Wren Hall Nursing Home

We found the following examples of good practice.

During the outbreak of COVID-19 there were restrictions on visiting the service which were in line with current government guidance. The provider had ensured that people were able to maintain contact with relatives using technology and window visits whilst visiting was restricted. The service was following guidance in regards to essential care givers were requested by relatives.

People were supported and encouraged to maintain their independence and continue with activities and social engagement during the outbreak. The provider supported this with comprehensive and robust risk assessments that were personalised to people living at the home.

The home looked exceptionally clean throughout and maintained to a high standard. Domestic staff carried out regular cleaning with additional cleaning and disinfection of high touch points such as door handles or handrails.

There was a system in place for visitors and appropriately placed signage to ensure they followed the current guidance on the use of personal protective equipment (PPE), testing and social distancing. We saw staff wearing PPE in line with the latest guidance.

There was a comprehensive infection prevention and control (IPC) policy in place and monthly audits were conducted that highlighted issues effectively. The service had implemented action plans accordingly to rectify and mitigate risk to people living within the home. This ensured care was delivered safely.

Wren Hall Nursing Home is registered to provide accommodation for up to 54 people who require nursing or personal care, the majority of whom are living with dementia. A day service which people within the service and community can access, is also provided.

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

The service clearly demonstrated how it continued and consistently met the characteristics of providing excellent care. People were at the heart of the service and the registered manager and staff were fully committed to providing high-quality person-centred care. Staff were clearly committed and compassionate, striving to provide excellent care at all times. People were treated with exceptional kindness, dignity and respect and received their care and support from a highly motivated and dedicated staff team.

There was an extremely open and transparent culture within the service and the providers vision and values were clearly understood and upheld. The registered manager and management team worked in partnership with others and strove to ensure the service was the best it could be.

Comprehensive auditing and monitoring programmes had been completed and excellent governance was embedded within the service. There was a strong emphasis on continuous improvement and the thoughts of the people using the service, relatives, staff, stakeholders and members of the local community were continually sought and listened too.

Staff were recruited safely, and appropriate numbers were available to meet people’s needs. Staff were extremely proud to work at the service and had received the training and support they needed to meet people’s needs in a person-centred and holistic way.

People were provided with a stimulating environment, which met their specific needs as well as promoting independence and socialisation. The staff team went above and beyond to find out the things important to people and activities and social interaction were an integral part of people's lives.

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

People were supported safely. Their needs had been comprehensively assessed and the risks associated with their care and support had been reviewed and managed. People felt extremely safe living at Wren Hall Nursing Home and staff knew their responsibilities for ensuring people were kept safe from avoidable harm.

The registered manager and staff team embraced comprehensive and innovative approaches to safeguarding and positive risk-taking, supporting people to have control over their lives.

Comprehensive plans of care had been developed and staff knew the people they were supporting extremely well. Staff worked hard to promote people's right to make their own decisions about their care where possible and respected the choices they made. People’s consent was always obtained.

People were supported to access relevant healthcare services when they needed them, and they were supported to eat and drink well. People received their medicine safely and as prescribed.

People were provided with care and support that not only met their care and support needs, but also their emotional, social, cultural and spiritual needs. People were greatly respected as individuals and their values and beliefs were upheld.

An end of life suite had been created to offer more comfortable, relaxed and private facilities for people and their families facing death and bereavement. People’s wishes at the end of their life were sought and followed and people received excellent end of life care.

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 outstanding (published 23 May 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.

Wren Hall is a large care home for older people, most of whom are living with dementia. Wren Hall provides accommodation for 53 people. At the time of the inspection there were 53 people using the service. The service is set in a rural area with a large garden with access onto a terraced area and is split into four separate areas with separate living areas and kitchens. Wren Hall also has a day service which people within the service and community can access.

On the day of our inspection there was a registered manager in place. 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.

Staff developed exceptionally kind, positive and compassionate relationships with people. They demonstrated person centred values, which placed an emphasis on respect for the individual being supported. People's care was individualised, staff put them first and knew them really well.

Staff continually developed their skills, and followed best practice guidance in providing people's care and treatment. People were encouraged to make their own choices and remain independent. All people and relatives told us staff showed the upmost respect and dignity towards people.

People and those important to them were encouraged and involved in making sure people received the care and support they wanted. People and their relatives and friends views were sought through care reviews, surveys and meetings. Care was personalised, staff knew about people's lives, their families and what they enjoyed doing. The service recognised the individuality of each person regardless of the support they needed.

