This inspection was unannounced and took place on 26 and 27 April 2018. At the previous inspection in February 2016, the service was rated Good. However, at this inspection we found the provider had not sustained this rating and received an overall rating of ‘Requires Improvement.

Wetley Manor Care 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.

Wetley Manor Care Home provides accommodation and personal care for up to 22 older people, some of whom were living with dementia, others had mental health needs and a physical disability. At the time of the inspection the home was fully occupied. The home is situated on one floor and was accessible to wheelchair users.

The home had a registered manager who was present on both days of our inspection visit. 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 provider did not have any governance systems in place to assess and monitor the quality of service provided to people. Medication practices were unsafe and people did not always receive their treatment as directed by the prescriber. Equality, diversity and human rights were not included in the assessment of people’s care and support needs to ensure they were not discriminated against. The provider’s recruitment practices were not entirely robust to ensure the suitability of people who worked in the home. There was a lack of emphasis focused on staff development and training to ensure staff had the skills to care and support people safely.

People confirmed there were sufficient staff to meet their needs. People felt safe living in the home and staff knew how to safeguard them from the risk of potential abuse. Staff had access to risk assessments that supported their understanding about how to reduce the risk of harm to people. Staff were provided with personal, protective equipment to help reduce the risk of cross infection.

People’s consent to care and treatment was always obtained by staff. People were provided with a choice of meals and drinks were available at all times. Staff supported people when needed to access relevant healthcare services. People were provided with relevant aids and adaptations to promote their independence.

People described staff as nice and caring and confirmed their right to privacy and dignity was respected. People’s involvement in their care planning ensured they received a service the way they liked.

People were supported by staff to pursue their social interests. People could be confident their complaints would be listened to, taken seriously and acted on. At the time of our inspection visit no one was receiving end of life care.

The registered manager was experienced and was supported in their role by the provider. People who used the service and staff described the registered manager as approachable and supportive. The provider worked in partnership with other relevant agencies to assist in meeting people’s needs.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We completed an unannounced inspection at Wetley Manor Residential Care Home on 9 February 2016. At the last inspection on 21 May 2013 the provider was meeting the required standards.

Wetley Manor Residential Care Home is registered to provide accommodation with personal care for up to 22 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 20 people.

The service had a registered manager. 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.

We found that medicines were not always managed in a way that kept people safe from the risk of harm.

Staff and the registered manager understood their responsibilities and action to take where abuse was suspected.

People’s risks were assessed and managed. Staff understood people’s risks and ensured people were protected from harm, whilst promoting their independence.

We saw there were sufficient, experienced and competent members of staff available to meet people’s needs. The provider had safe recruitment procedures in place.

People were supported by staff who had received training, which gave them the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care and the provider followed the requirements of the Mental Capacity Act 2005 where people lacked the capacity to make certain decisions about their care. Deprivation of Liberty Safeguards (DoLS) were in place for people who required certain restrictions to protect their safety and staff understood how these needed to be adhered to.

People told us that they had positive mealtime experiences. Where people were at risk of malnutrition there were plans in place to ensure they received sufficient amounts to eat and drink.

People were supported to access other health professionals to maintain their health and wellbeing.

People were supported in a caring and compassionate way that protected their privacy and dignity. Choices in care were promoted by staff and people’s choices were listened to and acted on.

People were involved in their care. People’s preferences had been taken into account and staff knew people who used the service well and knew their likes and dislikes.

People were supported to be involved in meaningful hobbies and interests within the service. People’s religious needs were met.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

The registered manager led the staff team well and worked closely alongside the provider to promote openness and transparency within the service. The ethos of care was clearly promoted by the management and the staff followed this when providing care.

There were systems in place to monitor the quality of care people received and people’s feedback was sought and acted on to make improvements.

During the inspection we spoke with people who used the service who told us that they were happy with the care provided. One person we spoke with told us, “I like it here, it‘s like home from home”. Another person we spoke with told us, “The staff here are very good, I get looked after well”.

We observed people being cared for in a respectful and compassionate way. People told us that staff respected their individual choices.

The provider had an effective recruitment system in place and the appropriate checks on staff had been undertaken to ensure that they were suitable to provide support to vulnerable people.

People told us that staff were caring and understood their needs. Staff told us that they received an induction and felt supported by their manager.

The provider had systems in place to monitor the quality of the service provided.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional.

Many of the people living at the home were unable to talk with us directly about their care because of their complex needs. We used the Short Observational Framework for Inspections (SOFI), which is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed that people were relaxed and comfortable with each other and with staff. All the staff we saw were open and friendly in their approach to people.

We talked with four people who lived at the home, two visitors and four members of staff about the quality of care and support provided. All the staff we talked with understood people’s individual preferences and their support and care needs. One person we talked with said, “None of the people here are my relations but they are all nice to me.” Another person told us, “It’s a nice place, it is always clean and tidy.” A visitor we spoke with said, “I would consider living here myself.”