Wiltshire Heights Care Home

Updated 19 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 3 inspectors.

Service and service type

Wiltshire Heights Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Wiltshire Heights Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 9 people and 7 relatives about their experiences of care received. We spoke with the registered manager, regional director and 13 members of staff. We also had feedback by email from 4 members of staff. We contacted 7 healthcare professionals for their feedback and heard from 4 either by telephone call or email. During feedback after the inspection, we also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed multiple medicines records, 4 staff recruitment files, care plans and risk assessments for 8 people, health and safety records, quality assurance information and governance records, records of complaints, incidents and accidents, the homes improvement plan, information about planned refurbishment work, training and competence records, compliments and policies and procedures.

Updated 19 October 2023

About the service

Wiltshire Heights Care Home is a residential care home providing accommodation, personal and nursing care for up to 63 people. The service provides support to adults over and under 65yrs and people with dementia. At the time of our inspection there were 53 people using the service.

Accommodation was provided over 3 floors accessed by stairs and lifts. People had their own rooms which were en-suite and communal areas such as dining rooms, a library, and lounges. People could also access secure gardens from the ground floor.

People’s experience of using this service and what we found

Medicines were not always managed safely. People had not had their medicines as prescribed and ‘as required’ guidance was not detailed. The provider had taken action to improve medicines management, however, we have made a recommendation about medicines policy. Staff received medicines training and had annual competence assessments.

We observed there were enough staff available to meet people’s needs however, feedback from people and staff was at times there was not enough staff available. The provider used a dependency tool to calculate staffing numbers and used agency staff to fill gaps in rotas. We have made a recommendation about using feedback from people and staff to help calculate staffing numbers.

People who experienced distress did not have detailed guidance in place to help staff to understand how to provide support. We observed 2 occasions where people were not responded to in a timely way. Other risks to people’s safety had been assessed and guidance was in place to help staff manage those risks.

Care plans were in place, but some were conflicting. The provider had changed systems prior to our inspection which had been a challenge and were carrying out monthly checks on the quality of recording. Senior staff also reviewed care plans monthly to make sure they were up to date. People had been given the opportunity to record their wishes with regards to end of life care.

People enjoyed the food and could have family and friends to eat with them if they wished. Menus were available informing people of choices. Systems in place for people choosing their meals were not effective for people with short term memory loss. The provider recognised this and gave assurance they were reviewing mealtimes across all their services. Despite this area for development, we found 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.

People and relatives told us people were safe at the service. Staff had been provided with training on safeguarding and understood how it applied to their role. New staff had been given a comprehensive induction which gave them knowledge and skills needed for their roles. Refresher training was provided in a range of areas and staff told us they could ask for training if needed.

The home was clean and cleaning schedules were in place to record what was cleaned and when. Personal protective equipment was available for staff, and we observed them using this safely. Staff were provided with guidance and training on infection prevention and control. Health and safety checks were carried out across the building and for all equipment. We did find rooms that needed to be locked were open and shared this with the provider. They gave assurance these rooms would be kept locked.

People, relatives and professionals told us staff had a kind and caring approach. We observed some positive interactions between staff and people. We also observed some interactions that were not person-centred and shared that feedback with the registered manager. The provider told us their head of dementia care was working with the service to develop staff skills and knowledge to provide good dementia care.

People had a range of activities to choose from if they wished. During our inspection we saw a variety of activities taking place to cater for a wide range of interests. The service had a minibus which was used to take people out to the local community or access local services.

Staff worked with healthcare professionals to meet people’s health needs. Local GPs visited the home weekly and other professionals were contacted if needed for advice. Staff had daily handovers and regular meetings to keep updated with people’s needs. Staff told us there was good communication amongst the team and good teamworking. Feedback from professionals confirmed this.

Quality monitoring systems were in place and shortfalls found during this inspection had already been identified by the provider. There was a service improvement plan in place to identify actions needed to make improvement and who was responsible for this action. Incidents and accidents were recorded, and any necessary actions carried out. Analysis of incidents, falls and other data was completed by the registered manager and the provider to identify any patterns or trends.

People, relatives, staff and professionals told us the registered manager was visible and approachable. People and relatives felt able to complain if needed and we saw complaints were well managed. People thought the service was well managed. Relatives told us they felt able to visit any time and were always made to feel welcome.

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

Rating at last inspection

The last rating for this service was outstanding (published 10 April 2019).

Why we inspected

The inspection was prompted to seek assurances about the safety and care of people following information received as part of ongoing safeguarding concerns and medicines management incidents. As safeguarding investigations were ongoing, the inspection did not examine the circumstances of those particular incidents. We wanted to seek assurances about the wider safety measures for people at the service. We inspected and found there was a concern with medicines management and the approach of some staff, so we widened the scope of the inspection to become a comprehensive inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from outstanding to good based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe key question section of this full report.

Recommendations

We have made 2 recommendations about medicines management and seeking feedback from people and staff to help calculate staffing numbers.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.