The Inspection took place on 15 February and 14 March 2018 and it was unannounced.

Great Wheatley is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide care and accommodation with nursing for up to 21 older people some of whom may be living with dementia and/or receiving palliative care. There were 21 people living in the service on day one of our inspection and 19 people on day two.

At the last inspection, the service was rated good and at this inspection, we found the service remains good.

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.

People received their care and support safely. Staff understood how to support people and they knew how to protect them from the risk of harm. The service recruited people safely and employed sufficient staff to meet people’s needs. Where shortfalls in staffing had been identified, the service actively sought to fill vacancies.

The computerised medication system was good. People received their medication safely as prescribed and the records were of a good standard. Staff had a good understanding of infection control and had been trained. Appropriate action and precautions were taken, as advised by the GP when an infection was present. The environment was well maintained, kept clean and was hygienic.

Peoples care needs had been assessed and their care plans updated as their needs changed. Staff were well trained and supervised and they knew how to care for people effectively. People received a choice of fresh home cooked meals. Alternatives to the menu were available should people require them. Where people had little appetites their food and drinks were fortified to ensure they had as much nutrition as possible. Staff ensured people’s healthcare needs were met. They worked well in partnership with other professionals to ensure that people received the healthcare they needed.

The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible. The service had carried out appropriate assessments in line with legislation. Where people were deprived of their liberty, the service had made appropriate requests for authorisation. People’s independence was encouraged as much as possible while minimising any risks to help keep them safe.

Kind and caring staff cared for people. They listened to what people had to say and let them know that they were important and that their feelings mattered. Staff were respectful and treated people with dignity, ensuring that their privacy was maintained. People and relatives were very complimentary and said that staff were kind, caring, respectful and compassionate.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Advocacy services were available if people needed them. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People received personalised care that was responsive to their needs. The care plans and daily notes were detailed and informative. Staff kept them up to date using the computer tablets and recorded information in real time. There was a good complaints procedure and where complaints had been received, they had been dealt with appro

The Inspection took place on 12 October 2016 and was unannounced.

Great Wheatley Nursing Home is registered to provide accommodation and personal care with nursing for up to 21 older people who may be living with dementia. There were 21 people living in the service at the time of our inspection.

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.

At our last inspection in October 2015 we found that the provider had taken steps to mitigate the risks to people and address the shortfalls found at the previous inspection in March 2015. This included implementing systems to monitor the quality and safety of the service. However, these measures needed to be embedded and sustained over time to ensure people were provided with a consistently safe quality service. The overall rating of the service was not changed.

At this inspection we found that the improvements made in October 2015 had been sustained. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines. There were sufficient numbers of qualified nurses to meet people’s assessed needs. There was an effective system in place to assess and monitor the quality of the service and to drive improvements.

People were cared for by well trained and supported staff who had been safely recruited. Staff knew how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had care plans and risk assessments in place to ensure that people were cared for safely.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed.

People received enough food and drink to meet their individual needs. People’s care needs had been fully assessed and their care plans provided staff with sufficient information to meet people’s needs holistically and to care for them safely. People’s healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when required.

Staff knew the people they cared for well. They were kind, caring and understanding and always ensured people had the privacy they needed and that their dignity was respected at all times. People expressed their views and opinions and participated in their choice of activities. People were able to receive their visitors at any time and their families and friends were always made to feel welcome. Advocacy services were available where people did not have family members to support them to have a voice. People were confident that their concerns or complaints would be listened to and acted upon.

The inspection took place on the 1 October 2015.

Great Wheatley Nursing Home is registered to provide accommodation and care with nursing for up to 21 people some of whom may be living with dementia. There were 18 people living in the service on the day of our inspection.

At our last inspection in March 2015 we had concerns about the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), the care planning and the quality assurance systems. We had also recently received some concerning information about medication practice, moving and handling practice and qualified nurses staffing levels. This report only covers our findings in relation to these requirements and the information of concern. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Great Wheatley Nursing Home on our website at www.cqc.org.uk

At this inspection we found that the service had improved in the application of MCA and DoLS, in care planning and in their quality assurance systems.

