Wilton Lodge - Care Home

We found the following examples of good practice.

Visits were arranged in line with government guidance.

People and staff were part of a regular testing programme.

Each COVID positive resident had a butterfly on their door identifying they were being barrier nursed.

Staff had received training in infection prevention and control (IPC).

Staff had received the COVID-19 vaccination as a condition of their deployment.

We found the following examples of good practice.

Visitors temperatures were taken, and track and trace information required before entry.

Each COVID positive resident had a butterfly on their door identifying they were being barrier nursed.

Staff worked on a designated floor of the home and with designated residents.

At that inspection we asked the provider to take action to make improvements to the management of medicines, meeting health care needs and working in collaboration with other health and social care professionals. They sent us an action plan saying when the improvements would be made.

This comprehensive inspection of Wilton Lodge – Care Home took place on 13 and 14 November 2017 and was unannounced. We found the overall rating for this service to be ‘Good’. The rating is based on an aggregation of the ratings awarded for all 5 key questions. Action had been taken and there were significant improvements in the meeting of regulations since we visited in 2016.

Wilton Lodge is registered to provide personal care and accommodation for up to 48 older people, including those who may be living with dementia related conditions. Communal accommodation is provided in a variety of lounge and dining areas and bedroom accommodation is provided in single rooms, some with en-suite facilities. The home is situated in a residential area on a main road and close to local amenities and bus routes into the centre of the City of Kingston-Upon-Hull. At the time of this inspection the service was being provided to 47 people.

The registered provider was required to have a registered manager in post. On the day of the inspection we found that the registered manager had been in post for the last one and a half years. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At this inspection we found the provider now met the regulation on safe care and treatment with regard to safe management of medicines. Procedures had been tightened up and practice was now much safer. We found that the management of medication was safely carried out. Other risks were also assessed and managed for people individually and on a group basis so that people avoided injury wherever possible.

People were protected from the risk of harm because systems were in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Accidents and incidents were appropriately managed, risk assessed and mitigated. Equipment was safely used in the service.

Recruitment policies, procedures and practices were carefully followed to ensure staff were ‘suitable’ to care for and support vulnerable people. Staffing numbers were sufficient to meet people’s needs.

People were protected from the risks of infection and disease because good infection control management systems and practices were in place.

At this inspection we found the provider now met the regulation on safe care and treatment with regard to supporting people’s health care and working collaboratively with other health and social care professionals. People’s medical conditions and health care needs were appropriately met.

Staff encouraged people to make choices and decisions wherever possible in order to exercise control over their lives.

People were cared for and supported by qualified and competent staff who were themselves regularly supervised and received annual appraisals of their personal performance. Staff respected the diversity that people presented and met their individual needs.

People’s nutrition and hydration needs were met to support their health and wellbeing.

The premises were suitable for providing care to older people and measures had been taken when developing the service to include features which ensured the environment was ‘friendly towards’ those people living with dementia.

People’s mental capacity was appropriately assessed and their rights were protected. Everyone that worked in the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The registered manager followed the ‘best interests’ route where people lacked capacity to make their own decisions.

Consent for all things to take place was respected so that staff always sought people’s cooperation and agreement before completing any support tasks.

People received compassionate care from kind staff that knew about people’s needs and preferences. People were involved in all aspects of their care and their rights were respected. The management team set good examples to the staff team with regard to attitude and approach, which meant staff had good role models to follow.

People’s wellbeing, privacy, dignity and independence were monitored and respected. This ensured people were respected, that they felt satisfied and were enabled to make choices regarding their lives.

We saw that people were supported according to their person-centred care plans, which reflected their needs well and which were regularly reviewed. There were opportunities to engage in some pastimes and activities if people wished. People maintained family connections and support networks and their communication needs were assessed and met.

We found that there was an effective complaint procedure in place and people’s complaints were investigated without bias.

The service sensitively managed people’s needs with regard to end of life preferences, wishes and care.

The provider now met the recommendation we had made at the last inspection to ensure quality assurance systems were effective. Audits, satisfaction surveys, meetings, handovers and the provider’s own internal quality monitoring tools ensured there was effective monitoring of service delivery.

The registered manager understood their responsibilities with regard to good governance and practiced a management style that was open, inclusive and approachable.

The registered manager strove for continuous learning around best practice, updated their learning and practice at every opportunity and searched for innovative ways to deliver the service. The service fostered good partnerships with other agencies and organisations.

We undertook this unannounced inspection on the 24 October 2016. At the time of the inspection there were 44 people living in Wilton Lodge. At the last inspection on 2 and 3 September 2015, we had concerns about staffing levels and how the lack of a registered manager had impacted on how the service was run; the quality monitoring had fallen behind schedule.

During this inspection, we found there had been improvements in both these areas. The service now had a registered manager in post as required by a condition of registration. 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 registered manager was carrying out more audits and checks on the quality of the service although we saw some areas required review to continue the improvement achieved so far, especially in relation to records. We have made a recommendation about this in the well-led section. People were asked their views in surveys and meetings. The registered manager was approachable and people who used the service and their relatives were listened to and their views taken seriously so practice could be improved.

