This inspection site visit took place on 19 December 2017 and was unannounced.

Welland House Care Centre 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.

Welland House Care Centre accommodates up to 51 people in one adapted building, with areas for people to spend time together or more privately as they choose. Accommodation and care is provided to older people, including those living with dementia. There were 44 people living at the home at the time of our inspection.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were supported to stay as safe as possible by staff who understood what actions to take to reduce risks to their well-being. This included reducing risks to people’s physical health and mental well-being. People, their relatives and staff were confident if they had any concerns for people’s safety the registered manager would put plans in place to help them. There was enough staff to meet people’s care needs. We have made a recommendation about the way staff were deployed as there were occasions where people did not consistently benefit from the opportunity to chat with staff. The registered manager told us they would follow this recommendation.

People could rely on trained and competent staff supporting them to have the medicines they needed to remain well and free from pain. People benefited from living in a home where there were systems in place to reduce the risk of infections and staff knew what action to take to care for people if they experienced any infections. Checks on the environment were undertaken and systems for identifying if there was any learning after safety incidents were in place.

Staff considered people’s care needs and involved people who knew them well before people came to live at the home, so they could be sure they could meet people’s needs. Staff had received the training they required so people would be supported by staff with the skills needed to help them. People were supported to choose what they wanted to eat and to obtain care from other health and social care professionals so they would remain well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had developed caring relationships with the staff who supported them and showed us they liked the staff who cared for them. Staff communicated with people in the ways they preferred and encouraged them to make their own day to day decisions about their care. People received care from staff who took action to promote their dignity and independence. We made a recommendation about the way people’s information was stored, so their privacy and confidentiality was further enhanced. The registered manager took immediate action to follow our recommendation.

People’s care had been planned by taking their individual wishes, histories and needs into account. People’s care plans incorporated advice provided by other health and social care professionals, so they would receive the care they needed in the ways they preferred. Staff checked if people’s needs were changing, and planned and provided their care taking any changes into account. Systems were in place to respond to any concerns or complaints and to incorporate any learning into care subsequently provided.

People told us they liked living at the home and found the home was managed well. Relatives and health and social care professionals told us the culture at the home was open. The staff at the home had received compliments about the way care was provided. The registered manager had supported staff to understand how they were expected to care for people. The registered

We undertook an unannounced comprehensive inspection of this service on 5 January 2016. After that inspection we received concerns in relation to staffing levels and staff skills and knowledge in assisting people to move safely. We also received concerns in relation to the support people received to manage their personal care and how people were supported to have enough to eat and drink so they remained well. As a result we undertook a focused inspection to look into those concerns on 30 August 2016. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Welland House Care Centre on our website at www.cqc.org.uk”

Welland House Care Centre is registered to provide accommodation for older people who require nursing and personal care and who may have a dementia or mental health related illness. A maximum of 51 people can live at the home. There were 43 people living at the home at the time of our focused inspection on 30 August 2016.

A registered manager was in post 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.

People were supported by staff who understood risks to their safety and took action so people would be cared for in ways which helped them to maintain their safety and met their care needs. People were relaxed when supported by staff and were confident if they raised any concerns about their safety or well-being staff would take action to support them. Staff had been supported to develop the skills they needed to care for people in safe ways. This included when people needed assistance to move and when people chose to walk.

People were encouraged to be involved in assessing their risks and deciding with staff how their risks could be reduced. Staff understood how effective personal care helped people to have healthy skin and enhanced people’s sense of well-being. Where people needed assistance to have enough to eat and drink so their physical safety and health was maintained this was provided by staff. Staff supported people promptly in ways which reduced the likelihood of them becoming anxious.

Staff knew people’s safety needs well and there was enough staff to care for people during different times of the day and night. Senior staff and the registered manager communicated information to the staff team about people’s changing safety needs. Staff took action to meet people’s safety needs and sought and followed the guidance given by external health professionals, so people’s safety would be promoted.

Senior staff and the registered manager checked people were provided with care which helped to keep them as safe as possible.

This inspection took place on 5 January 2016 and was unannounced.

The provider of Welland House Care Centre is registered to provide accommodation and nursing care for up to 51 people. At the time of this inspection 49 people lived at the home.

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.

People told us they felt safe living at the home. Staff understood their responsibilities to identify and report potential harm and abuse and knew who to contact if they had any concerns for people’s well-being. The registered manager and provider regularly reviewed accidents and incidents to see if there were ways to reduce the possibility of people being harmed. Staff knew the risks to people’s well-being and health, and worked with external organisations so people would receive the right care.

People, relatives and staff said there were enough staff to care for people in a safe way and to meet their care needs. The registered manager told us they were supported by the provider so there were enough staff available as people’s care needs changed. The registered manager had undertaken checks on the suitability of people who worked at the home, so people’s safety was promoted. People were able to makes choices about how they received their medicines. Staff who administered people’s medicines had received training and checks were undertaken so the registered manager could be sure people were receiving their medicines in a safe way.

Staff had received a wide range of training and support to develop their skills and knowledge, so they could provide care which met people’s needs. The registered manager had put processes in place so staff undertook an induction programme and were able to work with the support of more experienced staff. Staff showed a good understanding of the principles of the Mental Capacity Act, (2005) and applied their knowledge so people’s rights were protected. The registered manager had followed the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) where this was needed for people’s safety.

