About the service:

¿ Wilton Manor Care Home is a care home with nursing. People in care homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided. Both were looked at during this inspection.

¿ People living at Wilton Manor Care Home were aged over 65, some of whom had nursing care needs. Some people were living with dementia.

¿ Wilton Manor Care Home is registered to provide care for up to 69 people. At the time of inspection there were 58 people using the service.

¿ For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

People’s experience of using this service:

¿ People received high quality care that was safe, effective, caring, responsive and well led.

¿ People and their relatives consistently provided positive feedback about all aspects of the care they received.

¿Staff were highly skilled and motivated in their role. Many had taken on additional roles and responsibilities which had resulted in service wide improvements and outstanding outcomes for people’s health and wellbeing.

¿The provider had ensured excellent outcomes for people in relation to nutrition, hydration, falls management, pressure care and living with dementia.

¿The provider was creative in ensuring the environment was suitable for people needs.

¿ The provider worked with stakeholders to ensure they were following best practice and aspiring for continuous improvement.

¿ The registered manager was effective in their role and systems were in place to monitor the quality of the service and drive improvements.

¿ The registered manager had resigned from their role and the provider had appointed a new manager to take over the running of the service.

¿ People received safe care. The provider mitigated risks associated with people’s health and had systems in place to protect them against the risks of abuse and harm.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿People were treated with dignity and respect. Relatives told us communication by the provider was good and they were welcomed within the service.

¿People received personalised care which reflected their needs and preferences. The provider understood the principles of providing empathic and responsive care at the end of people’s lives.

Rating at last inspection:

¿At our last inspection, we rated the service good (report published 14 December 2016). At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

¿The rating has remained good but the service has now improved to outstanding in Effective.

Why we inspected:

¿This inspection was part of our scheduled plan of visiting services to check the safety and quality

of care people received.

Follow up:

¿We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated Good. We will continue to monitor the service through the information we receive

This inspection took place on 28 October 2016 and 1 November 2016 and was unannounced. Wilton Manor Care Home provides accommodation for a maximum of 69 people who require nursing or person care, including people living with a cognitive impairment. At the time of our inspection 59 people were living at the home.

At the time of our inspection there was no registered manager in place for the service. The previous registered manager had left the service three weeks prior to the inspection. An interim manager had taken responsibility for managing the home. 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.

At our previous inspection which took place on 19, 21 and 24 August 2015, we identified two breaches of regulations. The provider had failed to maintain a clean environment and to support staff and ensure that training updates were completed. The provider sent us an action plan detailing the steps they would take to become compliant with the regulations. At this inspection we found appropriate action had been taken and issues in relation to staff training and the cleanliness of the home had been addressed.

People and their families told us they felt the home was safe. All of the staff, including non-care staff, and the interim manager had received appropriate training in safeguarding and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

People were supported by staff who had received an induction into the home, appropriate training and professional development to enable them to meet people’s individual needs. There were enough staff to meet people’s needs.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people; they were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. Food and fluid intake was closely monitored and concerns were acted on quickly and effectively.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs. There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire.

People’s families and staff told us they felt the home was well-led and were positive about the interim manager who understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

People and relatives were able to complain or raise issues on a formal and informal basis with the interim manager and were confident these would be resolved. This contributed to an open culture within the home. Vi

We carried out an unannounced comprehensive inspection of this service on 19, 21 and 24 August 2015. At which a breach of a legal requirement was found. This was because we found concerns surrounding the cleanliness of the home.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements of the breach. We undertook a focused inspection on the 19 January 2016 to check whether they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wilton Manor Nursing Centre, on our website at www.cqc.org.uk.

Wilton Manor Nursing Centre is registered to provide accommodation for a maximum of 69 people who require support with their personal care. The home mainly provides support for older people who may have nursing needs, mental health needs or those living with dementia. At the time of our inspection 58 people were living at Wilton Manor.

At the time of our inspection, the home had a new manager who was in the process of becoming registered with 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.

At our focused inspection we found that the provider had followed their action plan which they told us would be completed by the 14 December 2015 and legal requirements had been met.

People told us they had no complaints about the cleanliness of the home and that staff were always tidying. We saw the bathrooms were clean and regular checks on the water temperature were being completed. Sealant had been replaced where required and a new bathroom installed on the second floor of the home. All the pipework was being boxed in and replaced.

