This inspection was carried out on 13 June 2017 and was unannounced. At their last inspection on 28 October 2015, they were found to be meeting the standards we inspected. At this inspection we found that they had continued to meet all the standards.

Wymondley Residential and Nursing home provides accommodation for up to 59 older people, including people living with dementia. The home is also registered to provide nursing care. At the time of the inspection there were 58 people living there with another person scheduled to move in.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People told us they felt safe were protected from the risk of abuse as staff were knowledgeable in the subject. Individual risk assessments were completed and accidents were reviewed to help identify trends. People’s medicines were managed safely and there was regular access to health and social care professionals.

People were supported by sufficient staff who were recruited safely. Staff had received regular training, received supervision and felt supported.

People had their ability to make decisions assessed, however, best interest decisions needed to be recorded. Consent was sought before care was delivered. People said staff were kind and we saw that they were treated with dignity and respect.

People enjoyed a variety of food and support was provided appropriately. People and their relatives were involved in planning their care and confidentiality was promoted.

People’s needs were met and their care plans were up to date and detailed. There were activities offered during the afternoons but these would benefit by being developed further to include mornings and evenings.

Everyone was positive about the management of the service and there were systems in place to monitor the quality of the service. People’s complaints were responded to promptly.

The management team actively sought updates to their knowledge and skills to help ensure they complied with regulations and to work to continually provide a good quality service.

This inspection was carried out on 1 October 2015 and was unannounced.

The Wymondley Nursing & Residential Care Home provides accommodation and personal care including nursing care for up to 59 older people. There was 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 and associated Regulations about how the service is run.

When we last inspected the service on 04 April 2014 we found them to be meeting the required standards. At this inspection we found that they had continued to meet the standards.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and some were pending an outcome. Staff were fully aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People had their individual needs met by staff who knew people well and provided support in a timely manner. There was sufficient food and drink available and people were consulted in developing the menus. Staff was committed to provide personalised care in well maintained environment. People were able to sit in different areas of the home which were adapted for people to pursue their hobbies and interests.

People had regular visiting health and social care professionals. Staff responded promptly to people’s changing health needs and sought the appropriate guidance or care by healthcare professionals. People received their medicines in time, however best practice guidelines were not always followed by staff in relation to safe recordings and administration of medicines.

Staff were clear on how to identify and report any concerns relating to a person’s safety and welfare and they were confident in reporting on any safeguarding concerns they had.

The manager responded promptly to any feedback and complaints which were appropriately recorded and investigated. The lessons learned were shared with staff to ensure a continuous improvement of the service.

Staff had been employed at the service for a number of years and there was a low staff turnover. Staff were recruited through robust procedures and provided with regular training to ensure their knowledge was up to date.

People, their relatives and staff were positive about the manager and their leadership. Staff were proud to work for the service. People and their relatives were happy with the care provided by the staff and they were positive and complimentary about the management.

Inspectors gathered evidence to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring, Is the service responsive? Is the service well led?

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 09 April 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

We looked at records which showed that people’s care and support needs had been assessed, documented and reviewed. They gave staff clear guidance on how to deliver safe and appropriate care that met people’s individual needs. A GP with experience of the care and treatment provided at the home commented, “Staff have a fantastic attitude and are genuinely caring. I am very confident that people are well looked after.”

We saw that care and treatment was provided in premises that were suitable and fit for purpose in terms of design and layout. We saw that the premises had been well maintained and were in a good state of repair and decoration both inside and out. However, we found that security arrangements were not as effective as they could have been because access to the premises was not restricted during daytime hours. The provider has agreed to review and improve existing security arrangements.

Effective recruitment policies and procedures had been put in place to ensure that staff employed at the home were of good character and appropriately skilled to meet people’s needs. This included carrying out appropriate checks before staff began work.

Is the service effective?

At our previous inspection carried out on 12 November 2013, we found that some people had not been sufficiently involved in decisions made about whether or not resuscitation should be attempted in the event of a medical emergency. During our inspection carried out on 09 April 2014, we found that necessary improvements had been made and that the regulations in relation to how consent was obtained had been met.

People told us that staff had always obtained their consent and agreement about the support, care and treatment provided. One person who lived at the home commented, “I have been fully consulted and involved about the care and support I need. I have agreed to it and frequently discuss my requirements with the manager, nurses and care staff.”

