Wilsmere House

We found the following examples of good practice.

People using the service and staff had access to regular testing for Covid19. Any staff or people using the service who had tested positive were isolated in line with government guidance. Designated trained staff carried out the tests to ensure that people and staff were tested for Covid19 in a consistent safe way.

All staff had received training about Covid19, infection control, hand washing and in the use of personal protective equipment (PPE). Staff also received infection control competency checks. This has helped assure the provider that people were protected and safe as staff had a good understanding of infection prevention and control.

All visitors to the home were screened and risked assessed. They received a temperature check and had to answer a number of questions including whether they had any symptoms of Covid19 or had been in contact with anyone who had the infection. This risk assessment helped ensure that people and staff were protected. At the time of the inspection only people who received end of life care had visitors. This had been recently implemented due to the home being located in an area rated as high alert level for Covid19. Visiting protocols were kept under review and government guidance followed.

People and staff had risk assessments in place that identified their individual risks associated with Covid-19 and included protective measures to keep them safe.

The care home had supported people to keep in contact with family and friends. This contact had included socially distanced visits in the garden and via phone and video calls. Religious services had been live streamed via electronic devices.

The home had ensured that they always had a suitable supply of PPE including face masks, disposable gloves and aprons. When supplies of disposable long sleeved gowns and respirator face masks had been difficult to obtain, management staff had worked hard by contacting a range of commissioning local authorities to successfully obtain them. This helped to minimise the risk of spread of infection and ensure that people received care and treatment safely.

During the pandemic management staff ensured they kept up to date with all relevant guidance to do with the pandemic. The provider’s senior managers kept in constant contact with the home and systems ensured that updates were promptly communicated to the home. This and regular communication from management with their staff, local authorities, hospitals and other care homes helped the home to share good infection prevention and control practice and improve people’s care during the pandemic.

To reduce the risk of infection transmission, staff did not work across different units and enhanced cleaning schedules were in place. These included regular cleaning of frequently touched areas such as handrails, light switches and door handles.

Further information is in the detailed findings below.

Wilsmere House is a care home that provides personal and nursing care for people, some of whom live with dementia and/or have a physical disability. It also provides specialist support for people who have experienced a brain injury. The service is registered to provide treatment, care and support for up to 94 people. However, the service has reorganised some areas of the service, which has led to there currently being 86 beds available. Management told us that the provider would take the necessary action to have the correct bed numbers included in our records. At the time of the inspection there were 80 people using the service. Accommodation was provided within a purpose-built home, across four units, with communal areas located within each unit.

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

We found some areas where the medicines management systems could be developed and improved. The service was very responsive in quickly addressing these shortfalls and making appropriate improvements.

There was a positive, open and supportive culture at the service. The registered manager and staff team were committed to ensuring people were at the heart of the service and provided with personalised care. They made sure people and where applicable people’s relatives and others important to them were central to how people’s care was planned and reviewed.

The service had developed links with the local community and the home provided a meeting place for carers groups. The home encouraged engagement with local community residents through activities including complimentary meals and a range of events.

There were quality assurance systems in place to identify and address any shortfalls and make improvements to the service. The registered manager and staff team were continually seeking ways to develop and improve the service for people.

People had the opportunity to participate in a broad range of social activities. They were supported to live life to the full despite many people having complex needs and sometimes life limiting medical conditions. The service provided the support people needed to fulfil their aspirations even when they were very unwell.

The service worked in partnership with external and inhouse healthcare professionals to encourage and promote people’s mobility, independence, good health and well-being.

People’s varied communication needs were understood by the service. A range of tools were used to support and promote people’s individual ways of expressing and communicating their needs and wishes.

Staff understood and valued people’s differences. They provided people with the support they needed to meet their cultural needs, follow their religious beliefs and maintain and develop relationships with friends and family.

We saw positive engagement between staff and people. People’s relatives told us they felt people were felt well looked after. They told us staff were kind and caring and provided care in a respectful and dignified manner.

Staff received the training, guidance and support they needed to do their job well and to effectively meet people's needs.