There were now cleaning schedules in place which were checked twice daily by the housekeeping staff and all housekeeping staff had undertaken infection control training. There were now two infection control leads within the housekeeping team and there was always one on duty.

Staff members were now allocated as the named person on a shift, to ensure all wheelchairs were kept clean. They would sign to say that all wheelchairs had been checked and they were clean. All waste areas were now kept secure and there was a system in place to keep the area clean.

To help us to understand people's experiences of the service we spoke with eight people who use the service and we observed the care people were receiving. We also spoke with nine relatives and eight staff. People told us they were happy living at the home and the staff looked after them well. People were treated with respect and the staff were courteous.

The relatives were complimentary about the care and support the staff provided. A relative commented ”you can go home and not panic”. Another relative said “he is very settled and content”. They told us the staff were “very kind”. A third relative told us “my husband likes the food and eats well”.

The care plans were variable, as some were detailed and others did not always reflect people’s current needs. People were supported with their food and fluids. However the food records were not reflective of people’s needs.

Medicines management was not robust and may put people at risk of not receiving their medicines as prescribed. The staffing shortages had been managed and recruitment was taking place. There was a lack of supervision and support for the staff ensuring their practices were monitored.

There was some auditing to assess the quality of the service provision, however this was not robust. There was a process in place to deal with any concerns and complaints. The records maintained in the home were inadequate because care, treatment and support given were not clearly and accurately recorded.

We spoke with nine people who were living at the home. Some people were unable to tell us about their experiences due their cognitive disability. To help us to understand the experiences of people we used a Short Observational Framework Inspection tool (SOFI), which helped us observe particular people and activities over a set period of time. We observed how people spent their time, the support they received from staff and whether they had positive outcomes. We also spoke to three relatives and five staff.

We observed interactions between the staff and people who use the service. People told us that they were treated with respect and that the staff were very good and that they felt safe living at the home. They said they were well looked after the food was “very good”. Comments from a relative included” My mother receives excellent care”. They said that their relatives were well looked after and staff notified them if relatives were unwell or required medical assistance.

Another relative told us that people were not always assisted with their hot drinks. We heard them saying “nobody has helped you with your drink again”. We were told that this occurred regularly. A visitor told us that their friend was “very well looked after” and that they were happy living at the home. They were aware that the home had a regular church service that their friend enjoyed and took part in this.

This inspection took place on 19, 21 and 24 August 2015 and was unannounced. The home provides accommodation for a maximum of 69 people and provides care to older people with mental health needs and those living with dementia. There were 65 people living at the home when we carried out the inspection.

Following our last inspection on 20, 24 and 25 November 2014, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Compliance actions were set for breaches of Regulation10, related to a failure to identify shortfalls and take action related to the environment. Also Regulation 13 management of medicines was not always safe, regulation 23 supporting staff were not receiving training and supervision and Regulation 12, infection control.

At this inspection we found improvements had been made to the management of medicines. Medicines were being stored safely on every floor of the service. Measures had been put into place to ensure medicines were given out safely and staff were not interrupted.

The infection control practices in the home were inadequate and put people at risk of cross infection. The provider had not taken adequate precautions to ensure infection control practices were safe and measures put into place to minimise the spread of infection.

Staff were not supported through formal supervision, but were able to approach the manager with any concerns and felt they would be acted on. Not all staff had completed updates in dementia training and safeguarding adults training as per the provider’s policy. However they knew the people at the service well and how best to meet their needs. Staff were also able to identify different types of abuse and what actions they would take. The home had adequate staffing levels and new starters completed a training programme during their induction.

Assessments of people’s needs were completed which included any risks and there person’s preferences. Care plans had been developed to identify the care and support people required and how to meet those needs. People’s healthcare was managed appropriately and specialist advice sought when required.

People were treated with privacy and dignity at all times. Staff kept relatives informed of any changes.

There were systems in place for monitoring the quality of the service provision and regular audits were completed. We found that these were not always effective.

There a system in place for responding to complaints. Complaints were recorded along with information about the investigation and outcome as well as any feedback which had been provided.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010.

You can see what action we told the provider to take at the back of the full report.