Wisden Court

During our assessment of this key question, we found concerns around the recording and reporting of unexplained injuries. From our review of wounds and associated records, followed by an analysis completed by the provider, 7 unexplained injuries were identified that had not been accurately recorded or reported. Investigations into the cause of these had not been completed and therefore placed people at further risk of injury and harm. This was a breach of regulation. You can find more details of our concerns in the evidence category findings below.

Risk assessments were routinely completed and reviewed for all aspects of people’s care. Where we observed people receiving care which was not in line with their assessed needs, the registered manager took immediate action once informed.

Staffing levels were assessed. We saw sufficient staff on duty, and that people’s needs were met in a timely manner. Robust recruitment practices were followed, and staff received a range of training.

There were systems in place to share learning from events that occurred at the service such as complaints, concerns or incidents. The environment was safe and equipment was routinely serviced and maintained.

Infection prevention and control measures were in place and alongside an up-to-date policy and guidance.

People received their medicines in accordance with the prescriber’s instructions and there were checks in place to ensure that the management of medicines was safe at the service.

The provider had a system of audits and checks in place. Processes, when operated effectively, gave an overview of the performance of the service and identified where improvements were needed.

Our assessment identified one aspect of the service where oversight was not consistently robust. The provider took immediate action to address this and implemented a number of increased checks and an ongoing analysis to prevent re-occurrence. Whilst we are assured by the action taken and have rated the Well Led domain as good, our scores are reflective of the shortfalls we found.

People, relatives and staff spoke positively about the management of the service. They felt supported to share their feedback regarding the service. Leaders were approachable and a visible presence.

Learning was shared with staff and stakeholders with a view to maintain good practice, as well as ensure the implementation of any changes required to make improvements.

The provider had a suite of up-to-date policies in place.