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 supported by staff that understood them. Staff had undertaken training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and demonstrated an awareness of the issues around people’s capacity and to consider people’s best interest when supporting them to make decisions. People’s capacity and ability to make informed decisions were assessed and recorded clearly. Staff asked people for their consent before providing any personal care and support.

People’s needs had been assessed and their care plans provided staff with sufficient information to meet their needs. Staff clearly knew how to support people in ways that they wished to be supported.

There were sufficient numbers of staff provided to meet people’s needs. Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs.

The management team were well established. People and their families were consulted with and the service used a variety of ways to assess the quality and safety of the care provided.

The provider had taken steps to mitigate the risks to people and address the shortfalls found at the last inspection. This included implementing systems to monitor the quality and safety of the service. However, these measures need to be embedded and sustained over time to ensure people are provided with a consistently safe quality service. The overall rating of the service will not change at this time.

The inspection of Great Wheatley Nursing Home took place on the 04 March 2015. Great Wheatley is a purpose built nursing home for up to 21 older people who may also have care needs associated with living with dementia.

At our last inspection in July 2014 we had concerns about the care and welfare of people using the service and staffing.

At this inspection we found that the service had improved in care and welfare of people and there were enough qualified staff to care for people and meet their needs.

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 supported by staff that understood them. Staff had undertaken training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and demonstrated an awareness of the issues around people’s capacity and to consider people’s best interest when supporting them to make decisions. However, people’s capacity and ability to make informed decisions were not always assessed and recorded clearly.

People’s needs had been assessed and they were cared for by kind and caring staff. Staff respected people’s privacy and dignity and worked in ways that demonstrated this. Staff asked for permission before providing any personal care or any activity. The social and daily activities provided suited people and met their individual needs.

Staff clearly knew how to support people in ways that they wished to be supported. There were sufficient numbers of staff provided to meet people’s needs. Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs, although this training was not always appropriate.

People were able to complain or raise any concerns if they needed to. Where people had raised issues these were taken seriously and dealt with appropriately. People using the service and their families were consulted with. The service used a variety of ways to assess the quality and safety of the service that it provided although this was not always effective. The management team at the service were well established.

We carried out this inspection as we had received concerns regarding people's welfare at Great Wheatley Nursing Home. We spoke with seven of the 18 people who were using the service at the time of our inspection. We also spoke with four staff members. We looked at four people's care records. We also looked at the staffing rotas, and documents regarding the level of dependency of people. 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;

Is the service safe?

We found that improvements had been made to care records although further improvements were required to ensure detailed and up to date information is available.

People told us that they felt safe and happy living at Great Wheatley Nursing Home.

Is the service effective?

People told us that, overall, their care needs were met at the service. However we found that there were not sufficient numbers of staff on duty to effectively meet the care needs of all the people who were using the service. We have asked the provider to tell us what they are going to do to meet the requirements of the regulation in relation to the provision of having suitably numbers of skilled and experienced staff employed.

Is the service caring?

We observed staff treating people respectfully. People told us that the staff were kind and caring.

Is the service responsive?

People told us that the service was responsive to their needs. The care plans had mostly been updated to reflect people’s changing needs, although improvements are required.

Is the service well-led?

There was a new manager in post who had experience of managing a care home. They had started to make improvements and staff we spoke to told us that the manager was approachable.

Improvements needed to be made to ensure that the systems and processes in place were used effectively for monitoring the quality of the service.

We spoke with and spent time with people who used the service. We also spoke with two people's relatives, a number of staff members and the business manager for the organisation.

We looked at four people's care records. Other records viewed included staff training records, staffing rotas, menus, health and safety checks and staff and resident meeting minutes.

We considered our inspection findings to answer five key questions; is the service safe, effective, caring, responsive and well-led? This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identity and we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would feel confident in speaking with the staff if they had concerns. We found that sufficient numbers of staff were being provided to meet people's needs.

