We carried out a review of the data available to us about John Wills House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about John Wills House, you can give feedback on this service.
We found the following examples of good practice.
The provider had robust visiting arrangements in place. Each visitor had their temperature checked and signed a disclaimer to confirm they were symptom free from Covid-19 and were not feeling unwell prior to their visit. Visitors were directed to an area where they could wash their hands and access personal protective equipment (PPE). The home was open to admissions and people were only admitted following a negative polymerase chain reaction (PCR) result. All new admissions had to isolate in their room for a 14-day period.
Staff were tested weekly as part of regular testing within the service. This consisted of a PCR test and twice weekly lateral flow tests. People living at John Wills house were tested each month. The majority of staff and people living at John Wills House had received their first dose of the vaccine.
The service used air sanitising units to cleanse the air and there was sanitising units where staff could sanitise their phones and eye protection before leaving work. The registered manager sought advice from the local authority and Health protection teams when required.
Staff had received training on the correct procedures for donning and doffing PPE along with effective hand hygiene techniques. Staff had a plentiful supply of PPE and the management team monitored compliance continuously.
Staff supported people with social activities and social distancing measures were in place throughout the home. Staff practised social distancing from their colleagues and people they supported wherever possible. Staff had access to a rest room where they could take an individual break from their duties away from other staff. Throughout the home social distancing markings and posters reminded people, staff and visitors to socially distance and wash and sanitise their hands.
People’s experience of using this service:
People and relatives consistently told us the registered manager and staff were excellent. The home was exceptionally well run. They said, “I have been happy with the atmosphere. Quiet, relaxed and welcoming” and “I would describe this home as doubly excellent.”
People received an outstanding leisure and wellness service which catered to individual interests and abilities. People had a comprehensive and varied menu of activities to choose from and were involved in the development of clubs and programmes within the home.
People were safeguarded from abuse. Staff understood how to identify abuse and how to report any concerns. Medicines were well managed. People received their medicines as prescribed by staff who were trained and competent to do so.
Staff recruitment procedures were robust and there were sufficient staff deployed to meet people's needs and keep them safe.
Risks to people had been identified and actions taken to keep them safe. The service was clean and tidy. Staff used appropriate personal protective equipment appropriately. Incidents and accidents were investigated, and lessons learnt to reduce the risk of further occurrences.
People received outstanding end of life care, which was compassionate, holistic and sensitive. Families were generously and respectfully supported during this time and were able to stay with their relative or visit around the clock.
People received an outstanding caring service. People told us they received very kind and respectful support from staff who promoted their abilities. Staff promoted people's privacy and dignity and enabled them to make choices and have as much control and independence as possible.
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.
We observed consistently kind and compassionate care from staff who were observant and focussed on people's wellbeing. A visitor told us, "The staff are all very kind and polite, and are really very good, nobody here has a bad word to say at all, everyone who works here is very friendly”. Respect for people's privacy, dignity and independence was embedded within the culture of the home.
Staff received excellent support with their learning and development. A broad range of key and specific training was delivered to staff in house and tailored to the needs of people living in the home. Internal progression opportunities and personal development were encouraged and funded by the provider.
People were cared for by well trained and skilled staff who knew their needs and how they liked to be supported. The whole staff group worked as a team to support people in a person centred way. People told us they felt safe and benefited from the development of closer links to their local community, which included everyone.
People had access to plenty of food and drink throughout the day. People told us the food was very good and there was plenty of choice. Meals were appetising and served in a calm and organised manner.
Provider oversight was embedded in the governance of the home. There was a strong culture of joint ownership within the whole staff team and senior management to achieve exceptional outcomes for people through effective team work, feedback, governance and improvement.
The provider's quality assurance processes were effective and there was a focus on continuous improvement. The registered manager provided good support for staff to be able to do their job effectively.
John Wills House met the characteristics of Outstanding in Caring, Responsive and Well Led.
Rating at last inspection: John Wills House was previously rated as ‘Good.’ Overall. Outstanding in Well-Led. (Published on the 22 March 2017).
