Wilnecote Rest Home

People’s experience of using this service:

•People said they felt safe and happy.

•Staff knew how to recognise and report any concerns they had about people’s well-being and how to protect people from harm and abuse.

•Medicines were managed in a safe way.

•There were enough suitably skilled staff to meet people’s needs.

•People had assessments and care plans in place which staff used to support people in a person-centred way.

•Risks to health and well-being were planned for and managed well.

•People had their dietary needs met.

•People were supported to have choice in their daily lives and staff supported them in the least restrictive way possible; the policies and systems in place supported this practice.

•Staff were kind and caring and supported people to be as independent as possible.

•People had access to a variety of meaningful activities.

•The home was run well by a registered manager who was held in high regard by people, their relatives and staff.

•The registered manager had a good oversight of the service and improvements had been made as a result of feedback received and through learning lessons when things went wrong.

Rating at last inspection: At our last inspection the service was rated as Good overall with the key question of Effective rated as Requires Improvement (Report published 12 August 2016). At this inspection, the service met the characteristics of Good in all areas.

Why we inspected: This was a planned inspection based on the date and the rating of the last inspection.

Follow up: We will continue to monitor the service through the information we receive and will re-inspect as per our inspection programme or sooner if required.

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

Wilnecote is registered to provide residential care for up to 23 older people. Following the concerns we identified during our inspection visit in July 2015, we issued a condition on the provider’s registration to prevent further admissions into the home. We reviewed this on our next inspection in December 2015 to enable the provider to admit up to 20 people. This meant on the day of our inspection visit 17 people were using the service. As a result of the improvements demonstrated by the provider at this inspection, we will remove this condition.

There was a registered manager in post, although they now worked within another home managed by the same provider and was providing support to the new 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. The new manager plans to submit an application to us to become the new registered manager.

People had a choice of food and were able to have drinks throughout the day. However, the meal times were not always managed effectively to ensure people did not have to wait for their meal and their meals remained warm.

People’s consent was sought prior to any support being provided and staff understood how to support people to make decisions where they no longer had the capacity to do so for themselves. Where people had restrictions placed on them, authorisations had been made to ensure this was lawful. The provider had not identified that other people may have restrictions placed on them as they needed support to remain safe in the community and the provider had not identified this.

Staff understood their responsibility to safeguard people from harm. Staff were available for people and had received training so that people’s care and support needs were met. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks.

People were involved in decisions about their care and they received support in the ways they preferred. People were encouraged to remain as independent as possible and able to pursue their hobbies and interests. People maintained relationships with people important to them and visitors were welcomed at the home. People were treated with kindness, compassion and respect and people liked the staff who supported them and had developed good relationships with them.

People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed so that people received their medication as prescribed.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. This was through regular communication with people and staff, surveys, checks on care workers to make sure they worked in line with policies and procedures and a programme of other checks and audits. People knew how to complain about their care and concerns were responded to.

• Ensure that providers found to be providing

inadequate care significantly improve.

• Provide a framework within which we use our

enforcement powers in response to inadequate care

and work with, or signpost to, other organisations in

the system to ensure improvements are made.

• Provide a clear timeframe within which providers must

improve the quality of care they provide or we will seek

to take further action, for example cancel their

registration.

This meant the service would be kept under review and inspected again within six months. We told the provider they needed to make significant improvements in this time frame to ensure that people received safe care and treatment that was responsive to their changing needs, were protected from abuse and not unlawfully restricted.

We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and to drive improvement. At this inspection, we made the judgement that the provider had made sufficient improvements to take them out of special measures but some further improvement was needed to ensure the quality and safety of the service was effectively monitored.

The service provided accommodation and personal care for up 23 people. There were 16 people using the service at the time of the inspection with a variety of needs including people living with dementia.

The manager had applied to register with us (CQC). 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.

People's medicines were not all stored safely and there was no guidance for staff to follow on the administration of 'as required' medicines. Some areas of the building needed maintaining and making safe for people who used the service.

People were safeguarded from abuse and the risk of abuse as staff knew what constituted abuse and who to report it to. The manager had made referrals for further investigation when they had suspected abuse had taken place.

People were supported to be as independent as they were able to be through the use of risk assessments and the staff knowledge of them.

There were enough suitably qualified staff who had been recruited using safe procedures available to maintain people’s safety and to support people in hobbies and activities of their choice.

The provider was working within the guidelines of the Mental Capacity Act 2005. The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people’s best interests where they are unable to do this for themselves. People’s capacity had been assessed and staff knew how to support people in a way that was in their best interest and was the least restrictive.

People and their representatives were involved in decisions relating to their care, treatment and support. Care was planned and delivered based on people’s preferences and regularly reviewed with people.

People were supported to have a healthy diet dependent on their assessed individual needs. People were given choices and asked what they would like to eat and drink.

People had access to a range of health professionals and staff supported people to attend health appointments when necessary.

People were treated with kindness and compassion and their privacy was respected. Staff supported people to be independent and have a say in how the service was run.

People had opportunities to be involved in the community and to participate in hobbies and interests of their choice. People’s religious needs were met.

Staff felt supported to fulfil their role effectively through regular support, supervision and training applicable to their role.

The manager demonstrated a passion in improving the service. The provider had put systems in place to monitor the quality of the service and an on-going improvement plan.

We understood why these concerns had arisen. In response, we reviewed policies, practices, care plans and other records. However, we found no evidence that the staff group had been neglectful when caring for this person.

We observed that the people who lived at Wilnecote Rest Home had dementia with varying degrees of severity. People could not be involved in most discussions about their care. We spoke with the relatives of two people, who were visiting the home that day. One relative told us: 'The care is exceptional here. The staff meet Mum's needs in every way. She always looks nice and the care workers are kind and respectful'. Another relative said: 'Mum was poorly, but she's picked up because she is so well cared for. The staff are very quick to obtain medical or nursing help when she needs it'.

We observed that people's dignity and right to privacy was respected throughout the day. We found that care plans provided enough personal details about people's needs and preferences to provide guidance for care workers in delivering safe and appropriate care. We found that significant improvements had been made to hygiene in the home since our last inspection.

We found that staff were experienced and well-trained. They told us they felt well-supported. We saw that they were skilled in working with people with dementia. We saw evidence of regular checks and audits by managers to ensure that the quality of care given to people was maintained.

We spoke with the relatives of five people who lived at Wilnecote Rest Home. They were all positive about the care their family members received. They told us, 'The staff are excellent'; 'The care is brilliant, absolutely fantastic'. They said that everyone who lived at the home was treated with kindness and respect. When we looked at people's care plans, we found a lack of written information. The plans did not reflect the quality of the care people had told us about.

We observed that there were enough care workers to meet people's individual needs. The care workers we spoke with had worked at Wilnecote Rest Home for between two and eleven years. We saw they had completed a broad range of training.

Prior to our visit we had received information about some areas of the home not being clean. We found some areas required intensive cleaning. Records of cleaning schedules in the kitchen had not been maintained. We could not inspect the home's quality assurance documents; there was no key available to a locked cabinet.