Weymouth Care Home is registered to provide accommodation with nursing care for up to 35 people. There were 32 people living in the home at the time of our visit, some of whom were living with dementia as well as other conditions such as parkinson’s disease and diabetes. The home is organised across two floors. There is a passenger lift to allow easy access to the first floor. The majority of rooms have ensuite facilities. There is a communal dining area, a lounge, and a library which is used as a quiet area for people to spend time with friends and relatives.

There was a registered manager in post. This person started as manager at the home in March 2018 and became registered manager in July 2018. 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 our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good.

People felt safe. They were supported by staff with a good understanding of how to safeguard them and how to raise concerns either internally or externally if they suspected harm or abuse. There were enough staff to meet people’s needs. A dependency tool was used to help ensure that staffing levels continued to match the needs of the people living there. People’s individual risks were assessed and reviewed.

The home carried out monthly accident and incident audits. This included a description of what had happened, the result of the investigation, and follow up action taken. This helped reduce the risk of things happening again.

People had thorough pre-assessments to support their move to the home. These included people’s needs, preferences, social background and their abilities. People were supported by staff who had received an induction. This involved shadow shifts with more experienced staff and regular competency checks. People were supported to eat a balanced and healthy diet. They were given choice of what to eat and drink and could eat as much or as little as they wanted. Snacks were available to people outside of typical meal times. Where people required extra support with eating and drinking this was provided in line with guidance from health professionals.

People were supported to access health services such as dentists and dieticians to help maintain their health and well-being. Where people’s health needs changed there was timely contact with relevant health professionals. People were supported by staff who understood the importance of offering choice and support in line with what they needed and wanted. This gave people the opportunity to live their lives how they wanted to.

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. Where people lacked capacity to make particular decisions they were supported by staff who were trained and worked in line with the principles of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides the legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack capacity to make particular decisions, any made on their behalf must be in their best interests and least restrictive as possible.

Staff consistently demonstrated a kind and caring approach towards people. People’s privacy and dignity were supported at all times. They were given time and space to spend private and uninterrupted time with friends and relatives. People were encouraged to maintain their independence.

This unannounced inspection took place on 15 November 2016.

Weymouth Care Home provides nursing care for 34 people. There were 32 people living in the home at the time of our visit, some of whom were living with dementia as well as other conditions such as a brain injury and multiple sclerosis. The home was organised into four areas across two floors. There was a passenger lift to allow easy access to the first floor. The majority of rooms had ensuite facilities and there was a communal dining area and lounge as well as a library room which was used as a quiet area or for meetings.

There was a registered manager who had been promoted into their current position three years ago. 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 had opportunity to engage in activities within the home such as games and reminiscence. There were trips out twice a week, some people had one to one time with staff to support them with their social and recreational needs. The provider had reviewed how activities were organised and delivered , this included feedback from meetings and questionnaires. They identified that improvements were required to ensure that activities were varied, planned according to people's interests and were a positive experience for people. There had been staff changes and a vacancy for an activity coordinator was in the process of being completed. This demonstrated the provider had reviewed how activities were organised and was actively making improvements.

There were sufficient staff to meet people’s needs. Staffing was planned according to people’s care and support needs. Staff were supported with their professional development and the registered manager told us three staff had recently left to commence their nurse training. There had been use of agency staff while new staff were recruited and the registered manager told us all vacant staff positions had been filled. Checks were made by the provider to ensure new staff were recruited safely and that the appropriate pre-employment checks were carried out.

The provider told us they had made improvements to training and development. Registered nurses had received training in a range of clinical procedures such as catheterisation and verification of death. All staff were up to date or had training booked which the provider identified as essential such as infection control and health and safety. Some staff had trained as trainers in specific areas such as moving and assisting, which meant training could be delivered when it was needed in the home environment.

People told us the food was good and we saw they were offered a choice of what they would like to eat and where they would like to eat it. People who needed support to eat their meals were supported with dignity. Staff sat with them on a one to one and were unhurried. People had their nutritional needs assessed and a plan of care was developed to ensure the persons needs were met. For example there were several people who had swallowing difficulties. They had been referred to the speech and language team (SALT) for a specialist assessment. We saw staff were following the recommendations which had been made to ensure people were supported safely to have enough food and drink. People who were identified at risk of not having enough to drink were monitored throughout the day and staff told us it was all of the staff teams’ responsibility to ensure people were appropriately hydrated.

