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Inspection carried out on 24 October 2019

During a routine inspection

About the service

Welcome Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At this inspection staff were providing personal care to 14 people aged 65 and over and the service can support up to 14 people.

People's experience of using this service

Staff implemented the provider’s safeguarding processes to protect people from the risk of harm and abuse. Staff completed training in safeguarding and understood how to take action promptly by reporting these to the local authority. Risks associated with people’s care needs were assessed and staff developed and followed a risk management plan to mitigate potential risks.

Staff managed people’s medicines so people had these as prescribed and in a safe way to help maintain their health care needs. When people needed health care support staff made referrals to specialist health care professionals and staff followed these guidelines to ensure people received appropriate care.

Meals were prepared by the chef that was employed at the service. Staff understood people’s nutritional needs and provided people with meals they enjoyed and met their cultural needs. People took part in activities they enjoyed and they were supported to meet their religious needs.

The staff rota showed that enough staff were available during the day and night to meet people’s individual needs. Recruitment checks were in place to ensure suitably experienced staff were employed to work at the service.

Assessment and care plans were in place and people contributed to these before they came to live at the service. People said that staff were kind, caring and provided care and support that was compassionate.

The complaints process was made available to people, relatives and visitors to make a complaint if they were unhappy about an aspect of the service and care provided.

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

Rating at last inspection

The rating at the previous inspection was Good. (The inspection report was published on 10 June 2017).

Why we inspected

This was a planned inspection based on the rating of the service at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 30 March 2017

During a routine inspection

Welcome Care Home Limited provides accommodation and personal care for people. The service accommodates a maximum of 14 people. At the time of the inspection there were 14 people using the service.

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 2008 and associated Regulations about how the service is run.

When we inspected this service in May 2015, there were a number of breaches of regulation. This included person centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, premises and equipment, good governance, staffing and fit and proper persons employed. The overall rating at that inspection was inadequate the service placed in ‘special measures’.

We then completed a focussed inspection on November 2015. We followed up on the breaches of regulation found at the previous inspection to see if the registered provider had made improvements to the service. We found that the service had made some improvements, however further action was required to meet the fundamental standards of the regulation. We found continued breaches related to person-centred care, need for consent and safe care and treatment. The service was rated overall requires improvement at that inspection. The provider wrote to us to say what they would do to meet legal requirements of the regulation.

We could not improve the rating for effective, caring and responsive from requires improvement because to do so requires consistent good practice over time. You can read the report from our last inspection, by selecting the 'all reports' link for Welcome Care Home Limited on our website at www.cqc.org.uk.

During this inspection on 30 March 2017, we found the service had made improvements. We followed up on the breaches of regulation we found at the inspection of November 2015. The registered manager had made the required improvements in relation to person-centred care, need for consent and safe care and treatment. The registered provider now met the fundamental standards of the regulations.

People received their medicine as planned. Records used in the management of medicines were accurate. These showed that people had their medicines as prescribed. We found that the service did not always record the stock of medicines that came into the service when people returned home from hospital. We have made a recommendation relating to the service in the management of medicines. Risks associated to people's health and well being were identified. Staff had in place a plan to manage and reduce the risks identified to keep people safe and well.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff supported people in line with the Mental Capacity Act 2005, their mental capacity assessments and DoLS authorisations as appropriate.

Staff engaged well with people. Staff and people knew each other and were courteous as they chatted and laughed together. Staff spoke with people in a way that was respectful. Staff delivered care in such a way that protected people’s privacy, dignity and individual choices were respected.

Safeguarding processes and guidance was in place to protect people from abuse. Staff understood what signs to look for if someone was at risk of abuse. Staff told us what actions they would take to report an allegation of abuse that occurred at the service.

Staff referred people to health care services for specialist health care advice. Health care professionals we spoke with were confident that people’s changing care needs were reported promptly

Inspection carried out on 5 November 2015

During a routine inspection

This inspection took place on 5 November 2015 and was unannounced. Welcome Care Home Limited is a residential care home that provides accommodation for people who require personal care and support. The service accommodates up to 15 people, some of whom were frail or had dementia. At the time of the inspection there were 13 people using the service.

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 2008 and associated Regulations about how the service is run.

The last time we inspected this service in May 2015, they were rated inadequate. There were a number of breaches in regulations including, person centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, premises and equipment, good governance, staffing and fit and proper persons employed.

During this inspection, we saw evidence of some improvements. One of the key factors of change we observed was in the daily management of the service. The provider had employed a new home manager. The manager had put actions in place to develop the service, but further action is required to meet the regulations. Some of the improvements we found included safeguarding service users from abuse, meeting nutritional and hydration needs, premises and equipment, good governance, staffing and fit and proper persons employed.

