spoke with the people who used the service, their relatives, the registered manager and care staff. We also observed staff supporting people with their daily activities.

Wychdene can provide accommodation for up to 28 people. There were 22 people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people and the registered manager:

Is the service safe?

The service was safe.

People felt safe living at the service. They felt confident that any concerns they had would be listened to and dealt with quickly. Staff knew how to keep people safe.

People had a care plan which detailed their care and support needs. There was guidance for staff to follow to reduce risks and make sure people were as safe as possible.

The service had systems to manage risks to the people’s care without restricting their activities or their life styles.

There were sufficient numbers of staff on duty at all times to make sure people were safe and received the care and support that they needed. The registered manager was available in case of an emergency.

When people had accidents the most appropriate and safe action was taken to make sure they received the treatment they needed. There were systems in place to make sure that the registered manager and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations.

Is the service effective?

The service was effective.

People were able to express their views about what mattered to them at regular meetings organised for them.

Care was consistently planned and delivered in response to people’s changing needs. People’s health and care needs were assessed with them and / or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person’s needs.

Staff had the knowledge, skills and competencies to carry out their role effectively and safely because staff were properly trained.

Is the service caring?

The service was caring.

Staff understood people’s needs and provided care with kindness, respect and compassion. Staff showed patience when supporting people and promoted their independence.

Relatives told us that they were involved and informed with the care of their loved ones. People and their relatives were happy with their care.

Is the service responsive?

The service was responsive.

People received the care and support they needed to meet their individual needs.

People and their relatives felt they would be listened to if they raised any concerns with the registered manager.

The service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led.

There was a clear management structure and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the registered manager.

People and their relatives told us that the registered manager was approachable. People were given the opportunity to comment on the service provided and their views were taken into account.

The action plan of works to improve the environment that was still outstanding at our last review was now completed. However, the home still looks tired and in need of some redecoration.

People living at the home stated they were very happy living at Wychdene. One told us, 'I wouldn't want to live anywhere else'. Another said, I feel safe here because everyone is so caring'. A family member visiting a relative told us, 'I wish we had found this home earlier and dad had all his respite here rather than in hospital first. We looked at some homes that were more like hotels in their decoration but it's the people who make the home what it is and why we chose here'.

Staff were observed to be very relaxed and friendly in their interactions with people living at the home, but showed respect and a good understanding of those they were caring for.

The provider had sent us an action plan covering the shortfalls we identified at the last inspection. The manager had prioritised the most important areas to work on first. This meant that the fire protection systems and the call system had been updated and improved to ensure people’s safety. Because the manager had prioritised, some actions had not yet been addressed. For example, the windows at the front of the property were still rotten in places, had flaking paint and looked ill fitting potentially affecting security. Light shades were still missing from some wall light fittings exposing hot light bulbs. This has been the case for years.

We will monitor the service closely to ensure that all the required improvements are made.

People who use the service said that staff treated them with respect and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home.

All of the five people with whom we spoke gave us positive feedback about most aspects of the service. One of them said, “I’ve found the staff to be very kind and friendly. They’ve always been willing to help me and I like them.” Some people voiced reservations about the accommodation. One of them said, “I think that the place is a bit rough and ready. I don’t want it to be posh but some of it looks tired and unloved.” Some people also had concerns about the adequacy of the staffing arrangements. One of them said, “The staff are too busy in the morning because they have lots to do at the same time and simply can’t get round to everyone as quickly as during the rest of the day.”

A relative said, “I see mum lots. She needs a lot doing for her but the staff are kind and overall I’m happy with the care she gets. Although the accommodation is run down, I think mum is okay here.”

We carried out an unannounced visit to the service to check that they had made improvements. We found that the compliance actions we made at the last inspection had been met.

People were relaxing in two lounges or in their bedrooms. People we spoke to said that they were happy living at Wychdene and that the service was meeting their needs.

People told us that the food was generally good and that they knew what they were having so could choose an alternative if they wished. One person said “The food is very good, I have no complaints”.

People said they were satisfied with the activities provided.

People told us that the home was clean and smelled fresh. One person said “The cleaning is good. They clean my room every day to a very high standard.”

Everyone we spoke to said that the staff were kind and were there when they needed them. One person said “The staff are very friendly. They are very good”.

People who use the service said that they were generally satisfied with the service. We observed that there was a relaxed atmosphere and that people were given the time they needed to eat their hot lunchtime meal.

People told us that their bedrooms were clean but some people had no view of the outside from their bedroom and little or no ventilation. One occupied bedroom had wet patches on walls and smelled of damp.

One bathroom was out of action with another bathroom not fully suitable so personal care choices for people were limited.

Visiting professionals, including care managers, told us that they had concerns about care plans and other documentation. They were also concerned about the cleanliness of the home, the cleanliness of some equipment and the use of closed circuit television.

People who use services told us they were happy at the home and they felt safe.

They told us the food was good and the staff were kind. They said the home was kept clean and they were happy with their rooms. Carers said they were made to feel welcome when they visited and were happy with the care provided to their relatives.