People were at reduced risk of harm and abuse. Staff were able to describe to us how they would recognise abuse and were aware of their responsibilities in reporting actual or potential abuse. Staff understood how they would escalate concerns about poor

People who received care at Weymouth care home have substantial and complex needs. They were not all able to verbalise their experiences. We used a variety of ways in which to determine their thoughts and feelings. We were able to talk to members of nursing staff, care assistants, chef, cleaner, family members and some people who use services. One person told us they had recently arrived at the home was "very happy, as been able to bring items from my own home such as my television and can watch satellite TV". We reviewed care plans, medicine charts, nutritional guidelines, staff records and training.

There were adequate numbers of staff on duty able to demonstrate systems that provided effective safeguarding and response to people's needs. Staff were aware of risk assessments and emergency procedures, how to report these and evaluate outcome.

One person's records showed evidence of recent risk assessment, that indicated a fall risk due to being unsettled for short period of time before they went to sleep. To reduce risk, information was written in their care plan to use increased observation during this time and use a bed with lowering facilities and to place "crash" mats either side of the bed while they were unsettled.

People had personalised care plans, choice in diet and activities. Family involvement was encouraged and one family told us they felt welcome any time and could visit when they wished.

We spoke with one person using the service and three family members of people who were unable to talk with us. They told us staff sought consent before delivering care and support. We looked at four care plans and saw they were signed by the person or a family member, indicating they agreed with the plan.

Three of the four people we spoke with told us care needs were met. One said, “I don’t think I could wish for better care”. An external health care professional told us, “The nurses I’ve seen have good standards of care, but the home needs more consistent staffing”.

Not everyone was able to tell us about their experiences. We therefore used the Short Observational Framework for Inspection (SOFI2) to observe care and help us understand the experience of people who could not talk with us. We saw care and support being provided in a warm, friendly and respectful way.

Medicines were not managed appropriately. One medicine was out of stock, two were not recorded accurately and there was a lack of guidance about when to use some “as required” medicines.

Appropriate checks were undertaken before people started work. People were cared for by staff who were appropriately trained and knowledgeable about their health conditions. Staff received supervision and appraisal.

People’s personal records including medical records were accurate and fit for purpose. Records were held securely and retained for the appropriate length of time.

We visited the home unannounced on 4 May 2012 to follow up compliance actions made following our inspection in September 2011. At that visit we made two compliance actions. One related to people's care and welfare and one related to staffing.

At lunch time we observed staff supporting people to eat their meal. They were encouraging and helped people at their pace, maintained eye contact and engaged them in conversation. They apologised when distracted.

One person told us "my legs might not work but my brain does" and staff recognised this and involved me in my care.

We spoke with a visitor who was happy with the care their relative received but was worried that staff did not give enough one to one time to the person. This was because their health had deteriorated and they were slower in communicating than before.

We observed that several people who were being cared for in bed had very little sensory stimulation in their room other than a television or radio.

We spoke with several people who told us they would speak to the registered manager if they were unhappy about their care. One person told us they would ask their relative to do this.

People we spoke with thought staff had enough time to provide their care at the pace they preferred. One person told us they did not feel rushed by staff.

People told us that they felt listened to and were able to make decisions. They told us staff were very kind and caring. We observed that staff treated people with dignity and respect. We observed that staff made sure that people had access to their call bell.

People were generally positive about the choices they were given especially regarding meals. People told us that they were asked their wishes for example when they wanted to get up or preferred bed time, but sometimes had to wait for staff to assist them.

Relatives we spoke to said they were generally kept informed and involved in care. One told us that they had been given information about the home and thought it had a lovely atmosphere. One person’s relatives told us of an incident when they felt they had been “the last to know” about some changes in medicines. However they said that they now felt listened to and that staff were responsive. Not all the people and relatives we spoke to were aware of their care plan, but told us there was good communication with staff about care and welfare needs of people. One relative told us that they were involved in developing the care plan.

People told us they liked going on outings in the mini bus with a member of staff, but would like to go more often. We observed that some people, particularly those without visitors, sat for long periods with little interaction from staff and appeared withdrawn. One person told us that they were bored a lot of the time and staff did not have time to sit and talk with them.

People living at the home told us that at some times of the day there were not enough staff to care for their needs. We observed that, in the evening when visitors had left, people were unsupervised for long periods in the lounge as staff were putting people to bed or answering call bells in other parts of the home.

People were very positive about the monthly residents meetings and said they were able to give suggestions and raise concerns.