This inspection was carried out on 24 May 2017 and was unannounced. At the last inspection on 12 and 14 July 2016, they were found to not be meeting the standards we inspected. These were in relation to staff not always establishing people’s wishes and obtaining their consent before care and support was provided. People’s privacy was not always respected by staff. At this inspection we found that the required improvements had been made and they were now meeting these requirements.

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 The registered manager had recently left Wilton House and had been replaced by an experienced manager who was applying to register with CQC.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.

The inspection took place on 12 and 14 July 2016 and was unannounced. At our last inspection on 13 October 2015, the service was rated as requiring improvement. At this inspection we found that the provider had made the required improvements in relation the concerns previously identified. However improvements were required in relation to staff obtaining people’s consent and around dignity and respect. Wilton House Residential and Nursing Home provides accommodation and nursing care for up to fifty-one people. At the time of our inspection 49 people lived at the home.

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.

This inspection took place on 13 October 2015 and was unannounced. At the last inspection on 05 March 2015 we found the service was meeting the required standards. We inspected Wilton House Residential and Nursing Home because we received information of concern that suggested people were not safe. This report only covers our findings in relation to the question, "Is the service safe and well led?"

Wilton House Residential and Nursing Home provides accommodation and nursing care for up to fifty-one people. At the time of our inspection 47 people lived at the home and the service had a registered manager. 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 this inspection we found the service to be in breach of Regulation 12, 13, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not transferred using equipment or moving and handling practises in a manner that was safe, or in line with their mobility needs.

People were not protected by staff who knew how to identify and report issues relating to possible abuse.

People were not protected from the risk of infection as there were areas of the home that required cleaning, equipment was dirty and stained and slings were shared when hoisting people.

Recruitment checks did not ensure that staff employed were of sufficiently good character.

There were not robust systems in place to monitor and mitigate the risks to people where risks to people’s health and safety were identified.

Systems were not robustly in place to assess, monitor and improve the quality and safety of the services provided to people.

An injury to a person living at the service had been notified to the Health and Safety Executive but had not been notified to CQC without delay as required by the regulations. 

This inspection took place on 05 March 2015 and was unannounced.

Wilton House Residential and Nursing Home provides accommodation and nursing care for up to 51 people with dementia. On the day of the inspection 47 people lived at the home.

There was a registered manager at 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 the last inspection on the 10 April 2014 we asked the provider to take action to make improvements in relation to the care and welfare of people who use the service, people’s nutritional needs, safeguarding people, supporting workers, assessing and monitoring the quality of service provision and records. We received an action plan from the provider that said they would meet the relevant legal requirements by 09 May 2014. We found at this inspection the provider had met all the relevant legal requirements.

The provider used safe systems when new staff were recruited and the staff were aware of their responsibility to protect people from harm or abuse.

Staff received regular training and knew how to meet people’s individual needs. Any important changes in people’s needs were passed on to all staff when they started their shifts, so that they all knew the up to date information. There were hand overs from staff at the beginning of each shift and daily notes for people were updated.

The staff were knowledgeable about the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff also understood the importance of giving people as much choice and freedom as possible. The manager had appropriately made applications for DoLS. Staff gained consent from people whenever they could and where people lacked capacity we saw that arrangements were in place for staff to act in their best interests.

People were provided with appropriate food and drink to meet their needs and there were systems in place for staff to support people, so that their health needs were met.

Staff were kind and people appreciated the positive relationships they had with staff. People we spoke with were complimentary about the staff providing the service. Choices were given to people at all times. People’s privacy and dignity were respected and all confidential information was held securely.

Care plans included information about people’s history and interests. People’s individual needs were assessed and were specific to them as individuals. Staff were knowledgeable about how to manage people’s individual needs and assisted them to take part in appropriate daily activities.

The manager encouraged staff to take responsibility and supported staff to grow. The manager also had a support structure in place from area managers. There were regular audits and action plans to improve the service.

During our previous inspection of Wilton House on the 9 and 10 April 2014, we found the provider was not meeting this standard because at least half of the care staff were unable to speak or read basic English language.

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 spoke with several people who live in the home and with two relatives. They were pleased with the service and the care provided. One person said, “The staff are very pleasant and caring.” This was echoed by another person who commented, “The staff are very good. They make sure we have plenty to eat and drink. We have plenty of dishes to choose from and they give us large portions.”

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.

During our visit, we spoke with people and several relatives who were all complimentary about the service and the care provided. People spoke highly of the staff who cared for them.

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.

People told us that the staff were ‘very kind’ and ‘really caring’. They said staff came when they called them. One person told us the night staff provided them with cups of tea during the night.

One person who is a regular visitor told us there was always a calm atmosphere and they observed that the staff were ‘patient and caring’. They described the service provided as being ‘excellent’.

People confirmed their medicines were given on time.

One person told us that a shower had been installed in their en-suite bathroom to enable them to maintain their independence.

People told us that they enjoyed their meals and were being offered choices.

The inspection team was made up of two inspectors, and the inspection was completed over two consecutive days . We set out to answer our five key questions; Is the service caring, responsive, safe, effective, and well led?

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.