This inspection was unannounced and took place on 17, 18 and 19 July 2018.

Following our previous inspection on 21 and 22 March 2017 the service was rated ‘Requires Improvement’. We found the provider needed to make improvements to how the home was managed. It required consistent management by a manager who was registered with the Care Quality Commission (CQC), improvements were needed to people’s care plans so they accurately reflected people’s care needs and the provider’s quality monitoring processes needed to be more effective in making improvements which could be fully embedded and sustained.

At this inspection we found some improvements had been made. People had benefited from a consistent manager being in post who was registered with the CQC. Some care plans had been re-written but several still did not reflect people’s needs. Quality monitoring processes had taken place but these had not, identified the shortfalls in the management of people’s risks, identified during this inspection, or successfully achieved full improvement in people’s care plans, required following our previous inspection.

We requested that the provider send us an immediate action plan on how they were going to ensure people’s risks were fully assessed and safe and effective care was planned. An action plan was subsequently received which we will follow up in due course.

Following this inspection an overall rating of ‘Requires Improvement’ was awarded. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Wyatt 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. The home can

accommodate 30 people in one adapted building. At the time of our inspection 29 people lived there. The home specialises in the care of people who live with dementia and who also require nursing care.

Wyatt House is a circular design with an inner, secure garden. People are accommodated across two floors. One floor provides accommodation for a small group of people who need less support and which promotes their independence. On the second floor people required all support with their daily needs which the design of the home and its fittings supported. The circular design is experienced on this floor, which allows people to walk freely, without interruption; but a seated area also provides a place to rest. People could access an outside seating area safely from this floor, but they were supported by staff to visit the whole of the garden. There was ample car parking in and around the home’s grounds and wheelchair access to the home.

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 2008 and associated Regulations about how the service is run.

Although the provider had processes in place to assess people’s risks, these had not always been completed, in a timely manner, to ensure people would remain safe. Some people had been left with risks and areas of need, which had not been fully assessed or addressed through the planning of safe and effective care. A breach of regulation was identified in relation to this. Practices were not consistent as we saw that other risks had been well assessed and appropriate care planned and delivered to reduce these.

People’s care plans still did not always give accurate detail about the care people required. This was despite staff completing regular reviews of these. This had potential for people to receive unsafe or inappropriate care and a breach of regulation was identified in relation to this.

Since the last inspection and since the registered manag

This unannounced inspection took place on 21 and 22 March 2017 .

Wyatt House provides nursing, residential, and respite care for up to 30 people living with dementia and some day care places. At the time of our inspection 26 people were living there. The home is purpose built over two floors. There is a small day centre which people from outside the home can access four days a week and join in with activities there.

There had been no registered manager in post for six months and a new manager had not been appointed that the provider had applied to register with CQC. 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. A peripatetic interim manager was currently managing the service until a new registered manager was appointed.

There were three breaches of legal requirements at the last inspection in October 2015. At our comprehensive inspection on 21 and 22 March 2017 the provider had followed their action plan which they told us would be completed on 30 June 2016 with regard to referring people to healthcare professionals when required, staff completing regular training updates and notifying the Care Quality Commission about all incidents.

Improvements could be made to the care plans we looked at to ensure they were more responsive to people’s needs and we have made a recommendation about the care plan information. Staff knew how to keep people safe and were trained to report any concerns. The home was well maintained and safety checks had been completed. People had their medicines administered by the staff and they were safely managed.

People were able to make some choices and decisions and staff supported them to do this. External healthcare professionals supported people when required and they were supported regularly by their GP.

People were supported by staff that were well trained and had access to training to develop their knowledge. There was a choice of meals. We observed one meal time and people’s experience could be improved with regard to waiting for their food to be served. People were treated with kindness and compassion. We observed staff engaged with people in a positive way and they were caring when they supported them. Relatives felt welcomed in the home and told us the staff were kind.

People had a range of activities to choose from which included cookery, quizzes, ball games, arts and crafts and musical entertainment. Community links included people being part of the local ‘memory walks’ in Stratford Park and Stroud Christian Fellowship provided a weekly service in the home.

