About the service: Wilnecote Rest Home provides accommodation and personal care for up to thirty people, some who may be living with dementia. At the time of our inspection, there were twenty five people using the service.

People’s experience of using this service:

•People said they felt safe and happy.

•Staff knew how to recognise and report any concerns they had about people’s well-being and how to protect people from harm and abuse.

•Medicines were managed in a safe way.

•There were enough suitably skilled staff to meet people’s needs.

•People had assessments and care plans in place which staff used to support people in a person-centred way.

•Risks to health and well-being were planned for and managed well.

•People had their dietary needs met.

•People were supported to have choice in their daily lives and staff supported them in the least restrictive way possible; the policies and systems in place supported this practice.

•Staff were kind and caring and supported people to be as independent as possible.

•People had access to a variety of meaningful activities.

•The home was run well by a registered manager who was held in high regard by people, their relatives and staff.

•The registered manager had a good oversight of the service and improvements had been made as a result of feedback received and through learning lessons when things went wrong.

Rating at last inspection: At our last inspection the service was rated as Good overall with the key question of Effective rated as Requires Improvement (Report published 12 August 2016). At this inspection, the service met the characteristics of Good in all areas.

Why we inspected: This was a planned inspection based on the date and the rating of the last inspection.

Follow up: We will continue to monitor the service through the information we receive and will re-inspect as per our inspection programme or sooner if required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 29 June 2016 and was unannounced. At our last inspection in December 2015 we identified concerns with how medicines were managed and how safely the environment was maintained. On this inspection we saw the medicines management system had been reviewed and medicines were now stored safely. Systems were in place to ensure all areas of the home were checked and areas locked where necessary to prevent people from harm.

Wilnecote is registered to provide residential care for up to 23 older people. Following the concerns we identified during our inspection visit in July 2015, we issued a condition on the provider’s registration to prevent further admissions into the home. We reviewed this on our next inspection in December 2015 to enable the provider to admit up to 20 people. This meant on the day of our inspection visit 17 people were using the service. As a result of the improvements demonstrated by the provider at this inspection, we will remove this condition.

There was a registered manager in post, although they now worked within another home managed by the same provider and was providing support to the new 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. The new manager plans to submit an application to us to become the new registered manager.

People had a choice of food and were able to have drinks throughout the day. However, the meal times were not always managed effectively to ensure people did not have to wait for their meal and their meals remained warm.

People’s consent was sought prior to any support being provided and staff understood how to support people to make decisions where they no longer had the capacity to do so for themselves. Where people had restrictions placed on them, authorisations had been made to ensure this was lawful. The provider had not identified that other people may have restrictions placed on them as they needed support to remain safe in the community and the provider had not identified this.

Staff understood their responsibility to safeguard people from harm. Staff were available for people and had received training so that people’s care and support needs were met. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks.

People were involved in decisions about their care and they received support in the ways they preferred. People were encouraged to remain as independent as possible and able to pursue their hobbies and interests. People maintained relationships with people important to them and visitors were welcomed at the home. People were treated with kindness, compassion and respect and people liked the staff who supported them and had developed good relationships with them.

People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed so that people received their medication as prescribed.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. This was through regular communication with people and staff, surveys, checks on care workers to make sure they worked in line with policies and procedures and a programme of other checks and audits. People knew how to complain about their care and concerns were responded to.

We inspected the service on the 26 November 2015. At our last unannounced inspection in July 2015 multiple regulatory breaches were identified and the service was judged to be ‘Inadequate’ and placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing

inadequate care significantly improve.

• Provide a framework within which we use our

enforcement powers in response to inadequate care

and work with, or signpost to, other organisations in

the system to ensure improvements are made.

• Provide a clear timeframe within which providers must

improve the quality of care they provide or we will seek

to take further action, for example cancel their

registration.

This meant the service would be kept under review and inspected again within six months. We told the provider they needed to make significant improvements in this time frame to ensure that people received safe care and treatment that was responsive to their changing needs, were protected from abuse and not unlawfully restricted.

We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and to drive improvement. At this inspection, we made the judgement that the provider had made sufficient improvements to take them out of special measures but some further improvement was needed to ensure the quality and safety of the service was effectively monitored.

The service provided accommodation and personal care for up 23 people. There were 16 people using the service at the time of the inspection with a variety of needs including people living with dementia.

The manager had applied to register with us (CQC). 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's medicines were not all stored safely and there was no guidance for staff to follow on the administration of 'as required' medicines. Some areas of the building needed maintaining and making safe for people who used the service.

People were safeguarded from abuse and the risk of abuse as staff knew what constituted abuse and who to report it to. The manager had made referrals for further investigation when they had suspected abuse had taken place.

People were supported to be as independent as they were able to be through the use of risk assessments and the staff knowledge of them.

There were enough suitably qualified staff who had been recruited using safe procedures available to maintain people’s safety and to support people in hobbies and activities of their choice.

