Wilton House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. These were analysed and lessons were learnt to continually identify, shared with staff to embed good practice.

Staff understood their responsibility to report concerns and actions taken to promoted people’s safety. One staff member told us, “We discuss incidents to understand if we could have done anything differently. Most of the time it's about good communication, managing risks and explaining things, like the risks, if they choose to do something that may not be safe. We have a de-brief after any incident to reflect on what happened, so we're constantly learning.” Records showed, people’s risk assessments were reviewed and updated and if required, referrals were made to healthcare professionals for advice and support.

People and relatives were confident to speak with staff or the registered manager and knew they would act on concerns. A person said “I've got a keyworker; it’s [Staff name]. We have a chat about how things are for me all the time.” Keyworker meetings were used effectively where the named staff member had responsibility for reviewing a person’s care with the individual on a regular basis.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

Some people living at Wilton House had been there for a number of years. Staff understood their needs and worked well with other healthcare professionals to support people. Emergency information and hospital transfer information was kept up to date and accessible to staff. This ensured people received continuity of care and health professionals had the relevant information they needed in a medical emergency. A relative described how staff ensured there was continuity of care and health appointments were arranged at times to suit their family member.

When people moved to Wilton House this was structured around the needs of the individual to ensure the transition was effective. This involved assessing and observing the person in their home environment or hospital and planned visits to familiarise themselves with the environment. A relative told us, “Initially [Person name] had 2 or 3 visits for a couple of hours, then a trial for a week. They seemed to like this place; there was no expectations or pressure from the staff or the other residents.”

Staff were trained and understood the specific needs of people with a learning disability and autistic people and followed the care pathways were designed to ensure support was person-led, consistent, and responsive. A staff member told us “It’s important that people are involved in their care to respect their rights, and choices.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The safeguarding policy provided clear guidance for staff to follow. This information was available in formats people could understand. Staff knew what abuse looked like, and how to recognise early signs of distress, responding to allegations, and how to report concerns both internally and to external agencies.Where safeguarding occurred, the management ensured this was investigated appropriately and immediate action was taken to keep people safe.

People told us they felt safe; the staff knew them well and understood how to protect them from abuse. One person said, “They're good at listening and understand me; we're all very different.”

Feedback from relatives was consistently positive. Their comments included, “I feel [Person Name] is safe; there's staff around if they need them. [Person name] needs to let staff know when they’re going out” and “I know [Person name] is safe, and staff support them to stay safe, and they know that's what staff there are to do.” Procedures were in place to support people with their finance, and this was regularly audited to prevent the risk of financial abuse.

The registered manager and staff understood their responsibility under the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Records showed relatives, with the appropriate legal authority, had been involved in making best interest decisions for their family member where they lacked capacity to make certain decisions.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s risk assessments were clear, and support plans provided staff with guidance on how to manage and minimise risk. These were person-centred and regularly reviewed, to enable them to live as independently as possible while remaining safe.Risk assessments were tailored around individual needs, and specific to the activity that people wanted to do, which enabled staff to support them to do this safely. Staff promoted positive risk taking and helped people to understand the associated risks, consent and ensured measures were in place to support them. These included using public transport, using the swimming pool and gym, managing finances and developing personal relationship.

People told us how their lives had changed for the better and felt they lived safely. One person said, “I did need staff around to help me at first, but now, I'm alright. I do my washing and try to keep my room tidy; well, it's tidy for me.” One relative said, “[Person name] is fairly content living there and has the freedom to go out. They go through the support. Another relative told us, “I've not been involved in reviews, but I know [Person] talks to their key worker about what they want or need. They manage [Person name] needs well.

Systems in place ensured staff were trained and equipped with the skills and knowledge they needed to support people safely. Staff knew people well for instance, they recognised triggers for anxiety and proactively re-direct focus on a new activity. Staff told us when they took prompt action it helps to reduce distress and prevents potential risk of incidents. We observed staff approach was consistently calm, respectful and always promoting people’s rights. Record showed staff worked closely with people, their family where appropriate and external partners to ensure risk management plans were robust.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People lived in one adapted building, designed to support and promote people’s safety. It was decorated and well maintained. People had their own private bedroom with ensuite. One person told us, “It's a nice place, my room is my private space and got my own shower and toilet - I love it.” Relatives were happy with the premises and had no concerns.

People had individual personal emergency evacuation plans in place that reflected their current needs. People knew where the meeting point was in the event of a fire. There was clear signage to enable people to leave the premises in an emergency.

Systems were in place to comply with health and safety requirements such as water safety, fire systems, and gas and electricity safety. Window restrictors were in place to prevent accidents. Regular checks of environmental hazards were completed, and auditing processes showed any issues identified had been addressed by the provider’s maintenance team.

The provider made sure people were supported by staff who had the right skills. Staff received regular training and supervision to ensure they had the skills and knowledge to support people effectively.

Systems in place were used effectively to determine staffing numbers based on people’s individual needs and to keep them safe, including those who require one to one. A staff member said, “We have enough staff, and [Registered manager] is here if we need extra support. We have a good team and we're always communicating so we know what's happening and can plan for it.”

During our inspection visit we saw there were enough staff to provide individual support with daily living skills and to go out or attend appointments. We observed people were comfortable around staff and asked questions and were responded to in a kind and appropriate manner. The staff rota was displayed in the kitchen so people could check to see which member of staff was working each day and night.

People and relatives spoke positively about the staff. A person said, “You can talk to any staff, [Staff name] working today and others who work here too.” A relative said, “All the staff are great, lovely people and there to support [Person name] and the others.”

New staff were recruited safely and records confirmed pre-employment checks were completed prior to employment commencing. Staff received a comprehensive induction, training for their role and competency checks. Individual learning needs were supported to ensure staff had the skills required to meet people’s needs. Records showed staff completed a wide range training to support people with specific health needs and conditions. This included the Oliver McGowan training which is a specialised training for working with people with a learning disability and autistic people. The senior support staff told us “I’m trained in NAPPI (non-abusive psychological and physical intervention), but I’ve not had to use this as you can talk with the residents here. We anticipate and use diversion, and restraint would be last resort – I’ve never had to use it.”

Staff received continued support through supervisions and appraisals and recognised for good practice. There were clear procedures for team working, and staff told us they worked as a team and communication was good.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Wilton House was clean and smelt fresh throughout. Regular cleaning was completed by day and night staff to ensure that the home remained consistently clean. In addition, an external contractor was used when required, for instance for professional carpet cleaning.

Staff received up to date infection control training. Staff understood the importance of good infection control practices and were observed following guidance for hand hygiene, personal protective equipment (PPE), and safe food handling. There were procedures in place for managing outbreaks and responding to infection risks, including regular audits to monitor compliance.

People told us staff supported them with to manage their laundry and to keep their bedroom clean. One person said, “My room is nice, it's clean and I've got the things that I need.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Systems were in place to ensure staff were trained and followed processes to store securely, record and administer medicines safely. Medicines were stored safely including medicines which required stricter controls and protocols for administering ‘as required’ medicines were in place. We checked a sample of the medicine administration records, and these had been completed fully and accurately. There was a clear procedure for managing people’s medicines during home visits to family, however, staff had not followed this consistently. This was raised with the registered manager and quality compliance manager and addressed immediately. No harm was caused to people.

People told us they were supported with their medicines and had no concerns. Relatives also were satisfied with the support their family member received to manage their health.

People’s support plans documented how people wanted to take their medicines which met their needs. This included where there were difficulties in communicating and when assessing risks of people taking medicines themselves. Staff ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. This demonstrated the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) helped to ensure people’s medicines were reviewed by prescribers.