Wilton House Nursing Home

Wilton House Nursing Home is a residential care home providing personal and nursing care to up to 37 people. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 32 people using the service.

People’s experience of the service and what we found:

People and their relatives spoke positively about the care and support they received. Comments included, “Everything about this place is lovely. The room is lovely, staff are very good and so is the food. We’re just very glad that someone recommended this place to us.” and “I’ve been here a few years and it’s excellent here. Staff are very good.”

Risks to people’s safety had been assessed and plans put in place to support staff to keep people safe. There were processes in place to safeguard people and protect them from harm and abuse. People received their medicines safely.

There were sufficient staff to meet people’s needs. The service followed safe recruitment practices to ensure people were supported by knowledgeable and skilled staff, who were of good character.

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.

There were systems in place to monitor the quality of the service and actions were taken to ensure improvements were identified and actioned. There was a positive and open culture and people and staff felt listened to by management. The service worked in partnership with other health and social care professionals to ensure people’s needs were met.

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 Good. Date of publication: 29 June 2018.

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

Follow Up

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

At this inspection we found the service remained Good.

This inspection was partly prompted by an incident which had a serious impact on a person using the service. The information shared with CQC about the incident indicated potential concerns about the management of risk. Specifically, the risk associated with nutritional needs. We reviewed the systems, policies and procedures put in place by the provider following the incident to check if these were effective in managing risk.

Wilton House 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.

The care home accommodates 37 people across two floors. At the time of the inspection 30 people were being supported in the home, 18 of which required nursing care.

The service had 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.’

Risks to people with nutritional needs were assessed regularly with associated care plans to provide support and guidance for staff to follow. People who required specialist diets were provided with the correct consistency meals. Policies and procedures supported this.

Risks to people and the environment were assessed and plans put in place to mitigate against them. The provider had a business continuity plan in place for staff guidance in case of an emergency. People had Personal Emergency Evacuation Plans (PEEPS) in place which were updated regularly providing support and guidance for staff in case of an evacuation situation.

Staff were aware of safeguarding processes and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Where lessons could be learnt from safeguarding concerns these were used to improve the service. Accidents and incidents were recorded and monitored as part of the provider’s audit process.

Care plans were personalised to include people’s likes, dislikes and preferences. Care plans were reviewed on a regular basis and updated when changes in need were identified.

The provider ensured appropriate health and safety checks were completed. We found up to date certificates were in place which reflected fire inspections, gas safety checks and portable appliance tests (PAT) had taken place.

Staff received regular supervision and an annual appraisal. Opportunities were available for staff to discuss performance and development. Staff mandatory training was up to date. Nurse’s training for specialised techniques were not easily located in staff records. The registered manager addressed this issue at the time of the inspection. We found additional refresher training and competency checks for nurses had been organised.

Recruitment processes were in place with all necessary checks completed before staff commenced employment. Staff received an induction on commencement of their employment. The provider used a dependency tool to ensure staff levels met the needs of the people living in Wilton House.

People’s nutritional needs were assessed and we observed people enjoying a varied diet, with choices offered and alternatives available. Staff supported people with eating and drinking in a safe, dignified and respectful manner. People were supported to maintain good health and had access to healthcare professionals when necessary and were supported with health and well-being appointments.

People and relatives felt the service was caring. Staff provided support in a respectful manner ensuring people’s privacy and dignity was promoted. Where possible people were supported to be as independent as possible.

People enjoyed a range of activities both inside and outside the home. The service had positive links with the community with people accessing the theatre, local centres and shops.

The provider had a complaints process in place which was accessible to people and relatives.

Staff were extremely positive about the registered manager. They confirmed they felt supported and could raise concerns. We observed the registered manager was visible in the service and found people interacted with them in an open manner. People and relatives felt the management approach in the home was positive.

The provider worked closely with outside agencies and other stakeholders such as commissioners and social workers.

The premises were well suited to people’s needs, with ample dining and communal spaces. Bedrooms were personalised to people’s individual taste. Bathrooms were designed to incorporate needs of the people living at the home. The garden area was accessible to people.

Wilton House care home provides nursing and personal care for up to 37 people.

We last inspected the service on 3 June 2014 and found the service was compliant with regulations at that time.

There was a registered manager in post who was on duty at the time of the inspection. They had worked at the service for six months and had just completed their registration prior to this visit. 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.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager had the appropriate knowledge to know when an application should be made and how to submit one. The registered manager also ensured that capacity assessments were completed and ‘best interest’ decisions were made in line with the MCA code of practice. This meant people were safeguarded.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

There were systems and processes in place to protect people from the risk of harm. The care staff understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the right action to take if they were concerned that abuse had taken place.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. We witnessed staff administering medication in a safe and correct way. Staff ensured people were given time to take their medicines at their own pace.

There was a regular programme of staff supervision in place and records of these were detailed and showed the service worked with staff to identify their personal and professional development. We fed back to the registered manager that the quality of recording around supervisions and appraisals was good.

We spoke with kitchen staff who had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. They also told us that they received any equipment and supplies that they requested promptly. People told us they enjoyed the food at Wilton House and we saw people were supported to have their nutritional needs met.

People told us they had good access to their GP, dentist and optician. Staff at the service had good links with healthcare services and people told us they were involved in decisions about their healthcare. This meant that people who used the service were supported to obtain the appropriate health and social care that they needed.

