Our previous comprehensive inspection to the service was on 16 and 17 January 2018. The overall rating of the service at that time was judged to be ‘Requires Improvement’. A breach of Regulation 9 [Person-centred care], Regulation 12 [Safe care and treatment] and Regulation 17 [Good governance] with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was made. At this inspection the required improvements had not been made.

Wensley House Residential Home 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. Wensley House Residential Home provides accommodation and personal care for up to 48 older people. Some people also have dementia related needs.

The inspection was completed on the 3 and 4 December 2018 and was unannounced. At the time of the inspection, there were 32 people living at Wensley House Residential Home.

The service did not have a registered manager in post. The service was being managed by a deputy manager and the registered provider. 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.

Quality assurance checks and audits were not robust, they did not identify the issues we found during our inspection and had not recognised where people were placed at risk of harm and where their health and wellbeing was compromised. The registered provider was unable to demonstrate overall responsibility and scrutiny of what was happening within the service to make the required improvements. The lack of managerial oversight had impacted on people, staff and the quality of care provided. Therefore, they were unable to demonstrate where improvements to the service were needed, how these were to be made and had been addressed; and lessons learned to ensure compliance with regulatory requirements and the fundamental standards.

Although people told us they were safe, the service’s previous manager had failed to notify the Local Authority and Care Quality Commission of two safeguarding incidents and internal investigations were poorly completed and provided insufficient evidence to back-up the findings and outcome.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered, and risk assessments had not been developed for all areas of identified risk. Care records were not maintained to ensure staff were provided with clear up to date information which reflected people’s current care needs. Where people were judged to be at the end of their life, information relating to their end of life care needs were not recorded. Improvements were required to the service’s medication arrangements as discrepancies relating to staff’s practice and medication records were found.

The management team had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people using the service, others were not respectful or caring and failed to ensure people received the care they required. People were not supported to participate in meaningful social activities. Improvements were also required to people’s overall dining experience as the support provided was not always provided in a respectful and dignified manner.

People’s capacity to make day-to-day decisions had been considered and assessed. Nonetheless, improvements were required to ensure staff had a better understanding of the main principles of t

Wensley House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 48 people over three floors in an adapted building. There is a passenger lift to provide access to people who have mobility issues and the garden is also accessible. 45 people were living in the service at the time of this inspection, two of whom were in hospital.

A registered manager was not 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.

The service had inconsistent management since the last inspection and the provider managed the service when no manager was in post. An experienced manager was now in post and who had made application to register with CQC as required.

We rated the service as Good at our last inspection on 5 January 2017. We received information of concern in November 2017 that insufficient staff were available in the service. Concerns also related to people’s care, communication, fire safety, medicines and the failure of the provider and manager to deal with these effectively. We shared the information with the local authority who visited and were supporting the service to improve. We also received information that recruitment procedures in the service needed improvement.

This inspection was unannounced and completed by two inspectors on 16 and 17 January 2018. We found three breaches of regulation and other areas of practice that needed to improve.

People’s individual risk management plans did not support people's safety. Equipment was not safely used. Medicines were not safely managed to ensure people's wellbeing. People’s care needs were not planned for in a way that gave staff clear guidance on how to meet these safely and well. This included people’s nutritional and social care requirements.

The lack of consistent competent leadership in the service had affected the quality and safety of the care people received. The provider’s quality assurance processes were not sufficiently robust as they had not identified the failings in the service so that corrective action could be promptly taken.

Discussion with staff and review records showed that information was not always shared or acted upon so that learning could take place to safeguard people. Records also showed that checks of prospective staff needed to be more thorough and ensure that references obtained were always from the most appropriate people.

Staff support systems had faltered. Staff had not received continuous training, support and competence assessment to ensure they provided people with safe and effective care. The manager had recently recommenced the provider’s systems to supervise staff, monitor their performance and to plan a staff training programme.

While staff generally sought people’s consent, improvement was needed to records and staff understanding to show that up to date guidance about protecting people's rights in decision-making was followed.

People told us they enjoyed the meals and drinks served overall although sometimes food was not hot enough. Staff approach to supporting people to have a positive mealtime experience needed to improve in some areas. People told us that staff were kind and caring overall and treated them with respect. We noted occasions where staff did not make efforts to interact and engage people. Visitors felt welcome.

