The inspection took place on 3 January 2019 and was unannounced. We last inspected this home in March and April 2018 and completed a published report; the overall rating was Inadequate which meant that the service was placed into special measures. We put conditions on the provider’s registration with us. This meant admissions into the home were restricted; we required the provider to develop people’s care records, provide training and to send us a report detailing how improvements were being made. The provider had not complied with the conditions of registration and had not completed all of the required actions. This impacted on the safety and wellbeing of people who used the service.

Wheathills House is a residential care home for 31 older people, some of whom were living with dementia. At the time of our inspection there were 20 people using the service. 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 overall rating for this service remains ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider is also the registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Within the report we refer to them as ‘the provider’.

The provider had failed to ensure improvements had been made, to ensure people received safe care. Where people may have been harmed, they had not identified incidents as potential safeguarding concerns, and not reported these to the local authority or sent this information to us.

People’s health care needs had not always been fully assessed when they moved into the home to ensure their needs could be met; the staff did not know how new people needed to be supported to receive their care to keep well. Necessary checks had not been made with health professionals prior to admission to ensure their care could be provided safely and to obtain details of any prescribed medicines.

Improvements were needed with how medicines were managed to ensure there were safe systems for people to receive medicines as prescribed. Improvements were needed with how medicin

We inspected this service on 22, 28 March and 5 April 2018. Wheathills House 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. Wheathills House accommodates up to 30 people in one building.

The service was last inspected in 7 September 2016. There were two breaches of regulation at that inspection. At this inspection the provider continued to be in breach of these regulations as they had not taken action to respond to the breaches.

On the first day of our inspection 28 people were using the service and this was reduced to 26 on the 5 April 2018. The service is required to have a registered manager. 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 is the registered manager.

During this inspection we found the service was unsafe as there were no systems in place to manage the service, identify and mitigate risk and therefore ensure people’s safety.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice

There were no systems in place to deploy staff to ensure people were supervised at all times. The provider was unable to show the staff had trained in and understood how to protect people’s rights under the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS).

Not everybody had a care plan that detailed their care needs and wishes. The care plans that existed were not inclusive and the information was inaccurate or was out of date. Some care plans consisted of data from various agencies. This information was not analysed and a plan of care written. There was no assessment process in place to re-admit people who had been in hospital. Daily notes were written in diary form. They were not referred to nor were they filed in a manner that supported the care of people.

On the first inspection visit the provider was unable to show us care plans for seven people who were using the service. Risk was not effectively assessed and put in an up to date care plan for staff to follow. Some accidents and incidents were recorded, however they were not reviewed to ensure the cause of accidents was recognised and, where appropriate, acted upon to prevent other accidents happening.

There was no process in place to identify people who were at risk of choking. People were left alone during breakfast without means of communication or calling for assistance.

There were not enough staff to meet people’s needs in a timely manner. People were left unattended for long periods of time. Staff were not up to date on the training the provider considered necessary to care for people safely and effectively.

Some medicine was stored and administered as prescribed. There were no systems in place to store medicines for people who were using the service for respite care.

There were no communication systems in place to ensure all staff were aware of the current needs and welfare of people. The provider was unaware of the number and gravity of the falls people had and was unable to supply us with accurate and up to date information when asked for.

Staff were not supported, trained or supervised. There were no systems in place to recognise and put best practice in place.

Menus were planned in advance taking in people needs wants and wishes.

There were no systems in place to recognise signs that the service may no longer be able to meet people’s needs.

People were not always referred for health assistance in a timely manner.

People’s dignity was not always promoted. People were not involved in the planning or delivery of their care. Staff were kind in their

This inspection took place on 7 and 13 September 2016; the first day was unannounced.

Wheathills House is a care home which provides accommodation and personal care for up to 30 older people in rural Derbyshire. At the time of our inspection there were 23 people using the service which provides accommodation with personal care and assistance.

The service had a registered manager who was also the provider of the service. 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 was last inspected on 14 May 2015, when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to assess, monitor and evaluate the quality of services and mitigate risks relating to health and safety. In addition, the provider did not ensure staff received the appropriate support, training and supervision. We asked the provider to send us an action plan to demonstrate how they would make improvements to meet the regulations. The provider did not send us their action plan. At this inspection, we found some improvements had been made. However, we identified several areas where improvements needed to be made to the quality of care on this inspection.

Staff recruitment procedures were now robust and the provider had carried out the correct checks to ensure staff were of the right character to work with vulnerable people.

People were involved in the decisions about their care however, staff had not received any training, supervision and support, and they were unaware of their roles in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw no evidence of how staff supported people to make decisions relating to their care.

The provider did not understand the need to inform the Care Quality Commission of any accidents, incidents or events at the service, as they are required to do.

Care plans provided information on how to assist and support staff to meet people’s needs. Care plans were in a pre-printed format; they were reviewed by the senior care staff, thorough analysis did not take place. People and relatives told us they had not been included in completing or reviewing care plans.

People were not consistently kept safe from the risk of avoidable harm. Risk assessments did not identify what actions or control measures staff should take to minimise the likelihood of harm.

