CQC report explained · a nursing home
What the CQC found at Wiltshire Heights Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Medicines were not always given as prescribed, and guidance for some medicines was incomplete. There were also concerns about call bell delays, unlocked rooms and insufficiently detailed guidance for people experiencing distress.
- Effective?
- Good
- People received support with their health needs and staff worked with healthcare professionals. Food was generally well received, although choosing meals the day before did not work well for some people with short-term memory loss.
- Caring?
- Good
- People and relatives described staff as kind and caring, and inspectors observed many respectful interactions. Inspectors also saw two occasions when people in distress were not responded to promptly and one disclosure of a person's health condition during a meal.
- Responsive?
- Good
- People had care plans, activities, outings and support to maintain relationships. Some care records contained conflicting information after the electronic care planning system was changed.
- Well-led?
- Good
- The manager was described as approachable and the home had audits, meetings and an improvement plan. Managers had identified most of the shortfalls found during the inspection and were open to feedback.
What inspectors found, October 2023
Rated Good overall, but inspectors found medicines, staffing feedback and responses to distress needed improvement.
This was an unannounced comprehensive inspection on 14, 19 and 27 September 2023. Inspectors spoke with people, relatives, staff and healthcare professionals. They observed care and reviewed medicines records, care plans, risk assessments, staff files, complaints and quality records.
The overall rating was Good. Effective, caring, responsive and well-led were all rated Good. Safe was rated Requires Improvement because medicines were not always managed safely, some people waited too long for call bells, and guidance for supporting people in distress was not detailed enough.
People and relatives generally described the care as kind and safe. The home had good activities, food choices, healthcare links and management systems. However, its overall rating fell from Outstanding at the previous inspection in 2019 because inspectors found evidence that improvements were needed.
Kind and respectful staff
People, relatives and professionals generally described staff as kind, caring and respectful. Inspectors also observed positive interactions and support that reduced anxiety for one person.
“People and relatives told us staff were kind and caring.” from the report
Activities and social life
People could choose from group and individual activities, entertainers, exercise, outings and community trips. The home also had a minibus and a secure garden.
“During our inspection we observed people engaging with entertainers, musicians, exercise classes and trips into the local community.” from the report
Good healthcare links
Staff contacted healthcare professionals when needed and relatives were kept updated about health issues. Professionals said referrals were timely and staff asked for clinical support appropriately.
“Professionals we spoke with told us staff made timely referrals and contacted them when advice was needed.” from the report
Medicines were not always safe
seriousSome people had missed medicines during a pharmacy changeover. Guidance for low medicine stocks, as-required sedatives and multiple laxatives was not detailed enough, and one sedative was given almost daily without reasons being recorded.
“People had not had their medicines as prescribed and 'as required' guidance was not detailed.” from the report
Call bell and staffing concerns
needs fixingInspectors saw enough staff during the visit, but people and staff said staffing was not always sufficient. Call bell records showed multiple waits of more than five minutes.
“We reviewed call bell data and found there were multiple times where people were waiting for over 5 minutes for staff to respond.” from the report
Support during distress
needs fixingCare guidance did not give staff enough detail about supporting people who became distressed. Inspectors saw two occasions when people were not responded to promptly.
“People who experienced distress did not have detailed guidance in place to help staff to understand how to provide support.” from the report
Care records were inconsistent
minorAfter the electronic care planning system was changed, some records contained conflicting information. The provider was carrying out monthly checks to improve consistency.
“We found some records had conflicting information recorded and shared this with the provider.” from the report
Unsafe rooms were unlocked
seriousRooms that people should not access were found unlocked, including again on the third day of the inspection. The provider said it would take immediate action.
“During our inspection, we found rooms that were unsafe for people to access were unlocked.” from the report
- 01What changes have been made to prevent medicines running out and to make sure all medicines are given as prescribed?
- 02How do you record and review the reasons for giving as-required sedatives?
- 03What are the current call bell response times, and how do you use feedback from people and staff to set staffing levels?
- 04What detailed guidance is now available for staff supporting people who become anxious or distressed?
- 05How have you checked that care plans are now consistent after the electronic system change?
This was a comprehensive inspection covering all five key questions, prompted by safeguarding concerns and medicines incidents, although the particular incidents under investigation were not examined. This explanation was written from the published report of 19 October 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2020
Inspected but not rated; inspectors were assured that infection control measures were in place.
The inspection took place on 6 November 2020 and was announced. It was part of a CQC review of infection prevention and control in care homes during the coronavirus pandemic.
Inspectors found that the home had measures to reduce infection risks. These included a separate visiting room, booking arrangements, social distancing, safe admissions, testing, effective use of protective equipment and updated infection control guidance.
People were supported to continue activities and hobbies, with events adapted for infection control. The home was inspected but not rated, so this report does not provide a Good, Requires Improvement or Inadequate rating.
Safer visiting arrangements
The home used a separate visiting room with outside access and a booking system. Staff were assigned to support visits and follow infection control procedures.
“A booking system had been introduced to ensure people had fair access to the visit appointments that were available.” from the report
Activities continued
People continued with hobbies and activities, including arts and crafts, discussion groups and entertainment. Events were adapted to maintain social distancing.
“People had been supported to continue with activities and hobbies they enjoyed.” from the report
Safe admissions
The home had procedures for new residents, including isolation periods and COVID-19 testing.
“The provider had set up clear procedures to support people to move into the home safely, including periods of isolation and COVID-19 testing.” from the report
Protective equipment available
Infection control hubs on each floor gave staff access to protective equipment and current guidance. Staff said they had received infection control training and management support.
“The registered manager had set up infection control 'hubs' on each floor of the home.” from the report
Inspectors raised no specific concerns in this report.
- 01How have your visiting arrangements changed since the inspection, including the use of the separate visiting room and booking system?
- 02How do you currently manage COVID-19 or other infection risks when someone moves into the home?
- 03How do staff access protective equipment and the latest infection control guidance now?
- 04How do you provide testing for residents and staff when it is needed?
- 05How are activities and hobbies being maintained while infection control measures are in place?
This was an announced thematic inspection of infection prevention and control under the Safe question; the service was inspected but not rated, and the other four questions were not covered. This explanation was written from the published report of 19 November 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Wiltshire Heights Care Home
5 rated inspections over 8 years: the service has improved, from Inadequate to Good.
- October 2023Goodcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2020Inspected but not ratedSafe: Inspected but not rated
- April 2019Outstandingup from GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: OutstandingWell-led: Good
- July 2016Goodup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2016Inadequatestayed InadequateSafe: InadequateEffective: Inadequate
- October 2015InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- September 2014
Report published without a new overall rating.
- December 2013
Registered with the Care Quality Commission on 6 December 2013.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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