We carried out an inspection of Walshaw Hall on the 6, 7 and 8 November 2018, the first day of the inspection was unannounced. The service was last inspected in July 2016, when it was given an overall rating of Good. Since that time the service has made changes to its registration increasing the occupancy levels from 50 people to 106 people.

Walshaw Hall 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 the care provided, and both were looked at during this inspection.

Walshaw Hall comprises of two properties, Walshaw Hall and The Beeches. There were 33 people living in Walshaw Hall and 30 people living in The Beeches, a modern purpose-built building, which is designated as a specialist dementia care unit. The top floor of The Beeches was unoccupied. The home is situated in a rural area close to Tottington.

The service had a registered manager. 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.

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

Whilst quality monitoring systems were in place to gather information about the service, we found these were not sufficiently robust nor had findings been acted upon to ensure potential risks were mitigated. Opportunities were provided for people and their visitors to comment on their experiences.

People told us that at times they had to wait for support. Staffing levels needed to be reviewed to ensure sufficient numbers were available at core times so that people receive the support they needed in a timely manner. Staff had not received all necessary training and support to develop the knowledge and skills needed to meet the individual needs of people.

Individual care records were in place. Information reflected people’s involvement where possible and had been reviewed and updated. Improvements were needed to ensure information accurately reflected the current and changing needs of people so that staff were clearly directed in the safe and effective delivery of people’s care.

People told us that occasional activities were provided however this was not consistent. We have recommended more meaningful activities are introduced so that people’s autonomy, choice and independence is promoted.

Whilst suitable arrangements were in place to ensure peoples nutritional needs were met. We have recommended improvements are made to enhance people’s mealtime experience.

We found the environment, particularly in The Beeches, did not provide a ‘dementia friendly’ environment. We have recommended the provider refers to good practice guidance about the suitability of the environment for those people living with dementia

People told us, and we observed, staff treat them with dignity and respect when offering care and support. Staff were said to be helpful and caring and understood people’s individual needs and wishes.

All relevant recruitment checks were undertaken prior to new staff commencing employment.

Relevant authorisations were in place where people were being deprived of their liberty. Care records show that capacity and consent had been considered when planning people’s care and support.

Safe systems were in place for the management and administration of people’s prescribed medicines. People had access to relevant healthcare support so that their health and well-being was maintained.

Effective systems were in place to ensure the premises and equipment were regularly serviced and safe to use. Internal maintenance checks were completed. Issues identified during the inspection were immediately acted upon so that the buil

This was an unannounced inspection which took place on 26 and 27 July 2016. The service was last inspected on 29 July 2015 when we made some recommendations.

Walshaw Hall provides accommodation for up to 50 people who have personal care needs, including those with dementia. There were 33 people living in the service on the day of our inspection.

The service had a registered manager in place 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 service is run.

During this inspection all the people we spoke with told us they felt safe in the service. Staff had received training in safeguarding and were able to tell us how they would respond to any concerns. They were also aware of the whistleblowing policy.

Recruitment processes and systems in place within the service were robust. This meant that people who used the service were protected against the risk of unsuitable people working within the service.

Risk assessments were in place in relation to hazards in the environment. We found these were sufficiently robust to protect people.

Wheelchairs, hoists and moving and handling equipment had been serviced to ensure it was safe to use. Records showed that staff members had received training in moving and handling procedures.

The registered manager and staff members all felt there were enough staff on duty to meet the needs of people who used the service. We checked the rota which was a reflection on what we had been told on the day of our inspection.

Records we looked at showed that people had been assessed in relation to their capacity. These assessments had been undertaken by the relevant and appropriate people and had involved the person and their family. We also saw that best interest meetings had been undertaken for those people who lacked capacity to consent.

All the people we spoke with told us the food was good. We checked the kitchen and found adequate supplies of fresh, fresh, tinned and dried food was available. The service had a 5* rating from environmental health.

People who used the service told us that staff members respected their privacy and dignity and knocked on their doors before entering.

Nobody in the service was receiving end of life care, however some staff members had undertaken training in this. All the staff we spoke with were able to tell us how they would care for someone at the end of their life.

Activities on offer within the service included, pamper afternoons, bingo with sherry and nibbles, singsongs, exercise sessions, greatest inventions of the times discussions, poetry corner and high tea with strawberries on Wimbledon Finals weekend. We observed a memory quiz was being held in one of the lounges.

