Wilbury

People’s experience of using this service:

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

People were protected from avoidable harm. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. People told us they felt safe and knew who to contact if they had any concerns. The registered manager continued to ensure there was enough staff to support people safely and they followed safe recruitment processes. One person told us, “I feel really at home here. If I hadn’t, I wouldn’t have stayed.”

People continued to receive their medicines safely and on time and staff were trained in administering medicines. People were protected by the prevention and control of infection and staff wore gloves and aprons when supporting people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. One person told us, “I can’t say a word against it’ I get up and go to bed when I want, and staff help me when I need help.”

People continued to be supported by staff who had the training, skills and knowledge to deliver effective care and support. People were supported to maintain their health and had support to access health care services when they needed. People were supported to maintain a balanced diet and were overwhelmingly positive about the food.

People continued to receive kind and compassionate care. One person told us, “The staff are all very kind and patient. We get to know them all as friends.”

People continued to receive personalised care that was responsive to their needs. People could choose how they spent their day and had access to a range of activities across the week. One relative told us, “I know she has a good social life here, as she often isn’t in her room when I phone her and that’s a good sign”. People and relatives knew how to make a complaint and told us they felt listened to and had confidence that the manager and staff would act.

People and staff spoke positively about the culture of the home. There were clear lines of accountability and the provider continued to have effective quality assurance processes in place. People told us they thought the service was well managed. One person told us, “My daughter comes every day at different times, and she is always made welcome.”

More information is in Detailed Findings below.

Rating at last inspection: Good (report published 19 May 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service continues to be rated Good overall.

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

A registered manager was 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 and associated Regulations about how the service is run.

People’s independence was promoted. One person told us “(Registered manager’s name) likes us to do as much as we can for ourselves. It’s important for us to be independent as we can be, and she encourages us to do that”.

People had access to activities and opportunities for social engagement and stimulation. One person told us, “We have great summer and Christmas parties. (Cooks name) prepares fabulous food, everyone comes, we all enjoy it”. Another person told us “We often have things going on downstairs; a pianist comes every now and then, we have talks and films. There are exercise classes and (person’s name) plays music in the afternoon sometimes”.

People were supported to maintain relationships with people that mattered to them. Relatives were made to feel welcome and visiting was not restricted. A visitor commented “It’s a family, that’s how I see it. The staff are really good and particularly caring. They are always really friendly; I can come and go as I want”.

Relatives were kept informed of their loved one’s wellbeing and any changes in their needs. A relative told us, “When my mum was ill and needed to go to hospital they phoned me straight away to let me know. They told me not to worry and dealt with everything, they kept me up to date with all the developments. That was really reassuring”.

People’s privacy and dignity was respected and upheld. One person told us, “The staff are really caring and friendly, they treat me with respect, it’s like a family hotel.”

Staff were caring and built friendships with people. One person “It’s quite remarkable how well we all get on, staff included. Everyone says good morning to each other and ask how you are when they pass by. They (the staff) are very, very thoughtful and endlessly good tempered”. Another person commented “We have a laugh and a joke with the staff”.

Meal times were relaxed and sociable. People spoke highly of the quality of the food on offer which was homemade from fresh ingredients. One person told us “The food is fabulous. (Cooks name) makes everything from scratch every day, it’s delicious”.

People’s needs had been assessed and planned for. Plans took into account people’s preferences, likes and dislikes and were reviewed on a regular basis. Staff worked in accordance with the Mental Capacity Act (MCA) and associated legislation ensuring consent to care and treatment was obtained. People were supported to make their own decisions and where people lacked the capacity to do so relevant legislation was followed.

People’s health and wellbeing was continually monitored and the registered manager regularly liaised with healthcare professionals for advice and guidance. People received medicines on time and records of people’s health and emotional wellbeing had been maintained. Staff were responsive when people needed assistance. One person told us “They answer the call bells quickly, pretty much immediately”.

People were supported by sufficient numbers of suitably qualified and experienced staff all of whom held a nationally recognised qualification in care. The recruitment and selection procedures in place ensured that appropriate checks were undertaken before staff began work. Staff knew what action to take if they suspected abuse had taken place and felt confident in raising concerns. They received the training and support they needed to undertake their role and spoke highly of the training and development opportunities. One member of staff told us “We get all the training we need but if you want more you just have to ask (registered managers name) and she will organise it for you”.

