This inspection took place on 11 and 12 December 2018 and was unannounced on the first day.

Wilton Road is a care home registered to provide accommodation and personal care for up to eight people diagnosed with mental health conditions. At the time of the inspection five people were living at the service. There were four bedrooms on the ground and first floors and shared bathrooms. The home had a communal lounge and kitchen and a large enclosed garden which had a smoking area for people to use.

The service had a registered manager in place although they were not present at the inspection. They had recently moved to another home in the group and a new incoming registered manager was on induction. There was an interim manager in place who was conducting the new registered manager’s induction.

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.

Risk assessments were in place which identified hazards and the safety measures to follow. These included many aspects of individual’s needs. However not all assessments reflected specific identified risks for some people.

People, their relatives and staff told us the service was safe. Staff were knowledgeable about how to recognise and report abuse. Staff were aware of their responsibilities to report any concerns they had and whistle blow if necessary.

Medicines were managed, administered and stored safely. Medicines were administered only by trained staff and the pharmacy carried out audits and competency checks. There was a daily checklist to ensure correct administration.

People living at Wilton Road had capacity to consent to their care and treatment and to make their own decisions. The service was supported by professionals in the community mental health team to monitor people’s capacity when they experienced a relapse in their mental health.

Staff were trained and had the skills to support the people they cared for. The service had plans in place to develop staff qualifications and roles and provide key working opportunities.

The staff had a good understanding and knowledge of people’s individual needs. People were supported to attend appointments when necessary and encouraged to take professional advice.

The staff team had a verbal handover between shifts and a checklist to ensure important information was shared. Staff received one to one support to address any concerns or learning needs. However, communication between the staff group was not always effective.

People, their relatives and staff told us Wilton Road was a caring service. People were treated with dignity and respect.

The service was not compliant with the Accessible Information Standard. Care plans were at different stages of development and guidance from professionals for monitoring people’s needs were not followed consistently.

People had access to various groups, clubs, activities and the local community. People were encouraged to remain as independent as possible and to maintain contact with friends and family.

There were quality monitoring and audit systems in place which had improved medicines administration. However, these needed time to embed for other areas such as care planning, risk assessments and monitoring charts.

The inspection took place on 11 September and was unannounced. The inspection continued on 13 September 2017 and was announced.

Wilton Road is a care home registered to provide accommodation and personal care for up to eight people diagnosed with mental health conditions. Seven people were living at the home at the time of our inspection all of whom received elements of personal care. There was four bedrooms on the ground floor and four additional bedrooms on the first floor. There was a shared bathroom on both the ground and first floors. People shared a communal dining and living area with a kitchen and laundry room. There was an enclosed rear garden area which led from the conservatory and laundry room.

The service had 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.

We were told that everyone had capacity to consent to their care and treatment. However, there had recently been questions about one person’s understanding of their health. There were no clear plans inplace to support the person with their diet.

We have made a recommendation about training on the subject of capacity assessment and best interest decision making.

Regular management quality monitoring systems were not fully established or embedded at Wilton Road. We reviewed the monthly task sheets which listed staff checks and management audits. We found that between June and August 2017 the manager’s finance, medicines, people’s files and daily/weekly/monthly checks had not been completed or signed off. The gaps in management quality monitoring had impacted on people’s files, risk assessments and goals being out of date and house meetings not being completed or recorded monthly.

Medicines were mostly managed safely. We found that temperature checks were not completed or recorded in medicine cabinets. One person received liquid medicines which could not be stored over a certain temperature. We noted that this medicine bottle did not have an open date recorded on it either. The registered manager told us that this would be addressed. Medicines were securely stored and only given by staff that were trained to give medicines.

Experienced staff knew what type of support people needed in terms of maintaining independence, attending appointments and achieving their occupational needs such as activities. However, this support was not always clear in their care files.

We were told that house meetings with people who lived at Wilton Road took place monthly. However found that these had not been taking place regularly and that there were long gaps between these meetings.

People were not supported to regularly review their goals or set new ones.

People, relatives and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training.

Risk assessments had been completed for people and staff. We noted that the assessments identified hazards, people exposed to risk, safety measures to follow, resources and a risk rating.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, mental health.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Advocacy information was available to people at the home.