Why we inspected: This was a planned inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.
Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
John Wills House is registered to provide nursing and personal care for a maximum of 80 people. At the time of the inspection there were 72 people living at the service.
The service comprised of two floors. The Willows accommodation on the ground floor provides general nursing care to people. The Orchards unit, which is also on the ground floor, provides care for people living with dementia. The Beeches accommodation on the first floor primarily provides shorter term care. This includes to people receiving end of life care or to people recently discharged from hospital who are receiving care and support for reablement and rehabilitation.
A registered manager was in post at the time of our inspection. 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 at the service told us they felt safe and spoke positively about the staff that provided their care and treatment. People received their medicines as prescribed. Risks associated with people’s care and treatment were assessed and managed. There were sufficient staff on duty to meet people’s needs and safe recruitment processes were completed. There were systems that monitored accidents and incidents to reduce the risk of reoccurrence and further harm. The service was cleaned to a high standard. There were effective systems that monitored the safety of the environment of the service and the equipment within it.
People said they were supported by effective staff that met their needs. The service had nominated ‘Champions’ in different specialisms to support staff in delivering care that provided a positive outcome for people. Staff understood the principles of the Mental Capacity Act 2005 and gave examples of how this legislation impacted in their work. The service understood their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). Staff knowledge in DoLS was good and conditions attached to people’s DoLS authorisations were understood where applicable. DoLS is a framework to assess the requirement to lawfully deprive a person of their liberty when they lack the mental capacity to consent to treatment or care and need protecting from avoidable harm.
Staff received appropriate training, supervision and appraisal to ensure that effective care was delivered to people. Where an opportunity had arisen, the provider had registered with a national pilot for staff to receive training in a new role being formally introduced into health and social care. The service could evidence outstanding practice through accredited schemes and there were systems in place to proactively motivate staff to provide a high standard of service. The environment had been adapted to meet the needs of people at the service in consultation with people and their families. The service was able to demonstrate they understood the importance of eating and drinking well and excellent relationships had been built with other health and social care professionals.
People commented very positively about staff and told us they were well cared for at John Wills House. The ethos of the service was, ‘Residents are not living in our workplace, we are working in their home’ and this writing was displayed at the entrance of the building. The service had received numerous compliments about the care provided. Observations made by all of our inspection team supported the compliments we read. Staff understood the people they cared for well and were able to tell us about people’s needs during conversations. People’s visitors were welcomed to the service.
People said that staff at the service responded to their needs. People’s relatives spoke positively about their involvement in care planning and care records were current, personalised and further demonstrated how the service had responded to people’s needs. We observed that staff were responsive to people’s needs when required. When needed, modifications within the service in response to people’s needs had impacted positively on their lives.
The systems to communicate people’s changing needs were robust and monitored. There were activities for people to partake in and there were systems to communicate with people and their relatives. The registered manager said that their aim of the service was for John Wills House to be seen as a support hub for the entire community of those people living on the Westbury Fields site, which is also run by the provider. This was evident by the current community links the service had established and positive steps had been taken to build further links.
People said the service was well led and commented positively on the management team. Staff we spoke with felt well supported by the registered manager and the rest of the management team. The registered manager had received written recognition of their leadership and the positive impact this had on people from a GP who attended the service. The service was involved in an innovative new multi-agency discharge scheme aimed at expediting hospital discharges. The registered manager had been asked to sit on the project board of this scheme and the project board had taken positive steps to improve communication with care homes as a result.
There were systems that captured the views of staff and meetings were held to communicate key messages. Where urgent messages needed to be communicated to staff there were methods in operation. There were effective governance systems in operation to monitor the health safety and welfare of people at John Wills House. A variety of quality assurance systems monitored the quality of service provided. The provider was a member of a local care and support network and participation in the local Care Home Provider Forum and Care Homes with Nursing Clinical Forum allowed the service to learn and contribute to the sharing of best practice The registered manager felt supported by the provider through supervision and appraisal.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
In February 2014 our inspection found the provider had breached regulations relating to care and welfare. The provider sent us an action plan telling us the improvements they were going to make to address the breach of regulation. During this inspection we looked to see if these improvements had been made.
