Wisteria House is registered to provide care and accommodation to up to 13 people. The home specialises in the care of older people. The home is situated in the centre of a village and had close links with the local community. The home does not provide nursing care and people who require nursing assistance were supported regularly by the community nursing team.

The service is also registered to provide personal care to people in their own homes in the community. This part of the service had been expanding rapidly and 60 people were now receiving care and support. The service was run from an office in the grounds of the home.

There is a registered manager in post. The registered manager was responsible for the day to day running 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.

The registered provider was responsible for the quality assurance and standards of the whole service. They supported the registered manager in relation to the running of the home and were closely involved in the day to day running of the domiciliary service.

The provider and the registered manager were open and approachable and supported people receiving a service and staff well.

People told us staff were kind and caring and always respected their privacy and dignity. People were very positive about the care and support they received both in the home and in the community.

One person living in the home said “I don’t know where else I could be happier. I have friends here amongst the staff. It is amazing but I am ever so happy.” One person receiving support in the community said ““They are a lovely care company. Very caring. There are no complaints at all.”

Care was responsive to people’s needs and personalised to their wishes and preferences. People were able to make choices about all aspects of their day to day lives.

Staff knew the importance of learning about people’s preferred ways of daily living and supporting them to continue to be independent when possible.

People were offered care they had been involved in planning themselves. People were involved in discussions about the care and support they received and were made aware of any risks. The staff responded to changes in people’s needs and adjusted care accordingly.

Staff were aware of how to assist people to make decisions if they lacked the mental capacity to make decisions for themselves.

People enjoyed the food in the home. They had a choice of food and staff catered for people with specific dietary needs and preferences when required. Food was plentiful and the size of people’s meals varied according to their appetite and preferences.

People in the community were offered support with their diets in a variety of ways that met that their needs.

In the home people were seen by doctors, nurses, chiropodists, opticians and were supported to attend hospital appointments where needed.

In the community people’s health needs were assessed and plans were in place to reduce the risk of them becoming ill. The service supported people with complex needs by working in partnership with other professionals

All staff had access to on-going training which ensured they had the skills and knowledge to safely and effectively support people.

There was a recruitment procedure which minimised the risks of abuse to people. There were sufficient staff to ensure people received appropriate, unhurried care.

Staff had received training in recognising and reporting abuse and were confident that any concerns would be fully investigated to make sure people were protected.

People knew how to make a complaint and everyone told us they would be comfortable to do so. All were confident they would be

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe. Staff were trained in safeguarding and understood their role in preventing and reporting abuse. The service worked well with other agencies to help keep people safe. The house was clean and there were infection control measures in place.

Is the service effective?

People told us that they were satisfied with the care they received. From our observations and speaking with people and staff we saw that care plans were up to date and changes were noticed and acted upon. The service cooperated with other agencies to ensure changing needs were met. One person told us, “they know what to do but most importantly, they listen to what I've got to say because we are all different and we are different each day."

There was enough equipment in place to meet people's needs. We found where people were unable to give their consent to care, the provider worked with family or other advocates, and relevant professionals to determine people's best interests.

Staff told us they received regular supervision and training, and felt supported working as part of a team.

Is the service caring?

We found that care plans were up to date and that staff worked with people, offering choice and support. One person told us, “I find the carers excellent; I’ve never had anyone rude or discourteous." Members of staff we spoke with demonstrated respect for people, most of whom had complex long term conditions including physical and mental health needs.

Is the service responsive?

We found people’s needs had been assessed and reviewed and that care plans contained simple clear guidance for staff about people's preferences and specific care and support needs. One member of staff told us, “my carer knows exactly what to do and how to handle my care needs." A member of staff told us they found it easy to contact the manager or supervisor to discuss someone's care or to report changes. One member of staff told us," the managers are very open to considering new ways of doing something, as people's needs change all the time."

Is the service well-led?

