Wainford House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Wainford House is registered to provide personal and nursing care to a maximum of 28 older people. At the time of inspection there were 26 people using the service.

At the last inspection on 22 and 23 November 2017, we rated the service ‘Requires Improvement’ overall and we told them to make improvements to the quality assurance system in place and how people’s capacity and consent to care was assessed and recorded. At this inspection, we found that the standard of service provided to people had deteriorated. The service was found to be in breach of Regulations 12, 9, 10, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A new manager had started working for the service three weeks prior to our inspection and was in the process of registering with the Commission. 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 not enough suitably skilled, supported and knowledgeable staff to meet people’s needs in a timely way, including their social and emotional needs. People told us staff did not have time to spend with them and that interaction with them was linked to tasks.

People were not adequately supported to be engaged in meaningful activities and people told us they got bored.

The provider had failed to bring about sustained improvement to meet the fundamental standards and maintain compliance with regulations. The service has not met the fundamental standards or complied with regulations since an inspection in March 2014. This means that people have continued to receive a poor service over an extended period of time.

The décor and overall condition of the service did not promote people’s dignity and respect. Some areas of the building were in a poor state of repair and redecoration had been completed to a poor standard. The service was not decorated in a way which helped people living with dementia orientate themselves around the building.

Medicines had not always been administered in line with the instructions of the prescriber and it was not clear why. This had not been identified and acted on by the service.

There were environmental risks that had not been identified by the service. Actions to ensure the safety of the premises had not always been completed and checks were not consistently carried out to identify issues.

Not all staff had received training in key subjects, nor had they received regular supervision or appraisal to develop their skills. The new manager had identified this and booked all staff onto training.

People and their relatives told us they did not remember being involved in care planning. Care planning did not make clear people’s views about their care and evidence their involvement. Improvements were required to fully personalise care plans and improve information about people’s personal preferences. Despite this, staff knew people well and provided them with personalised care.

The service was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Risks to people were appropriately planned for and managed. Staff understood the risks to people and how they could be reduced. People received appropriate support to maintain healthy nutrition and hydration.

Staff treated people with dignity and respect. People were suppor

Wainford House is a ‘care home’. 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 care provided, and both were looked at during this inspection. Wainford House provides accommodation and personal care for up to 28 older people some living with dementia. At the time of our inspection there were 27 people living at the service.

This unannounced comprehensive inspection took place on 22 and 23 November 2017.

There was a registered manager in post when we inspected the service. 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.

The overall rating of this service was Requires Improvement at our last inspection of 6 July 2016. The key questions Effective, Responsive and Well-led were rated as Requires Improvement. Safe and Caring were rated as Good.

There had been some improvements made in the service but not sufficiently in Effective and Well-led which remain at Requires Improvement and therefore the service rating remains overall at Requires Improvement.

We undertook this unannounced inspection to provide a rating for the service and to check that the service was now meeting legal requirements. There had been a breach in regulations regarding the implementation of the Mental Capacity Act 2005 (MCA). We found that improvements had been made but that further improvements were still required with documentation.

People were not always fully involved in the writing and review of their care planning. Staff had been trained in the MCA and Deprivation of Liberty Safeguards. We observed that they put this training into practice when providing day to day care. However, the principles of the MCA were not always put into practice with regard to recording information in people’s care plans about mental capacity assessments and best interest decisions

People felt safe living in the service. There were systems in place designed to protect people from the risk of harm. Individual risk assessments were in place and covered key risks specific areas to the people such as personal emergency evacuation plans, moving and handling and falls.

The staff demonstrated a clear understanding of the actions they would take if they suspected or witnessed any concerns about people’s safety. Risks were assessed and management plans were in place to minimise the risk to people’s safety. Medicines were managed safely and sufficient numbers of staff were deployed to meet people’s needs.

Staffing levels were calculated using a dependency tool and there were sufficient numbers of staff to support people to meet their individual needs. Safe recruitment practices were followed. Staff had received training and support to enable them to provide people with appropriate support.

Staff had received infection control training and used this information for the storage of food and cleanliness of the accommodation.

The registered manager learned from incidents or accidents within the service and made the necessary improvements. They shared this information with the staff through supervision and staff meetings.

Staff were provided with a wide range of training appropriate to the various needs of the people living at the service. People were provided with a healthy and well balanced diet and their choices had been taken into consideration.

Other professionals worked with staff so that people had access to healthcare services and on- going healthcare support.

People were involved in the running of the service. They had been asked to give their views about the decoration of the premises. The decoration and signage within the service had been updated and improved.

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This inspection took place on 6 July 2016 and was unannounced.

