21 March 2023
During an inspection looking at part of the service
Wellesley House Nursing Home Limited is a care home providing personal care to 25 people at the time of the inspection. The home is registered for up to 38 people. People have access to their own bedroom along with communal spaces including lounges and gardens.
People's experience of using this service and what we found
Quality checks in place to monitor the home were not consistently completed. When completed they did not always identify areas of improvement or demonstrate the actions taken. The provider could not always demonstrate when things had gone wrong, and lessons learnt.
There were no systems in place to work out staffing levels in the home. Despite this, people felt safe and felt their needs were met. Further improvements were needed to ensure people had ‘as required’ medicines plans in place when needed.
Risks to people were considered and reviewed, when needed. Infection control procedures were in place and followed. People received their medicines when needed and were happy living in the home.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (Published 17 March 2020).
Why we inspected
We received concerns in relation to safety and leadership. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wellesley House Nursing Home Limited on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to how the home is governed.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.