The staffing levels had been increased since the last inspection, which meant staff had more time to meet people’s needs safely.

We found people had not always received their medicines as prescribed. You can see what action we have asked the registered provider to take at the back of the full version of this report.

Although people had access to a range of health care professionals, we had concerns that at times staff did not always follow their instructions and work together with them to ensure the optimum level of care was delivered to people. There was also an instance when a person’s health care needs had increased beyond the skills of the care staff team and this had not been recognised in a sufficiently timely way. The registered manager told us they would seek another meeting with health care professionals to ensure issues could be addressed. You can see what action we have asked the registered provider to take at the back of the full version of this report.

People’s nutritional needs were met. People told us they liked the meals and there were choices available for them and alternatives if they didn’t like what was on the menu. Nutritional risk was assessed and people were weighed in accordance with risk and their diet adjusted when required.

Staff knew how to keep people safe from the risk of harm and abuse. They had received safeguarding training and followed procedures in notifying other agencies when required. Care plans were updated to reflect risk and how this was to be managed safely.

People’s needs were assessed prior to admission and after admission at intervals to make sure any changes in need were updated. Staff produced care plans to help them support people in the ways they preferred.

Staff approach was kind and caring. Staff knew how to respect people’s privacy and dignity and gave examples of how they did this. We saw confidentiality was maintained and personal data protected and stored securely. People told us they liked the staff and they felt safe living at Wilton Lodge.

We saw staff enabled people to make their own choices and decisions when they were able to. When people lacked capacity for this, staff acted within the principles of the Mental Capacity Act 2005 and ensured important decisions were made within best interest meetings with relevant people attending.

Staff had access to training which helped them to feel skilled and confident when supporting people who used the service. The training was monitored and refresher courses made available. Staff received supervision, appraisal and support.

We found the environment was clean and tidy. There were some minor issues that were addressed on the day.

There was a complaints procedure on display and people felt able to complain.

At the last inspection in September 2015, staff had been recruited safely and all employment checks had been carried out before they started work in the service. The recruitment process had not changed in the interim so we did not feel it necessary to check this again. Recruitment processes will be checked at the next inspection to ensure the robust processes continue to be maintained.

To help us gain an understanding of the care received by people who used the service we spoke with eight members of staff and five people who used the service. We looked at a range of documentation including eight care plans, staff files and appraisals and meeting minutes.

We saw evidence that the manager had completed a number of 'night checks'. The manager explained, 'I do regular night checks, I get up early and arrive when the night staff are here. I come to see how things are going and that it's running the way it should be.'

We spoke to several members of staff who could independently describe the different types of abuse that could occur and what actions they would take if the suspected abuse had taken place.

We discussed staffing levels with the manager and were told that the home operates with, four carers including one senior from 10:00 pm until 7:00 am, seven carers including two seniors between 07:00 am and 2.30 pm and seven carers including two seniors between 2.30 pm and 10:00 pm.'

You can see our judgements on the front page of this report.

People told us that staff helped them to be as independent as was possible. Visiting relatives told us they were very happy with the service provided. They told us that staff were, 'Very kind and caring" and good at keeping them informed about changes concerning their members of families.

We found that each person who used the service had a care record which focussed around there individual needs to ensure staff could support them effectively.

People who used the service told us they felt safe and trusted the staff. We saw the service adhered to the local authority's adult protection procedures. There was evidence the service had correctly notified both us and the local authority about potential safeguarding concerns, to ensure people who used the service were safeguarded from harm.

A member of maintenance staff was employed by the service to ensure the building and equipment was kept safe to use. There was evidence of a range of up to date certificates available for utilities such as gas, electricity and the emergency lighting. Records were seen that demonstrated electrical equipment was tested in accordance with current legislation, and a fire risk assessment was in place for the building.

We found that checks had been made with the Criminal Records Bureau (CRB) for staff prior to them commencing employment and that new staff were screened by the Disclosure and Barring Service (DBS) to ensure they were safe to work with people who used the service.

We found that a monthly return and analysis of accidents and incidents, infections, medication issues and complaints were submitted to the provider to enable the quality of the service to be monitored. We saw evidence of consultation with people and their relatives. We found that regular meetings took place to enable feedback to be provided to help the service be further developed. Visiting relatives were very positive about the home. They told us, "You can talk with any one and know things will get done", 'The manager is very responsive and provides positive leadership to staff.'

We found that the service had policies and procedures in place to guide staff when safeguarding vulnerable people from the risk of harm and abuse. Staff had completed safeguarding training.

People told us they were happy with the cleanliness of the home. We found the home was clean and tidy with no unpleasant odours.

We found there was a range of equipment used in the home. We also found that this equipment was checked, maintained and serviced in line with manufacturer's guidance.

People told us they liked the staff. They found them caring and friendly and people's care was not rushed. Comments included, 'The staff are pleasant and obliging' and 'I can't fault the staff at all.'

We found that staff received appropriate training.

People who used the service told us they knew how to complain and would feel able to complain. Some people named specific members of staff as the people they would approach if they had concerns.