Staff had safeguarding processes and guidance in place to support them to protect people from harm. Staff could demonstrate their awareness of the signs of abuse and the actions to take to report them.

People had access to health care services when necessary. Referrals to health care services occurred when people’s health care needs changed or for further investigation. Health care professionals became involved in the care needs of people and developed professional guidance for staff as required.

People's care needs were assessed and their care planned and delivered to meet them. Care plans provided guidance for staff to ensure that care delivered met the needs of people. Staff provided appropriate care to address and manage people’s changing care needs. People gave staff consent to care and support to meet their needs.

People had food and drink available to them, which met their needs. Staff were aware of people’s nutritional needs and foods, and how this affected their health. People enjoyed their meals and staff supported them to have meals of their choice.

People, relatives, and staff provided feedback to the provider. The manager analysed these and actions taken to improve the service. The manager completed regular monitoring and reviews of the service to ensure the care delivered was safe. There was a complaints process for people and their relatives if they wanted to raise a complaint. People gave positive comments about the care and support they received.

Recruitment processes were effective and safe to ensure the employment of suitable people to work at the service. Staff had appropriate checks completed before they worked with people. Training, supervision, and appraisals were available to support staff in their roles. They were sufficient numbers of staff cared for people.

People lived in a service that was clean, and free from unpleasant smells. There was an effective cleaning schedule in place at the service. Risks of infection were reduced for people because staff used appropriate cleaning equipment and they followed the guidance for cleaning. The provider had a process in place to record, manage, and promptly resolve repairs required at the service. The service was in good state of repair and maintenance work took place when required.

However, we found the provider had not made enough improvements and some standards of the 2014 regulations were still not met. The breaches in regulations are related to person-centred care, need for consent and safe care and treatment.

People and their relatives were not always involved in making decisions on their care needs. Staff did not routinely involve people or their relatives in the review of their care. Risks to people were identified and a plan in place for staff to reduce them. However, staff did not always follow this guidance to reduce their recurrence. We found the risk assessments were not robust enough to give staff that were unfamiliar with people’s needs, enough detail for them to reduce risks effectively.

People were not always treated with dignity and respect or their privacy valued. We observed some examples where staff engaged well with people and spoke with them with kindness. However, we observed other occasions were this did not happen, and staff had not respected and promoted people’s dignity.

People did not have their care managed in line with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager did not always make prompt referrals to the authority to consider an application for Deprivation of Liberty Safeguards (DoLS).

Medicines were not managed safely. There was no ‘when required’ PRN medicine protocols in place for people. Medicines were not stored safely in a suitable pharmaceutical fridge. There was a risk that medicines were not stored at the correct temperatures. The provider had not taken into account guidance from the Royal Pharmaceutical Society: The handling of medicines in social care.

We had previously rated this service as ‘inadequate’. In recognition of the improvements that have been put in place after our inspection in May 2015, we have now rated this service as ‘requires improvement’.

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

Inspection carried out on 15 May 2015

During a routine inspection

The inspection took place on 15 May 2015 and was unannounced. Welcome Care Home Limited is a residential care home that provides personal care and support for up to 15 people, some of whom were frail or had dementia. At the time of the inspection there were 14 people using the service.

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 2008 and associated Regulations about how the service is run.

At the last inspection on 30 September 2014 the service was not meeting the regulations we inspected. The service did not provide safe care and meeting nutritional and hydration needs for people.

At this inspection we found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not protected against the risk of abuse because the procedures in place did not identify risks to people. They were at risk of receiving unsafe care because the registered manager and staff had not updated people’s care plans, risk assessments and did not have plans in place to monitor and manage risks. People’s medicines were not managed safely and staff did not follow the provider’s medicines policy. People were at risk of infection because the cleaning of the service was ineffective.

The recruitment process used by the service was not robust; staff were employed at the service without criminal records checks in place. We saw that staff were busy but this did not impact on the care people received. Staff did not have effective support, induction, supervision, appraisal and training to support them in their caring roles.

People were not consistently supported to access health care when required and were not involved in making decisions in planning their own care. People were not provided with meals which were balanced and met their nutritional or health care needs. The registered manager did not understand the requirements and their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s records were not stored securely.

People did not receive a service which was responsive to their needs. Staff did not respond to people’s changing care needs and the way care and support was delivered was not tailored to meet their individual needs. People were not always treated with dignity and respect and did not have privacy when they wished.

