This inspection took place on 14 and 16 November and was unannounced. The nursing home is registered to provide a service for up to 39 people. At the time of our visits there were 22 people living at the service.

At our last inspection we rated the service good. At this inspection we found evidence that this was no longer the case and that the service required improvement. We brought this inspection forward because we had received information that suggested standards had deteriorated. Two visiting health care professionals had contacted us with their concerns and told us some staff who worked at the home did not think the service was meeting the current rating of Good awarded in December 2017. In addition, we received information from a whistle-blower and relatives who also expressed concerns. This inspection report will evidence and focus on areas that compromise the safety and quality for people who use the service.

The manager in post had worked at the home since April 2018 and had applied to CQC to be the registered manager. Their application was being processed by CQC registration at the time of this inspection.

Why the service was rated Requires Improvement.

A number of improvements were required to ensure people were kept safe and received quality care. The arrangements in place to ensure the service was well led from provider level down were unsatisfactory. Monitoring the quality of the service was not robust enough to ensure quality and safety. The manager lacked knowledge and understanding about their legal obligations.

We could not be satisfied that staffing levels and routines would keep people safe. Medicines were not always managed safely. People were not protected from the risk of cross infection. This was because appropriate guidance had not been followed. People were not cared for in a clean, hygienic environment. Parts of the environment still required improvement. We could not be satisfied that induction for new staff was effective.

People did not consistently receive person centred care and respect and dignity was not always promoted and practiced. Activities and people’s emotional and psychological well-being required improvement. Staff were knowledgeable about people's lives before they started using the service. Improvements were required to enhance this knowledge so that their life experiences remained meaningful.

Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Staff received supervision and training required to meet people’s needs.

Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice.

We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from them was positive. Those people who used the service spoke well of all staff.

Further information is in the detailed findings below.

This inspection took place on 6 and 7 December 2017 and was unannounced. Wickwar Nursing Home provides accommodation and nursing care for up to 39 people. At the time of our visit there were 26 people living at the service.

At the time of the inspection the registered manager had been on long term leave and they had submitted an application to CQC to de-register as the 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. A temporary manager was in post to help ensure smooth running of the service whilst plans were in place to recruit a new manager.

At our last inspection in September 2016 we rated the service overall as Requires Improvement. This was because we found a breach in Regulation 12 and people were not protected from the risks associated with cross infection. In addition we could not be satisfied that good management and leadership of the service would be sustained.

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good.

Even though there was a temporary manager in post their appointment had already significantly helped improve the previous lack of management of the service. Their previous experience as a manager had equipped them with the skills and knowledge required for their roles and responsibilities. It was evident they were confident and committed to embrace the new challenges and to improve the service. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received quality care.

Improvements had been made to help ensure people were protected from the risk of cross infection. This was because appropriate guidance had been followed. People were now cared for in a clean, hygienic environment.

The manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They felt supported by the manager and deputy at all times. The manager, deputy and nurses had a good understanding of the Mental Capacity Act 2005 (MCA). The care staff understood its principles and the importance of supporting people to make decisions and protect their rights.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. Staff demonstrated a genuine passion and commitment for the roles they performed and their individual responsibilities. It was important to them that those living at the service felt ‘valued and happy’.

People benefitted from a service that was well led. People who used the service felt able to make requests and express their opinions and views. Staff were embracing new initiatives with the

This inspection took place on 14 and 15 September 2016 and was unannounced. This service was previously inspected in August 2015. At that time we found there were areas that required improvement and we made recommendations to the provider in order to achieve this. Wickwar Nursing Home provides accommodation and nursing care for up to 39 people. At the time of our visit there were 26 people living at the service.

The new manager had been in post since May 2016 and they had applied to become the 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.

During 2015 there had been a lack of consistent management within the service. Because of this a significant number of improvements were required to ensure people were kept safe and received quality care. The arrangements in place to ensure the service was well led were unsatisfactory. The provider acknowledged the deterioration in the service provision earlier this year and contracted an independent company to oversee the operation and running of the service. Health Care Management Solutions joined the home in February 2016. It was evident at this inspection they had made significant improvements.

A comprehensive action plan had been developed highlighting areas for improvement. We were able to see where action had been completed and where other areas were being addressed. Work had been prioritised and realistic timescales had been put in place so that the quality of work and further development was not compromised. The service had been supported by various health and social care professionals and this had been embraced by the management and staff. They acknowledged shortfalls, learnt lessons and took action to resolve issues. It was evident that much had been achieved and working progress continued.