Some care plans contained detailed information to guide staff on the care and support to be provided. However, some care plans we looked at lacked information and direction for staff members. We spoke with the registered manager and area manager regarding this. They told us the format of the care plans was still being trialled and that they were amending them when they felt improvements needed to or could be made.

People who used the service told us they were able to make their own choices such as what they wanted to eat, what they wanted to wear and how they wanted to spend their time.

Throughout our inspection we observed the registered manager interacted with people in a friendly and personalised manner. They knew the names of all the people who used the service and were able to speak in great detail about any of them.

Staff members we spoke with told us they would be happy for one of their relatives to use the service. They told us there was a good culture and the registered manager was

We carried out an unannounced comprehensive inspection of this service on 24 March 2015 and found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in us serving two warning notices and making three requirement actions.

People who used the service and others were not protected against the risks associated with unsafe management of medicines. Service users were deprived of their liberty for the purpose of receiving care or treatment without lawful authority. The systems and processes in place to ensure the service was assessed, monitored or improved were not sufficiently robust to identify where quality needed to improve. In the process of meeting a service user’s nutritional and hydration needs, there was no regard to the service user’s well-being. There was also a lack of sufficient hand washing facilities in areas throughout the service.

As a result we undertook an unannounced focussed inspection on 29 July 2015 to follow up on what action had been taken to address the warning notices and requirement actions.

Focussed inspection of 29 July 2015.

The warning notices stated that the provider and registered manager must be compliant with these regulations by 15 June 2015. The registered manager sent us an action plan in regards to the requirement actions informing us they would be compliant with these by 04 July 2015.

We undertook an inspection on the 29 July 2015 to check that they had met these legal requirements and found that they had met the warning notices and all requirement actions had been complied with.

During this inspection we found the management of medicines was safe.

People’s care records contained sufficient information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk.

We saw there were risk assessments in place for the safety of the premises and suitable arrangements were in place with regards to fire safety.

We found that wooden door wedges were no longer being used in the service and these had been replaced with ‘door stops’ (heavy material weights). We further recommend the service considers contacting the local fire authority for advice on this.

We saw that hazardous substances were stored securely.

People who used the service had their own personal toiletries and hand washing facilities were available in all bedrooms and bathrooms.

The registered manager had made 26 Deprivation of Liberty Safeguards (DoLS) applications to ensure that people who used the service were not restricted unlawfully.

We saw people’s dietary needs were catered for. Jugs of water/juice were available in communal areas for people to help themselves to.

People who required support were assisted to eat their meals in a timely and sensitive manner.

People who used the service had eating and drinking care plans in place. We saw people had been referred to a dietician if a risk was identified.

People who used the service told us staff were kind and caring. We saw interactions from care staff that were kind, sensitive and respectful.

Regular audits were undertaken in areas such as medicines, complaints, risk assessments, care plans and infection control.

Some policies and procedures had been reviewed and updated. This process was ongoing.

This was an unannounced inspection which took place on 24 March 2015 and 7 April 2015. The service was last inspected on 23 September 2013 when we found it to be meeting all the regulations we reviewed.

Walshaw Hall provides accommodation for up to 50 people who have personal care needs, including those with dementia. There were 44 people living in the service on the day of our inspection.

The service had a registered manager in place 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 service is run.

During this inspection we found that a staff member failed to recognise that a safeguarding incident had occurred and did not report this to the registered manager.

People were at risk of receiving unsafe care and support as risk assessments were not in place to show how identified risks were to be managed.

Correct recruitment procedures were not followed for volunteers. This meant that people who used the service were not protected against the risk of unsuitable people working within the service.

We found the management of medicines was unsafe and did not protect people who used the service. Care staff members handled medicines with their bare hands, medicines were not stored safely, inaccurate recordings of when medicines had been given and there was no robust system in place to account for controlled drugs.

People who used the service had access to hazardous substances. A clinic room and hairdresser’s room containing sharp objects and hazardous liquids were unlocked.

We found the registered manager had identified a number of people for whom a Deprivation of Liberty Safeguards (DoLS) application was required. However, we found that no applications had been made and consequently people were being deprived of their liberty unlawfully.