Activities were individualised, meaningful and well thought out with the focus being on people's past history, interests or hobbies. People's care plans were very detailed and written in a person-centred way. People and their relatives were given clear information about how to make a complaint.

Without exception people, visitors, staff and professionals were overwhelmingly positive about the leadership of the service. They felt that the reason for the consistent high quality of service came from the proactive and positive leadership which filtered down to all of the staff.

People received a consistently high standard of care because the registered manager led by example and set high expectations for staff. Staff were highly motivated and enthusiastic, and were committed to ensuring each person had a good quality of life.

The provider and registered manager had ensured staff were provided with a working environment that demanded excellence, but also encouraged them to develop their roles, equipping them with the skills needed to provide all people with high quality, person-centred care. The service worked in partnership with other organisations to make sure they are following current practice and providing a high quality service.

We found there was a strong emphasis on continually striving to improve, recognise, promote and implement innovative systems in order to provide a high quality service. The service had sustained outstanding practice and improvements over time.

Regular audits of care records, medicines management and health and safety checks were carried out, with positive action taken on areas that needed improvement. The registered manager met their legal obligations to submit statutory notifications when certain events occurred, such as when injury to a person occurred.

People were safe living at the service because staff knew how to recognise and report any incidents of harm. Staff were confident that the registered manager would deal with any concerns that they reported. The needs of all people living at the home were met, because the numbers of staff supporting them were high and staff were always available when people needed them. Medicines were safely administered and stored.

People had their needs met by staff that were knowledgeable and skilled to carry out their roles and responsibilities. People were asked for consent before care was provided. People were supported to have sufficient amounts to eat and drink. People had the support they needed to maintain their health and the staff worked with healthcare professionals to support people appropriately.

We also spoke with six staff, including the registered manager. We observed the care that was given to people. We looked at some of the records held in the service including the care records for three people.

During the inspection we gathered information to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. Relatives we spoke with also told us they felt their family members were safe.

We used our SOFI (Short Observational Framework for Inspection) tool during the inspection. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We conducted a SOFI observation for 55 minutes in one of the lounges at lunchtime. We saw staff provided appropriate and safe support.

We looked at the care records for three people who used the service. We saw that care plans contained detailed information and were centred around people's individual needs.

People who used the service and relatives told us they had no concerns about the building. One relative said, 'They're always making improvements.' They also said they had no concerns about equipment.

People who used the service, relatives and staff all told us they felt there were enough staff. We found there were enough staff to meet people's needs.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the service understood when it was appropriate to contact the local DoLS team to seek their involvement.

Is the service effective?

People who used the service told us they received the care they needed in a timely manner and they were happy with the care. One person said that the care was, 'Very, very good.' Relatives were very positive about the care and told us their family members received the support they needed.

Is the service caring?

People who used the service told us staff were caring. One person said staff were, 'Very caring.' Relatives also told us staff were caring. One relative said, '[Staff are] very caring' and, 'They're so nice.'

We saw that staff communicated warmly with people as they supported them and staff were caring and kind.

Is the service responsive?

Staff told us how other agencies were involved. This meant the care home involved other professionals in people's care and treatment.

We saw care plans about different needs and saw these were reviewed regularly. A care plan is a document that should identify a person's needs and how staff can meet those needs.

Is the service well-led?

People who used the service told us they felt the care home was well-led. One person said it was 'definitely' well-led.

Staff also told us they felt the service was well-led.

We found that effective systems were in place to regularly assess and to manage risks relating to the health, welfare and safety of people who used the service.

We found that people had received care that was specific and appropriate to their individual needs and that care had been evaluated and reviewed regularly.

We saw that staff treated people with dignity and respect and that people who lived at the home appeared comfortable in their surroundings.

We spoke with members of staff. One staff member told us 'It's brilliant here. I have had induction training and other training to help me understand the needs of people. There are enough staff on duty.'

The relative of a person who was living at the home told us 'The care is amazing here I am involved with all decisions about care and there is always plenty of staff on duty.'

We saw staff respected people's privacy and dignity at all times. We found people who use the service were given information and support regarding their care to enable them to make an informed choice.

We looked at a number of care files. The plans of care were personalised and reflected people's choices and preferences. Relevant risk assessments were in place and family members had been involved with the care planning.

We spoke with six relatives they were complimentary towards the staff. One relative said, 'My husband has been at his best since he has been here.' Another relative said, 'The staff are lovely.'

Staff had a good understanding regarding safeguarding concerns and who they should report to and staff told us they felt supported by the management team at all times.

Records were accurate and fit for purpose.