We did however find one area where the service was in breach of regulation. People were not protected from the risk of cross infection. This was because appropriate guidance had not been followed. People were not cared for in a clean, hygienic environment. On the second day of our inspection some concerns that required a quick fix had been addressed.

People and visitors told us they were happy and things were improving. Despite the areas for improvement, people said things were satisfactory and staff always did the best they could. Comments included, “There is a lot going on and they are doing their best”, “I cannot fault the staff, they are a lovely” and “I am very happy living here, it was the right decision”. Two relatives we spoke with shared their views about where they felt there was room for improvement and we fed this back to the area manager.

Staff were knowledgeable in safeguarding procedures and how to identify and report abuse. People were protected by the recruitment policy and practices to help ensure that staff were suitable. The manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift. Despite staff vacancies, every effort was made to ensure continuity when using agency staff.

A training programme had been developed for all staff and good progress had been made rolling this out to staff. Staff acknowledged the training had been useful and effective. People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferenc

On the day of our visit the home had organised their Christmas party. People and staff were looking forward to the celebrations and some staff had dressed up in comical Christmas themes. The party was arranged for 2pm and people were talking about the event all through the morning.

There were various activities organised for the party and we participated in a Christmas quiz with a small group of people. The quiz was very popular and we saw relatives also joining in. Some staff were sat with people individually because they required help with the quiz, they were supported sensitively.

The atmosphere in the home was happy, we were introduced to people throughout the day and they were glad to see us. We spoke with people in small groups and individually in their own rooms. Feedback from everyone was positive and people were happy living at Wickwar.

We were supported by management and staff throughout the day. They were knowledgeable about the people in their care, the policies and procedures in the home and were confident to share with us their views and experiences.

One relative recently wrote to the home “We want to thank a special member of staff. We were impressed with their attitude when we first visited Wickwar looking for a home. They were instrumental in our choice”.

On the day of our visit we were informed that due to unforeseen circumstances the manager had left and that the home was in the process of recruiting a replacement manager.

The area manager and deputy were available throughout the day and both were very knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home.

People shared with us their experiences about living in the home and we spoke with four people at length. Everyone expressed positive comments.

People told us, “I couldn’t wish for a better place, we have everything we want and nothing could be too much trouble for the staff” and “I made the right choice. I can honestly say I have never has any problems and the staff are so very, very kind”.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at the home received. There was a constant interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company.

This inspection took place on 8 and 9 January2015 and was unannounced. There were no concerns at the last inspection of 18 December 2013.

Wickwar provides a service for up to 39 older people. At the time of the inspection there were 32 people living at the service.

There was not a registered manager 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.

A permanent manager had been appointed and they had applied to register with the commission. They had received an appointment to attend a fit person interview. However due to unforeseen circumstances they were unable to attend and had to take urgent leave of absence. This absence was regularly reviewed and supported by the provider for 11 months. The length of time could not have been anticipated. The provider contacted us during the 11 months and notified us of management arrangements during the period of absence. The permanent manager was returning to their post 12 January 2015.

Systems were in place to keep people safe. Staff were knowledgeable in safeguarding procedures and how to identify and report abuse. The provider ensured there were enough staff to meet people's needs. They recognised where a change in circumstances may require a short term increase in staffing levels. Suitable recruitment procedures ensured staff were safe to work in the service.

Staff had the knowledge and skills they needed to carry out their roles effectively. They told us they enjoyed attending training sessions and sharing what they had learnt with colleagues. Staff said they felt supported on a day to day basis however, formal supervisions did not always happen and those they had attended had not always been useful. We have made a recommendation about improving supervisions for staff.

People told us they would like to be involved in menu planning so that it offered more variety. We have made a recommendation about menu planning and involving people. People were supported to eat and drink sufficient amounts. Where people were at risk of poor nutrition or hydration, measures were in place to monitor this. Arrangements were made for people to access healthcare services and receive ongoing healthcare by the nurses working in the service.

People enjoyed receiving visitors and had made “friends” with people they lived with. They were relaxed in each other’s company. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. Choice and personal preferences were encouraged and supported by staff and people told us they were listened to. One person said, “Every day is different and routines are flexible”.

Although people and staff confirmed care and support was personalised, care plans did not always capture this. Audits in care documentation had identified where improvements were needed. Additional hours had been allocated to address this in addition to care review meetings with everyone who lived in the service.

Staff had found the last year “unsettling” with inconsistent management. Staff said at times “morale had been low but things were improving”. Despite the inconsistencies of management arrangements staff had supported each other as a team. The interim manager told us the staff were “very good and worked extremely hard”.