People who required support to eat were left for long periods of time with their food in front of them before assistance was given. Those people who were supported to eat their meal were not given sufficient time to swallow their food.

People were not given a choice of what drink or biscuit they would like during the drinks service. Staff chose the biscuit and handed this to people with their bare hands.

We observed one staff member treat people in an undignified and disrespectful manner. A safeguarding alert was raised regarding this concern by the registered manager and the inspector.

Confidential information about a service user’s medication was displayed on a notice board in a thoroughfare.

People were sitting in wheelchairs for long periods of time in the main lounge and library areas. The registered manager and staff members could not tell us why people had not been supported to transfer to a comfortable chair.

There was a lack of stimulation for people with dementia. Sensory equipment was stored in the attic area of the service and not made readily available for people to use.

Care records we looked at did not contain sufficient information to show how people who used the service were to be supported and cared for.

People’s health and welfare was at risk due to the lack of risk assessments for choking, pressure ulcers and bed rails.

There were no robust systems in place to assess and monitor the quality of the service provided to ensure people received safe and appropriate care.

The registered manager lacked knowledge in key areas such as Deprivation of Liberty Safeguards (DoLS).

During this inspection we found the service was clean and people were able to personalise their rooms to their own tastes.

People told us their privacy and dignity was always maintained.

People knew how to make a complaint and told us they felt able to approach the staff with any concerns.

The registered manager had regular meetings for people who used the service where they were able to discuss anything about the service or their care.

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

We saw that appropriate arrangements were in place to help safeguard people from abuse.

During our visit to the home we spoke with one of the people using the service and asked them to tell us how their medicines were managed. They told us their medicines came on time, and did not raise any concerns with us.

The provider had a satisfactory system in place for checking the quality of care the service provided.

People using the service were protected against the risk of unsafe or inappropriate care and treatment because records contained enough information to protect their safety and wellbeing.

We looked at the care files for three people. Their needs had been assessed and care workers told us they knew what these needs were. There were some gaps in the records, particularly around the recording of people’s mental capacity and food intake. We saw an example of the home applying to the local authority for a Deprivation of Liberty Safeguard (DoLS). Staff were aware that making a decision in the person’s ‘best interest’, as they lacked the capacity to do so, would have deprived them of their liberty.

People told us they were satisfied with the care and support they received. They said they had a choice of appetising food at each mealtime. They also said that staff asked for their consent prior to care or support being given.

There was a complaints procedure in place and people said they felt able to approach staff if they had a complaint.

We saw that assessments and monitoring of the quality of the service provided were not routinely carried out. Procedures were in place stating quality audit reports should be completed and analysed, but the manager told us they were unaware of this requirement.

During our visit we spoke to two people who used the service. They told us:

“I love being here; they are all so good and caring”.

“Marvellous”.

“They look after me well and I have no complaints”.

During our visit to Walshaw Hall on the 9 February 2012 we spoke with four people who use the service and with two relatives.

The people that we spoke with were very complimentary about the staff and the way they were cared for. Some of the comments were:

“I really love this place, I love everything”.

“The staff are really good, they can’t do enough for you”.

“I have only reached the age that I am because I live here. It’s the way they look after you”.

“I have total choice in how I spend my day”.

“They are really very good. If anything goes wrong they are in and out checking on you”.

“Can’t fault them”.

“They give good care”.

“Of course they look after me, they are smashing”.

People that we spoke with told us that they "felt safe" and “had no worries”.

People using the service told us they were well looked after. Comments made were, “It was the only place I wanted to come to as I had heard such good reports about it and I am not disappointed” and “Absolutely fine, well looked after”. The care plans that we looked at however did not contain enough information to show how people were to be looked after. They were not always accurate or up to date; putting people at risk of receiving unsafe care and treatment.

The systems in place to help protect and safeguard vulnerable people from the risk of abuse were not adequate. Staff had not received training in the protection of vulnerable adults.

The management of medicines was unsafe. This could place people's safety, health and well being at risk.

Management had started to gather information about the quality and safety of the service provided. The systems in place however, were not robust enough to help protect people against the risks of inappropriate or unsafe care and treatment.

People's care and medication records were not always accurate or up to date, putting them at risk of receiving unsafe care and treatment.