We saw people’s care plans were personalised and had been well assessed. Staff told us they referred to care plans regularly and they showed regular review that involved, when they were able, the person. We saw people being given choices and encouraged to take part in all aspects of day to day life at the service.

The service encouraged people to maintain their independence and the activities co-ordinators ran a full programme of events which included accessing the community with people. We saw people popping in and out of the registered manager’s office to chat and spend time with them and it was evident that everyone knew the registered manager well and were comfortable to speak with them at any time.

We observed that all staff and the registered manager were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members and there was a warm and caring atmosphere in the service and people were relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were kind and professional.

We saw the registered manager had a planned programme of staff and resident meetings for the rest of the year as resident meetings had not always taken place previously. The service had an accessible complaints procedure and people told us they knew how to raise a complaint if they needed to. We saw that complaints were responded to and lessons learnt from them.

Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Wilton House and actions plans and lessons learnt were part of their on-going quality review of the service.

During this visit we checked what progress the service had made to the compliance action we made in May 2013 about care practices. This was because at the last inspection we found medicines were not being managed in the right way and nursing staff had training in several areas of care but not in all the areas of care they were providing. The provider wrote to us outlining what actions would be taken to put this right. Since the last inspection the provider had put systems in place to address the problems with medication and booked staff onto relevant training courses.

The inspection team consisted of one inspector and a pharmacist inspector. During the inspection, we spoke with ten people out of 25 people living at Wilton House, two relatives, the manager and eight staff. We looked at four sets of care records. We also observed care practices within the home.

The management of the home was good and we saw strong leadership in place and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

We set out 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?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe. Wilton House was clean, hygienic and well maintained. The provider may wish to note that the flooring in the treatment room was in need of replacing. There were good processes in place that ensured infection prevention and control in the home.

People who used the service received their medicines at the times they needed them and in a safe way.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. While no applications had been submitted to the local authorising authority, the home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately. Staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

Care plans and risk assessments were in place and updated on a regular basis. We found that care plans were not person centred and did not detail what the person could do independently or the assistance needed from staff. This meant that people may not receive care and support in the way they want it to be delivered.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew people well. Assessments included dietary, social and leisure and emotional needs.

People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met.

People had access to a range of health care professionals some of which visited the home and all was documented in the care files.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people, whilst helping them to remain independent.

People who used the service, their relatives and friends were asked for their views on the care and service provided. Where shortfalls or concerns were raised, however small, these were taken on board and dealt with.

People told us that they were happy with the care and support provided to them.

Is the service responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

Discussion with the manager during the inspection confirmed that any concerns or complaints were taken seriously. We looked at the complaints record which confirmed that complaints had been investigated thoroughly and in line with the complaints policy.

Is the service well-led?

There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

Regular audits were carried out which were used to identify changes and improvements to minimise any risks to people and staff. We saw people had completed a customer satisfaction survey. This was reviewed and an action plan developed where needed and in the main we were able to see that these actions had been addressed.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people said:

People who were able to express their views told us they were satisfied with the care and support they received. One person told us, "The staff are very caring," another said, "It is very comfortable here and always warm.' And another said 'I know what care I need, if I ask for anything the staff provide it, they also look after my visitors.' Everyone we spoke with told us they enjoyed living at the home and they were happy with the care provided. People told us, "Staff are very good here." and "Staff are helpful.'

We spoke with two people about their medication. One said 'I know what medicines I take and I always get them regularly'. The other person said 'I like to manage my own inhalers, staff get them when I need them and I never run out.'

Staff told us they enjoyed working at Wilton House. Staff spoke highly of their team and of their manager. One staff member told us, "I love working here, when I am at work that is where I get my happiness." Another told us, "We are really proud of what we have achieved here; it is a happy, caring place to be.' And 'The manager has an open door policy, she is very supportive and really, really good.'

Relatives and friends of people who used the service said 'I feel that all their needs are met.' And 'Staff are lovely, although I feel they need more staff, but I suppose everyone says that.'

We found medicines were not being managed in the right way.

We found nursing staff had training in several areas of care but not in all the areas of care that they had been providing. We found staff had not had individual supervision sessions with their line supervisor for several months.

We spoke with eight people who lived at Wilton House, four relatives and two health and social care professionals. All had positive comments about the 'caring' and 'friendly' attitude of staff. For example one visitor told us, 'It's a very nice home and the staff are very caring.'

The agency carried out the right checks of new staff before they started work to make sure they were suitable to work with vulnerable people.

During this inspection we also checked what progress the provider had made to a compliance action we made in May 2013 about its quality assurance systems. We found the provider had improved the way it checked the quality and safety of the service.

All the records we looked at were accurate, up to date, stored securely and promptly located.

We carried out this visit during the evening. We spoke with day staff and night staff, a visiting relative and four people who lived at the home. People described the home as 'friendly, warm and comfortable'.

We saw that people were being offered a choice of hot drinks and suppertime snacks. People were well dressed, kempt and clean. People described entertainment and activities they had enjoyed that day. People told us their choices about where they spent their time and when they retired to bed were respected.

Most people were in their own bedrooms due to their poor health. We found that sometimes staff did not respond immediately to call alarms in people's rooms, but put the system 'on hold' at the main panels in the corridors instead. This practice could place people at potential risk as their requests for assistance were not always acted on in a timely way.

We found that there were still some concerns about moving and assisting practices and some staff using mobile phones when they were on duty. Similar concerns had been raised in the past about this home. This meant the provider's quality assurance actions had not led to sustained improvements.