Medicines management and procedures meant people received their medicines as prescribed. People felt happy and safe living at the service; there were sufficient numbers of staff employed and they were deployed effectively on a day-to-day basis.

Staff knew how to protect people from the risk of abuse and had a good understanding of people’s individual needs and preferences.

People using the service were very complimentary about the service and care they received. Staff were caring, kind and compassionate towards people. Staff ensured people were supported in a manner which promoted and respected their privacy, dignity and self-esteem.

People were supported to have food and drinks to meet their dietary needs and personal choices. People were supported by staff to have access health care professionals when it was required. Relationships with friends and relatives were encouraged.

The provider had implemented a system of checking the environment by carrying out audits to assess and review the quality of service.

We found one of breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (registration) Regulations 2009 (part 4). You can see what action we took at the end of this report.

This inspection took place on 14 May 2015 and was unannounced.

Wheathills House is a care home which provides accommodation and personal care for up to 30 older people in rural Derbyshire. At the time of our inspection there were 29 people using the service which provides accommodation with personal care and assistance.

The service had a registered manager who was also the owner of the home. 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 in 30 September 2014 found the provider was not meeting two regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010. These were in relation to management of medicines and requirements relating to workers. We issued warning notices requiring the provider to make improvements by 31 December 2014. We found the provider had made sufficient improvements with regard to medicines but improvements to recruitment processes had not been made.

Staff recruitment procedures were not robust and did not ensure the correct checks were carried out before staff started working at the service.

Medicines management and procedures had improved and people received their medicine as prescribed.

There were sufficient numbers of staff employed and they were deployed effectively on a day to day basis. Staff told us they had not received any training, supervision and support, and they were unaware of their roles in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff knew how to protect people from the risk of abuse and had a good understanding of people’s individual needs

People using the service were very complimentary about the care home and staff. We saw staff were caring, kind and compassionate and cared for people in a manner that promoted and respected their privacy, dignity and self-esteem. People felt listened to and had their views and choices taken into account

There was a variety of choices available on the menus and people were supported to have food and drinks to meet their dietary needs and personal choices.

People were supported to access other health and social care professionals when required.

Relationships with family and friends were encouraged and people were supported to maintain those contacts.

People were very much involved in the decisions about their care and their care plans provided information on how to assist and support them in meeting their needs. Care plans were in a pre-printed format and were reviewed and updated.

The provider did not have a system in place to assess review and evaluate the quality of service provision.

We found 3 of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

When we visited Wheathills House the service was providing care and support for up to 30 people. The focus of the inspection was to answer the five key questions below:

Is the service safe?

People who lived at the home were at risk because their medicines were not managed safely.

The arrangements in place for the storage of controlled medications did not comply with the requirements set out within the Misuse of Drugs Regulations (2001).

Robust recruitment procedures were not in place. This meant that people were at risk of being cared for by staff who were not suitable to work at the care home.

Is the service effective?

Staff had not been trained or assessed as competent in the management and administration of medications.

Is the service caring?

People we spoke with told us that they were happy with the way staff managed their medications.

Is the service responsive?

People we spoke with told us that they received their medicines on time.

Is the service well-led?

The concerns relating to the management of medications and standards of recruitment following our last inspection had not been acted upon.

Medications and pharmacy audits had not been carried out.

Robust recruitment procedures were not in place. This meant that people were at risk of being cared for by staff who were not of good character, and who may not have the skills and experience necessary to provide a high standard of care.

We spoke with 12 people who used the service, two relatives and a visitor.

People told us they were happy with the care and service they received, and felt that their needs were being met. One person told us ‘’the home provides high standards; I cannot fault the service.’’ Another person told us ''the staff are lovely and look after us really well.’’

People said that they felt that they get the help they needed as there was usually enough staff on duty.

People said they enjoyed their meals, which included a choice of home cooked foods. People were supported to have a well balanced diet and sufficient fluids throughout the day.

People’s medicines were handled safely and they received them at the times they needed them. Although we found that some arrangements for handling and safe keeping of medicines required strengthening to ensure they are managed appropriately.

Relatives and people we spoke with felt that the service employed reliable and trustworthy staff. We found that the provider’s recruitment procedures required strengthening in line with the regulations to ensure that staff are suitable to carry out their work.

People said they felt listened to and able to express their views or raise any concerns with staff if they were unhappy.

Required records were not kept to show that concerns were listened to, acted on and resolved, where possible.

We spoke to eleven people who use the service, five relatives and eight members of staff.

People able to express their views said they were happy with the care and support they received, and felt that their needs were being met. One person told us “It’s a lovely home; staff are friendly and helpful and we share a laugh.” Another person said “I can’t fault the place; it’s relaxed and I can do what I like.”

People said they get the help and support they need as there is usually enough staff on duty. People felt that staff essentially treated them with dignity and respected their privacy. People also felt safe and able to raise concerns with staff if they were unhappy.

Most relatives we spoke with were happy with the care and support their family member received, and felt involved in decisions about their care and treatment.