This inspection took place on 23 March 2016 and was unannounced. Welbourn Hall provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 36 people living at the home. The home is divided into two units, the main hall and the Willows. The Willows provides care for people with dementia.

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.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe from accidents.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

People’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

Staff received training to help them to provide appropriate support to people. The provider had a training plan in place and staff had received regular supervision.

Staff usually obtained people’s consent before providing care to them. People had access to a range of leisure pursuits and activities. Staff had an understanding of people's life experiences and used this information when supporting them in leisure pursuits.

Staff felt able to raise concerns and issues with management. Relatives were clear about the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Audits and systems were in place for areas such as falls and infection control. The provider used nationally recognised systems and processes to support the development of the service. Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

The home provided care to people in two units.

Many of the people who lived at the home had dementia and were unable to talk to us about their care. We spoke with staff and looked at records.

To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI) tool. The tool allows us to spend time observing and helps us to record how people spend their time. We carried out the tool for an hour and observed four people. We observed positive responses and contact with people.

Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care in both units and saw staff were responsive to people and interacted with them positively.

We observed staff offering activities to people. We heard staff ask people “Shall we paint your nails.” We observed another group of people completing a jigsaw and heard staff ask a person if they wanted to join them.

We saw staff explaining their care to people. For example a person had an apron on and they asked. “What have I put this on for” and staff explained it was to protect their clothes.

We saw from the care plans people received care which was appropriate to their needs.

We also looked at the cleanliness of the home and the systems which protect people from the risk of infections. We found the home had systems in place to protect people from infections and care for them in a clean environment.

Many of the people who lived at the home had dementia and were unable to talk to us about their care. As part of our inspection we spoke with a person who used the service. We spoke with staff and relatives and looked at records.

On the day of our visit the manager was unavailable and we could not locate some information. The provider forwarded additional information to us after the visit.

Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities. We did not find evidence that all staff had received appraisals to support them in their roles.

To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI) tool.The tool allows us to spend time observing and helps us to record how people spend their time. We carried out the tool for an hour. We observed positive responses and contact with people.

People told us they liked living at the home. One person said, “Couldn’t wish for anything better.” We asked people about staff they said, "Very kind here." One person when asked about the food said, “Can’t go wrong” and “You can have what you want.” We saw from the care plans people had choices, for example whether they preferred a bath or shower.

During our visit we were unable to evidence regular quality monitoring. We looked for examples of involving people in monitoring but found this was not available.