This inspection took place on 5 December 2017 and was unannounced.

At our last comprehensive inspection on 27 October 2016 the overall rating of the service was, ‘Requires Improvement’. This summary rating was the result of us rating the key questions ‘safe’, ‘responsive’ and ‘well led’ as, ‘Requires Improvement’. In relation to the key question ‘responsive’ and ‘well led’, we found that there was a breach of regulations. This was because the registered manager had not ensured everyone had a care plan which met their needs at all times. We also found the registered manager had failed to maintain accurate and complete care records in respect of each person.

At our last inspection for the key question, ‘is the service safe?’ we found peoples risk assessments did not include enough detail to ensure people were supported safely. For example, we saw 'repositioning' charts were in place but there was not detailed information or guidance on the risk assessment to say how this was to be managed. Another person had been identified to be at risk of choking. There was no risk assessment in place to provide guidance to staff on how to manage this. We also found one staff member not following good hygiene procedures. Whilst supporting people to take their medication they used their hands to give it to them instead of using an appropriate hygienic method such as a spoon. They did not wash their hands in between each person's administration. This put people at risk of cross contamination.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question’s ‘safe’, ‘responsive’ and ‘well led’ to at least good. At this inspection the overall rating of the service was changed to, ‘Good’. We found significant improvements had been maintained and we rated each of our key questions as being, ‘Good’.

Wyndham House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Wyndham House accommodates 44 people in one adapted building. There were 37 people living in the service at the time of our inspection visit.

There was a registered manager in post. 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 of the Health and Social Care Act 2008 and associated regulations.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, the necessary provision had been made to ensure that medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service to support people to stay safe and meet their needs. Background checks had been completed before care staff had been appointed. People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong.

Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

Care staff had been supported to deliver care in line with current best practice guidance. People enjoyed their meals and were supported to eat and drink enough to maintain a balanced diet. In addition, people had been enabled to receive coordinated and person-centred care when they used or moved between different services. As part of this people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had

Wyndham House Care is registered to provide accommodation and personal care for up to 44 people some who may be living with dementia. They were 41 people living in the home at the time of the inspection. The accommodation is over two floors which is served by a passenger lift.

This unannounced inspection took place on 27 October 2016.

We carried out an unannounced comprehensive inspection of this service on 3 August 2015. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. This was because improvements were needed to make the home effective, caring, responsive and well led. We asked the provider to take action to make improvements to ensure that people were receiving adequate nutrition, hydration and had opportunities to take part in activities in the home and in the community. During this inspection although action had been taken to make improvements, further improvement were still needed.

There was a registered manager in post at the time of this inspection. 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.

Care plans and risk assessments did not always give staff the information they required to meet people’s needs.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

People were provided with a good choice of meals. When necessary, people were given any extra help they needed to make sure that they had enough to eat and drink to keep them healthy.

Staff had received training, which was regularly updated in order to enable them to provide care in a way which ensured people's individual and changing needs were met. Staff knew how to manage any identified risks and provided the care people needed. Peoples health needs were supported as they had access to a range of visiting health and social care professionals.

Clear arrangements were also in place for ordering, storing, and disposing of people's unused medicines. However, improvements were required in the administration of medicines to ensure people were protected from cross contamination.

The provider had a recruitment process in place and staff were only employed after all essential pre-employment checks had been satisfactorily completed.

Staff treated people with dignity and respect.

A process was in place to identify record and respond to people’s concerns and complaints. Complaints were resolved to the complainant’s satisfaction.

Whilst we found audits had been undertaken, these were not all effective.

We found two 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.

We inspected this service on 3 February 2015. The inspection was unannounced .

Wyndham House provides accommodation and support for up to 45 older people, many of whom live with dementia. There were 37 people living at the home at the time of our inspection.

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.

At our last inspection in June 2014, we found breaches of the regulations and asked the provider to make improvements to how people were protected; how the service was monitored; how records were kept and how we were notified of significant events. These actions had been completed.

The atmosphere of the home was welcoming and friendly and there were sufficient numbers of suitable staff to meet people’s needs and keep them safe. There had been improvements over the last year and visitors were pleased with the refurbishment and decoration of the premises which had made it lighter and brighter for people.

Health and social care professionals were positive about the home and the care and support provided to people living there. Staff were good at keeping relatives informed of events that affected their family members: something which they greatly appreciated.