People and their relatives were encouraged to formally feedback to staff and the registered manager regarding the quality of care for people. The registered manager analysed these responses however they had not identified any areas for improvement for the quality of care for people. Concerns raised by people and their relatives were not always followed up promptly. The service held meetings with staff were to gather their suggestions about how to improve the service but these were not always acted upon.

The day to day operation of the service was not effectively led, coordinated and managed by the registered manager as they did not understand their responsibilities and did not provide clear leadership and support to other managers to deliver their roles effectively.

People were treated with kindness and compassion by staff. People and staff engaged well with each other.

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.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

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

Inspection carried out on 30 September 2014

During an inspection to make sure that the improvements required had been made

This inspection was carried out to check whether improvements we required after our last inspection on 22 May 2014 had been carried out. During that inspection, we found the provider was not meeting essential standards relating to care and welfare of people who use services,, safeguarding people from abuse and assessing and monitoring the quality of service provision. The provider wrote to us and told us the improvements they planned to make to meet these essential standards.

One inspector carried out this follow up inspection. During our visit we gathered evidence to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service caring?

We found that people did not always receive appropriate advice and input from a health professional. We found that the pull cords and alarms in the downstairs and upstairs bathrooms did not work which meant people were not able to notify staff if they required assistance

Is the service responsive?

People and their relatives told us they were involved in reviewing their plans of care when their needs changed and we saw that following the review appropriate support recommended was implemented.

Is the service safe?

Staff were aware of safeguarding processes and procedures and they were aware of and recognised the signs of abuse and how to report allegations of abuse. At our last inspection on 22 May 2014, we had concerns about how people�s money was being managed by staff. During this inspection, we saw there were records of all financial transactions. Records were signed and countersigned by two members of staff. We were able to check incomes, expenditures and balances for people. We were able to look at records and check balances with the money that was available to people, this was correct and was accurate. People�s money was kept onsite in a locked safe and senior members of staff on duty had access to the safe as required.

Is the service effective?

People were supported to have their assessed needs, preferences and choices met by staff with the necessary skills and knowledge. People had Do Not Attempt Resuscitation (DNACPR) instructions in place. We saw the next of kin was involved in making these decisions. However, people were not supported to have a balanced diet as fresh fruit and vegetables were not available for people.

Is the service well led?

People told us that they were able to speak with staff and their key workers if they needed to. There were quality assurance systems in place to improve the care provided to people. The home manager regularly met with people and their relatives and changes to improve the service were made in response to their views. Staff were supported with regular supervision, appraisal, training and team meetings.

Inspection carried out on 22 May 2014

During a routine inspection

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?

As part of this inspection we spoke with the four people who used the service, two visiting professionals, the registered manager, the home�s manager and three care staff. We also reviewed records relating to the management of the home which included three care records.

Below is a summary of what we found. The summary describes what people using the service, visiting professionals 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.

This is a summary of what we found.

Is the service safe?

There were procedures in place to protect people from abuse and staff knew how to respond to allegations of abuse. The provider had not taken all the reasonable steps to identify the possibility of abuse and prevent abuse from happening. People who used the service were protected from the risk of most type of abuse but we found that the arrangements in place did not ensure that people were fully protected against the risk of financial abuse.

People�s care records contained risk assessments which identified risks to people and ways to reduce them to ensure their needs were met as safely as possible. We found that most risks to people�s welfare and safety were managed appropriately. However, the plans in place to manage risks associated with people�s diabetes for two people were not appropriate due to a lack of relevant risk assessments and guidance to staff. This meant that the risks were not kept at the lowest possible level.

There were arrangements in place to deal with foreseeable emergencies however we found the plans were not reviewed at appropriate intervals.

There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. We found that accidents and incidents were recorded and saw that appropriate actions were taken by the service.

We found there were enough qualified, skilled and experienced staff to meet people�s needs.

Is the service effective?

People�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People�s individual needs, choices and preferences were reflected in their care plans. Although the three care plans we looked were available to staff and were evaluated on a regular basis we found these were over a year old and their evaluation were not recorded consistently.

People�s health was monitored and they received medical attention when it was needed.

People were involved in decisions about the environment they lived in. People we spoke with told us they felt they were listened to and their views were taken into account. We found evidence that people�s feedback was regarded and changes were made to the service as a result.

Is the service caring?

We spoke with four people who used the service to get their feedback on their experiences living at the home and about quality of the service. People told us they were satisfied with the care they received and told us, �I like it (the home)�, �it�s ok� and that �they (staff) are alright.� From our observations and discussions with staff we saw that they made efforts to get to know people who used the service in order to provide them with personalised support.

During our visit, we saw that people who used the service were treated with dignity and respect. People also told us they felt listened to and their privacy and dignity was respected. We found that people�s diverse needs were recognised, for example special dietary or cultural needs were accommodated.

