We inspected Welbourn Manor on the 19 November 2018, the visit was unannounced. Welbourn Manor 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. Welbourn Manor is registered for 31 people in one adapted building. On the day of our inspection, 23 people were living at the service.

There was a registered manager in post who was available throughout the 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.

Environmental risks had not always been assessed and measures put in place to reduce risk to protect people at the service. Although individual risks to people’s safety had been assessed, there was a lack of information in people’s care plans to provide guidance for staff to provide appropriate care to reduce ongoing risks to people’s care. The information was not always up to date and although nationally recognised assessment tools were used to assess people’s needs, the guidance in the tools was not always used to provide people with the level of care required.

Staffing levels, especially at night did not reach the established number identified to provide consistant safe care. People were not always protected from the risks of cross infection ,as staff were not always provided with timely training and support to undertake their roles.

People were protected from potential abuse as staff were aware of their responsibilities to keep them safe and there were clear processes for managing safeguarding concerns. However the service did not always show learning from incidents and accidents to ensure a reduction in reoccurance of incidents. People’s medicines were managed safely.

People were supported to maintain a healthy diet, with staff showing good knowledge of people’s nutritional and health needs. They received support to manage their health needs through well-developed links with local health professionals. The environment people lived in was not always well maintained to meet the needs of the people who lived there.

Staff sought consent from people before caring for them. However, the principles of the Mental Capacity Act, 2005 (MCA) were not always followed. There was a lack of clear assessment of people’s mental capacity to show they were receiving the most appropriate support to have maximum choice and control of their lives, and be supported in the least restrictive way possible.

People at the service, and relatives were treated with kindness and care by staff who supported people with respect and dignity. however there were times when people’s views and opinions on their care was not considered in line with their choices, and care was delivered in a task orientated way.

People could maintain relationships with people who were important to them, and relatives felt their views and opinions about their loved one’s care were listened to.

The care people received was not always person centred and their care plans lack sufficient detail to support staff to meet people’s individual needs. People were supported to take part in a range of social activities to prevent isolation. Their wishes in relation to their end of life care were discussed with them so their wishes were known. There was a complaints procedure in place and people knew who to complain to should they have any issues.

The service was not always well led, the registered manager was visible and supportive towards people, their relatives and the staff who worked at the service. However, there was a lack of consistant support from the senior management team, and the qua

We inspected Welbourn Manor Care Centre on 26 April 2017. Our inspection was unannounced. The home provides care and support for up to 31 people, some of whom may experience memory loss associated with conditions such as dementia. When we undertook our inspection there were 20 people living at the home.

The home was run by a company who was the registered provider. 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘The registered persons’.

At the last inspection we carried out the home was rated ‘Good’.

At this inspection we saw that the registered manager had made our last inspection report available for people who lived in the home and visitors to see and read. We also found the provider had ensured their website contained the current rating for the home.

During this inspection we found some areas in which improvement was needed to ensure people were provided with care that was safe, effective, responsive and well-led and that the provider's regulatory responsibilities were being met in full.

This was because the registered provider had not ensured the arrangements for the safety, and maintenance of the building were consistently being planned for and managed.

Care staff had not received all of the training they needed to ensure they could meet people’s needs in an effective way.

People were supported to make decisions for themselves. However, when people needed additional help to make specific decisions about how care was provided, the detail about which decisions had been made and by whom had not been fully reflected in the care records. In addition, care plan reviews did not give clear enough information about the effectiveness of the care being provided, who had been involved in the reviews or any actions planned or taken after reviews had been completed.

The provider’s quality assurance and audit systems were also not reliably or consistently managed so as to enable them to quickly identify and resolve shortfalls in the services provided for people.

In other areas, the registered persons were meeting people’s needs effectively.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support at the times they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People’s emotional needs were recognised and responded to by a staff team who cared about the individuals they were supporting. People were able to enjoy a social life and to develop and maintain their interests.

People were invited to give their views on how the service was run.

Prior to our inspection we reviewed all the information we had received from the provider about the home.

As part of our inspection visit we spoke with six people who used the service and three visiting relatives about their view of the home. We also spoke with four staff members and the registered manager.

One person said, “There is plenty of heating and water. I like the place and it feels homely.” A visiting relative said, “We as a family are very happy with the care given to xxx.”

We spoke with three staff members who said they felt they had enough time and support to care for people and respond to their changing needs.

We saw systems for staff recruitment were safe and the proper checks were carried out in advance before any new staff member started to work at the home.

Overall we found the service was well led and the manager had training and supervision arrangements in place to support staff to enable them to carry out their work safely.

We also found there was an effective system in place for the provider to monitor and assess the quality of services within the home.

We found that people were cared for in a clean, well presented home. People’s care was based about their individual needs. The staff provided care in a pleasant and professional manner. One person living at the home said, “I’ve no complaints at all.”

We saw staff had time to interact with people and were attentive to people's needs. Their interaction with people was friendly, respectful and professional.

We saw the cook provided a choice of hot and cold foods at each mealtime. One person said, “The food is good, really good.”

We looked at how the premises had been maintained. One staff member told us, “The building is really well looked after, it’s so old but they keep it really nice.”

A person told us how someone had visited them prior to them coming to the home and completed an assessment of their needs with them.

People told us they felt they were treated with respect and encouraged to be independent. One person told us, “We are as independent as we are able to be. I can’t stand, can’t walk, but I do what I can do for myself.” Another person said, “Our privacy and dignity is respected.”

People said their needs were known before they moved to the home and they felt the care and support provided met their needs. They also said they were happy how their care was provided and they thought staff do “all they can.” One person told us, “I enjoy coming back here after I have been out, it feels like home.”

Another person said, “I still read and watch TV. I can argue a bit! Most of the things I want to do I can do here. There is a very good activities lady. They got a bus that can take wheelchairs and we went out for a meal. It made a nice change, I hope it will happen again.”

We asked people if they felt safe in the home and they said they did, and they told us they did not feel they had ever been put at risk. One person told us they felt safe because, “I ring the bell and someone comes.”

People told us that staff speak with them and treat them in an appropriate way and they did not have any concerns about how they had been treated.

People told us the staff who supported them knew what they were doing and they had been able to provide them with the support they required. One person said, “Yes, they all know what they are doing, they know more about what I need than I do!”

Another person commented they thought staff worked well together as a team and when they were supported by two care staff they felt comfortable. They also said “You have to give the younger ones (new staff) a bit of time, but they soon learn.”

People said they attended residents’ meetings where they had been able to express their views about the home. They said they thought the building was lovely and praised the enthusiasm of the staff. They also said they thought the manager and deputy manager were very good and ran things well.