Wellesley Lodge Residential Home provides residential care and support for up to 21 people. The service specialises in meeting the needs of older people living with dementia. At the time of our inspection, 21 people were using the service.

At the last Care Quality Commission (CQC) inspection in October 2015, the service was rated ‘Good’ overall but we rated the service ‘requires improvement’ for the key question, ‘is the service well led?’ We did not find the service in breach of regulations but we found some gaps in audit systems and there was a lack of robust scrutiny and oversight at provider level. There was also no registered manager in post. A registered manager is a person who has registered with 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 2008 and associated Regulations about how the service is run.

At this inspection we found the service remained ‘Good’. Improvement had been made to the well led question. The range of quality monitoring checks of the service had been improved to give the provider better assurances that key aspects of the service were effective. There was improved scrutiny of the service at provider level including meetings every three months with trustees on how the service was meeting its aims and objectives for people. There was also a registered manager in post. We have revised the rating for the well led question to Good. The service demonstrated they met the regulations and fundamental standards.

People continued to be safe at Wellesley Lodge Residential Home. Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and wellbeing. There were enough staff to keep people safe. The provider maintained recruitment checks to assure themselves of staff’s suitability and fitness to support people.

The environment was clean and staff followed good practice to ensure risks to people from poor hygiene and cleanliness were minimised. Staff also made sure the environment was clear of slip and trip hazards so people could move freely around. The premises and equipment were regularly maintained and serviced to ensure these were safe. The provider maintained appropriate arrangements for the safe management of medicines. People received these as prescribed to them.

People continued to receive support that was personalised and which met their specific needs. Senior staff reviewed people’s needs regularly to ensure the support they received continued to meet these. Staff received relevant training and felt well supported by senior staff. Staff knew people well and had a good awareness and understanding of their needs, preferences and wishes.

People were supported to eat and drink enough to meet their needs. People were also supported to stay healthy and to access healthcare services when needed. Staff encouraged people to participate in activities and events and to maintain relationships with the people that mattered to them. Staff were warm and welcoming to visitors to the home and friends and families were free to visit when they wished. There were good links with the local community which helped to enhance the quality of people’s lives.

Staff treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. People were encouraged to do as much as they could and wanted to do for themselves to retain their independence. People were prompted to make choices and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People and relatives were satisfied with the support provided by staff. The provider maintained arrangements to deal with people’s complaints appropriately if these should arise.

People and staff

We spoke with three people who used the service. One person said “It’s a lovely place to live and the girls are marvellous.” Another told us “The food is first class, I am well looked after.” Most people appeared relaxed and content and we observed that staff quickly picked up on any sign of distress or discomfort.

Some people were not able to express their views and so we observed the care provided. We saw that people were spoken to with respect and that their views were sought before providing care. People’s wishes were respected and staff were observed to engage positively with people using the service. We spoke with five staff members who knew the needs of the people who used the service well. Up-to-date care plans were in place that identified people’s needs and included people’s preferences for their care. We saw that the service worked actively with a range of health professionals.

Medication was stored and administered safely. There were appropriate checks in place for the maintenance and service of equipment. We saw from the duty rota that there were sufficient levels of staff on duty, and staff confirmed this was the case. One person we spoke with said “You are never waiting long if you need something. Everyone is very helpful.” The service had an effective system to deal with any complaints.

At the inspection we spoke to people who used the service and staff and looked at records. Some people told us “the staff are nice “ and “ we are looked after well here”. However not everyone was able to give us their views so we carried out a structured observation at the service.

We saw from people's records, their individual care and support needs had been assessed and care plans were in place to meet these needs. We observed that people using the service were consulted as far as possible, about their preferences in relation to their care. We also spoke to the local authority commissioning team about their contact with the service and learnt there were no issues. We saw there were well managed systems in place for cleanliness and infection control.

Staff were aware about what they should do to protect people who may be at risk of abuse, harm or neglect. They had also received regular training to keep their skills and knowledge refreshed.

