The inspection was completed on the 8 and 10 May 2018 and was unannounced. The service was last inspected in September 2017 and was rated as requires improvement. This inspection was brought forward because we had received concerns from two whistle blowers and the local authority. The concerns related to how people were being cared for, the culture of the home and some environmental concerns. They also raised concerns about a high turnover of staff who were in a senior management role. The provider and registered manager had taken action and was addressing these concerns prior to the inspection. They had drafted in some additional management support to assist with the improvements needed.

The Worthies is a 'care home'. People in care homes receive accommodation 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 Worthies provides personal care and accommodation for up to 26 older people. At the time of our inspection there were 23 people living at the home.

There was a registered manager in post. They were also responsible for another registered home, which was in close proximity to The Worthies. 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 2008 and associated Regulations about how the service is run.’

The provider had made improvements in respect of the breaches found at the inspection in September 2107. What they told us they would do in their action plan they had completed. Further action plans had been developed in conjunction with the local safeguarding team and these were being implemented with assistance from the additional management support. The additional management support was from registered managers employed by the provider who worked at other services owned by the provider.

People were receiving care that was effective and responsive to their changing needs. Care plans were in place that described how the person would like to be supported and these were kept under review. People’s medicines were managed safely and improvements had been made since our last inspection. This included regular checks, which provided the provider with assurances and addressed any shortfalls promptly.

People had access to healthcare professionals when they became unwell or required specialist help. People were encouraged to be independent and were encouraged to participate in activities in the home and the local community.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. People confirmed their involvement in decisions about their care. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected. This was done by involving relatives or other professionals in the decision making process.

Staff were knowledgeable about the people they were supporting and spoke about them in a caring way. Staff had received suitable training enabling them to deliver safe and effective care. Further training was being organised in May 2018 to provide staff with updates. People were protected because staff went through a thorough recruitment process. Regular staff meetings were taking place. Staff were supervised on a one to one basis. This had recently improved with staff receiving these every two months instead of three monthly.

Sufficient staff supported people living at The Worthies and this was kept under review. People’s views were sought about the service. Surveys were also completed by relatives and staff.

The quality of the service was regularly reviewed by the provider/registered manager and staff. The registered manager was aware of the areas that required improvement with an action plan in place.

The Worthies provides personal care and accommodation for up to 26 older people. At the time of our inspection there were 25 people living at the home.

This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. This inspection took place on the 20 and 21 September 2017. This inspection was brought forward because we had received concerns from a whistle blower. The concerns related to how people were being cared for, the culture of the home and some environmental concerns. Some of the concerns were substantiated. However, it was evident that the provider and registered manager had taken action and had addressed some of these concerns prior to the inspection.

A registered manager was in post at the time of our 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 home is run.

At the last inspection in October 2016, the service was rated good overall, with improvements needed to ensure people were safe. This was because we did find some recording omissions and inaccuracies in regards to people's medicines. There were no breaches of regulation.

During this inspection, we found people’s medicines were still not managed safely, in respect of the administration and the disposal of pain patches. We also found that a person that was at risk of choking was not being provided with a suitable textured diet and thickened drinks to reduce these risks. We also brought to the provider’s attention some environmental issues in respect of hot water, which could pose a scalding risk to people, a loose handrail leading down some stairs and a slight odour in parts of the home. There was also a lack of signage where there was low headroom leading down from the stairs. Whilst action had been taken to address these concerns, the provider’s own checks had not identified these shortfalls with prompt action being taken.

People were receiving care that was effective and responsive to their changing needs. Care plans were in place that described how the person would like to be supported and these were kept under review.

People had access to healthcare professionals when they became unwell or required specialist help. People were encouraged to be independent and were encouraged to participate in activities in the home and the local community.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. People confirmed their involvement in decisions about their care. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected. This was done by involving relatives or other professionals in the decision making process.

Staff were knowledgeable about the people they were supporting and spoke about them in a caring way. Staff had received suitable training enabling them to deliver safe and effective care. People were protected because staff went through a thorough recruitment process.

Staff confirmed they received support and guidance from the management of the service. Sufficient staff supported people living at The Worthies and this was kept under review. People’s views were sought about the service. There was a programme of change, which included refurbishment of the environment and developing the skills of the staff to improve the way they supported people living with dementia. They were supported by the Dementia Wellbeing Service in introducing these changes.

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 this report.

We undertook an unannounced inspection of The Worthies on 18 October 2016. When the service was last inspected in April 2015 three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We found that suitable arrangements were not being made for the management of people’s medicines and also in relation to cleanliness and infection control. Systems for assessing and monitoring the quality of the service were found to be ineffective. These breaches were followed up as part of this inspection

The Worthies provides personal care and accommodation for up to 26 older people. At the time of our inspection there were 22 people living at the home.

A registered manager was in post at the time of our 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 home is run. The registered manager was on long term planned leave at the time of our inspection. The home had notified the Commission of this absence and had suitable managerial arrangements in place.

At the last inspection in April 2015 we found that suitable arrangements for the management of people’s medicines and cleanliness and infection control were not being met. At this inspection we found improvements had been made in both areas to meet the regulations. However, we did find some recording omissions and inaccuracies in regards to people’s medicines which we brought to the attention of senior staff.

