Wilton House Residential and Nursing Home

People’s experience of using this service and what we found

Infection prevention control measures were poorly managed. Staff were not wearing personal protective equipment (PPE) in line with the guidelines. Where people were positive of COVID-19, measures were not in place to mitigate the risk of spreading the infection. This was addressed at the first inspection visit and improvements had not been made on the second visit.

The provider and registered manager had a governance system in place, which included various audits and monitoring. However, actions were not always documented, and it was unclear if actions were completed. In addition, immediate improvements in relation to infection prevention control were not actioned between inspection visits which posed a risk to people.

People had risk assessments in place, which detailed how to support them. People received their medicines when they needed them. However, records for medicines prescribed for when needed were not present which did not offer clear instruction as to when it was appropriate for the person to have this medicine. Staff received training to help ensure they were sufficiently skilled.

People and relatives felt staff provided care that was safe, and systems were in place to report concerns. The staff team had been safely recruited. Systems were in place to report and respond to accidents and incidents.

Staff felt morale was good and felt supported by their manager. The registered manager had built positive relationships with professionals and was dedicated in making sure people got input from health professionals when needed. The registered manager gave examples of where professional involvement benefited the people they supported.

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

Rating at last inspection

The last rating for this service was good (published 24 December 2019)

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention control measures. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with infection prevention control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe infection prevention control practice at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wilton house is a residential and nursing home registered for up to 51 people. At the time of our inspection 48 people were living at the home.

People’s experience of using this service and what we found

People felt safe. However, during the inspection we followed up on a recent concern in relation to people’s safety. This is detailed in the well led section.

We received positive feedback in relation to peoples experience of the service.

People were supported to remain as independent as possible and were encouraged to make decisions where possible. Staff supported people in the least restrictive way and in their best interests.

There were adequate staff deployed to meet peoples needs in a timely way. However, people told us that on occasions they had to wait to be supported. Staff were stretched at times of peak demand.

Peoples individual risks were assessed and where possible risks were identified. Measures were put in place to help reduce the risk as much as possible.

Medicines were safely managed. People received their medicines in accordance with the prescriber’s instructions. They were stored safely and disposed of in line with the providers medication policy.

Staff were supported and received an induction when they started working at the service and had regular training. They had individual supervisions and attended team meetings. Staff mostly felt supported by the management team, in particular the deputy manager.

People had developed good relationships with staff who understood their individual preferences and care needs. Staff knew the people they supported well. Staff maintained people’s dignity and privacy. People and their relatives were involved in discussions about their care.

People and their relatives told us that the staff were kind and caring. Peoples personal information was kept secure to ensure it remained confidential.

Complaints received were appropriately investigated in accordance with the providers complaints procedure. Any learning from complaints was considered and was used to drive improvements and shared with staff. Comments and Compliments had been received and recorded.

Internal audits were carried out to monitor the service and address any improvements required. The registered manager notified CQC of accidents and incidents.

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

Rating at last inspection

The last rating for this service was good (published 22 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wilton House Residential and Nursing Home is registered to provide accommodation for up to 51 people who require nursing or personal care and may also be living with dementia. At the time of the inspection there were 49 people living at the home.

The service did not have a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. The registered manager had recently left Wilton House and had been replaced by an experienced manager who was applying to register with CQC.

People told us that staffing levels were good. Medicines were consistently managed safely. People were supported by staff who were recruited through a robust process. Accidents were reviewed to ensure all action to reduce a reoccurrence was taken, we saw that people were supported safely.

People were supported in accordance with the principles of the Mental Capacity Act. Staff received the appropriate training and felt supported. People had enough to eat and drink and we received positive feedback about their food. People had access to health and social care professionals when needed.

Staff were attentive and communicated well with people. People dignity was consistently respected by staff. People felt supported by staff.

People were involved in the planning of their care. Care plans were clear and gave staff enough information to meet people’s needs. People had access to a range of hobbies and interests that they enjoyed, the activity coordinators were developing ideas daily.

People, relatives and staff were positive about the manager and we found that systems had been developed to help identify and address issues in the home. The manager had implemented changes since joining the home.

People’s voices were sought and complaints were responded to in a timely manner.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Staff did not always obtain people’s consent before providing personal care and support, the registered manager held immediate workshops to discuss these issues with staff. Information about local advocacy services was available to help people and their family’s to access independent advice or guidance.

Care was not always provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff was knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs. However people were not always communicated to in a way that promoted their choice and independence.

The environment and equipment used were regularly checked and well maintained to keep people safe. The registered manager reviewed this daily. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and people were positive about staff skills, experience and abilities. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People told us they felt safe, happy and well looked after by staff working at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

People were involved in the planning, delivery and reviews of the care and support they received. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

People were supported with activities at the home and in the wider community. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives and staff were complimentary about the manager, deputy manager and how the home was operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.

As a result, CQC had issued a formal warning to Wilton House Limited telling them that they must improve their policies and procedures which related to the 'requirements relating to workers' by 30 May 2014.

During a follow up inspection on 6 June 2014, we found that the provider had made significant improvements and were continuing to address the shortcomings relating to the requirements relating to workers.

We observed how people were being cared for in the home. We observed staff assisting people in the communal areas and in their individual bedrooms. We noted that in some cases 'verbal communication' was minimal.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at Wilton house lodge told us they were well looked after. However we observed people had minimal meaningful interaction with staff as many staff had a limited command of the English language. Although there was a safeguarding policy and procedure in place, it was not always followed.

Is the service effective?

We found the home was not effective because people's care, treatment and support did not achieves good outcomes, or promote a good quality of life because communication was poor and ineffective.

Is the service caring?

We found that staff were kind and attentive to people who used the service. However staff were not able to involve and engage with people or to treat them with dignity and respect, because they could not demonstrate that they knew what this meant.

Is the service responsive?

We found that the service was not responsive. By responsive, we mean that the service was not well organised so that they could meet people's needs.

Is the service well-led?

We found that the the service was not well-led. The leadership, management and governance of the organisation did not assure the delivery of high-quality person-centred care, in an open and fair culture.

One relative commented that since their relative arrived for respite care, their condition had

improved and that they had no complaints about the staff or the care they had provided. Another relative said, 'I like the way they look after (my relative). The staff are great and very nice.'

During our inspection, we found that the provider had an effective recruitment policy and procedures in place to ensure staff employed were experienced and competent in their role. The home had a system in place to ensure that the risk of cross-infection was minimised and we saw that medicines were administered and recorded appropriately.

Several relatives said that they had visited the service daily at different times and had always found the staff 'polite and gentle'. All the visitors commented that they felt the staff were 'very good' and their relatives were 'well looked after'.

When asked about language and communication, two relatives said that, although English was not the native language of some of the staff, this had not been too much of a problem because the staff could understand when people spoke slowly or used hand gestures and signs. A relative said, "The staff are so wonderful in the way they care for and look after (their relative). I can't speak too highly of them."

People we spoke with commented that they had been given a choice of activities to attend daily, if they wished to. They said that they were given a choice of menu, and could request other dishes as well.