Wotton Rise Nursing Home Limited

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

People and their relatives told us they felt Wotton Rise was safe and that staff responded to their needs. Staff had received training in recognising safeguarding concerns and knew the actions to take to protect people from harm. Nursing staff engaged with external healthcare professionals to ensure people received timely care and support that was appropriate to their needs.

People’s needs were known by staff. Staff spoke positively about people and the support they required. People’s care plans were reflective of their needs and the support they received. The management were implementing an electronic care planning system.

People and their relatives spoke positively about the registered manager and clinical lead and the caring culture of the staff. Staff spoke positively about the support they received from the management team.

Safe recruitment practices were in place. The registered manager and provider ensured appropriate checks were being carried out to ensure staff were of good character.

There were enough staff deployed to meet people’s needs. Staff spoke positively about the staffing at Wotton Rise.

The provider had infection control procedures in place to protect people and prevent the spread of infection. Staff used personal protective equipment (PPE) and acted in accordance with government guidance.

We observed positive interactions between people and staff throughout our inspection. People living in the home clearly enjoyed the time they spent with staff and others. People enjoyed the engagement and activities provided by staff and others.

Incidents and accidents were reviewed to reduce the risk of a reoccurrence. Complaints were responded to appropriately and opportunity was made to identify and make improvements.

The manager and deputy manager ensured appropriate action was taken when people lacked capacity in accordance with the Mental Capacity Act. Staff supported people in the least restrictive way possible and in their best interests.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 13 November 2018). At this inspection the rating remained the same.

Why we inspected

This inspection was prompted by a review of the information we held about this service and the length of time since the last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wotton Rise Nursing Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The home provided permanent accommodation and care to people, but also provided shorter-term accommodation and care to people waiting for further social or health care assessment following discharge from hospital. It provided care and treatment to those who were recovering from surgery and to those who lived with dementia and mental health needs.

People were provided with single bedrooms with washing facilities; there was one shared bedroom. Additional communal bathrooms, toilets, a dining area and lounge were provided. A small garden area and car parking was available. There was wheelchair access to the building and garden area.

At our last inspection in April 2016 we rated the service as ‘Good’. 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. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. It met all fundamental standards.

There were two registered managers who shared responsibility for managing the service. A registered manager is a person who has registered with the 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.

People were kept safe. The premises were well maintained and kept clean. There were enough, suitably recruited and experienced staff to look after people. People’s risks were identified, reduced and removed altogether, where possible. People were protected from potential abuse and discrimination; the policies and systems in the service supported this. People were given help to take their medicines safely. Accidents and incidents were monitored and action taken to reduce recurrences. Lessons were learnt from errors and duty of candour was applied.

People had access to health and social care professionals. Staff worked closely with other agencies and services to help support people’s use of or transition through different care services. The principles of the Mental Capacity Act and Deprivation of Liberty Safeguards were followed. People were supported to have 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. People’s nutritional risks were identified and addressed. Staff received training and support to be able to meet people’s needs.

Staff were caring. People told us their care was delivered by staff who were kind and compassionate towards them. Relatives told us they also felt supported and welcomed. People’s privacy and dignity was upheld and staff were respectful of people’s diverse needs and preferences. Staff adapted the way they communicated with people to meet people’s individual communication needs. People’s preferences and wishes were respected and met.

People’s care was planned and reviewed. Care was planned and reviewed with people’s involvement, where possible. People’s representatives, where appropriate, were part of this process. People were supported with their social needs and to get involved in activities provided in the home. Managers were currently looking at ways of making activities provision more personalised. A complaints procedure was in place which was followed when any complaint or area of dissatisfaction was expressed. Staff supported people at the end of their lives to have a dignified and comfortable death.

The home was well managed by the two experienced registered managers and a new manager had been recently recruited. It was planned that this manager would eventually register to become the sole registered manager of the home. The two currently registered managers would continue to manage the business under their roles as Directors of the company.