We saw that people had been involved in the assessment of their individual needs and in the planning, delivery and reviews of the care and support they received.

Is the service caring?

During our inspection we saw that staff treated people who lived at the home with respect and kindness while delivering appropriate levels of care and support. We also saw that care was delivered in a way that met people’s individual needs and requirements.

People who lived at the home and their relatives were very positive and complimentary about the levels of care provided and the care staff who supported them. One person commented, "The care we get here is absolutely first class it really is. Everybody is so very well looked after in such a kind, patient and efficient way. Staff come quickly when you call for then and can never do enough for you.”

Is the service responsive?

People told us they liked the opportunities provided by the activities coordinators and the range of facilities available at the home. These included computer games, poetry sessions, flower arranging and gardening, arts and crafts activities and use of a music room, hairdressing salon and library.

We saw that people had been given information about how to make a complaint if the need arose and that concerns raised had been properly documented and resolved in a prompt and effective way. Everybody we spoke with told us they knew how to make a complaint but had not had the need to do so.

Is the service well led?

We found that effective systems had been put in place to assess and monitor the quality of services provided and to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home.

We saw that the home worked well with healthcare professionals such as GP's, dentists and chiropodists to make sure that people received care that met their individual needs in a joined up way.

We spoke with members of staff who told us that both the provider and manager demonstrated strong, visible and consistent leadership in a way that made them feel valued and supported.

When we inspected Wymondley Nursing and Residential Care Centre on 12 November 2013, we saw that people were asked for their consent about the care and support they received and staff acted in accordance with their wishes about every-day tasks. We asked people whether the staff asked for their consent when providing support and one person said, “They are very good at that.”

Arrangements were not in place for establishing and acting in accordance with the best interests of people using the service in relation to their capacity to express their wishes about resuscitation in a medical emergency.

We found that people’s needs were assessed and care was planned and delivered in line with those individual needs. One person who was living at the home told us, “Everybody [staff] seems to make an effort to make you as comfortable as possible.” The relative of one person who was visiting said, “I think they provide an exceptional service. My [relative] gets everything they need.”

We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The provider was operating a standardised medication management system which used personalised colour-coded blister packs for each of four medication rounds throughout the day. People's medication records were accurate and medicine stock numbers matched those records.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider ensured that the professional registration of nursing staff was up to date.

People's care plans and other records contained up-to-date information. Records were accurate and fit for purpose. Staff records were diligently maintained.

There were sufficient numbers of staff with appropriate skills knowledge and training to meet the assessed needs of the people who used the service.They received regular supervision and support from senior management. Staff we spoke with confirmed they received regular supervision, one person said "The senior staff are approachable and very supportive, we can always contact someone out of office hours.

We saw staff interacting with people used the service, listening to them and responding in a polite and courteous way and also knocking on doors before entering. People’s needs were assessed and peoples likes and dislikes were identified including, the time they like to get up and go to bed, what they like to eat and drink,

Breakfast was available from 8am till 11am, people were able to eat in their room if they wished. One person who used the service said "The food was very good, we get lots of choices.at all meal times" Another person said " When my relative visits they join me for dinner in the dinning room where staff ensure we have access to our own dinning table."

The provider regularly assesses and monitors the quality of the service, regular audits are carried out and appropriate action is taken to address any issues. The provider produces a monthly newsletter informing people of what is happening within the service such as the current improvement plan regarding the installation of 27 overhead hoists and upgraded mains electricity supply.

We included an expert by experience on our visit to Wymondley Nursing and Residential Home, on 14 December 2011. An expert by experience is someone who has had personal experience of using or caring for someone who uses a care service.

During our visit we spoke to a range of people using the service and their relatives who were visiting them. The people we spoke with were very positive about the service they receive at Wymondley.

People told us they were treated with respect. One person who had recently moved in told us they had settled in well and were pleased with ‘every aspect’ of the service. They said the staff were absolutely ‘superb’. Another person said the service had ‘exceeded their expectations’ and the staff were ‘all very kind’.

People told us they were able to choose how they spent their time and were involved in making decisions about how they wanted their care needs to be met.

People told us that they enjoyed the meals they had been served and confirmed that they were offered choices to suit their personal preferences.

Visitors told us that there was always a welcoming, bright cheerful atmosphere and they were kept informed of any changes effecting their relative or events taking place at the home. One person said ‘it’s like being part of a big family’.

People told us their home was always fresh and clean.