What life is like for people using this service:

At the last inspection in February 2017, the service was rated as Requires Improvement overall, with breaches of the regulations in relation to medicines management, the safety of the environment and ineffective quality assurance systems. The provider wrote to us to tell what action they would take to comply with these regulations. At this inspection, we found that the provider had made considerable improvements and there were no longer breaches of the regulations. However, we found new areas for improvement and the service remains ‘Requires Improvement’. This is the third time the service has been rated as ‘Requires Improvement’.

Staffing levels were sufficient to keep people safe. However, staff were continually busy and were unable to deal effectively with unexpected situations while continuing to meet other people's needs in a timely manner. People’s lunchtime experience was compromised because staff were not always available to serve meals and provide support and encouragement. Whilst the provider had improved the effectiveness of their quality assurance systems, they had not recognised the need to continuously assess, monitor and review staffing levels to ensure they were sufficient to meet people’s needs at all times. We have made a recommendation that the provider sources a system that meets best practice guidance.

Although staff were stretched and could not always spend a meaningful amount of time with people, we received positive feedback from people and relatives about their relationships with staff. We saw that staff were kind and caring but on occasions, staff did not recognise that their actions failed to promote people’s privacy and dignity. Improvements were needed to ensure the provider’s training and support for staff was in line with best practice and underpinned by the key values of kindness, respect, compassion and dignity in care.

People were protected from the risk of harm by staff who understood their responsibilities to identify and report any signs of potential abuse. Risks associated with people’s care and support were managed safely. People received their medicines as prescribed. Significant improvements had been made to ensure the environment was safe for people and the provider had considered the needs of people living with dementia in the adaptations and décor.

People were supported to have choice over their daily routine. However, when people lacked the capacity to make certain decisions themselves, people were not always supported to have maximum choice and control of their lives. The registered manager and staff did not fully understand the legal requirements and did not always support people in the least restrictive way possible; the policies and systems in the service did not support this practice. We have recommended the provider researches current guidance to ensure they meet legal requirements.

People did not always receive personalised support and their care plans did not always reflect their preferences. People had discussed their care needs when they moved to the service. However, we found people’s likes, dislikes and preferences were not always recorded and people were not supported to engage in reviews of their care plans, to ensure they continued to reflect their preferences.

The service worked well with other organisations and health and social care professionals were positive about the registered manager and staff. People were supported to have a varied and healthy diet and to access other healthcare professionals to maintain good health.

There was a positive atmosphere at the service. The management team and staff were approachable and people felt able to raise concerns and complaints. People and relatives were asked for their feedback on the way the service was run. The provider acted on their comments to make improvements to the service where possible.

More information is in Detailed Findings below.

Rating at

This inspection was unannounced and took place on 15 and 16 February 2017.

Wall Heath Residential Care Home provides accommodation and personal care for up to 34 older people and for people living with dementia. On the days of our inspection there were 32 people living there.

At our last inspection on 27 April 2015, the provider was in breach of regulations 11, need for consent, 12 safe care and treatment and 14, meeting nutritional and hydration needs. The provider sent us an action plan to tell what measures they would take to comply with these regulations. At this inspection we saw improvements had been made. However, there were areas that needed to be reviewed and improved to ensure people received a safe service.

The home has not had a registered manager for week. An acting manager was in place who told us they had submitted an application to be 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.

Since the last inspection improvements had been made to ensure practices safeguarded people from the risk of potential abuse. People told us they felt safe living in the home and there were enough staff to care for them. However, some medication practices were unsafe and placed people at risk of harm.

People were placed at risk of harm because systems and practices exposed them to dangerous cleaning chemicals. Staff did not have access to appropriate lifting equipment which placed people and staff at risk of injury. Accidents were recorded, monitored and action was taken to avoid a reoccurrence.

Since our last inspection staff had a better understanding of the Mental Capacity Act and the Deprivation of Liberty Safeguards [DoLS]. However, there are areas that could be improved to ensure practices do not compromise people's human rights. Improvements had been made to ensure people’s meal preferences were catered for. People were supported by staff who may not be suitably skilled but they did receive regular one to one [supervision] sessions. People were supported by staff to access relevant healthcare services when needed.