We saw senior staff regularly reviewed and assessed the quality of service provided. We also saw people using the service and their representatives were asked for their views about the quality of service provided.

We spoke to a number of people who use the service. One person told us “I attend the residents meetings; we talk about things like meals and activities”. Three people told us staff always respected their dignity and privacy. All of the people we spoke to told us that staff treated them with respect at all times.

One person told us “the food here is good, I can talk to staff about the meals and they would provide me with something different if I wanted it”. Another person told us “I used to work in school dinners, the food is very good here, I should know”.

People told us they lived in comfortable surroundings and the home was always very clean.

People spoke very highly about staffs attitude and commitment to working at the home. One person told us “I have no complaints about staff at all they are all very nice, helpful and very obliging”.

People told us they knew how to make a complaint if they needed to and the registered manager and staff would do something about their complaint.

This inspection took place on 13 October 2015 and was unannounced. At the last inspection on 14 January 2014 we found the service was meeting the regulations we looked at.

Wellesley Lodge Residential Home provides accommodation and personal care for up to twenty one older people. The service specialises in caring for people living with dementia. At the time of our inspection there were 19 people living at the home.

The service did not have a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The current home manager was previously the registered manager for the service up until June 2015 at which time they left and subsequently cancelled their registered manager status with CQC. However, they have since returned to the home permanently in September 2015 and we were able to check and confirm during our inspection they had submitted the appropriate registered manager application to CQC to reapply for this.

People and relatives told us people were safe at the home. Staff knew what action they needed to take to ensure people were protected if they suspected they were at risk of abuse. Risks to people’s health, safety and welfare had been assessed by staff and the service had appropriate plans in place to ensure identified risks were minimised to keep people safe.

The premises and equipment was checked and maintained to ensure it was safe. Staff kept the home free from obstacles and trip hazards so people could move around safely. There were enough staff to support people in the home and to meet their needs. The provider had carried out appropriate checks to ensure they were suitable and fit to support people using the service.

Staff received appropriate training and support. They had a good understanding of people’s needs and how these should be met. People and relatives said staff looked after people in a way which was kind, caring and respectful. Staff knew how to ensure that people received care and support in a dignified way and which maintained their privacy at all times. Staff supported people, where appropriate, to retain as much control and independence as possible, when carrying out activities and tasks.

Staff encouraged people to stay healthy and well. People were supported to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. Staff regularly monitored people’s general health and wellbeing. Where there were any issues or concerns about a person’s health, staff ensured they received prompt care and attention from appropriate healthcare professionals such as the GP or dietician. People received their medicines as prescribed and these were stored safely in the home.

Care plans were in place which reflected people’s needs and their individual choices and preferences for how they received care. Where people were unable to make complex decisions about their care and support, staff ensured relatives and other professionals were involved in making decisions that were in people’s best interests. People were appropriately supported by staff to make decisions about their care and support needs. People’s care and support needs were reviewed with them regularly.

The home was open and welcoming to visitors and relatives. People were encouraged to maintain relationships that were important to them. People were also supported to undertake activities and outings of their choosing. People and relatives said they felt comfortable raising any issues or concerns directly with staff. There were arrangements in place to deal with people's complaints and issues appropriately.

The home manager demonstrated good leadership. People, relatives and staff said they were approachable and supportive. The home manager sought people’s views about how the care and support they received could be improved and made changes where these were needed. They ensured staff were clear about their duties and responsibilities to the people they cared for and accountable for how they were meeting their needs. The service used learning and good practice from reputable sources, particularly in relation to supporting people living with dementia, to continuously improve the quality of care and support people experienced.

Although there was a quality assurance system in place not all aspects of the service were routinely audited and checked. This meant the provider could not be fully assured all the systems designed to care for and support people were as effective as they should be.

The home manager had sufficient training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to understand when an application should be made and in how to submit one. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.