The provider’s representative and the manager monitored the quality of the service with regular checks and when necessary action was taken. Staff felt well supported by the management team. Staff meetings and resident/relative meetings were held and they were able to contribute to the running of the home. All complaints we looked at from relatives had been investigated robustly by the manager and responded to within the required timescales.

We previously visited this home in November 2012. At that time we had a number of concerns. The standard of record keeping was generally poor. People's personal records did not provide evidence that they received appropriate care and support. We saw incorrect practice and documentation in relation to obtaining consent for people who lacked capacity. We were concerned that some staff had a limited understanding of their responsibilities under the Mental Capacity Act 2005.

Staff told us that the home was frequently under staffed. There were high levels of sickness absence and this was not effectively managed. Systems to monitor quality and safety were not effective; in particular there were inadequate systems to capture the views of people who used the service or their representatives.

When we returned to the home we found significant improvements had been made. Staff had completed records training and this included training in the Mental Capacity Act. Records provided good evidence that people's needs were assessed, regularly reviewed and met. We observed that people received prompt and appropriate care and support.

Staff told us that staffing level, team working and morale had improved. This corroborated the findings of a staff survey which the home carried out following our last visit. The home was taking steps to capture more feedback from relatives of people who lived at Wyatt House. The home had an effective complaints system.

This unannounced inspection took place on 13 and 14 October 2015.

Wyatt House provides nursing, residential, and respite care for up to 30 people living with dementia and some day care places. At the time of our inspection 30 people were living there. The home is purpose built over two floors. There is a small day centre which people from outside the home can access four days a week and join in with activities there.

There was no registered manager but the home manager had already applied to become registered with us. 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. There were no legal breaches of legal requirements at the last inspection in July 2013.

Generally people were supported by sufficient staff but this was not the case at all times. Some people did not have access to a call bell when they needed assistance from staff. There was a shortage of activity staff when we visited, which the manager was aware of.

People had access to health and social care professionals but referrals were not always made quickly to relevant health services when people’s needs changed. This required improvement.

Staff had not completed regular training updates to ensure they had sufficient knowledge to carry out their roles. Staff supervision had not been completed regularly to identify staff training needs. This required improvement.

People were kept safe by staff trained to recognise signs of potential abuse and they knew what to do to safeguard people. The CQC had not been notified of all safeguarding incidents and this required improvement. Some staff required an update to their safeguarding training. The people and relatives we spoke with felt the home was safe and the service provided was safe. They were complementary about the security of their surroundings. Relatives told us, “My wife is very settled here, I feel she is in good hands, I love it here”, “I have been impressed by the staff and their care” and “I have only seen kindness”.

People’s medicines were managed safely and regular checks were made to monitor staff practice.

People were supported to have a well balanced diet that met their individual needs. Meal times were an important social time. Staff sometimes joined people at lunchtime and this encouraged people to eat and engaged them in conversation.

Staff knew people well and were concerned for their well being and responded to them in a caring way. Age appropriate language was used and peoples preferred term of address which was recorded in their care plans. There was evidence of genuine friendships between people and this was supported and encouraged by staff. A person told us, “I meet X and we have a chat and a laugh together”. The activity organiser was passionate and enthusiastic and had prepared a varied and active activity plan.

Personalised care plans and input from the provider’s specialist dementia nurse helped staff support people with the care they needed. People were monitored to prevent pressure ulcers and maintain their health and well being. The activity organiser had forged links with the community and people had enjoyed memory walks.

The service had been without a registered manager for nine months but staff told us the new manager was approachable and had some great ideas for improvements. Quality assurance procedures were used to improve the service for people but it was unclear when some actions identified had been completed. The monthly review visits recorded by the provider’s area operations manager looked at various aspects of the service.

People were asked about their satisfaction with the service at six monthly reviews. Residents meeting were held to include people in developing and improving the service. Recently people had said they wanted to go out more often and have additional entertainment in the late afternoons. We saw people were entertained in the afternoons. Staff meetings were held and changes were completed and planned. Some systems had been audited to improve the service but not all.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.