The provider was working within the guidelines of the Mental Capacity Act 2005. The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people’s best interests where they are unable to do this for themselves. People’s capacity had been assessed and staff knew how to support people in a way that was in their best interest and was the least restrictive.

People and their representatives were involved in decisions relating to their care, treatment and support. Care was planned and delivered based on people’s preferences and regularly reviewed with people.

People were supported to have a healthy diet dependent on their assessed individual needs. People were given choices and asked what they would like to eat and drink.

People had access to a range of health professionals and staff supported people to attend health appointments when necessary.

People were treated with kindness and compassion and their privacy was respected. Staff supported people to be independent and have a say in how the service was run.

People had opportunities to be involved in the community and to participate in ho

This inspection took place on 27 July 2015 and was unannounced. Wilnecote Rest Home provides residential care for up to 23 older people. There were 16 people using the service at the time of the inspection some of whom were living with dementia.

There was a manager in post; however they were not yet registered with us to manage Wilnecote Rest 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.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. People were not always kept safe and their welfare and wellbeing was not consistently promoted.

People were not protected from the risk of abuse; some people had been abused by other people who used the service. Incidents were not identified as potential abuse; they were not reported or investigated.

Risk assessments and care plans did not reflect the current support and care needs of people. People were at risk of not receiving their prescribed medication when they needed it or in the correct way. Infection control was compromised by staff working practices. Some areas within the environment posed a risk of harm for people.

Some people who used the service were unable to make certain decisions about their care and treatment. The legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were not being consistently followed. The MCA and DoLS set out the requirements that ensure where appropriate; decisions are made in people’s best interests when they are unable to do this for themselves. People could not be assured that decisions were being made in their best interests when they were unable to make decisions for themselves.

Staff had a good knowledge of people’s individual care needs but made assumptions on behalf of people in regard to choices and options.

People had access to healthcare professionals but did not always receive medical support and interventions in a timely way to ensure their health and well-being was upheld.

People told us the staff were kind, caring and helpful. However, some staff working practices compromised people’s rights, privacy and dignity.

The provider had a complaints procedure and people told us they would speak with the manager or staff if they had concerns. The response and solutions to complaints were not made in a timely way.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. Poor care was not being identified and rectified by the provider.

We found several breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

We visited Wilnecote Rest Home on 25 June 2013 after we had received concerning information about a person who had lived there. We had been told that a person's care may have been neglected.

We understood why these concerns had arisen. In response, we reviewed policies, practices, care plans and other records. However, we found no evidence that the staff group had been neglectful when caring for this person.

When we visited Wilnecote Rest Home, we found that the people who lived there enjoyed a homely atmosphere. The L-shaped lounge enabled people to choose to watch television or relax and listen to music. One person had their budgerigar in the room.

We observed that the people who lived at Wilnecote Rest Home had dementia with varying degrees of severity. People could not be involved in most discussions about their care. We spoke with the relatives of two people, who were visiting the home that day. One relative told us: “The care is exceptional here. The staff meet Mum’s needs in every way. She always looks nice and the care workers are kind and respectful”. Another relative said: “Mum was poorly, but she’s picked up because she is so well cared for. The staff are very quick to obtain medical or nursing help when she needs it”.

We observed that people’s dignity and right to privacy was respected throughout the day. We found that care plans provided enough personal details about people’s needs and preferences to provide guidance for care workers in delivering safe and appropriate care. We found that significant improvements had been made to hygiene in the home since our last inspection.

We found that staff were experienced and well-trained. They told us they felt well-supported. We saw that they were skilled in working with people with dementia. We saw evidence of regular checks and audits by managers to ensure that the quality of care given to people was maintained.

We visited Wilnecote Rest Home in February 2013. Seventeen people were living there at that time. They all had dementia and some people had difficulties with mobility as well. When we spoke with people who lived at the home, they could not give us a clear account of their care, although some people were able to tell us they enjoyed their meals at the home. We relied on relatives who were visiting that day to tell us about the overall care people received.

We spoke with the relatives of five people who lived at Wilnecote Rest Home. They were all positive about the care their family members received. They told us, “The staff are excellent”; “The care is brilliant, absolutely fantastic”. They said that everyone who lived at the home was treated with kindness and respect. When we looked at people’s care plans, we found a lack of written information. The plans did not reflect the quality of the care people had told us about.

We observed that there were enough care workers to meet people’s individual needs. The care workers we spoke with had worked at Wilnecote Rest Home for between two and eleven years. We saw they had completed a broad range of training.

Prior to our visit we had received information about some areas of the home not being clean. We found some areas required intensive cleaning. Records of cleaning schedules in the kitchen had not been maintained. We could not inspect the home's quality assurance documents; there was no key available to a locked cabinet.

"Mum has lived here for five years and we have never had to complain. Its absolutely marvellous. We always have a warm welcome and the staff are attentive and positive, they are a great team led by a professional manager. I recommend the home to people all the time. The dignity and respect shown to all the people living in the home is wonderful."