The inspection took place on 29 May 2018 and was unannounced. Wisteria House (Plymstock) Dementia Care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Wisteria House (Plymstock) Dementia Care accommodates up to 20 people in one adapted building. On the day of the inspection 18 people lived at the home.
This is Wisteria House (Plymstock) Dementia Care’s first inspection since they registered with CQC in 2017. The provider’s other service had been rated as outstanding by CQC at their last inspection in 2016 and the provider used their experience to provide outstanding care at Wisteria House (Plymstock) Dementia Care. The home’s website stated, “Wisteria House in Hooe, Plymstock specialises in 'Quality of Life' for elderly people living with a dementia.” The national care homes review website had many positive reviews from relatives of people using the service. Most rated the service as excellent. We saw that people received outstanding care and were supported to have the best quality of life possible.
Wisteria House (Plymstock) Dementia Care had achieved a Level 1 (Level 1 being the highest) Butterfly award in October 2017. The Butterfly award is awarded by “Dementia Care Matters” a leading UK organisation inspiring culture change in dementia care across the UK. This was reported as being highly exceptional as the home had only been open for six months. The report stated, “Wisteria House (Plymstock) Dementia Care is an inspiring reminder that it really is possible to live well with a dementia.” We found this to be the case during our inspection.
There were two full time registered managers covering seven days a week and they worked closely with people, relatives and the staff team. 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. There was a very detailed daily dependency tool which enabled the provider to plan high staffing levels which supported at least weekly outings for people, give staff time to complete paperwork, organise events and further champion role projects which directly benefitted people and families.
People were living a full life and were enjoying the company of the staff. Visitors enjoyed being at the home and stayed for long periods as there was lots to see and do. Relatives’ meetings had further promoted friendships between families of people living with dementia which they said was very supportive. There was a calm and relaxed atmosphere within the service when we arrived, each person engaged with staff, each other and activities. As the day went on people were busy and enjoying a wide selection of activities and interaction from the staff led by a quality of life lead care worker. An allocated staff member was responsible for managing people’s quality of care each day. People were encouraged to live active lives and were supported to participate in community life where possible and build relationships with each other. Activities were meaningful and reflected people’s interests and individual hobbies, including achievable ‘bucket lists’. The environment and the outside spaces had been tailored for people living with dementia to promote their independence.
People, relatives and professionals were very happy with the care the staff provided. Everyone spoke about the staff and the care provided as being; “Amazing”, “A massive family with staff and people as one” and “The best home ever.” They agreed staff had the skills and knowledge to meet people’s needs and learning from extensive training supporting the ethos of person centred care and relationship care was evident throughout the inspection. This included sharing their learning about dementia care and health and safety with relatives who found this extremely helpful. Their learning in dementia care then enabled them to understand how their loved ones experienced the world. They were able to understand any triggers to behaviour which could be challenging and minimise risk and distress, making their time with loved ones a positive experience for all. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives and take considered risks to promote independence and inclusion in the wider community. For example, taking taxis to their usual hairdresser, going to church and celebrating the royal wedding at a local primary school. Staff promoted awareness of living with dementia and were sourcing children’s books for the primary school to further enhance this relationship.
People, staff and relatives worked together to run the home. People and families were very involved in care and risk planning, findings ways to access the community safely, organising events such as BBQs and charity fetes to preparing for birthdays and being involved in the lengthy recruitment process.
People had their privacy and dignity maintained. Staff were observed supporting people with understanding about how individuals living with dementia saw the world and patience and kindness. Compassionate care was really important to the values of the service and was clearly reflected in how staff cared for people. They used a ‘relationship care’ model of care which meant they also understood how people living with dementia often were expressing ‘feelings’ through their behaviour. Doll and soft toy therapy was supported by the whole team and relatives also interacted with the dolls and realistic furry pets in a way which made their loved ones happy and relaxed. Valuing people and enabling them to feel they mattered was important and staff enabled people to make their own drinks, do their own laundry and gardening which people were clearly enjoying. People said they were very happy living at the service and staff found ways for people to enjoy accessing the community as they had done when living at home.
People were protected from harm as staff demonstrated they had the knowledge and skills to recognise and keep people safe from abuse. Staff had safeguarding of vulnerable adults training and had the knowledge on how to report any concerns and what action they would take to protect people. The provider worked hard to ensure relatives understood their loved ones needs and this had resulted in people being less anxious or displaying previous behaviour which could be seen as challenging.
People were assessed in line with the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguarding (DoLS). People who did not have capacity to make decisions for themselves were supported by staff to make sure their legal rights were protected and staff worked with other professionals in their best interest. The registered managers had sought and acted on advice where they thought people’s freedom was being restricted and had acted as advocates to ensure people’s rights were protected.
People had their health needs met. People received visits from healthcare professionals, for example GPs and district nurses, to ensure they received appropriate care and treatment to meet their health care needs. Professionals confirmed staff followed the guidance they provided. The provider also pro-actively sought audits from external agencies to further assess how the service was performing. Staff took on champion roles in a meaningful way and ensured specialised knowledge was used to benefit people. For example, there was an excellent end of life, continence and infection control champion.
People’s medicines were managed very safely and overseen by a medicines champion. Medicines were managed, stored, and disposed of safely. Senior staff administered medicines and had received training and confirmed they understood the importance of safe administration and management of medicines. The provider had asked the local medicines optimisation team to carry out an audit and were working to share their knowledge and good practice experience with other services and primary and secondary care such as hospitals and GP surgeries.
People were supported to maintain a healthy balanced diet and adequate hydration. People told us they enjoyed their meals, there was plenty of food and we observed people were not rushed. Drinks and snacks were provided throughout the day and could be accessed freely by people. Taste testing sessions were organised weekly to enable people to try different foods in a fun way and results were incorporated into the menu and snack table. Staff understood how taste buds in the elderly could reduce flavour so they could monitor how people enjoyed different foods. People received support from staff as necessary in a careful, dignified manner and all staff routinely ate and had coffee with people each day. This had helped to forge close relationships between people and staff. The provider promoted a no ‘them and us’ ethos. For example, there was no uniform, staff area or bathroom and staff enjoyed relaxed time with people, often visiting out of work hours with their families and pets and attending events.
People’s care was fully planned with them and their relatives following a day at the service before they moved in and people were very in control of saying how they wanted their needs met. An extra member of staff was on duty to help a new person settle in. Feedback was constantly sought and ideas for improvement quickly implemented. People’s care records were very personalised, comprehensive and detailed people’s preferences including picture life history books and achievable bucket lists.
People, relatives and staff felt the servic