We found that people and their relatives were involved in discussions and made decisions regarding their end of life care plans and arrangements.

Is the service responsive?

People were supported in promoting their independence and community involvement. People told us they participated in various activities of their choice within the home and in the community as well. People�s life history, their likes/dislikes were recorded and the plans were person centred. We found that people�s diverse needs were reflected in their care plans and that people received personalised support.

Is the service well-led?

We found that the quality of the service was regularly assessed and monitored. There were procedures in place to carry out various health and safety checks to ensure that people were getting a safe and appropriate level of service. Although checks that were carried out, we found that the systems were not robust enough and effective to identify risks relating to people�s welfare and safety.

We found that the service worked in partnership with the local authority and health professionals to ensure people�s health and well-being.

We spoke with three members of the staff who told us �I love it (working in the home)�, �it�s a lovely and nice place to be�, �I enjoy the work and the residents are good� and �yes, I do like it here.� Staff said they felt supported and that the manager was approachable and helpful.

Inspection carried out on 10 May 2013

During a routine inspection

Our last inspection of 6 and 7 September 2012 found Welcome Care Home Limited was non-compliant with four outcomes we reviewed. During this inspection, we found improvements had been made.

We spoke with three people using the service, all of whom commented positively about the care and support they received. One person told us, "On a day to day basis, I'm looked after well." Another person told us, "It's fine here, it's relaxed. It's turned my life around. I have no complaints." Another person told us, "I get everything I need - I have no problems."

Appropriate arrangements, including training and procedures, were in place to protect people from abuse. Clear accounts were maintained for people who were supported to manage their weekly allowances, which protected them from financial abuse.

People using the service we spoke with told us they felt safe and had not experienced any form of abuse.

During this inspection, we have seen some evidence of audit and other quality monitoring activities carried out by the provider. However further improvements are required.

Inspection carried out on 6 September 2012

During an inspection to make sure that the improvements required had been made

There were 13 residents living at Welcome Care Home Limited when we inspected the service on 06 and 07 September 2012. We spoke with four of the residents during our inspection, and observed how most of the residents were being cared for.

We found that people were well cared for and received appropriate support from the staff team to meet most of their observed needs.

People in the home spoke well of the staff team and life in the home. Their comments included:

"The staff are alright, they're good. It's alright here as a home. Although it's not like my own flat, I've been able to make my room my own. I brought my own things in there."

"I'm social, I like people around me, so I enjoy the lounge. I'm quite happy here."

"We have activities we can do: play games, walk in the garden, go to the town centre."

People also made positive comments about the food, saying, "The food's excellent - there are good sized portions" and "I like the food". However one resident told us they felt the food was 'nothing special'. We noted that all the residents we observed ate all of the lunch provided during our inspection.

We carried out this inspection to check that the provider had made improvements following our last inspection on 13 March 2012. We also reviewed some additional standards we did not review in our last inspection.

We found that the service remained non-compliant in some standards we had previously reviewed. The residents and people close to them, such as their family and friends, were not consistently involved in the development of their plans of care. People were not offered a range of stimulating activities to take part in during the day.

Whilst the staff support arrangements had improved since our last inspection, some pertinent courses had not been prioritised for staff to attend to ensure they delivered on certain aspects of the care arrangements.

People who use the service were not protected from the risk of financial abuse by means of a robust system to support them in managing their finances properly.

There was no audit plan in place for the various aspects of the service, which would have given the service assurance about the quality of its care arrangements as well as identifying areas for improvement.

Inspection carried out on 16 March 2012

During a routine inspection

We spoke with various people who lived at the home and with some relatives who were visiting the home. People we spoke to said they knew there was a care plan for them, and that we could examine it if we needed to as part of the inspection.

They said that they had been asked about their care needs when they were moving into the home, and that they knew they had a care plan showing staff what help they needed. They said that they were regularly asked about their care needs when their plan was being reviewed.

One relative said that the staff were friendly, and knew her mother�s care needs well. Another relative said that her relative was happy there but felt there could be more stimulating activities and exercise opportunities offered by the home. Relatives said they said they could visit the home at any time, day or night and were welcomed by staff.

All of the people we spoke to told us they felt their relatives were safe and well cared for by Welcome Care Home. They said that the staff were friendly, helpful and respectful, and that the food at the home was good. They told us that the staff knew how to support their relatives and that they could speak with the manager if they were worried about anything.

Overall, the feedback we received from people who lived at the home was very complimentary about the way staff respected their rights and helped them to be safe and secure.

Reports under our old system of regulation (including those from before CQC was created)