Enough staff were deployed to meet people’s needs. Systems were in place to monitor staffing levels in line with people’s changing needs and these were positively supported by the provider. Arrange

This inspection was undertaken on 5 January 2017 and was unannounced.

Wensley House provides accommodation and personal care to up to 48 people. People living in the service may have care needs associated with dementia or mental disorder. There were 39 people living at the service on the day of our inspection.

A registered manager was 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.

At this inspection we found a number of improvements had been achieved across the service. The service was led by an experienced manager who had worked with the support of the provider to stabilise the service and demonstrate sustained improvements. Staff morale was high and staff worked as a team to provide care in a friendly and homely environment.

Medicines were safely managed to ensure people received their prescribed medicines to meet their needs. Risk management plans were in place to support people and keep them safe. There were also processes in place to manage any risks in relation to the running of the home. Care records included better detail of people’s care needs and staff had information on how best to meet people’s needs. Quality assurance systems were better established and effective in support safe, quality care.

People were supported by staff who knew them well and were available in sufficient numbers to meet people's needs effectively. Recruitment procedures were thorough. Staff knew about identifying abuse and how to report it to safeguard people.

People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences. Arrangements were in place to support people to gain access to health professionals and services.

People were well cared for by kind and caring staff. People’s dignity and privacy were respected. Visitors were welcomed and relationships were supported. People’s care was planned and reviewed with them or the person acting on their behalf. People were supported to participate in social activities that met their needs.

People felt able to raise any complaints and felt that the provider would listen to them. Information to help them to make a complaint was readily available. The provider had listened to people’s views and ensured that people were satisfied with the actions taken.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

We carried out an unannounced comprehensive inspection of this service on 18 and 19 September 2015. Breaches of legal requirements were found. The service was judged to be Inadequate and placed in special measures by CQC to ensure sufficient improvements were made. On 22 September 2015, the provider entered into a voluntary agreement with us not to admit any further people to the service without our agreement while improvements were made. To require the safety and well-being of the people living in the service we issued warning notices to the provider on 21 October 2015 that had to be met by 27 November 2015.

We undertook a focused inspection on 17 and 18 December 2015 to check on those warning notices. We found that additional time was needed to further improve the service and establish the delivery of safe care to people living there. Further warning notices were issued that had to be met by 18 February 2016.

This inspection took place on 16 and 17 March 2016. We found that while further progression was still needed in some areas, sufficient improvements had been made and sustained to the safety and quality of the service and the legal requirements of the warning notices were met.

Wensley House is registered to provide accommodation with personal care to up to 46 older people. People living in the service may have care needs associated with dementia. There were 20 people receiving a service on the day of our inspection.

A manager was in post who had made application to the Care Quality Commission to be registered. 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.

At this inspection of 16 and 17 March 2016, improvements were noted in all areas from the previous inspections, further minor improvements were needed in regards to aspects of how people’s individual care needs and risks were assessed and planned for and one area of medicines management.

Improvements were needed to ensure that all the people using the service were given sufficient choice and information to enable consistently good nutritional intake and participation at mealtimes. The manager took immediate action to address shortfalls in staff practice and ensure a good mealtime experience for all the people using the service.

Although in place, social activities were not always suitable for all of the people living in the service so as to reflect their personal interests and abilities. Work was needed to ensure people’s voice was heard in all instances and that people were addressed by their own name so as to respect them as individuals. The provider’s quality assurance system, although improved needed further development to ensure that all aspects of shortfalls in the service was captured and addressed on an ongoing and sustained basis. The manager was aware of the areas that still required some improved and we felt assured that improvements would continue to enhance people’s wellbeing and safety.

Improvements were noted to the management of risks to the environment and the running of the business so as to ensure people’s safety. This included the safety of the water system. Equipment such as that relating to fire or moving and handling equipment had been tested and checked to ensure it was safe and in good working order.

Where people lacked capacity to give consent, assessments had been carried out to ensure their rights were protected. Staff were knowledgeable about identifying abuse and how to report it to safeguard people.

People were supported by staff who were clearer on their roles and responsibility. The recruitment of additional permanent staff meant there was less use of agency staff, so people were cared for by staff who were familiar to them. Staff training

On the day of inspection there were 25 people living at Wensley House.

