Wren House Residence for the Retired & Elderly - Warminster

Wren House is a residential care home providing accommodation for to up to 14 older people. At the time of our inspection there were 8 people using the service.

Wren house is a listed building situated on the outskirts of the market town of Warminster. The house is of an older style, set on the road and has a garden to the rear. The bedrooms are arranged over two floors and all have en-suite facilities.

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

People told us that they felt safe at Wren House. Peoples families felt that they had a high standard of support from the staff. We were told that people were able to make choices about all aspects of their lives. Several relatives made comments about the” fantastic” quality of care people received.

People and their relatives felt confident about the support the received from staff, the assistant manager and the registered manager. We were told that they were happy to approach the management team with issues and felt they were listened to.

The home was very clean and well maintained and staff were seen to be wearing personal protective equipment (PPE). Staff understood the need to use PPE and had been trained in putting it on and taking it off.

Rating at last inspection

The last rating for this service was good (report published 07 November 2017)

For more details, please see the full report which is on the CQC website

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

We found the following examples of good practice.

The positive impact visitors had on people’s wellbeing was recognised, so clear focus was given to enabling relatives and friends to visit in a safe way. The service had introduced strict measures to prevent visitors from catching and spreading infections. Visitors were screened for symptoms of COVID-19 and were provided with personal protective equipment (PPE) to wear whilst in the home.

Additional cleaning measures had been introduced. All areas of the home were clean, and records demonstrated the additional cleaning that had been completed. To ensure maximum effectiveness, cleaning had become the responsibility of the whole staff team, not just housekeeping staff. All equipment, such as the blood pressure machine, was also wiped clean after each use.

The provider regularly updated their infection prevention and control policy to reflect the COVID-19 pandemic and additional measures that had been introduced. The written policy was readily accessible to staff and regularly discussed in meetings, handovers or informally in conversation.

Staff had received training on infection prevention and control measures and how to use PPE safely. The training was arranged regularly, and delivered in different formats to aid interest and understanding. PPE was available in people’s rooms and at points throughout the home. Staff were seen using PPE effectively and there were posters around the home, reminding staff of how to put on and take their PPE off safely. Senior staff undertook regular checks and observations to ensure staff were working safely.

Regular testing for COVID-19 was being carried out for people using the service and staff. The tests were recorded and registered in line with current guidance. People also had their temperature and oxygen saturation levels taken daily. This was to identify any possible early signs of infection.

The provider had effective systems in place to check staff and professional visitors were vaccinated against COVID-19. All professional visitors had to show their vaccination status before being allowed into the home.

Management valued the staff team and recognised they had worked hard throughout the pandemic. Their appreciation was shown in various ways, which also helped morale. This included hiding golden tickets, which gave a prize if found.

At our previous inspection in September 2015 the service was rated as Good, we found that people were receiving good care. At this inspection we have found that these standards have been maintained. This meant that people received good levels of care that responded to their individual needs and preferences. People, relatives and visiting healthcare professionals spoke positively about the staff team; they were described as considerate, caring, helpful and always available. We found that staff were skilled, caring and supported people to live in the way that they chose.

People told us they felt safe. We found the service continued to keep people safe, as staffing levels were appropriate to meet people’s needs. Staff knew and understood their responsibilities for safeguarding people against potential risk or harm, and were able to tell us how they would report any concerns. Staff received supervision and training to support them in their role.

Medicines continued to be stored, administered and recorded safely. People were encouraged to self-administer their medicines where appropriate.

People had access to food and drink and were consulted about their likes and dislikes. Menus were changed every four weeks to adapt to seasonal demand. People and their relatives were very complimentary about the food offered.

People were supported to maintain relationships that were important to them. There were no restrictions on visiting and access to the local community was encouraged and supported where possible.

Care and support plans were individualised and described the person’s needs in detail. 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.

There were robust auditing systems in place for all aspects of the service provision. People, staff and relatives all spoke very highly of the management team and the support they gave to people and staff.

We also reviewed records relating to the management of the home, for example three care plans, two sets of daily recording documents and monitoring charts, maintenance and audit documents, quality assurance survey responses, policies and procedures and information displayed around the home such as the activity timetable.

At the time of the inspection there were nine people who used the service. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found '

Is the service safe?

All of the comments were received about the service were positive, both from people who used the service, relatives and staff. People told us they felt safe in the home.

There were systems in place to ensure that incidents and accidents were recorded and these were followed up as appropriate. There were reporting systems in place to make an alert to the local authority regarding abuse. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care settings. While no applications have been submitted, appropriate policies and procedures were in place. Relevant staff had received training in the Mental Capacity Act and the application of DoLS.

Is the service effective?

People's needs were assessed and they told us that they were involved in planning their care. We saw from the care records kept in their home that people were involved in making decisions about their care and that these were respected by staff. People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. This ensured their needs were clearly identified and the support they received was meaningful and person centred. People received good care and there were positive outcomes for people.

Is the service caring?

We observed that all staff treated people respectfully and were attentive and caring. All of the comments we received were of a positive nature and confirmed that people and relatives were happy with the support received. Care staff told us they had sufficient information about people's needs and how they should be cared for. This included their preferences and the things that were important to them. The care records we looked at demonstrated that people were consulted about their care needs and that the service offered had been tailored to the individual.

Is the service responsive?

People's care had been reviewed regularly. Other agencies were consulted when there were changes to people's care. All those involved in the person's care were aware of changes so they could respond appropriately and consistently.

Is the service well-led?

People were asked for their views about the service to help ensure their views contributed towards improvements and further development of the service. The service had quality assurance systems in place so that the quality of service could be maintained and shortfalls could be identified. The home had a clear staffing structure in place. Staff we spoke with were clear on their roles and responsibilities and there were defined reporting lines so all staff knew who to report to.

One person living at the home said 'the home is very good, I always think how lucky I am, staff are very good'.

There were effective systems in place to reduce the risk and spread of infection. One person living at the home said 'it is spotlessly clean'.

There were enough qualified, skilled and experienced staff to meet people's needs. One person living at the home said 'there are enough staff, they come if you call'.

Some people's personal records were not fit for purpose. In some cases they did not contain sufficient information about people's preferences about how care and treatment should be delivered.

The quality assurance system used ensured the views of people, their relatives and social and healthcare professionals were sought about the home. Where comments were made the manager contacted the person directly to ensure they were satisfied with the action taken. The analysis of the responses received showed people views influenced the way the home was run.

People told us they would have no hesitation in raising any concerns with staff if required. Staff were very aware of their responsibilities to recognise and report any form of abuse. They had undertaken training in safeguarding vulnerable people. More training in safeguarding and the Mental Capacity Act was planned. A review of the storage of people's medicines was also being considered. Locked cabinets in people's bedrooms were being considered as a possible option to improve safety.