We had previously carried out an inspection on 16 February 2016. Breaches of legal requirements were found. After that inspection the provider wrote to us to say what they would do to ensure legal requirements were met.

We undertook this inspection to check that they had followed their plan and to check if they were now meeting legal requirements. We found that improvements had been made but that further improvements were still required.

Wainford House is a care home providing care and support to a maximum of 28 people. On the day of our inspection there were 23 people living in the service some of whom were living with dementia.

The service had a registered manager in place. 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 were not always fully involved in the writing and review of their care planning. We have made a recommendation about involving people in decisions about their care.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. We observed that they put this training into practice when providing day to day care. However, the principles of the MCA were not always put into practice when sharing information with others.

The decoration and signage within the premises did not meet the needs of people living in the service, particularly those living with dementia. We have made a recommendation regarding decoration of the service.

People felt safe living in the service. There were systems in place to protect people from the risk of harm. Individual risk assessments were in place and covered key risks specific to the person such as moving and handling and falls.

Staff levels were calculated using a dependency tool. We were told, and observed, there were sufficient numbers of staff on duty to support people’s needs. Safe recruitment practices were followed. Staff had received training and support to enable them to provide people with appropriate support. Support with training had been sought from key agencies outside the service.

People were involved in meaningful activities. Staff provided a range of activities for people to participate in. Plans were in place to develop and personalise activities.

The Registered Manager was developing an open and honest culture within the service. They were receiving support from the provider to do this. A range of audits were in place or being planned to monitor the quality of the service provided. These need to be sustained and used to drive improvement in the service.

Wainford House is a care home providing care and support to a maximum of 28 older people, some of whom were living with dementia. At the time of our visit there were 27 people using the service. The inspection was unannounced and took place on 16 February 2016.

We carried out an unannounced comprehensive inspection of this service on 12th October 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wainford House on our website at www.cqc.org.uk.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

• Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

The home had a registered manager in place. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.

People told us they felt safe living in the service. However, people were put at risk of harm because care records and assessments did not reflect current areas of risk and how these should be managed to protect the person from harm.

Medicines were not consistently managed and administered safely.

People told us, and we observed, that there were not always enough staff available to meet people’s physical and emotional needs. The manager had not made improvements to the staffing levels.

The manager and provider had not taken action to ensure the competency of staff following our previous inspection where we identified that the training staff had received was ineffective and did not provide them with the knowledge they required for the role. Staff did not receive the appropriate support from the management of the service to develop in their role.

Improvements had been made to ensure that appropriate Deprivation of Liberty Safeguards referrals had been made where required, and assessments of people’s capacity had been completed where appropriate. However, staff remained confused and unsure about the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.

People were not consistently supported to live full and active lives, and to engage in meaningful activity within the service.

Care planning for people did not reflect their current needs and the information was generic. There were limited life histories for people living with dementia, and care records were not personalised to include people’s hobbies, interests, likes and dislikes. Some work had been undertaken to improv

Wainford House is a care home providing care and support to a maximum of 28 older people, some of whom were living with dementia. At the time of our visit there were 27 people using the service. The inspection was unannounced and took place on 12 October 2015.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

• Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

The home had a registered manager in place. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.

People told us they felt safe living in the service. However, people were put at risk of harm because care records and assessments did not reflect current areas of risk and how these should be managed to protect the person from harm.

People told us they did not always receive their medicines when they needed them. Medicines were not managed and administered safely.

There was a recruitment procedure in place to ensure that prospective staff members had the skills, qualifications and background to support people. However, further action is required to improve the quality of the checks carried out on new staff members before they commence work.

People told us, and we observed, that there were not always enough staff available to meet people’s physical and emotional needs.

The manager had not identified that the training staff had received was ineffective and did not provide them with the knowledge they required for the role. Staff did not receive the appropriate support from the management of the service to develop in their role.

The service was not complying with the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Appropriate DoLS referrals had not been made where required, and assessments of people’s capacity had not been completed where appropriate.

People were not supported to live full and active lives, and to engage in meaningful activity within the service. People told us they were bored, and we observed that people did not have access to appropriate stimulation during our inspection.

Care planning for people was out of date, did not reflect their current needs and the information was generic. There were limited life histories for people living with dementia, and care records were not personalised to include people’s hobbies, interests, likes and dislikes.

Improvements were required with regard to how people are involved in the planning of their support in the future, and how their views are reflected in their care records.

There was a complaints procedure in place but people told us they did not know how to complain.

