Wythall Residential Home is registered to provide accommodation and personal care for older people who may live with dementia for up to 22 people. At the time of our inspection 15 people were living at the home.

We carried out an unannounced comprehensive inspection of this service on 3 November 2016. After that inspection we received concerns in relation to the safety of people, the care people received and the management of the home. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

Following the previous inspection we rated each of the five key questions as Good. The overall rating for the service was Good. We have not changed our overall rating of the service. However, the question ‘Is the service well-led’ is now rated as Requires Improvement.

The rating following our previous inspection was not on display within the service on our arrival. This was later seen to be in place.

There was a manager in post. This person had commenced on the process necessary to register with the Care Quality Commission although no application had been received by the commission at that time. 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 we spoke with told us they felt safe living at the home. Staff had an awareness of their responsibility to report poor or potentially abusive practice. People told us they were able to get up when they wanted. Information about when people got up in the morning was included within their care plan. Care records were not always detailed such as the assistance needed in the event of a fall however staff had an awareness of people’s needs

People were supported around the home as they wished with the guidance of staff to reduce the risk of falling. Equipment was available such as hoists if needed. We saw staff administered people’s medicines and record as required. Staff were seen to respond to people’s needs throughout the day. People were able to undertake their interests and staff were seen spending time with people.

You can see what action we told the provider to take at the back of the report.

The home is registered to provide accommodation and personal care for adults who require nursing care and who may have a dementia related illness. A maximum of 22 people can live at the home. There were 20 people living at home on the day of the inspection.

There was no registered manager in place. 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.

We had previously carried out an unannounced comprehensive inspection of this service on 24 September 2015. A breach of legal requirement was found in relation to Need for Consent. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements as people who use services were not supported to make decisions or have their capacity assessed. We found these improvements had been mad.

People and their relatives told us the service was safe. Staff knew how to keep people free from the risk of abuse and had undergone safeguarding training, had access to policies and guidance which enabled them to safeguard people.

People’s risks were managed and had been assessed in relation to their mobility skin care and other health risks. Care staff identified risks and understood how to mitigate the risks. People told us that cares staff were approachable supportive and motivated to provide good care to people.

There were enough care staff who had the correct skills and knowledge to safely meet people's needs in ways that they preferred. People's medicines were ordered, stored and disposed of safely. Staff had completed medicines training and updated their internal medicines training and told us they felt confident in administering medicines.

People told us the staff were trained. Care staff had received suitable training, on-going support and professional development to ensure they were competent to deliver people's care. People reported that their consent was asked for when care was being given. Care staff were able to demonstrate how it applied to their day to day work with people.

People were happy with the quality of the meals provided. People were appropriately supported by staff wherever they were eating within the service. People's weights were monitored and appropriate action was taken if people were at risk from weight loss. People reported there was good healthcare provision. Staff arranged for people to see a range of health care professionals as required.

People and relatives said the care delivered was good and the care staff were friendly, kind, helpful and respectful. People experienced positive relationships with the staff who cared for them and who upheld their privacy and dignity when providing their care.

People told us they received the care they needed and were cared for by staff who had information about how to respond to their individual needs. People were encouraged to enjoy interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

People, their families and staff all told us the service was well led. Staff had a good understanding of their roles and responsibilities and felt appreciated. They described the culture as friendly and that there was good teamwork. The provider identified that improvements in medicine administration and care plans were required and were working to improve these areas.

There were 19 people using the service at the time of our inspection. We spoke with nine of these people, the staff that were supporting them and two relatives. Positive feedback was received about the service provided at the home.

We spent time in the dining room and observed the care and support received by people who were using the service. We saw that staff supported people in a respectful manner and offered them choices of how and where they wanted to spend their time.

People told us that they were happy with how their care and support needs were being met. One person told us:" I am very comfortable living here." People told us that staff were available at the times they needed them and that they felt safe living at the home. People told us that they were satisfied with the choice and quality of meals available to them.

Arrangements were in place so that people received their medicines in a safe and timely manner.

Arrangements were in place to ensure that staff employed were suitable to work at the home. Staff turnover was low and we obtained positive feedback in relation to support provided by staff.

Systems were in place to monitor the quality and safety of service provided at the home. People using the service and their relatives were involved in this.

Records were complete and easily located upon request. Records about care had been reviewed and updated to ensure they reflected people's current needs.

