Wilton Place Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We reviewed 6 quality statements in this key question.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives shared positive feedback with us regarding assessments carried out by staff. Comments included, “[Person] had an assessment at home before moving in. All the information has gone into the care plan and has been acted on ever since” and “[Registered manager] did the assessment and I was involved in the process.”

The registered manager told us everyone had a pre-admission assessment completed prior to being offered a room at the service. These assessments could be carried out in the service when people came to look around, in people’s homes or in hospital. The registered manager said the assessments covered all aspects of people’s needs and activities of daily living. If the person had dementia, it was usual for the person’s family to be present.

The provider had systems to make sure people’s needs were assessed prior to admission. Whilst assessments and admissions were usually planned the service could also accommodate urgent admissions at times if there were safety concerns for the person. As part of the pre-admission process, staff always contacted the person’s GP for a medical history and information on medicines taken by the person. All of the assessment information was used to start the person’s care plan. Care records we reviewed demonstrated people’s needs were assessed with them before they started using the service. Staff regularly reviewed people’s assessments in care plans to make sure the level of support required from staff remained correct.

People and relatives told us they were involved in their assessments and care planning. People had mixed feedback about the food at the service. Some people felt it was an area that required some improving, whilst others felt it was good. In response to people’s feedback the registered manager was taking steps to improve the food. For example, a ‘light bites’ menu had been introduced for alternatives if people did not want options from the main menu. The chef was included in residents’ meetings to discuss food with people and learn about their wishes and preferences.

The registered manager told us they had support from the provider to make sure care delivery was evidence based. The provider emailed a weekly bulletin with updates and organised monthly calls for all registered managers. New ways of working were discussed and how this would be cascaded to frontline staff. The regional director told us during their visits to the service they checked how the registered manager was cascading this information. The regional director spoke with staff at the service to make sure they were understanding any updates and policies.

The provider had evidence-based national assessment tools embedded in their care planning system, for example, tools related to nutrition and skin integrity. These helped to ensure care was planned in line with current best practice guidance. Staff using these tools were able to identify early signs of concern and take action to mitigate risks. For example, if people were identified as being at risk of being malnourished, staff increased weight monitoring and referred people to their GP. Staff liaised with professionals when planning people’s support for some health needs. For example, people with dementia at times needed additional support from the care home liaison service who were specialists in dementia and mental health.

People had care and support that met their needs as staff worked closely with healthcare professionals and worked well as a team.

Staff told us there was very good teamwork at the service amongst all of the staff. Comments from the staff included, “I think it is a good team as the staff work hard, but we also have fun and the residents enjoy that”, “Between the whole lot of us, we make sure [people’s] needs are met. We look after each other and make sure we get the breaks we need. The home is not huge, it works really well” and “I do enjoy it. I like the team I work with, they are supportive, there is good teamwork. We all care about each other, and we have lovely surroundings we work in. I don’t have any worries about it.” The registered manager told us they were proud of the staff and how well they worked together. The registered manager told us they encouraged a ‘whole home approach’ to meet people’s needs. For example, all staff had dementia training and all staff received training on moving and handling. This meant all staff were on hand to support people at any time. Staff told us they liked working with this type of approach. One member of staff told us, “I think, one of the biggest things of Barchester is whole home approach, the whole home does that, we all help each other, even at the weekends.”

We received positive feedback about this quality statement from healthcare professionals we contacted. One professional told us, “It is better for us and good for them [staff] to have good relationships. We try to have regular monthly meetings and we are really happy with them [staff]. They [staff] sit down with us and go through the caseload, talk things through, if anyone has questions, we are talking about it.”

Staff had a handover before they started their shift which made sure they were updated with any changes in needs. There was a daily head of department meeting where staff discussed topics such as new admissions, discharges, events, safeguarding concerns and maintenance work. We observed one of the meetings during our site visit and saw very good communication and respect amongst the staff present. A record was kept of these meetings for staff who were not present to update themselves on the discussion. Visiting professionals were greeted at reception and staff were made available to share information with them about people’s needs. The service offered people short term care and accommodation on a ‘respite’ stay. People’s needs were assessed, and information shared with relevant healthcare professionals to make sure they had continuity with their care. When people moved back to their own homes, staff liaised with relevant healthcare professionals to make sure care was transferred effectively. The registered manager told us they believed staff managed respite stays well. They said people often returned for more stays at the service which was an indication of a positive experience.

People had access to healthcare professionals and told us they could see a GP when needed. People had support from staff to make healthy choices and were provided with information on specific health conditions.

Staff supported people to access health services where appropriate and staff told us their systems for doing this worked well. Staff shared positive examples with us of how they had supported people to be involved in healthcare decisions. For example, 1 person with a health condition was struggling to make healthy choices with their meals. Staff told us how they worked with kitchen staff to source food that was suitable for their needs. Kitchen staff met with the person and together they agreed a menu plan. Staff told us this partnership working had helped to improve health outcomes for the person and reduce reliance on medicines.

People's care records demonstrated they had been supported to access relevant health services, including GP, community nurses and physiotherapists. Staff had been given training on common health conditions and understood the impact on people’s health. The service did not provide nursing care but if needed staff had access to clinical guidance from the providers clinical lead and local community nursing teams. There were regular clinical governance meetings to monitor and discuss people’s health needs and any actions needed.

People and relatives told us people had the support they needed from staff to monitor any health conditions. Feedback demonstrated staff were consistently working to improve outcomes for people where possible. One relative told us, “[Person] is now eating so much better, putting on weight, and getting better in themselves. [Person’s] social skills have improved, and communication has got better.”

The deputy manager told us people’s health was monitored to identify any changes. This was recorded on the care planning system and was used to inform health professionals to review the care that people needed. Care staff told us about monitoring they carried out and how they had observed improved outcomes for people. This was across people’s health and social care needs. For example, staff shared how people’s pain management had been improved, due to careful monitoring of pain symptoms and a review of the medicines people needed.

Records we reviewed demonstrated people’s health needs were being monitored. If people were at risk of being malnourished staff used food and fluid monitoring, if people were at risk of pressure damage staff used re-positioning to try and prevent pressure damage. Staff could access guidance anytime on an electronic care planning system and check monitoring carried out.

People and relatives did not share any concerns about this quality statement. Relatives shared examples with us of staff supporting people to maintain control of their care.

Staff understood the principles of the Mental Capacity Act (2005) and told us how this applied to their day-to-day work with people. Staff recognised the importance of not assuming people did not have capacity and supporting people to make their own decisions. Staff also recognised people had the right to make unwise decisions and they were comfortable supporting people to do this.

Staff had completed training in the Mental Capacity Act (2005) and the provider had a policy and procedures to support staff. Records demonstrated people had consented to their support plans. Where people lacked capacity, an assessment had taken place and decisions made in people’s best interest.