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 The gaps in management quality monitoring had impacted on people’s files, risk assessments and goals being out of date and house meetings not being completed or recorded monthly.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 observed very positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them. People told us that staff respected their privacy and dignity.
There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.
Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.
The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.