We found that, although some improvements were needed, appropriate arrangements were in place to ensure that people who used the service were protected against the risks associated with the unsafe use and management of medicines. People had their medicines at the times they needed them, and in a safe way.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. Staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS.) This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People made comments such as, "I like it here." "The staff are friendly and supportive," and, "So far I have found it alright and I have no complaints."

Although people spoken with were happy with their care, we found that people's care records maintained by the provider needed improvement. Shortfalls noted meant that care and treatment was not being planned and delivered in a way that ensured people's safety and welfare. Care plans did not provide adequate person centred information to help staff understand people's individual needs and choices.

Staff working in the service were supported through on-going training and supervision to offer people care and support to meet their needs.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. Staff demonstrated a genuine affection, warmth and compassion for the people they supported. People told us that the staff treated them with respect.

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken in to account and listened to.

We saw that staff were responsive to people's changing wishes and needs and supported them well.

People told us that they felt able to raise any issues they might have and felt that the service would act upon their concerns.

People's care records showed that where concerns about their well-being had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from other health care professionals.

Is the service well-led?

The service had not benefited from consistent or stable management since the registered manager left the service eight months ago. This had effected the ability of the service to be 'well-led' and provide consistency for people. Another manager was about to take up the role, and will be applying for registration with us in due course.

People had the opportunity to express their views about the service, and we saw that people's views were listened to.

The provider had systems in place to monitor and improve the service.

People told us that they were happy with the care and support provided at Great Wheatley Nursing Home. People said, "I have no complaints. I feel safe and the staff are kind and caring," and, "The staff are friendly and supportive."

We saw that people's care needs were assessed and planned for with any risks associated with their care being minimised as far as possible. The service was caring and responsive to people's changing needs. Staff sought support from other professionals or agencies when needed. Staff had a good knowledge of people's individual needs and offered them appropriate support.

People told us that they enjoyed the food available at Great Wheatley Nursing Home. We found that people's nutritional needs were assessed and monitored to ensure their on-going wellbeing.

We found that attention was needed to ensure that people's medicines were always managed effectively with robust monitoring procedures in place.

The service was kept clean and provided a hygienic place for people to live.

We saw that staff were safely recruited to protect people. Staff had access to good levels of training and support. We found that the provider needed to monitor more effectively the levels of staffing provided to ensure that people's needs were met at all times.

We found that the service listened to people's views, but that more robust quality monitoring was needed to ensure a consistently effective, good quality and safe service.

This visit took place in the late evening so we did not spend time speaking with people using the service.

We found that insufficient qualified staff were being provided to meet the needs of people using the service.

The majority of people living in this service were living with dementia and were unable to tell us about the quality of care they received. To enable us to be able to access people’s wellbeing we spent time sitting with them observing the care they received and the level of staff interaction with the people.

We observed that the staff were attentive to people’s needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted well with each other.

We were able to talk with some visitors while they visited their friends and relatives and two of the people who lived in the service. The people told us that they liked living there, that the care staff showed them respect and looked after them well. They also told us that they were comfortable. One person told us that the staff were, “Awful, bad people.” They spoke with a smile and gave the thumbs up to the manager who was present at the time.

We saw that there were enough staff on duty to effectively care for the people they supported and that staff received training essential for caring for older people. People told us that they felt safe living in the service.

We also saw that quality assurance procedures were in place and that the records we looked at were well organised, comprehensive and complete.

People told us that they experienced good care at Great Wheatley. One person said, "The care is very good, they check on me regularly and change me frequently." People felt that their privacy and dignity was respected at Great Wheatley and that staff did involve them. A person using the service said, "Staff tell me not to worry, they respect me in the way that they talk to me and care for me, and they tell me what they are going to do and what is happening. I can make choices."

People spoke positively about the staff working at the home and described as them as caring, hardworking and helpful. They told us that they felt safe at the home and confirmed that they would feel able to tell a member of staff or the manager if they had any worries or concerns.

People said they were satisfied with the quality of the service overall and that they could express their views. Some people felt that they had told the owner they felt the food was not as good as it had been but that no action had been taken regarding this.