John Wills House provides accommodation, personal and nursing care for up to 80 people. They have three separate parts of the home, the Orchards supporting people living with dementia, the Willows providing nursing care and the Beeches providing respite and rehabilitation. At the time of our visit there were 80 people living at the home.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.
During the two days of our visit we observed care staff responding and supporting people in a caring and supportive way. People told us care staff were “kind and friendly” and “the care is amazing it makes one’s body strong and able to be independent”. People told us they felt safe in the home and had confidence in the skills of care staff to meet their needs. Relatives were very positive about the care provided and felt involved in how care was delivered.
We saw how staff had a good understanding of people’s needs and how these could be met. There was a person centred approach to providing care with respect for people’s choices. Where people had complex needs either of a physical or mental health nature the service liaised and sought the advice and guidance of other professionals.
There was positive feedback from all the professionals we spoke with. Comments made by professionals who had regular contact with the home included: “I would say John Wills House is a home of choice for many people", "I find staff to be caring and efficient in dealing with people’s needs”, “the care team have worked extremely hard to get to know this individual, involving both the family and the team in an attempt to resolve issues and alleviate their distress”.
We noted how the service had made improvements in providing a more supportive environment for people living with dementia. Care staff we spoke with had a good understanding and knowledge of people’s specific and individual needs particularly in relation to responding to people who were distressed or agitated or whose behaviour could challenge staff.
People’s welfare and best interests were protected. Any actions taken without consent were agreed as part of a best interest’s approach to providing care and support with a positive approach to risk taking.
People and their relatives had opportunities to express their views about the quality of the service. People told us they felt their views were listened to and any concerns acted upon. They described the management as “approachable and open”. One person told us “I know I could make a complaint if I wanted and they would do something about it”. Another person told us how approachable the manager was and “I would go to her she would listen”.
There were a range of methods used to look at the quality of the service provided at John Wills House. Included were internal and external audits and action had been taken to address any shortfalls or need for improvement in the quality of care.
The care we observed was provided in a respectful and timely manner to people and staff displayed a good understanding of people's care needs. The home was clean and had a calm and organised atmosphere.
The expert by experience gained the views of people living in the home and their experiences. People we spoke with were positive about the care and support they received. Comments included; 'You get everything you need', 'If I need help they do it'.
We left comments cards at the home for people to complete in order to gain their views. Four people completed a comment card. Comments included; 'It is a safe environment, there is good care and friendly staff'. 'My X receives very good care. All staff treat them with respect and compassion. I have witnessed other residents being treated the same way. St Monica's trust is a fantastic facility for people with this dementia disease.
The provider had systems in place to monitor the quality of the service provided. Various audits were undertaken by the provider. However the care plan audit failed to highlight the shortfalls in some people's care plans.
Although two registered managers are identified in this report we can confirm that the registered manager at the time of the inspection was Ms Wendy Alison Leaman.
The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
During our visit all the people we spoke with told us that they liked living at the home. One person said 'I have been here for 2 years and don't have a moment of regret.'
People told us that they discussed their care and support needs with staff. One person told us 'I am able to tell them (my key worker) how I want things done; my key worker knows what I want even before I do sometimes because we get on very well.'
We saw that the home had meetings for the people who lived at the home. They told us that they feel listened to at these meetings and are able to influence how the service is run.
People told us that they liked the food and were able to choose what they wanted to eat and when they wanted to eat it. One person we spoke with told us that they preferred to eat in their room at meal times. They said 'I am a quiet person; I like to be in my room.' This person told us that this choice was respected and their food was brought to their room.
The people we spoke with told us they felt safe at the home and were all aware of how to raise a complaint. One person told us they had made a complaint about a member of staff to the lead nurse on the unit. They felt they had been listened too, reassured and their complaint had been acted on.
We observed that the staff were confident and suitably trained to fulfil their role. One relative we spoke with said 'If you have the right amount of staff and the right staff how can anything go wrong? This place has both.'