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Inspection carried out on 13 November 2017

During a routine inspection

At the last inspection of Wilton Lodge – Care Home in October 2016 the service did not meet all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated ‘Requires Improvement’. This was because the provider was in breach of regulation 12: Safe care and treatment, on three occasions. This was with regard to safe management of medicines, health care and collaborative working with healthcare professionals. We also found that audits were not as effective as they could be and so we made a recommendation about identifying all shortfalls.

At that inspection we asked the provider to take action to make improvements to the management of medicines, meeting health care needs and working in collaboration with other health and social care professionals. They sent us an action plan saying when the improvements would be made.

This comprehensive inspection of Wilton Lodge – Care Home took place on 13 and 14 November 2017 and was unannounced. We found the overall rating for this service to be ‘Good’. The rating is based on an aggregation of the ratings awarded for all 5 key questions. Action had been taken and there were significant improvements in the meeting of regulations since we visited in 2016.

Wilton Lodge is registered to provide personal care and accommodation for up to 48 older people, including those who may be living with dementia related conditions. Communal accommodation is provided in a variety of lounge and dining areas and bedroom accommodation is provided in single rooms, some with en-suite facilities. The home is situated in a residential area on a main road and close to local amenities and bus routes into the centre of the City of Kingston-Upon-Hull. At the time of this inspection the service was being provided to 47 people.

The registered provider was required to have a registered manager in post. On the day of the inspection we found that the registered manager had been in post for the last one and a half years. 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.

At this inspection we found the provider now met the regulation on safe care and treatment with regard to safe management of medicines. Procedures had been tightened up and practice was now much safer. We found that the management of medication was safely carried out. Other risks were also assessed and managed for people individually and on a group basis so that people avoided injury wherever possible.

People were protected from the risk of harm because systems were in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Accidents and incidents were appropriately managed, risk assessed and mitigated. Equipment was safely used in the service.

Recruitment policies, procedures and practices were carefully followed to ensure staff were ‘suitable’ to care for and support vulnerable people. Staffing numbers were sufficient to meet people’s needs.

People were protected from the risks of infection and disease because good infection control management systems and practices were in place.

At this inspection we found the provider now met the regulation on safe care and treatment with regard to supporting people’s health care and working collaboratively with other health and social care professionals. People’s medical condi

Inspection carried out on 24 October 2016

During a routine inspection

Wilton Lodge is registered to provide personal care and accommodation for a maximum of 48 people, including those living with dementia. Communal accommodation is provided in a variety of lounge and dining areas and bedroom accommodation is provided in single rooms, some with en suite facilities. The home is situated in a residential area on a main road and close to local amenities and bus routes into the city of Hull.

We undertook this unannounced inspection on the 24 October 2016. At the time of the inspection there were 44 people living in Wilton Lodge. At the last inspection on 2 and 3 September 2015, we had concerns about staffing levels and how the lack of a registered manager had impacted on how the service was run; the quality monitoring had fallen behind schedule.

During this inspection, we found there had been improvements in both these areas. The service now had a registered manager in post as required by a condition of registration. 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.

The registered manager was carrying out more audits and checks on the quality of the service although we saw some areas required review to continue the improvement achieved so far, especially in relation to records. We have made a recommendation about this in the well-led section. People were asked their views in surveys and meetings. The registered manager was approachable and people who used the service and their relatives were listened to and their views taken seriously so practice could be improved.

The staffing levels had been increased since the last inspection, which meant staff had more time to meet people’s needs safely.

We found people had not always received their medicines as prescribed. You can see what action we have asked the registered provider to take at the back of the full version of this report.

Although people had access to a range of health care professionals, we had concerns that at times staff did not always follow their instructions and work together with them to ensure the optimum level of care was delivered to people. There was also an instance when a person’s health care needs had increased beyond the skills of the care staff team and this had not been recognised in a sufficiently timely way. The registered manager told us they would seek another meeting with health care professionals to ensure issues could be addressed. You can see what action we have asked the registered provider to take at the back of the full version of this report.