People told us that staff were caring. We obser

This was an unannounced inspection which took place on 26 February 2015.

Wilton Road is registered to provide care without nursing for up to 8 people living with enduring mental health issues. People have their own bedrooms and shared bathroom facilities. The home offers accommodation over two floors, accessed by two staircases. People with any physical limitations are provided with ground floor accommodation. There are spacious shared areas within the home and gardens.

There is a registered manager running the service. 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 service had a variety of ways to keep people as safe as possible. Care workers were trained in and understood how to protect people in their care from harm or abuse. Staff helped people to keep their money safe. Accidents and incidents were used for learning and the registered manager and staff ensured they did as much as possible to prevent them happening again. Individual and general risks to people were identified and managed appropriately. People were helped to take their medicines safely, at the right times and in the right quantities. The service had a recruitment process which tried to ensure the staff employed in the home were suitable and safe to work there. There were enough staff on duty to keep people safe.

The service had taken any necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLs provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm.

People were supported and staff used their knowledge and skill to encourage them to look after their health. However, people made their own decisions about their lifestyle. The service worked closely with other professionals to ensure they supported people to meet their physical and mental health care needs. Some staff told us they did not feel supported in their daily work. However, staff were properly trained and supervised to enable them to meet the needs of people.

People chose to pursue their chosen daily activities independently. Staff provided people with information and support to participate in activities. People were treated with dignity and respect at all times. They were involved in all aspects of their daily life and were helped to meet any behavioural or emotional needs.

The new manager who was registered in October 2014 was popular with the people who lived in the home. However, staff felt that they did not have enough leadership. They told us the manager was not always available, when needed, because she was often working in the other home she was registered to manage. People were asked for their view of the quality of care they received. The service had a formal quality assurance system to ensure the quality of care was being maintained or improved.

The people we met and talked with were positive about the staff and the way they were supported by them. One person told us, "the staff are lovely. It's good here."

We reviewed three people's care plans so we could find out how people were supported with their care needs. We saw people had individual support and recovery plans which described their preferences and routines. We saw the plans were well maintained by the staff team. We asked people about the care and support that they received. People told us, "the staff give me the help I need."

We saw the premises were well maintained. The toilets were clean and hygienic and all communal areas were tidy and organised. One person told us ”we all take turns in cleaning up because we like the place to look nice. It’s our home.”

People told us they knew how to make a complaint and were confident the manager would resolve any complaint they had. People told us the staff asked them about the service they received. One person told us, “I am really happy with the service, but I would soon tell them if I wasn’t.”

The people we met and talked with were positive about the staff and the way they were supported by them. They told us "the staff are nice here. It’s a happy home. We all get on very well". One person said "they help us when we need them".

We reviewed two people's care plans so we could find out how people were supported with their care needs. We saw people had individual support and recovery plans which described their preferences and routines. We saw the plans were well maintained by the staff team. We asked people about the care and support that they received. People told us "the staff help me go out to places”.

The manager told us “we rarely have a vacancy here. It’s a home for life". The manager told us "we have a range of ways people give us consent. For example we have a form that people can sign that allows staff to share information with the doctor”.

We looked around the house to see if people lived in a hygienic environment. We saw the house was clean and well maintained. The manager told us” every one is responsible for keeping the house clean". They told us there was an infection control lead for the home and they were able to describe their duties in relation to ensuring the home had effective cleaning regimes.

People told us that they made decisions about the support they wanted. They could talk to staff about any concerns. One person commented ‘it’s nice to know that staff are here if we have a problem’.

People said that they could do a lot of things independently, and staff supported them with things they found difficult. People told us they were expected to help out with the household jobs. They thought it was fair that they did this and shared the work.

People told us what they liked about the home. One person mentioned the walk-in shower. Other people appreciated the support they received with meals and ‘having somebody to talk to’.

People told us that staff helped them to follow their interests. One person was keen on poetry; they had produced a printed booklet with staff support, and joined a local poetry group. This was a good opportunity for the person to meet up with people from different backgrounds, but who shared the same interests. Somebody else went to flower arranging and jewellery making groups.

People told us that they felt safe when at the home. They said the staff were available when needed. One of the staff said they were a ‘close knit team’. The relationships which we observed between people during our visit were friendly and respectful.