This inspection took place on 4 April 2018 and was unannounced.

Wilton Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Wilton Lodge Residential Home provides accommodation and personal care for up to 36 older people, some of whom may live with dementia. It does not provide nursing care.

At our last inspection on (date) February 2017, the service was rated requires improvement and there were breaches of regulation 12, 13 and 17. This was in relation to assessing the risks to the health and safety of the service users, proper and safe management of medicines, systems and processes established and operated effectively to prevent abuse of service users and assess, monitor and mitigate the risks relating to the health and safety and welfare of service users.

At this inspection, we found that the provider had taken the required action to address these shortfalls and were meeting the required standards. The service has been rated good.

The service does have 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.

People felt safe in the service. Staff understood their responsibilities with regards to safeguarding people and they had received effective training.

Recruitment procedures were in place. Sufficient staff were on duty and were deployed effectively to meet the needs of people. Staff were competent in their roles and received support and guidance from management.

People's health care needs were met and they received support from healthcare professionals when required. Medicines were managed safely and audits were completed.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People had been involved in planning their care and deciding in which way their care was provided, where possible. People’s care plans reflected their preferences and included personalised risk assessments to meet their needs.

People were supported to make choices in relation to their food and drink and a balanced, nutritious menu was offered.

Staff were kind and helpful. They provided care in a friendly and relaxed manner, treating people with respect. Staff promoted and maintained people’s dignity and provided encouragement to people throughout their support.

People, their relatives and staff knew who to raise concerns. Quality assurance processes were used to improve the service being provided.

The inspection took place on 7 and 13 February 2016 and was unannounced. At our last inspection on 26 February 2015, the service was found to be meeting the required standards in the areas we looked at. Wilton lodge had been rated as good in all five domains. However at this inspection we found the service had deteriorated. The manager had recognised the need for improvements and was committed to improving the service. Wilton Lodge Residential Home provides accommodation and personal care for up to 36 older people, some of whom have dementia. It does not provide nursing care. At the time of our inspection 34 people were staying at the home.

There was no registered manager in post. 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 and associated Regulations about how the service is run. However the manager has started the registration process and this had been received at the time of the inspection.

Trained staff helped people to take their medicines at the right time. We found that prescribed creams were not always documented when applied and that the guidance for medicines given when required (PRN) was not detailed enough. Safe medicines practices were not always followed by staff when administering people`s medicines.

Accidents and incidents were documented but not always investigated to identify trends and patterns and to ensure people were kept safe.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. However we found that written and verbal communication skills some staff had needed improvement.

Care was not always provided in a way that promoted people’s dignity and respected their privacy.

Staff obtained people’s consent before providing personal care and support, they developed positive and caring relationships with the people they cared for and knew them well. However we found that the Mental Capacity Act principles were not always followed.

Complaints were recorded and responded to in line with the service’s policy. People, relatives and staff were complimentary about the manager and how the home was run. However we found that audits did not identify shortfalls or areas of concern and had not led to the necessary improvements being made.

People were not always supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community.

People felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

People received personalised care and support which took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances, however the environment was not designed to promote the wellbeing of people living with dementia.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe.

People and relatives were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to access health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely main

People we spoke with during our inspection were complimentary about the care and service they received. They knew who to speak to if they had any concerns or needed any help. People said that the staff were ‘always helpful and kind’ to them.

A relative commented, “The staff are very good with the residents. The place is very clean. My (relative) is always clean and neatly dressed. We are very pleased with the care.”

People we spoke with said that they participated in group activities when they wanted to. A couple of them said that they enjoyed reading books. One person said, “The books are changed once a month by the mobile library service.” Another person said, “I usually read the books on the bookshelf in the community room.” This showed that people had been given choices and their wishes had been respected.

We observed staff encouraging people to have drinks and offering them a choice of hot and cold drinks between mealtimes. We noted that people’s nutrition and hydration needs had been met. People had received their medicines on time. This indicated that people’s well being had been promoted by taking account of their physical needs.

We found that work was in progress to renovate the interior of the premises and staff had ensured people’s safety during the process.

During our visit on 01 November 2012, we spoke with several people who gave positive feedback about the care and service provided. A person commented, "Staff are very good; they are lovely people and the service is very good as well."

When asked about choices, people told us that they had a choice of activities and menu. We were told that people participated in residents' meetings, at which they could express their opinions and raise any concerns they may have. The management had taken prompt action to address any issues raised.

A person commented, "The staff organise different type of activities. I can join in any group activities. Sometimes I prefer to play card games, but not many people like to do that, so a member of staff joins me for a game."

This inspection took place on 26 February and the10 March 2015 and was unannounced. Wilton Lodge Residential Home was last inspected on the 05 September 2013 and was compliant against the regulations we looked at.

Wilton Lodge Residential Home provides accommodation and personal care for up to 36 older people, some of whom were living with dementia. It does not provide nursing care. On the day of the inspection there were 30 people living in the home and a registered manager was 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.

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

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 made applications for DoLS when appropriate. Staff gained consent from people whenever they could and where people lacked capacity we saw arrangements were in place for staff to act in their best interests.

Staff were kind and people appreciated the positive relationships they had with staff. People using the service were complimentary about the staff. Choices were given to people at all times for example, about what they wanted to ware. People’s privacy and dignity were respected and all confidential information was held securely.

There were systems in place to ensure people had their health needs assessed and met. People were given sufficient quantities to eat and drink.

Staff received regular training and knew how to meet people’s individual needs. Any important changes in people’s needs were recorded and all staff were updated. There were hand overs from staff at the beginning of each shift and daily notes for people were updated.

People’s individual needs were assessed and collated in their care plans. These also included information about their history and interests. Staff were knowledgeable about people’s individual needs and people to take part in appropriate daily activities.

The service was well led. The manager encouraged staff to take responsibility and supported staff to develop their skills. The manager received support from area managers. There were regular audits and action plans in place to improve the service.