Staff had received appropriate training for their role and had also received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards so that people, who could not make decisions for themselves, were protected. Staff knew how to manage risks to promote people’s safety and independence.

People’s needs were assessed and support was planned and delivered in line with their individual needs. Their health was monitored and they were supported to see a wide range of health professionals if needed. Medicines were stored correctly and people received them as prescribed.

The manager had implemented a number of improvements since our previous inspection and all areas we had identified as non-compliant with the Regulations then, were now compliant. However improvements were still required in a number of areas, including in how people were supported to maintain their nutrition and the level of activities available to them . We also identified the need for improvement in how staff moved people, the information about how people’s behaviour was managed and the management of people’s complaints.

We found two breaches of the regulations and you can see what action we have told the provider to take at the back of the full version of the report.

As part of our inspection we spoke with three people using the service and four relatives. We spoke with the manager, deputy manager and seven members of staff. We observed people using the service and observed how staff interacted with them. We examined six sets of care records at the service.

Below is a summary of what we found.

Is it safe?

We spoke with three people who used the service. They were able to communicate that they felt happy and safe. We spoke with four relatives. They said they felt confident to report any concerns to the manager. The relatives we spoke with also said that they felt their family members were cared for in a safe way. Records showed that assessments of any potential risks to people had been carried out and measures put in place to reduce the risks.

There were effective systems in place to reduce the risk and spread of infections. Staff we spoke with were knowledgeable and clear about their responsibilities with regard to cleanliness and infection control. This meant that people were protected from the risk of infection.

We found that the manager did not have processes and procedures in place to ensure that medicines were administered safely.

The provider did not have a system in place to demonstrate that they had given consideration as to whether each person using the service had the capacity to make decisions about their day to day care under Mental Capacity Act (MCA) 2005. The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone’s behalf is recorded, including the reasons why it has been made, how the person’s wishes and preferences have affected the decision and how they were involved in the decision making process.

Is it effective?

Our observations showed that staff members knew people’s individual health and support needs. Staff knew how to support people living with dementia. We saw that people had a positive relationship with the staff who supported them. Staffing levels were satisfactory to meet the needs of people who lived at the home. We saw that there were sufficient skilled and trained staff on duty to meet the needs of people who used the service. Care plans were in place for each person using the service, however we saw that the recording was not always as reliable as it needed to be.

Is it caring?

We saw that staff interacted very positively with people using the service. Staff supported people in a professional way, with respect and in a kind and friendly manner. The relatives we spoke with all said that the staff were very caring to their family members and they made relatives feel welcome when they visited. We saw that personal care was offered and delivered discreetly so that people’s privacy and dignity was respected. The staff we spoke with said that they enjoyed their work. They demonstrated a sensitive understanding of the needs of people who lived at Wyndham House and a desire to support each person to enjoy a good quality of life.

Is it responsive?

People’s needs and care plans were regularly reviewed by the staff and management at the home. One person’s relative said, ”The staff here are fantastic. I have nothing but praise for them." Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills. Support plans included information on people’s likes and dislikes and their preferences. This was done to ensure care and support was delivered in the way that people wanted it to be. People participated in a range of activities and we saw that staff actively encouraged them to participate. There were enough qualified, skilled and experienced staff to meet people’s needs.

Is it well-led?

There was effective leadership in place. Staff told us they felt well supported by the manager and trained to do their job. One member of staff said, "The manager is brilliant. It’s lovely working here." Relatives told us they felt the manager had made a positive impact on the service. However, staff were not receiving regular supervision and appraisals. This meant that staff had not been adequately supported to do their job. The provider had some effective quality assurance and audit systems in place to monitor aspects of the service. Other quality assurance systems needed some improvement.

All of the seven people with whom we spoke gave us positive feedback about the service. One of them said, “I think that the staff are wonderful to us. They’ll always try to help and they’re nice about it too. It’s a friendly sort of place.”

We saw that staff had consulted with people who used the service (and their representatives) about what care was to be provided.

People said or showed us that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

We found that the provider had measures in place to help safeguard people from abuse (including financial abuse).

Records showed that security checks had been completed on staff to help ensure that only suitable and trustworthy people were employed in the service.

We saw that there were measures to check that people were reliably provided with the facilities and services they needed.