People’s nutritional needs were met. People told us they liked the meals and there were choices available for them and alternatives if they didn’t like what was on the menu. Nutritional risk was assessed and people were weighed in accordance with risk and their diet adjusted when required.

Staff knew how to keep people safe from the risk of harm and abuse. They had received safeguarding training and followed procedures in notifying other agencies when required. Care plans were updated to reflect risk and how this was to be managed safely.

People’s needs were assessed prior to admission and after admission at intervals to make sure any changes in need were updated. Staff produced care plans to help them support people in the ways they preferred.

Staff approach was kind and caring. Staff knew how to respect people’s privacy and dignity and gave examples of how they did this. We saw confidentiality was maintained and personal data protected and stored securely. People told us they liked the staff and they felt safe living at Wilton Lodge.

We saw staff enabled people to make their own choices and decisions when they were able to. When people lacked capacity for this, staff acted within the p

Inspection carried out on 2 and 3 September 2015

During a routine inspection

Wilton Lodge is registered to provide personal care and accommodation for older people, including those with dementia related conditions. Communal accommodation is provided in a variety of lounge and dining areas and bedroom accommodation is provided in single rooms, some with en suite facilities. The home is situated in a residential area on a main road and close to local amenities and bus routes into the city of Hull.

The last full comprehensive inspection was completed on 21 January 2014 and the service was compliant in all five areas assessed.

The service is required to have a registered manager. 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. At the time of the inspection the service did not have a registered manager as they had left in June 2015.

This inspection was unannounced and took place on 2 and 3 September 2015.

We found there were insufficient staff to meet the needs of people who used the service. There had been some people recently admitted to the service who had complex needs. Staffing levels had not kept pace with this.

We found there had been inconsistent management of the service since the registered manager and deputy manager left in June 2015. This had affected staff support and morale, and the effectiveness of the quality monitoring system.

Staff were recruited safely and they received induction and training. The training record showed some refresher training was required. Staff told us they found workbooks used for refresher training were not the most effective way to absorb important information and suggested more face to face, classroom-based methods would enhance this.

We found staff ensured they gained consent from people prior to completing care tasks. In the main, staff worked within mental capacity legislation when people were assessed as not having capacity to make their own decisions. However, we found two instances when best practice had not been followed when gates had been installed at bedroom doorways which restricted entry and exit. Consultation with relatives had occurred but documentation was missing to reflect capacity assessments and decision-making. The deputy manager told us they would address this straight away.

We observed staff engaged positively with people who used the service and supported and reassured them in a caring way. Staff respected people’s privacy but we found more care could be taken when looking after people’s belongings.

We found people’s needs were assessed and plans of care produced to guide staff in how to meet them. In some instances, the care plans were thorough and in others they could have included more person-centred information.

There were policies and procedures to guide staff in how to keep people safe from abuse and harm. Staff were aware of how to raise concerns with management and other agencies. Staff had completed safeguarding training. Risk assessments were completed to guide staff in helping people to remain safe during activities of daily living.

We found people’s health and nutritional needs were met. Health professionals were involved in their care and treatment when required. Menus provided a choice of meals for people and a tool was used to help gauge their nutritional risk; dieticians were contacted and people’s weight was monitored in line with their risk assessments.

We found people received their medicines as prescribed. Medicines were stored, recorded and administered to people in line with good practice. A new air conditioning unit was planned for the ground floor medicines room to ensure the correct temperature for storing medicines was achieved consistently.

There were two activity co-ordinators. They ensured there was a programme of events which included activities within the service and the opportunity for some people to access the community via trips out and attendance at a local church club.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 18 March 2014

During an inspection in response to concerns

We received information of concern alleging that people who used the service were supported to get up from 3:00 am. This information was shared with the local safeguarding and commissioning teams; a joint visit was carried out at 6am on 18 March 2014. We found no evidence to substantiate the allegations that were received.

