We inspected Well House on 06 July 2017. This was an unannounced inspection. At the last inspection completed on 30 September 2015, we found the service was meeting all of the legal requirements we looked at. We provided an overall rating for this service of 'good'.

Well House provides accommodation and personal care for up to 43 older people who may also be living with dementia. The service does not provide nursing care. At the time of our inspection there were 32 people using the service.

At this inspection, we found four breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

The service had a registered manager in post who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The registered provider had not ensured effective medicine management systems were in place at the service. There were no protocols in place for medicines that are prescribed as and when needed. We found discrepancies in stock levels of medicines.

The registered manager had not done all that was required to reduce risk. Moving and handling risk assessments were not being updated and bedrails were in place without an appropriate risk assessment.

The provider had not ensured that the building was well maintained. We found that windows were in a poor condition, and two bathrooms had been condemned and were not in use. Some refurbishment works had been started but other works did not have specific dates of completion.

The provider had not worked in line with the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) as mental capacity assessments and best interest information was not recorded when people's freedom of movement was restricted. There was no overview in place for deprivation of liberty safeguard authorisations, which meant the registered manager did not have oversight of authorisations in place or whether people still required them. We saw that people were supported with making decisions around their care. Staff sought people's consent before providing them with care and support.

There were gaps in staff training. We requested a revised training record which showed there were many staff who required updates in mandatory training subjects such as health and safety and fire training. Some training, such as safeguarding adults had been updated but other subjects still required updating.

Arrangements were in place for the provision of meaningful activities and stimulation. However, these arrangements were not consistent or always available for people that used the service. More opportunities are required particularly for people living with dementia. We have identified this as an area of practice that needs improvement.

People could not be assured that they would receive the support they required as care plans did not always contain accurate, up to date information.

Quality checks had not reliably identified and resolved shortfalls in some aspects of the quality and safety of the service provided.

Appropriate recruitment checks took place before staff started work. Sufficient staffing levels were being maintained.

Staff spoke positively about wanting to provide people with a high standard of care. People were supported by staff that knew them well. People were treated with kindness and compassion in their day-to-day care. People and their relatives spoke highly of the staff and the care and support they provided.

People were happy with the food and drinks provided. The chef had a good knowledge of people's likes and dislikes. People also had good access to drinks and snacks.

The above concerns in relation to the quality a

During our inspection we saw that people received care that met their needs. We noted that improvements had been made since our last inspection and overall staff understood people’s preferences and delivered care respectfully.

On the day of our inspection we saw that people enjoyed their lunch and we saw that there were processes in place to ensure that people received appropriate nutrition to meet their specific needs.

Staffing levels were sufficient to meet the needs of people who lived at Well House; staff received the support and training they needed to enable them to care for people safely.

Suitable arrangements were in place to support staff and provide training to enable them to deliver care safely.

People’s views were taken into account and there were processes in place to make improvements in response to any concerns raised or feedback from people who used the service.

Improvements had been made to records which contained the information staff needed to deliver care safely.

We visited Well House on the 30 April 2013 and found that the provider was not compliant with Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. A warning notice was served on the 5 June 2013 informing the provider that we expected them to be compliant by the 5 July 2013.

We visited the home to follow up on the warning notice on the 8 July 2013.

We found that the provider had taken steps to improve the care management and associated record keeping at the home.

On this occasion we did not speak to the people living in the home about the inspection but those we spoke with were happy and comfortable within their surroundings and the interactions with staff were positive.

We had conversations with nine people living in the home, four relatives who were visiting at the time of our inspection and one relative following our inspection. People we spoke with were very complimentary about the home and the staff. One person described the staff and manager as “wonderful“. Another told us: “Staff make it feel like home.” One relative considered that the standard of care and support varied, depending on which staff were on duty. Another relative described the staff as “very supportive”.

As part of this inspection we checked on the standards that were not met at our last inspection in May 2012. These related to care and welfare, staff training and record keeping. The care plans and risk assessments were still not being kept up to date following changes in people’s medical condition and care needs. This meant that people’s care and treatment was not planned and delivered in a way that ensured their health, safety and welfare and enabled staff to provide a consistent standard of care.

Staffing levels were not consistent and this at times impacted on the standard of care provided. People’s nutritional needs were not always being met. We found that there were still gaps in staff training and therefore people using the service could not always be assured that their care and support would be delivered safely and to an appropriate standard. The service had a quality assurance programme but greater analysis was needed for it to be effective.

As part of our inspection of Well House we had conversations of various lengths with seven people living in the home and with three relatives, who were visiting at the time of our inspection. One relative who contacted us following our inspection considered that the home was short of staff at times. People and the relatives we spoke with during our inspection told us that they were happy with the standards of care in the home. One person said “I’m really happy here. I haven’t had to complain about anything.” Another told us “I’m contented. I can’t think of anything that could be better.” A relative confirmed this by saying “I can’t fault the home. The carers are lovely.” We observed that people with more advanced dementia were treated in a caring and respectful manner and that staff spent time offering choices and establishing their needs and wishes.

We carried out an unannounced inspection at Well House on 04 January 2012. During our inspection we had conversations of various lengths with five people living in the home. People told us that they were happy with the standards of care at Well House. One person said “I feel safe here because they look after me so well. If there’s anything I need I’ve only got to ask.” We observed two people with advanced dementia interacting with each other and showing great enjoyment while looking and pointing at a vase of fresh flowers in one of the communal areas.

During our unannounced inspection on 05 September 2011 we had conversations of various lengths with nine people living in the home. People looked more content and we saw them regularly chatting and laughing amongst themselves. One person told us “Everybody on the staff is kind and helpful in every way.” Another said “People are well looked after. It’s a lovely place.” Two people told us that they did not want to be in the home. We did not observe any staff engaging people in meaningful activities or stimulation during our inspection. Four people told us that there was nothing for them to do during the day. People told us that the home was kept clean and that they liked the food, although two people told us that the meals were sometimes cold.

The inspection took place on 30 September 2015 and 1 October 2015 and was unannounced.

Well House provides accommodation and personal care for up to 43 older people who may also be living with dementia. The service does not provide nursing care. At the time of our inspection there were 31 people using the service.

A registered manager was in post at the service. 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.

People were safe because the manager and staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

Staff had been recruited safely and they had the skills and knowledge to provide care and support that met people’s needs in ways that they preferred.

The provider had systems in place to manage medicines and staff supported people to take their prescribed medicines safely.

Staff had the skills and knowledge to provide effective care. People’s health and social needs were managed effectively with input from relevant health care professionals. People had sufficient food and drink that met their individual nutritional needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

People’s care was delivered in a dignified manner and they were treated with kindness and respect by staff who knew them well.

Staff respected people’s choices and took their preferences into account when providing care and support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

There was an open culture and the manager supported and encouraged staff to provide care that was centred on the individual.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.