People had assessments in place to minimise risk and there was suitable guidance for staff in risk management. Staffing levels were safe. People and relatives told us there was enough staff to deliver care and support effectively. The home ensured people were safe by having thorough recruitment procedures. This was followed by an effective induction, supervision and training programme to ensure staff were skilled and well supported in their role.

Senior staff were aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. The home kept clear records of how conditions attached to a DoLS authorisation were being met. People’s capacity had been considered and documented in care records. When a best interest decision was needed, this was fully documented with the involvement of family and health or social care professionals. Staff were confident in their knowledge of DoLS and the Mental Capacity Act 2005.

We observed good relationships between people and staff. Staff knew people well and ensured there was a happy and positive atmosphere within the home. Positive comments were made by people and relatives about staff’s kind and caring approach.

Staff were responsive to people’s care and support needs. Care records were person centred, showing people’s personal preferences. Staff supported people to be involved in a range of activities both within the home and in the community. People were involved with decisions made at the home.

At our last inspection in April 2015 we found that systems to monitor the quality of the home were not effective. We saw that the home had reviewed and implemented changes to their systems as detailed in the action plan they sent us. We received positive feedback about how the home was led and run. Regular staff meetings were arranged and there were effective communication systems in place. Feedback was sought from people, staff and relatives. Any areas that required further follow up were thoroughly completed.

This inspection took place on 14 April 2015 and was unannounced. The previous inspection of The Worthies was on 24 June 2013. There were no breaches of the legal requirements at that time.

The Worthies is a care home without nursing for up to 26 people.

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 said they felt safe living at The Worthies and could talk to staff if they had any concerns. However there were shortcomings in the safety of the service. People’s medicines were not always being managed in a safe way. We also found that although most parts of the home were clean, some areas were not in a hygienic state. The condition of some facilities meant they were difficult to keep clean.

There were procedures in place for checking the home and the service people received. However, these were not being followed consistently to ensure good standards were maintained. The checks were not always effective in identifying areas for improvement.

People told us the staff were available to help them when needed. New staff had been checked to ensure they were suitable for the work and were safe to be working with people. Staff knew how people could be at risk of abuse and the need to report any concerns they may have.

People said the staff supported them in a friendly and respectful way. Staff told us they felt well supported and received training so they were competent in the tasks they undertook. Staff understood their responsibilities in relation to the Mental Capacity Act 2005. This meant people’s rights were protected when they lacked capacity to make decisions about their care and support.

People felt their needs were being met at the home. They received support in different areas of their lives. A range of social activities were arranged and staff were aware of people’s individual needs. One person said they continued to attend the church they had been to for many years. Relatives told us they felt welcome at the home and were able to pass on their views.

A person said the meals were one of the main things liked about the home. People’s comments included “The meals are fine” and “I’m never hungry”. Staff understood the importance of people having a suitable diet and enough to drink. People’s health was being monitored and any concerns followed up with the appropriate healthcare professionals.

People felt they could talk to staff about their care and what they wanted to do. Care plans had been produced and people’s needs were being kept under review. One person told us it was good to have a plan, as it meant staff “would know what I need and what they have to do.”

We found three breaches of regulations during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

We spent the day in the company of the provider, manager and care staff. Their knowledge and enthusiasm of the service and the people in their care was evident. The manager was newly appointed and started in January 2013. They were currently applying to register with CQC. They had made significant improvements. Staff morale was positive, they were ‘happy’ about what they achieved as a team so that people received good care and support.

Some people living in the home remembered us from previous visits and we were welcomed by everyone. We spoke with people individually and we participated in an activity in the afternoon. This gave us the opportunity to get to know people and their views about the home.

People shared with us their experiences about living in the home and we spoke with three people at length. Everyone expressed positive comments. People told us, "I couldn't wish for a better place” and "The manager is good as gold, very helpful and very thorough” and “I can honestly say the staff are so very kind. We all live together happily like a family".

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the care, attention and support that people received. There was a constant interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company. It was a positive inspection and the provider was compliant in all five outcomes that we looked at.

The manager was appointed this year and had made many improvements in order to improve the care that people received. This had included, reviewing care documentation, promoting a person centred approach to care and introducing an extensive training programme.

People were positive about their experiences. Comments from people included, “I am very happy here and the manager and staff have been lovely”, “Things have really improved since your last visit and I have settled in well” and “All the staff are very kind and we are all good friends here”.

Staff we spoke with us told us, “Moral has greatly improved and there is a great team of staff”, “Communication has improved and the manager welcomes any ideas and suggestions we may have” and “The training has really helped us improve our knowledge and skills”.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at the home received.

There was constant interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company. We were introduced to people throughout the day and they welcomed us to their home. They talked freely with staff in front of us and people were confident and comfortable in their surroundings.

People living in the home were relaxed and happy when we visited. Everyone was happy to see us and wanted to speak with us on the day. Comments from people living in the home included, “Staff are wonderful, my clothes are always nice and clean and the food is good, I have no complaints at all”, “The home is very friendly; it feels like an extended family” and “I have been here a year and I couldn’t be happier”.

Staff told us, “Overall we are a very happy stable team, we all work together and want the best for people who live and work in the home”, “I like the fact that the home supports the people living here to make choices in aspects of their daily lives” and “I think people are very happy living here”.