People were at risk of receiving unsafe and an ineffective service because the provider’s governance did not assess or monitor the service provided to people. Meetings were carried out to enable people to tell the provider about their experience of living in the home. People were aware of the management team and staff felt supported by the managers to carry out their role.

People received care and support from staff who were caring and compassionate. People’s involvement in their care planning ensured their specific needs were met in a way that promoted their privacy and dignity.

People were actively involved in their care assessment and were provided with opportunities to pursue their interests. However, the environment was unsuitable for people living with dementia which may add to their confusion. People were able to maintain contact with people important to them. People felt confident to share their concerns with the managers which were listened to and acted on.

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

This inspection took place on 27 April 2015 and was unannounced. At our previous inspection in June 2013 we found no concerns in the areas we looked at.

The service provided accommodation and personal care to 34 people. At the time of the inspection there were 34 people using the service.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. The Deprivation of Liberty Safeguards are for people who cannot make a decision about the way they are being treated or cared for and where other people are having to make this decision for them. The provider did not consistently follow the guidance of the MCA and ensure that people who required support to make decisions were supported and that decisions were made in people’s best interests.

People who had specific dietary needs did not always receive the nutrition they required to maintain a healthy, balanced diet.

We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the report.

Staff told us they knew what constituted abuse and that they would report it, however we saw two recorded incidents that should have been considered as suspected abuse that had not been reported or acted upon.

Lessons were not always learned and risks to people following harmful incidents were not minimised through the use of effective risk assessment.

Medicines were safely stored and administered, however records had been altered and medicines were not always given at the prescribed times.

There were sufficient trained staff who had been recruited through safe recruitment measures to meet the needs of people and keep them safe. Staff told us they felt supported to fulfil their role through regular training and supervision and appraisal.

People had access to a range of health care professionals and were supported to attend appointments when required.

People who used the service told us they were happy and felt well cared for by the management. Interactions between staff and people were kind and compassionate. People’s privacy and dignity were respected.

People were involved in how the service was run, for example through effective communication and regular meetings.

Community links were maintained through regular community visits and planned entertainment. People were encouraged to be as independent as they were able to be and kept informed of any changes that may affect the running of the service.

People who used the service and their relatives told us the management were open, friendly and receptive. People knew that any complaints they had would be dealt with appropriately.

We found that the provider had systems in place to gain consent for care and treatment from people who used the service. We spoke with staff who told us that they respected people’s wishes and had some understanding of the Mental Capacity Act 2005.

People who used the service who told us they were happy with the care they received. One person told us, “The staff and the service are very good”. Another person told us, “They treat me very well and staff always listen to what I say”.

We saw that the provider had systems in place that prevented the risk of cross infection. We saw staff used protective equipment and staff we spoke with understood the importance of infection control. People who used the service told us that staff wore gloves and aprons and the service was always kept clean.

Staff we spoke with felt supported by the provider. Staff told us they received regular appraisals and training to carry out their role.

The provider had a system in place to record and investigate complaints about the service. People we spoke with told us that they knew how to make a complaint and any issues were acted upon.

We saw that people who used the service were involved in the planning of how their care needs were to be met. People told us that they were involved in the planning and reviewing of their care.

People received care to meet their individual needs. People told us that they were happy with the care provided and that staff listen to peoples wishes and were treated in a dignified way when providing support. People who used the service told us, "Staff treat me respectfully".

We saw that people who used the service enjoyed mealtimes and specific dietary needs were take in to account by the provider and monitored regularly.

We spoke with staff who were aware of their responsibilities to keep people who used the service safe from harm. People we spoke with told us, "I feel safe and comfortable here" and "I would speak to the manager if I wasn't be treated right".

The provider had a suitable system in place to ensure that the staff employed were suitable to work with vulnerable adults and staff employed at the service had received appropriate training.

The provider had effective systems in place to gain the views of people who used the service and made improvements when required.

The provider did not have suitable arrangements in place to inform the Care Quality Commission of any deaths or other incidents that had occurred to people who used the service.

People told us that they were happy with service looking after their medication. They also told us they were satisfied with the way staff administered their medicines.

We asked people who lived at the home about the management of their medicines and we found that people were happy with the service looking after their medicines and when their medicines were being administered.