There were no current systems in use to monitor the quality of the service and to identify shortfalls and areas for improvement. There wasn’t an open culture at the service. There was no process in place to gain the feedback or views of staff, and staff were not included in the development of the service. People and their relatives were supported to give feedback on the service during surveys, but this information was not used to improve the service and people told us they didn’t feel listened to.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection to follow up on non-compliance identified during our inspection on 3 December 2013. A new manager was appointed soon after that inspection, and they sent us an action plan setting out what action they were going to take to become compliant in the four areas found not compliant during our inspection on 3 December 2013.

We greeted and talked generally to people who used this service, but did not ask their opinions about the their care or running of the service on this occasion.

During this inspection we found that the new manager had instigated changes and improvements to the quality assurance monitoring within the service and they were now compliant. We looked at the way the service assessed and monitored the quality of service it provided and found that the provider had an effective system to regularly assess and monitor the quality of service that people received .

We saw that the service had taken precautions to protect people from infection and that staff had received training in infection control and food hygiene.

We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We carried out this inspection to follow up on non-compliance identified during our inspections of 06 and 09 September 2013. We found some improvements had been made since our last inspection but we found other areas which were still in need of improvement. In particular a new kitchen had been fitted which had been awarded a level 5 hygiene rating by the environmental health officer.

We looked at the care records of four people who used the service. We found that they contained appropriate assessments of people's needs and plans for their care. An infection control specialist looked at infection control in Wainford House and has identified a number of areas for improvement. A pharmacy inspector inspected the management of medicines within the service and has again identified some areas for improvement.

We looked at the way the service assesses and monitors the quality of service it is providing. We found that accurate records relevant to the management of the premises were not always kept and that although audits were being carried out these were not effective.

We inspected this service to assess compliance with issues we had identified and raised at our previous inspection and also following information of concern we had received.

During our inspection we spoke with six people who used the service. They told us about the care and support they received. One person said that they thought the care was, “Reasonable.” They added that they were, “Luckier than some of the people here because I can still get out and about on my own.”

We looked at the care people received and found that there had been significant improvements in the quality of care plans since our last inspection. However, this still required further attention.

We looked at the maintenance of the premises. We found that the premises were not adequately maintained or cleaned. Cleaning schedules showed that cleaning of the premises was not planned and cleaning which took place was not monitored.

The service did not have an effective complaints system in place. People were not able to bring complaints to the attention of the service with confidence that they would be investigated.

The service did not have effective systems in place to assess and monitor the quality of service which was being provided.

The service had improved record keeping since our last inspection. Care plans had been revised and were kept in a secure cabinet.

During our inspection we spoke with three people living at the service and one friend of a person living at the service. All were happy with the service provided. One person said "It is a nice place." Another said, "The girls always come when I ring."

We inspected four people's care records. We found that they were not kept securely and did not accurately reflect the care and treatment people required. Advice from visiting professionals such as a social worker was not followed.

The service did not have an effective complaints procedure.

We inspected the premises and looked at maintenance records. We found that maintenance and cleaning was not adequately planned and recorded.

We spoke with nine people who used the service who told us that the staff treated them with respect and respected their privacy. Comments made by people about the approach of the staff included "They are very nice to me," "If I want a little help they are very obliging" and "They are very kind."

People said that they were consulted about the care and support that they were provided with and the staff listened and acted on what they said. One person said "They (staff) read my care plan to me and I told them that I agreed with it". People said that they felt that their needs were met. One person said "You only have to ask and they (staff) do their level best.”

People told us that they were provided with enough to eat and drink and that the quality of the food was good. They also said that they could choose what they wanted to eat and drink. We asked a person if they felt that they were provided with enough to eat and they answered "Definitely." Another person said they were provided with "A jug of fresh water in my room every day."

We spoke with eight people who used the service who told us that their needs were met, that they were treated with respect and that their choices and views were listened to and acted upon. People told us that they were provided with enough to eat and that the quality of food that they were provided with was good. They told us that the home was clean, comfortable and warm.

We found that since our last inspection the premises were cleaner, the overall atmosphere had improved and new complaints procedures were in place. Everyone who used the service had a copy of the new procedure in their room.

We looked at the care records for five people who used the service. They contained conflicting information and had not involved the person they related to or their relatives. Other records we looked at included medication records, quality audits and cleaning schedules. We found a number or omissions and errors in all of these records and could not be satisfied that they were accurate or up to date.

Measures to assess the quality and effectiveness of the service provided were not sufficient and there was no evidence that where errors were identified, appropriate action was being taken.

Although work had started on installing a new kitchen this had not taken into account the impact on people who used the service. Measures were put in pace while we were there to remedy this.