The service benefitted from an additional registered manager since the last inspection and additional supervisory staff. We found care plans had been reviewed and updated. There were checks for making sure these remained up to date. We found there were checks on the environment of the house and we saw improvement plans in progress. Checks on risk were made in response to people’s care needs and in response to the environment in the house. Monitoring of quality was being developed in areas related to the experience and wellbeing of people who use the service. A new system of visits monitoring was helping to provide information about the effectiveness of the domiciliary care service.

When we inspected Wisteria House on 15 March 2013 we found that people spoke positively of the service. A relative of one person who used the domiciliary service said, "They are absolutely fine, very kind." A person who lived at the home said, "It's very pleasant here. They are very good." We saw that one person had a display of collectable pottery in their room and a staff member told us, "It's all about making it feel like home."

Although people spoke positively about the care they received, we found that their needs were not properly assessed and their files contained limited or no information. As a result, care and treatment was not planned in a way that ensured their safety and welfare.

People were not protected from the risk of abuse. We found that there were two separate incidents of alleged abuse that had not been notified to the CQC according to the provider's registration responsibilities and the local authority had been made aware of only one of these incidents.

Staff were supported to carry out their role. We found that staff had access to a wide range of relevant training and that they were supported through regular supervision.

The provider generally had systems in place to monitor the quality of service that people received. However, this was not the case with people's care files which had not been audited and which contained limited and poor quality information.

This inspection was carried out to look into concerns that were raised with us about the domiciliary care agency run by Wisteria House. Concerns raised related solely to the regulated activity ‘Personal Care.’ This report relates to the domiciliary care agency only.

People we spoke with were happy with the care that they received from the agency and the staff who assisted them.

People told us that they felt the staff were competent and “know what they are doing.” One person told us that they felt very safe when being hoisted.

We observed that people were very comfortable with the care staff who supported them and with the provider. People said that staff were “kind and respectful.”

People told us that the provider often visited to support them with their care needs and was always approachable. One person said “We can always speak with the owner of the agency and they are always ready to listen to our views or concerns.”

Everyone at Wisteria House was happy with the care that they received. One person said “Care is very, very good it could not be better.” Another person said “Staff are always happy to help and they take you through anything you’re not sure of.” We observed that people who were unable to verbally express themselves appeared comfortable and well cared for.

People living at the home said that they are able to make choices about their day to day lives. People said that they were able to make decisions about when they got up, when they went to bed and how they spent their day. One person said “You can please yourself what you do but they like you to tell them when you are going out.”

People said that they were able to continue their own personal routines and did not have to fit in with staff routines.

People were complimentary about the food served at the home. Comments included, “Food is always nice,” “There’s always plenty to eat” and “It’s like good home cooking.”

People said that they could ask for hot drinks at any time of the day or night.

People said that they felt safe and secure at the home. People said that they were able to express their views about the care that they received. Everyone asked said that they would not hesitate to talk with a member of staff if they were unhappy with any aspect of their care. All felt that any concerns would be listened to and addressed.

People living at the home felt that there was generally enough staff to meet their needs. Some people said if they rang their bell for assistance staff responded promptly, whilst other said it depended on how busy staff were.

People using the service said that staff who assisted them were kind and caring. One person said “Staff are always kind and polite,” another said “Anything I want they try to do.”

The people living at Wisteria House were all older people with varying support needs. Wisteria Care provides care at home to adults with a range of support needs. Some of the people receiving care have varying capacity and complex support needs.

This inspection was to look at the progress made in achieving compliance since our last inspection in March 2013. We spoke with seven people who live in the home, six people who use the domiciliary care service, and seven members of staff. People spoke highly of the staff. One person told us “They are all very kind and caring”.

The staff working in the home were kind, but they were not always respectful in their interactions with people. People appeared comfortable and relaxed with the staff who supported them, and activities were taking place. However, in some instances we saw that care plans were not being followed.

The home was not clean and we found that hot water was not working properly in the upstairs sinks. Equipment was serviced but necessary work was not always arranged.

Staff had received training around safeguarding however, there was a lack of clarity about who decides when, and if, an alert should be raised.

The home had started to undertake quality assurance audits , however these systems had not identified the majority of the concerns outlined in this report.