There were twenty one people using the service at the time of our inspection. We spoke with five of these people and the staff that were supporting them. We spoke with three relatives. We observed the care and support received by people who, due to their medical conditions, were unable to speak with us. Staff supported these people in a respectful manner and offered them choices of how and where they wanted to spend their time.

People told us that they were happy with how their care and support needs were being met. They told us that staff were available at the times they needed them. A person told us “I enjoy having a bath. I can have one whenever I want to.”

People told us about the quality and choice of food and drink available. They told us that they were satisfied about the choice and quality of meals. A person told us “The food is great, there is a choice.”

People told us that they felt safe living at the home and that they would speak to the staff if they had any concerns. A person told us “I enjoy the security of living here.”

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They told us that they did not have any concerns about the quality of care provided. However, they told us that dementia care training provided by themselves had, on occasions, been poorly attended by staff. Further training dates had been arranged.

Worcestershire County Council social services told us in late January 2012 that they had concerns about the way that the provider had managed risk for one person who used the service. This had led to actual harm from a fall.

We visited the service on 1 March 2012. The acting manager told us that there were 21 people living in the home at that time. We followed the care of three people. We met and spoke with two of those people.

One person had a low level of need for support and care. We asked for their view on the home. They told us "it's as good as it can get. Everyone is kind here."

We looked at people's care records and found that the quality of assessment of need, care plans and review of care plans varied. People with complex conditions did not always have risks to their health and well being consistently managed and this put them at risk. We have required the provider company to comply with regulation and improve this.

We spent two hours in the communal rooms of the home. We saw that workers and managers treated everyone with patience, kindness and respect. There were three care workers on duty and they were stretched over lunch time to provide the level of individual attention that some people needed. We have asked the provider company to improve this.

We spoke to another person over lunch. They told us that they felt happy, safe and settled at the home. They said that there were no over restrictive rules and that workers were very attentive.

We looked at the bedrooms of two of the people whose care we followed. We saw that they were clean, warm and comfortable.

We spoke to care workers on duty. They were able to tell us about people's needs and care plans. They spoke very positively about the dementia awareness project that the staff team was involved in with Worcestershire County Council. Workers understood their responsibilities to safeguard people from risk of abuse.

Workers and managers held qualifications in social care. The provider company was not able to show us accurate records of up to date staff training in compulsory subjects such as safe moving and handling of people and food hygiene and infection control. We have asked the provider to improve planning for keeping skills and knowledge regularly updated.

The manager is not registered with us.

The inspection was unannounced and took place 24 September 2015.

Wythall Residential Home is registered to provide accommodation and personal care for adults who have a dementia related illness for a maximum of 22 people. There were 21 people living at home on the day of the inspection. There was a manager in place however they had not been registered with us. A 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 told us they felt safe and staff were available to them. Staff told us about how they kept people safe from the potential risk of abuse and provided medicines as required. People and relatives told us there were enough staff to support people at the home. Staff at the home felt there were enough staff to meet the needs of people living at the home.

Assessments of people’s capacity to consent and records of decisions had not been completed where required. The provider could not show where people had not been able to give their consent to care and treatment or that the relevant people had been consulted. People told us they liked the staff and felt they knew how to look after them and made day to day choices about their care and support.

Staff were provided with training, however they told us they would like further training and awareness in understanding the Mental Capacity Act and specialist dementia care. People’s consent to care and treatment would be better supported from staff that had more knowledge in this area. The provider told us they would ensure training was arranged to support staff.

People enjoyed their meals and had choices and their preferences noted when the menus were planned. People had been supported to maintain access with other health and social care professionals. People were helped to contact and arrange appointments with services which were not available within the home. They had regular visits from their GP when needed and were supported by staff to attend appointments in hospital.

Staff knew people’s care needs and people felt involved in their care and treatment. Staff were able to tell us about the care needs of people. People’s privacy and dignity were respected and staff were kind to them. People had been involved in the planning of their care and relatives were involved in supporting their family members care.

People were supported with things to do during the day and live in an environment that supported their needs. People and relatives felt that staff were approachable and listen to their requests.

The manager was available, approachable and known by people and relatives. Staff also felt confident to raise any concerns of behalf of people. The management team had kept their knowledge current and they led by example. The management team were approachable and visible within the home and people knew them well. The provider and manager had made regular checks to monitor the quality of the care that people received and look at where improvements may be needed. The management team were approachable and visible within the home which people and relatives liked.

You can see what action we told the provider to take at the back of the full version of this report.