Wilmington Manor Care Home

We found the following examples of good practice.

The registered manager had implemented procedures to minimise the risk of infection from visitors. All visits were by appointment only and a pre-visit risk assessment was completed. Face to face visits by one designated person were allowed following a negative rapid test for COVID-19. A visitor pod had been created to support safe visiting for other visitors.

The service had enough personal protective equipment (PPE) to meet current and future demand. Staff were using PPE correctly and in accordance with government guidelines. Staff always wore masks; aprons and gloves were used when giving personal care. All staff changed into their uniforms on site to minimise the risk of infection. Staff training in infection control and hand hygiene had been completed.

There were restrictions on capacity for each of the communal areas to support social distancing. Clear signage on each door indicated the maximum number. There was a one-way system in place with separate entry and exit points. The service looked clean and there were various cleaning schedules in place which had been completed and were up to date. Stickers identified the touch points that required more frequent cleaning and labels on equipment, such as hoists and trolleys, indicated they had been sanitised.

The service had up-to-date policies for infection control and specifically for COVID-19, including risk assessments and a business continuity plan. Infection control audits were completed monthly and cleaning schedules were checked and monitored by the registered manager.

Wilmington Manor Care Home is registered to provide nursing care with accommodation for up to 50 people. There were 46 people living at the home on the day of our inspection. Most people lived in the home permanently, however, some people stayed for a planned period of respite care. For example, if they were recovering from a medical procedure or health issue or if their usual carers were having a break. People living at the home had varying nursing care needs. Accommodation was over two floors plus a mezzanine floor. A lift was available, so people could move between floors easily.

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

People and their relatives felt the service was safe. One person said, “I feel very safe, the staff know how to keep me safe. It is very nice here.” Staff understood how to recognise and report concerns or abuse. The provider continued to have a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people.

There were risk assessments in place to identify any risk to people and staff understood the actions to take to ensure people were safe. There were enough staff to support people with their daily living and activities.

People and relatives felt staff had the right training to meet people’s needs. People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People were supported to have enough to eat and drink. People and relatives spoke positively about the quality and choices of food and drinks. Staff contacted medical services promptly for advice if there were concerns about people’s health.

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 and relatives said the support provided from staff was kind and caring. A person said, “I feel the staff care about me in the way that they are with me. I said that I preferred to have a female carer when showering and they have respected that.” Another person said, “They [staff] always knock on my door before coming in. They respect me.” One relative said, “The staff are laid back, friendly and kind when I visit.” People also commented on how well staff knew them and supported them in the ways they preferred. People said they felt involved in making decisions about their care.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes.

There were systems to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people's views. Records showed the service responded to concerns and complaints and learnt from the issues raised.

People and relatives felt the service was well-led. One person said, “It is wonderful here.” The management team demonstrated an open and positive approach to learning and development. Staff said the management team were open to suggestions and approachable.

The management team and staff worked professionally with agencies outside of the service and ensured a transparent, honest and open approach to their work which was valued by others.

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 14 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.

We asked the provider to take action to meet regulations 9, 10, 11, 13 and 18. We took enforcement action against the provider and told them to meet regulation 12 and 17 by 24 February 2017.

The provider sent us a report of the actions they were taking to comply with Regulations 9,10, 11, 13 and 18 and they told us they would be meeting the Regulations by 10 February 2017.

We returned to carry out a comprehensive inspection on 25 and 26 April 2017. The inspection was unannounced. At this inspection we found that the provider had implemented new ways of working to address the breaches from the previous inspection which had resulted in an improvement to the service provided.

Wilmington Manor Care Home is registered to provide nursing care with accommodation for up to 50 people. There were 47 people living at the home on the day of our inspection. Most people lived in the home permanently, however, some people stayed for a planned period of respite care. For example, if they were recovering from a medical procedure or health issue or if their usual carers were having a break. People living at the home had varying nursing care needs. Some people were living with dementia and some people had complex medical conditions such as diabetes or having suffered a stroke. Some people were receiving the care needed to support them at the end of their life. Accommodation was over two floors plus a mezzanine floor. A lift was available so that people could move between floors easily.

A registered manager was not based at the service at the time of our inspection. However a new manager was in post and had made an application to register with CQC and this application was in progress. 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.

People were now receiving a safer service. Staff understood their responsibilities in reporting potential abuse and felt confident to raise concerns with the manager or provider. Safeguarding alerts had been raised with the local authority by the provider and the manager since the last inspection.

The management of medicines had improved although this continued to progress and some further improvement was required. We have made a recommendation about the medicines administration.

Improvements had been made to individual risk assessments which were now in place to mitigate the risks of people coming to harm when they were receiving care and support. More detailed guidance was in place to give staff the advice necessary to manage the risks faced by people.

Safer procedures were now in place when reporting accidents and incidents. The manager reviewed and signed off all incident records and logged these on to the provider’s electronic system themselves once they had completed their review.

There were suitable numbers of nurses and care staff across the service to provide the right amount of staff people required to meet their assessed needs. Staff confirmed they were not under pressure and had the time to give to people without rushing. Safe recruitment practices continued to be followed to ensure new staff were suitable to work with people whose circumstances meant they were vulnerable.