People were able to make choices about the food and drink they had. Staff knew what people’s individual dietary requirements were, and staff checked that people were eating and drinking enough so they would remain well. Staff also successfully used the opportunities provided by mealtimes as a way of increasing people’s physical independence

People were cared for by staff who they described as caring and kind. Staff knew about people’s individual life histories and their preferences. Staff spent time chatting to people about things which interested them, and supported people to do things they enjoyed. Staff respected people’s dignity and privacy and made people’s visitor’s feel welcome at the home.

People and their relatives knew how to raise any concerns or complaints. The registered manager responded to people’s complaints and took action to improve the service as a result of complaints. The registered manager also used other ways to obtain feedback from people living at the home, so the care they received could be developed further. Where people had made suggestions these had been actioned.

The registered manager and the provider had developed systems to monitor the quality of the service people received. There was evidence of learning from checks and audits, and we saw action plans were developed where suggestions for improving the service further had been identified. This was done so that people would benefit from living in a home where staff constantly sought to improve the care people received.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by Care Quality Commission (CQC) which looks at the overall quality of the service.

The inspection was unannounced, which meant the provider and staff did not know we were coming. At the last inspection in May 2013 the provider met all the regulations we checked.

Welland House Care Centre is a care home that provides personal and nursing care for up to 51 people. Care and support is provided to people with dementia, nursing and personal care needs.  At the time of our inspection 49 people lived there.

The provider has recruited a new manager who had been in post as acting manager since March 2014. The manager had submitted an application for registered manager status to the Care Quality Commission (CQC).  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us that they felt safe and staff treated them well. Staff were seen to be kind and caring, and thoughtful towards people and treated them with dignity and respect when meeting their needs.

Staff knew how to identify harm and abuse and how to act to protect people from the risk of harm which included unsafe staff practices. We also saw that the provider had arrangements in place to demonstrate that there was sufficient staff on duty to meet people’s needs so that they were protected from harm.

Staff understood people’s care and support needs.  We saw staff supported people with their eating and drinking so that they had the nourishment and hydration to meet their needs.

We saw that improvements had been made to the environment so that it met people’s specific needs. We also saw some people were supported to do interesting and fun things but the manager had ideas to improve this further for all people who lived at the home.

Staff made appropriate referrals to other professionals and services in the community. The health and social care professionals we spoke with shared with us examples where action had been taken to meet people’s individual needs in the most effective way. When one person moved into the home different approaches and ideas were looked at so that their needs were responded to in the best possible way for the person.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report what we find. We saw that consideration of the MCA was evidenced in care plans where people and or their representatives gave their consent to people’s care and treatment. We also found that the manager and staff were aware when levels of intervention or supervision may represent a deprivation of a person’s liberty and when an application needed to be made.

The provider had responsive systems in place to monitor and review people’s experiences and complaints to ensure improvements were made where necessary. The management team had used this information in their action plans to enable improvements to be sought. This helped to support continued improvements so that people received a good quality service at all times.

Many of the people living at the home had varying levels of dementia and mental health needs, so not everyone was able to tell us about their experiences of living at Welland House. Therefore we spoke with six relatives and observed daily life at the home.

There were some positive interactions between staff and people and clear friendships were established. It was clear from what we saw that staff knew people’s needs and provided care and support in a gentle way when people’s behaviour needed to be supported.

Relatives told us positive things about the care and support people received whilst living at the home. They told us that they felt involved in any decisions that needed to be made and these were done with their relation’s best interests at heart. One relative told us: “They (staff) are very caring and aware of what he needs”. Another relative said: “They (staff) ask me questions” and they are: “Well informed on things”.

We saw that people and their representatives had access to a complaints procedure and their concerns had been listened to. Relatives told us that they would feel comfortable raising any concerns.

In this report the name of one registered manager appears who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still registered managers on our register at the time.

44 people were living at the home when we inspected. We talked with four of them, six relatives and one friend about their experiences of living there. We spoke with the manager designate and three staff. We also looked at the care records for six people who lived at the home to see how their needs should be met.

Relatives told us that they were happy with the care and support that their relation received. Relatives shared with us that they had been involved in the care planning so that people received the right support in the right way.

Throughout the day we observed some examples of staff supporting people with words of encouragement and reassurance where needed whilst completing tasks. We also saw examples where staff on duty did not fully engage with providing care and support to two people who lived at the home. For these two people this meant their individual needs including their emotional needs were not met at the time and they experienced distress.

There were also regular meetings for people and their relatives to attend and satisfaction surveys were given to people or their representatives. This supports people in expressing their experiences of living at Welland House. This meant the manager designate regularly assessed and monitored the quality of the service people received at Welland House to make sure people’s experiences were acted upon.

There had been no manager at the home since November 2011. When we visited we found there was a new manager who had been in post for four days. The manager told us that it was their intention to register with the Care Quality Commission.

People who used the service had a dementia related illness and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they were given and whether they had positive experiences.

Care workers were seen to be courteous and kind, but the care appeared to be about the task rather than the person’s social and emotional well being. We saw that one person got up from their chair and appeared to want to go for a walk. The care workers responded by repeatedly assisting the person to sit back down, rather than offer any social interaction. We spoke to visiting relatives who told us they had been happy with care provided and did not have any concerns to raise.