Effective quality monitoring systems were in place. These monitored the performance of the service and quality of care provided. Actions for improvement were identified and completed. This process however, was not always recorded and there was no formal record of on-going improvement actions or when and if these were completed. This was currently managed informally between the two registered managers who were fully aware of who was responsible for what action and who shared their plans for on-going improvement effectively with their staff. This was however, a largely, informal system, which the registered managers were going to review when they started to delegate more responsibility for the management of the home to the new manager. We made a recommendation in relation to the recording of quality monitoring processes and systems.

Both registered managers kept their individual knowledge up to date. They did this by discussing areas of best practice with visiting professionals, by retaining membership of various professional groups and by taking part in local health and adult social care initiatives.

The views of people and their representatives were sought to help improve the services provided to people overall. The feedback provided was reflected on and acted on where it would help improve outcomes for people.

Further information is in the detailed findings below.

Wotton Rise Nursing Home provides nursing and personal care to a maximum of 27 people.

Wotton Rise had two registered managers 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 2008 and associated Regulations about how the service is run.

Staff and management understood how to protect people from harm and abuse. People’s individual needs were known to staff.

People had their prescribed medicines safely and on time. However the service needed to ensure there was sufficient guidance for staff on the administration of certain ‘as required’ medicines.

Staff were caring and supported people in a calm, sensitive and effective manner. There were sufficient staff to meet people’s needs. People and their representatives appreciated the caring approach of the staff with one visitor describing “kind, caring staff”.

Risks to people’s safety were identified, assessed and appropriate action taken. Visitors were welcomed to the home at any time.

Staff received support to develop knowledge and skills for their role. They commented on how well the staff team worked with each other to keep people safe and meet their needs. The management were visible and accessible to people, their visitors and staff. They strove to provide a quality service to people through engagement with them and their representatives. People and their representatives were asked for their views about Wotton Rise Nursing Home. Surveys and individual meetings with the registered manager provided an opportunity for feedback. Where areas were identified for improvement, appropriate action was taken.

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

Is the service safe?

People were cared for in a clean and hygienic environment. There were enough staff on duty to meet the needs of people who used the service. The staff we spoke with were knowledgeable about their roles and demonstrated a good understanding of the needs of people.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. During our inspection we saw evidence that people had been assessed in accordance with these safeguards in line with procedures and we found the provider was compliant. The registered manager demonstrated an in-depth knowledge of the safeguards which showed us they understood their responsibilities to the people who used the service. 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.

Is the service effective?

Care records we saw were well documented and up to date. Care plans had been reviewed and updated to reflect when people's needs changed.

Is the service caring?

Staff that we spoke with and observed were kind and caring. They treated people with respect and offered assistance in a calm and unhurried manner. People who used the service appeared happy and relaxed. They were smiling and laughing with staff.

Relatives we spoke with told us "I can't speak highly enough of the staff; they are so caring" and "The care is good here".

Is the service responsive?

People's needs were assessed before they moved into Wotton Rise. Care plans were regularly reviewed and updated in order to respond to changing needs. Records confirmed people's preferences had been documented and that care reflected their wishes.

People had access to support services when required such as a GP, dietician or the mental health team. One relative told us "The staff are very quick to ring the doctor if X is poorly" and "The staff are great at communicating with us and keeping us updated".

Is the service well-led?

The registered manager was a visible presence throughout the home and staff told us they felt well supported. One relative told us "The manager is here every day and very accessible".

There were effective systems in place to monitor the quality of services provided. People were regularly asked for their feedback on the service they received.

The provider had systems in place to recruit staff. We looked at the staff training records. These showed us that all staff had received safeguarding training. We observed that the registered managers took a 'hands on' approach and were present in the home most of the day. They told us they regularly talked to people who used the service and their relatives and took part in activities. The manager confirmed they had not received a complaint since 2011, although systems were in place should people wish to raise concerns.

The satisfaction surveys all showed positive results. The comments made to us during our visit included 'the staff talk to me very nicely'. 'Sometimes I have a job grasping what the staff say'. 'My mother has been here for three years and it's lovely. She has made a lot of progress since her admission'.

During our visit we observed staff talking to people about how they wanted to spend their time and what they wanted to eat and drink. We also observed staff interacting with people in a respectful and attentive manner.

Consent for care and treatment was consistently sought from people or their relatives who acted on their behalf. Care was provided in an environment that was safe, well maintained and met people's needs.