Wilton House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to risk management and people’s safe the ways people’s medicines were managed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had improved their systems and processes to enable a proactive and positive culture of safety based on openness and honesty. Systems to report and monitor accidents and incidents had been strengthened, and this enabled the provider to have effective oversight of accidents and incidents, or to learn lessons from them. The management team always listened to concerns about safety and always investigate and report safety events. Lessons were learnt to continually identify and embed good practice. Staff had received additional support to strengthen the culture of reporting and learning and we found improvements in reporting since our last assessment.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider had strengthened its approach to working with people and healthcare partners to establish and maintain safe systems of care. They actively managed and monitored people’s health and ensured continuity of care, including during transitions between different services. Staff worked closely and effectively with a range of health professionals, such as district nurses, GPs, and speech and language therapy (SALT) teams, and the service provided external agencies with robust and up-to-date records. Care plans were in place to manage people’s conditions. For example, care plans included SALT guidance where required. The provider had also improved their responsiveness since the last assessment, ensuring timely contact with medical services when needed.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe living at the service, and safeguarding systems had been strengthened. Concerns were consistently reported externally as required. There was appropriate recording and oversight in place, ensuring all safeguarding concerns were reported to the local authority and CQC. Staff had been trained in safeguarding and demonstrated confidence in whistleblowing on poor practice. Training had been effective in ensuring incidents were recorded, reported, and escalated appropriately. Additional training and strengthened systems had driven improvements, which needed to be embedded into practice to demonstrate sustainability. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care settings this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they supported people who were deprived of their liberty within the service. DoLS had been applied for and followed up.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider had strengthened its approach to working with people to understand and manage risks. Staff provided care that was safe and supportive, and enabled people to do the things that mattered to them. Records relating to people’s health conditions had been improved, and staff had access to up-to-date guidance to follow. For example, risk assessments and care plans for managing pressure care were in place, and we saw evidence of regular repositioning to manage pressure wounds. Where people required specific interventions, such as leg elevation to manage oedema, care plans now included clear instructions and guidance for staff, including how to record and respond to refusals.

While significant improvements had been made, further work was needed to ensure records remained consistently detailed and up to date for every person. We found some care plans were comprehensive and current, while others required further review to achieve the same standard. The provider acknowledged this and continued to embed improvements into practice to ensure sustainability.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider had made improvements to detecting and controlling potential risks in the care environment; however, during our visit we identified environmental risks the provider had not previously recognised. We asked the provider to review risks from an electrical appliance and a potential fall-from-height risk, which they took prompt action to look into. When issues were highlighted, the provider acted responsively to address and reduce risks. Whilst risk management had been improved, audits needed to be strengthened and embedded into practice to ensure sustainability. Further work was required to make sure all risks, including those relating to falls and environmental hazards, were consistently identified and managed.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The provider had strengthened systems to assess and manage infection risks, and cleaning standards had improved. However, oversight and monitoring of cleaning needed to be strengthened, and some areas still required additional deep cleaning and closer checks. During our visit, we found areas such as equipment, sinks, fridge seals, and some infection risks related to the use of hand towels and toilet brushes that required further attention. When these issues were highlighted, the provider took prompt and responsive action to address and reduce risks. Whilst risk management had improved, audits needed to be strengthened and embedded into practice to ensure sustainability and consistency.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The provider had not ensured that medicines were always managed in a safe way. Whilst medicines administration records (MARs) were complete electronically and ‘as required’ medicines protocols were in place; we could not be assured that medicines were stored appropriately and in line with the providers policy. We found medicines storage areas to be very hot due to kitchen appliances being in the medicines room, record keeping for controlled drugs was not robust, and when people were supported outside the service, the provider was not following its medicines policy on recording stock taken out of the medicines cabinet.

The registered manager had audited a selection of properties on the site but had not identified any of the shortfalls we found. In addition, team leaders were carrying out weekly audits, which were ineffective in identifying issues. This highlighted that governance and oversight of medicines was not robust or ensuring safe management of medicines, and it questioned the frequency of managers audits and their quality and effectiveness.