There were systems in place to safeguard people from the risk of possible harm. Staff knew what their responsibilities were in relation to keeping people safe. They knew how to recognise and report any concerns they had about people's welfare. Risk management plans were in place to protect people from harm and to support them to remain independent.

The provider had systems in place to manage and resolve complaints. People and their relatives were listened to. They had opportunities to provide feedback about the service, and action was taken to address issues they raised.

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 benefited from living in a care home which provided effective, caring and well-led care and support.

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 (published 17 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

There was a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. On the day we were supported by the registered manager, the deputy manager and the clinical lead.

There was sufficient numbers of staff deployed at the service to meet people's at a time they needed and preferred. People told us they felt safe at the service and staff had a good understanding about the signs of abuse. Staff were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from potential risks.

Recruitment practices were safe and relevant checks had been completed before staff started work. Nurse’s professional registration was kept up to date. Medicines were managed, stored and disposed of safely. Any changes to people's medicines were prescribed by the person's GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business contingency plan that identified how the service would function in the event of an emergency and staff were knowledgeable about the procedures to take.

Staff had received appropriate supervision with their managers including clinical supervision. We found the staff team were knowledgeable about people's care needs. People told us they felt supported and staff knew what they were doing and that the training they received was effective.

Staff were up to date with current guidance to support people to make decisions. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

People had sufficient amount to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

The environment for people living with dementia was appropriate to their particular needs.

Staff involved and treated people with compassion, kindness, dignity and respect. We saw staff treat people in a caring way. People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted when personal care was undertaken.

People's needs were assessed when they entered the service and on a continuous basis to reflect changings in their needs. Care plans were detailed and provided staff with guidance on how to provide the most appropriate care.

People were encouraged to voice their concerns or complaints about the service. Concerns were used as an opportunity to learn and improve the service.

People had access to activities that were important and relevant to them. People were protected from social isolation through systems the service had in place. There were a range of activities available within the service and outside.

The provider had systems in place to regularly assess and monitor the quality of the care provided. The provider actively sought, encouraged and supported people's involvement in the improvement of the service.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive and staff felt valued.

The registered manager had informed the CQC of significant events. Records were accurate and kept securely.

The provider sent us an action plan informing the us, that action had been taken to ensure people using the service had more opportunities to participate in in-house and community based activities. We carried out an inspection on 12 February 2014 and assessed the new procedures and activities implemented by the provider. We saw a wide range of new activities implemented, both in-house and community based, and systems enabling people using the service and relatives to comment on what activities they would like to take part and see at Wilsmere House.

We received information from a whistleblower, alleging that equipment provided by the home was unsuitable and unsafe to use. During our inspection on 12 February 2014 we spoke to people who used the service and viewed documentation in regards to the equipment provided by the home and found suitable equipment checks had been carried out and people who used the service did not raise any concerns about the equipment provided.

People were free to move around the home but we noticed that there was a lack of activities for people to engage in. People we spoke with told us, "There's not much to do around here" and, "There aren't many activities available". We spoke with the staff and one staff member said, "There could be more in terms of activities as there is not much available".

We saw that consent was obtained from people before care and treatment took place. People received care and treatment in line with their individual care plan but there was little information about people's likes, dislikes, preferences and life history.This meant that the care was not always centred around the person. We saw that the provider had a plan to address these issues.

The provider had appropriate arrangements in place to ensure that medicines were recorded and administered correctly.

There were sufficient numbers of suitably qualified and experienced staff to meets people's care needs, and that the staff received appropriate supervision and training.

The provider had taken appropriate steps to ensure that information was kept securely, was accurate and fit for purpose.

Some of the things that people who used the service told us were, "the Staff are great" and "it's ok". Relatives said, "the physiotherapy here is excellent".

Staff told us that people who used the service were treated according to their individual needs and we saw evidence that confirmed this.

We spoke with staff who were unable to explain what was meant by safeguarding and were unsure how to raise safeguarding concerns. We did not see appropriate information displayed about safeguarding procedures. Therefore there was a risk that people who used the service, relatives, visitors and staff were not made aware how they could raise concerns.

The staff told us that they did not receive appropriate supervision or appraisals. There was no evidence that adequate supervision or appraisals took place.