Wilton Manor Care Home

¿ Wilton Manor Care Home is a care home with nursing. People in care homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided. Both were looked at during this inspection.

¿ People living at Wilton Manor Care Home were aged over 65, some of whom had nursing care needs. Some people were living with dementia.

¿ Wilton Manor Care Home is registered to provide care for up to 69 people. At the time of inspection there were 58 people using the service.

¿ For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

People’s experience of using this service:

¿ People received high quality care that was safe, effective, caring, responsive and well led.

¿ People and their relatives consistently provided positive feedback about all aspects of the care they received.

¿Staff were highly skilled and motivated in their role. Many had taken on additional roles and responsibilities which had resulted in service wide improvements and outstanding outcomes for people’s health and wellbeing.

¿The provider had ensured excellent outcomes for people in relation to nutrition, hydration, falls management, pressure care and living with dementia.

¿The provider was creative in ensuring the environment was suitable for people needs.

¿ The provider worked with stakeholders to ensure they were following best practice and aspiring for continuous improvement.

¿ The registered manager was effective in their role and systems were in place to monitor the quality of the service and drive improvements.

¿ The registered manager had resigned from their role and the provider had appointed a new manager to take over the running of the service.

¿ People received safe care. The provider mitigated risks associated with people’s health and had systems in place to protect them against the risks of abuse and harm.

¿ 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.

¿People were treated with dignity and respect. Relatives told us communication by the provider was good and they were welcomed within the service.

¿People received personalised care which reflected their needs and preferences. The provider understood the principles of providing empathic and responsive care at the end of people’s lives.

Rating at last inspection:

¿At our last inspection, we rated the service good (report published 14 December 2016). 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.

¿The rating has remained good but the service has now improved to outstanding in Effective.

Why we inspected:

¿This inspection was part of our scheduled plan of visiting services to check the safety and quality

of care people received.

Follow up:

¿We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated Good. We will continue to monitor the service through the information we receive

At the time of our inspection there was no registered manager in place for the service. The previous registered manager had left the service three weeks prior to the inspection. An interim manager had taken responsibility for managing the home. 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 our previous inspection which took place on 19, 21 and 24 August 2015, we identified two breaches of regulations. The provider had failed to maintain a clean environment and to support staff and ensure that training updates were completed. The provider sent us an action plan detailing the steps they would take to become compliant with the regulations. At this inspection we found appropriate action had been taken and issues in relation to staff training and the cleanliness of the home had been addressed.

People and their families told us they felt the home was safe. All of the staff, including non-care staff, and the interim manager had received appropriate training in safeguarding and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

People were supported by staff who had received an induction into the home, appropriate training and professional development to enable them to meet people’s individual needs. There were enough staff to meet people’s needs.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people; they were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. Food and fluid intake was closely monitored and concerns were acted on quickly and effectively.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs. There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire.

People’s families and staff told us they felt the home was well-led and were positive about the interim manager who understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

People and relatives were able to complain or raise issues on a formal and informal basis with the interim manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

We looked at the care and welfare of people, safeguarding adults, medicines management, staffing, supporting staff, assessing the quality of the service and records. We spoke with six people, three visitors, eight staff and the manager. 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?

We found the service was not always safe as there were not always adequately trained staff and in sufficient numbers to ensure care was delivered in a safe and consistent way. This may put people at risk of receiving inappropriate care. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing in order to meet the assessed needs of people

We found the service had systems in place to ensure people were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults.

There were appropriate arrangements in place to manage people's medicines. Staff carried out a daily audit of medicines and checks were carried of the medication administration records.

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. The manager confirmed to us, there was no one under this safeguard, who was receiving care at the time of our inspection.

Is the service effective?

Care plans, included risk assessments, had been developed and these were relevant to the person. We saw specific action required was developed to manage risks. Care plans showed people's needs were assessed and information relating to people's assessed needs was provided for the staff. This included appropriate support with food and fluids. Specific equipment was in place to support people to maintain their independence. Care plans were not always updated to reflect up to date changes which meant people did not receive care as planned.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to planning individualised care and management of risks.

Is the service caring?

The staff were caring and people were supported with their care in a compassionate way. We observed staff interacted well with people when supporting them. Staff and people using the service had developed good relationship and people were treated with respect. People were complimentary about the staff and were satisfied with the support they received. A relative commented 'the care is good and the staff are good with (the person).'

Is the service responsive?

The service was mainly responsive to people's changing needs and took appropriate actions. We saw people were supported to access external healthcare facilities as needed and referrals were made to healthcare professionals. People had opportunities to express their views. We were not assured these were always acted upon, particularly the process of people's involvement in activities to meet their individual needs.

Is the service well-led?

There was a system to look at the safety of equipment which was serviced regularly. There was an auditing process in place to regularly assess and monitor the quality of service provided. Although risks were assessed and incidents and accidents were looked at, it was not evident how learning from incidents and accidents took place in order for appropriate changes to be implemented. These meant shortfalls were not always identified and remedial actions taken.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing risks, incidents and accidents as part of the service provision.

The relatives were complimentary about the care and support the staff provided. A relative commented 'you can go home and not panic'. Another relative said 'he is very settled and content'. They told us the staff were 'very kind'. A third relative told us 'my husband likes the food and eats well'.

The care plans were variable, as some were detailed and others did not always reflect people's current needs. People were supported with their food and fluids. However the food records were not reflective of people's needs.

Medicines management was not robust and may put people at risk of not receiving their medicines as prescribed. The staffing shortages had been managed and recruitment was taking place. There was a lack of supervision and support for the staff ensuring their practices were monitored.

There was some auditing to assess the quality of the service provision, however this was not robust. There was a process in place to deal with any concerns and complaints. The records maintained in the home were inadequate because care, treatment and support given were not clearly and accurately recorded.