Risks to people were identified and managed appropriately and people had personal emergency evacuation plans in place in the event of an emergency. Accident and incidents had been recorded and monitored to identify any themes or trends.

Feedback was regularly sought from people, relatives and staff. ‘Residents’ and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas.

People, their visitors and staff had confidence in the leadership of the service. One person told us “(Registered manager’s name) is inspirational. She’s full of beans, extremely caring, very sensitive and practical. There’s a good combination of being organised without being obvious. It’s very relaxed here”.

The management of the service were open and transparent and a culture of continuous learning and improvement was promoted. The provider had ensured there were processes in place for auditing and monitoring the quality of the service and complaints were responded to appropriately.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

We spoke with five people who lived at the home, two relatives and a visiting GP. We also spoke with three members of staff, who were the registered manager and two care workers.

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?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us, "It's reassuring to know that mum is safe and well cared for here."

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The manager had full responsibility for the selection and recruitment of new staff. They took people's care and support needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

The home had policies and procedures in relation to safeguarding adults at risk, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw that staff had completed training on the subject and further training had been identified as needed in relation to the recent changes in DoLS. Staff had also received relevant safeguarding training to understand and recognise abuse and were aware of the process for reporting such abuse.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People's needs were taken into account with the accessible layout of the service, enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

The home had systems in place to assess and manage risks and to provide safe and effective care. Staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with complex needs.

We also found evidence of staff seeking advice, where appropriate, from the GP or social services. A visiting GP we spoke with described the effective working relationship with the service and the high level of care provided. They told us, 'It's a well-managed home and the care is very good. I would be happy for my parents to live here.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person who used the service told us, "The staff here are all very kind and caring."

We spoke with relatives who said they were able to visit the service at any time and they were always made to feel welcome. We saw that the staff took time interacting patiently and sensitively with people throughout the home. We observed that people were treated with consideration, dignity and respect.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to take part in a range of social and recreational activities, reflecting their interests and preferences, both in and outside the service.

People's needs were assessed before they moved into the and comprehensive care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people's individual needs.

We were told by the manager that the service had good systems in place to monitor its own standards of service delivery and to gain feedback from people who used the service, their relatives and other stakeholders. As well as satisfaction questionnaires, the manager told us they frequently carried out a range of internal audits, including care planning, medication and staff training.

People told us they were asked for their views on the service and their feedback was heard and, where necessary, changes were made as a result. People and their relatives, who we spoke with, said they would be happy to raise any issues or concerns that they might have and were confident that their concerns would be listened to and acted upon. One person told us, 'I wouldn't hesitate to speak to Audrey (the manager) about anything. She is always very approachable and very helpful.'

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up and consistent way.

The service had established quality assurance systems in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service provision continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff showed a good awareness of the ethos of the service and a sound understanding of the care and support needs of people who used the service. They told us that they felt valued and supported by the manager and were happy and confident in their individual roles.

People we spoke with told us they were happy with the care they received and with the staff team. One person who used the service told us, "I'm very happy here and have no complaints'. Another person told us, 'The staff are all very kind here, they know what I like - and the food is very good".

We saw that individual care plans provided guidance for care workers, to ensure that the assessed current and on-going support needs of people using the service could be met consistently and safely.

The people who used the service were supported to have adequate nutrition and hydration. People were given choices of food and drink that met their diverse needs. One person who used the service told us, 'The food is excellent and there is always a choice of main meal'.

Robust recruitment procedures were in place. Staff members we spoke with told us that as part of their recruitment they had completed an application form, been interviewed by the manager and had provided two references.

People were protected against the risks associated with medication because the provider had appropriate arrangements in place to manage medicines.

The service had effective systems in place to deal with people's comments and complaints.

We found that systems for consultation, interaction and communication were effective and people were treated with respect and dignity. Relatives we spoke with felt well informed and had the opportunity to partake in individual assessment, care planning and reviewing processes.

As far as practicable and in accordance with their individual care plans, people were enabled and supported to make choices about their daily lives. They had input into how the home was run and were able to influence decision making processes.

We also found that care workers had developed awareness and a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

Positive comments received from people living in the home and their relatives indicated a high level of satisfaction with the home and the services provided:

'It's so lovely living here and we have everything that we could possibly need. The staff are all so kind and the food is excellent'.

'We are self funding, so if we didn't like it here we wouldn't stay. It's marvellous, very friendly, very comfortable and we certainly have no complaints'.