The provider had reviewed their care plans in relation to mental capacity assessments. People’s capacity to make specific decisions had been considered and support mechanisms put in place to support those who were assessed as not having capacity. Staff now had the information they needed to support people more effectively to make choices and decisions.

People’s care plans had improved to reflect their individual needs and their personal preferences. This assisted staff in delivering care that was more person centred. Although some people were happy with the activities on offer, others, who preferred to stay in their rooms, or were too ill to join others in the communal lounge areas, would have liked more one to one time.

The provider had made additional training available for all staff to refresh and update their skills and knowledge in the areas found to be of concern at the last inspection. Staff told us they found this had been of real benefit and had added to the improvements made in the service. Staff were supported to carry out their role through one to one supervision although this was still a work in progress.

People received kind and considerate care. People’s care and support was provided by staff who understood people’s needs, reflective of the detailed care plans written by the nursing staff, with the advice and guidance of the GP and local hospice specialist staff.

The manager held resident and relatives meetings to enable people to give their views of the service and to have a say in decisions that affected them. People were given the information they needed to make a complaint if they needed to. Some complaints had been made and these had been dealt with according to the provider’s complaints policy.

Staff described an improved service where changes had been made that had been welcomed by all staff and morale was now high. People and staff were complimentary about the new manager, saying that the service had changed for the better since they started in post. We found that the manager responded to issues identified and made changes immediately.

The provider had a number of monitoring and auditing processes in place to check the quality and safety of the service and these were now used effectively. The improvements made had had a positive impact on the service people now received at Wilmington Manor Care Home.

The home had a registered manager. 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.

Risks to people’s safety were not always safely managed by staff. People who were at risk of malnutrition, falls or developing pressure ulcers, did not have appropriate assessments carried out consistently. Risk assessments were not always developed with detailed management plans to offer guidance for staff in what steps were needed to mitigate the risks and keep people safe.

There were insufficient numbers of suitable staff available and deployed to meet people’s needs consistently across all areas of the home. Safe and effective recruitment practices were followed to make sure that staff were of good character and had the experience and qualifications necessary for the roles they performed.

Incidents or accidents were not always reported to the registered manager for review, subsequently not all were reported to the local safeguarding authority or Care Quality Commission (CQC). Not all the staff spoken with were knowledgeable about the risks of potential abuse or knew how to report concerns internally and externally to local safeguarding authorities.

People had their medicines administered by trained staff; however they did not always receive their medicines as intended by the prescriber. Staff did not always follow GP`s instructions when administering people`s medicines.

Not all the people who had a diagnosis of dementia or had a confused state of mind had mental capacity assessments in place to establish if they had capacity to understand and take informed decisions regarding the care and support they received from staff. Best interest processes were not always followed to ensure the care and support people received was in their best interest.

People told us they were not always involved in decisions about their care, they could not recall having been involved. Their consent was not always accurately reflected in their individual plans of care. Care plans were not personalised to reflect people`s likes, dislikes and preferences about the care they received. They had not identified and detailed all the care needs people had and did not offer sufficient guidance for staff to understand and deliver care and support in a personalised way. People`s care plans were not always reflective of their current needs.

People who lived at the home had mixed views about the skills and abilities of the care staff. Staff received induction training when they started working at the home. However the provider failed to ensure that staff had yearly refresher training in key areas such as safeguarding, food hygiene, manual handling and fire training. Staff told us they had regular supervisions and felt supported by the home management team.

The quality assurance systems were not effective. The regular audits carried out by the registered manager and the provider had not identified all the issues and concerns we identified at this inspection. Care records were not up to date and were not always reflective of people`s care needs.

People were cared for in a kind and compassionate way by staff. However the care and support provided for people nearing the end of their life did not always promote their dignity and privacy.

At this inspection we found the service to be in breach of Regulations 12, 13, 11, 9, 10, 18 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

There were forty seven people living in the home at the time of our visit. Some of the people were experiencing dementia. This meant they were not always able to tell us about their experiences. The report is based on our observations during the inspection, talking with people who used the service, their relatives, and staff who were working in the home, and reviewing records.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. There were systems in place to make sure that the manager and staff learned from events such as accidents and incidents and the risks associated with the environment.

Risks to people's health and welfare were identified and managed to ensure people were protected from risk of harm.

People had personal emergency evacuation plans for staff to follow in the event of a fire.

Is the service effective?

People's health and care needs were assessed with them, and they, or their representatives were involved as far as possible in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. We saw that people were comfortable with the staff who were working with them.

Staff knew people well and were able to describe people's preferences, interests and diverse needs. This meant that care and support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities regularly. An activities coordinator provided a programme of activities for people to choose from. People were able to take part in outings.

Staff responded promptly when people needed support or reassurance. People who lived in the home and staff who worked there told us they were able to raise any concerns with the manager and were confident these would be dealt with.

Is the service well-led?

The service had an effective quality assurance system, records seen by us showed that identified shortfalls were addressed promptly.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The manager was accessible and approachable. We saw that people were comfortable talking with the manager during our visit. Staff told us the manager was supportive.

We found that people did not experience care, treatment and support that met their needs and protected their rights.

We found that people who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that although the provider did not have an effective system in place to assess and monitor the quality of service that people received.

We found that that the provider did not have an effective complaints system available. Comments and complaints were not responded to appropriately.