We considered our inspection findings to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found based on our observations during the inspection, where we looked at written records and spoke with seven people who used the service. We also spoke at length with the manager, the owner and three members of care staff.

If you want to see the evidence supporting our summary, please read the full report.

Is the service caring?

We spoke with seven people who used the service. One person said to us, "I am very happy here, I have no complaints. Everyone is very kind." Another person said, "The staff are very friendly; we often have a good laugh with them." We observed the care and attention people received from staff. All interactions we saw were appropriate, respectful and friendly and there was a relaxed atmosphere throughout the home.

Is the service responsive?

We saw that care plans and risk assessments were informative, up to date and regularly reviewed. The manager responded in an open, thorough and timely manner to complaints. Therefore people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the home.

Is the service safe?

The home was undergoing refurbishment at the time of inspection to improve the facilities at the home. People had been properly consulted about this and risk assessments were in place to ensure the ongoing safe operation of the home. People's bedrooms were personalised to them. People were protected by effective staff recruitment systems. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines.

Is the service effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with generally positive feedback from people reported in the provider's own annual quality assurance survey. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

During our visit to Wensley House on 17 April 2013 it was clear staff had a good relationship and communicated well with people living in the home. People could spend time how they wished, with some choosing to sit in their own rooms, or a quiet lounge. Some people preferred the social atmosphere in the television lounge.

All staff had been trained in the Mental Capacity Act. With the knowledge they had of people they were caring for, meant they knew what assistance an individual would require to make a decision or give consent.

People told us they enjoyed the food at Wensley House. One person said, "They spoil me, I've never had a bad meal."

We found there were appropriate arrangements in place for the management of people's medicines.

We saw there was a complaints policy and procedure in place and on display in the communal entrance hall. The procedure was clear and informed people how to complain and when they could expect their complaint to be dealt with. All complaints or concerns, no matter how minor, were reported and had been acted on appropriately.

People told us that they were happy living at Wensley House and told us they felt safe living there and said that staff looked after them well. People told us that staff respected their privacy and dignity and treated them well. Relatives we spoke with were satisfied with the care provided at Wensley House and said that the manager was always available. People told us they enjoyed the food and various activities. Other people that we spoke with said they appreciated that staff supported them to remain independent and respected their right to live the life they chose.

We carried out an unannounced comprehensive inspection of this service on 18 and 21 September 2015. Breaches of legal requirements were found. This was because the provider did not have suitable arrangements in place to ensure that people who used the service received safe care, that their consent had been obtained in line with legal requirements and to ensure effective arrangements were in place to monitor and assess the quality of the service provided.

Warning notices were issued to the provider on 21 October 2015. The provider agreed to voluntarily suspend new admissions to the service until compliance with regulation was achieved.

We undertook a focused inspection on 16 and 17 December 2015 to check that the provider had now met legal requirements of the warning notices. This report only covers our findings in relation to these requirements.

Wensley House is registered to provide accommodation with personal care for 46 older people. People living in the service may have care needs associated with dementia. There were 22 people living at the service at the time of our inspection, including two people who were in hospital.

A new manager had been appointed since our previous inspection. They had commenced the procedures to enable them to make application to be registered with the commission. 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.

Improvements had been made to respecting people’s rights and CCTV cameras were only operating in communal areas and not in people’s private bedrooms. Further improvements were needed and assessments carried out by the service where people lacked capacity to give consent to ensure that their rights were fully protected.

Each person now had a plan of care in place to inform staff of the person’s care needs and how to meet them. Improvements were noted in relation to the safe management of medicines. Further improvements relating to the detail of the care records and in relation to risk management was required to ensure safe care.

Staff training and development opportunities had been enhanced to help staff to provide safe care. Staff support and competence assessment systems had been set up. However they had not been implemented sufficiently as yet to enable their effectiveness to be assessed.

Systems to monitor, assess and improve the quality and safety of the service were being put in place. The manager had not had sufficient time to establish these and demonstrate their ongoing effectiveness.

The rating for this service will not change at this time. Whilst improvements had been made in several areas, time was needed to further improve the service for people and to embed good practice around the service. You can see what action we have taken in the end of this report.

You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Wensley House on our website at www.cqc.org.uk