To help us gain an understanding of the care received by people who used the service we spoke with eight members of staff and five people who used the service. We looked at a range of documentation including eight care plans, staff files and appraisals and meeting minutes.

We saw evidence that the manager had completed a number of ‘night checks’. The manager explained, “I do regular night checks, I get up early and arrive when the night staff are here. I come to see how things are going and that it’s running the way it should be.”

We spoke to several members of staff who could independently describe the different types of abuse that could occur and what actions they would take if the suspected abuse had taken place.

We discussed staffing levels with the manager and were told that the home operates with, four carers including one senior from 10:00 pm until 7:00 am, seven carers including two seniors between 07:00 am and 2.30 pm and seven carers including two seniors between 2.30 pm and 10:00 pm.”

You can see our judgements on the front page of this report.

Inspection carried out on 22 January 2014

During a routine inspection

We saw people looked comfortable and well cared for and that staff interacted with them in a friendly and caring manner. We observed staff interacted with people compassionately to ensure their individual needs were met.

People told us that staff helped them to be as independent as was possible. Visiting relatives told us they were very happy with the service provided. They told us that staff were, “Very kind and caring" and good at keeping them informed about changes concerning their members of families.

We found that each person who used the service had a care record which focussed around there individual needs to ensure staff could support them effectively.

People who used the service told us they felt safe and trusted the staff. We saw the service adhered to the local authority's adult protection procedures. There was evidence the service had correctly notified both us and the local authority about potential safeguarding concerns, to ensure people who used the service were safeguarded from harm.

A member of maintenance staff was employed by the service to ensure the building and equipment was kept safe to use. There was evidence of a range of up to date certificates available for utilities such as gas, electricity and the emergency lighting. Records were seen that demonstrated electrical equipment was tested in accordance with current legislation, and a fire risk assessment was in place for the building.

We found that checks had been made with the Criminal Records Bureau (CRB) for staff prior to them commencing employment and that new staff were screened by the Disclosure and Barring Service (DBS) to ensure they were safe to work with people who used the service.

We found that a monthly return and analysis of accidents and incidents, infections, medication issues and complaints were submitted to the provider to enable the quality of the service to be monitored. We saw evidence of consultation with people and their relatives. We found that regular meetings took place to enable feedback to be provided to help the service be further developed. Visiting relatives were very positive about the home. They told us, "You can talk with any one and know things will get done", “The manager is very responsive and provides positive leadership to staff.”

Inspection carried out on 13 November 2012

During a routine inspection

People who used the service told us they were consulted about their care and they could make choices about aspects of their care. They said staff contacted the doctor or nurse if they told them they felt unwell. Comments included, “Staff talk to us and they ask us things” and “One lady objected to a man carer so she has a female.” People who used the service and their relatives told us their health care needs were met in the home.

We found that the service had policies and procedures in place to guide staff when safeguarding vulnerable people from the risk of harm and abuse. Staff had completed safeguarding training.

People told us they were happy with the cleanliness of the home. We found the home was clean and tidy with no unpleasant odours.

We found there was a range of equipment used in the home. We also found that this equipment was checked, maintained and serviced in line with manufacturer’s guidance.

People told us they liked the staff. They found them caring and friendly and people's care was not rushed. Comments included, “The staff are pleasant and obliging” and “I can’t fault the staff at all.”

We found that staff received appropriate training.

People who used the service told us they knew how to complain and would feel able to complain. Some people named specific members of staff as the people they would approach if they had concerns.

Inspection carried out on 16 November 2011

During a routine inspection

We spoke with one person living at the home and observed the interaction between staff and other people living at the home. The person we spoke with told us that staff respected their privacy and dignity and that they were able to make choices about their day to day lives, including what time to get up and go to bed, how to spend their day and what to have for meals.

They told us that staff were kind and considerate. They said that they could speak to staff if they had any concerns or needed any advice and added, “I like it here and I get well looked after”. They also said that they felt safe living at the home.

Reports under our old system of regulation (including those from before CQC was created)