This unannounced comprehensive inspection took place on 17 and 18 December 2018.

Wealstone is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and we reviewed both areas during this inspection.

This is the first time this service has been inspected under the new registered provider.

The service has 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.

Wealstone is a single storey residential care home which has 42 single bedrooms, seven of which have en-suite facilities. Within the 42 beds, there is a separate 11 bedded unit called Bluebells that provides care for people with mild dementia. At the time of our inspection there were 37 people living in the home.

The building was not always clean and hygienic. This visit found that there were offensive odours in some bathrooms and toilets and that areas were not clean and had not been subjected to a thorough deep- clean in order to maintain hygiene standards and minimise the spread of infection. The second day of our visit found that some remedial action had been taken but this was not sufficient to address the issue. Some maintenance issues had also been identified within the building.

The registered provider did not have effective systems in place to monitor the quality of the service. For example, not all people had a care plan in place and this had not been identified by the registered provider before we visited. This was subsequently addressed. The registered provider had also not identified before our visit that concerns from a relative had not been responded to. This had now been addressed. While the registered provider routinely sent notifications to us regarding significant incidents, they had not understood the procedure for notifying us of significant grades of pressure ulcers.

The registered provider had systems in place to ensure that people were protected from abuse. Staff were aware of who to contact if they had concerns about the care provided by the service.

Staffing levels were maintained although difficulties in recruiting domestic staff had had some impact on cleanliness standards within the building. Staff were recruited appropriately.

The management of medication was safe. Assessments were in place to ensure that people were not at risk of malnutrition, pressure ulcers or falls.

Equipment used by people were regularly checked to ensure that their use was safe.

Staff received the training they required to perform their role. Staff were also supervised appropriately.

The registered provider ensured that people’s nutritional needs were met. The health needs of people were responded to appropriately.

The registered provider operated within the principles of the Mental Capacity Act 2005.

People felt cared for and that they were treated in a kind and patient manner. People had their personal information protected. People had access to advocacy service if they wished.

Care plans were person centred. Not all daily records were detailed.

We have made a recommendation in respect of daily record writing.

An activities programme was in place. Details on activities were not always advertised in line with people’s communication needs.

We have made recommendation in relation to reviewing information provided to people in line with their communication needs.

A complaints procedure was in place but issues with the governance of the service meant that not all were responded to in a timely fashion.

The staff team felt supported by the registered manager. The views of people were asked for a