Wisteria House Stoke Limited

Wisteria House Dementia Care Limited accommodates up to 22 people in an older style building. On the day of the inspection 22 people lived at the home. At the last inspectionin 2016 we rated Wisteria House Dementia Care Limited as Outstanding in the areas of caring and well led. At this inspection we found the areas of safe, effective and responsive were also outstanding. The provider, Wisteria House Dementia Care Limited also runs Wisteria House (Plymstock) which was rated as Outstanding at their last inspection in 2018. The provider continues to use their passion and experience to provide outstanding care and ensure people are living their best lives.

Why the service is rated Outstanding

The home's website stated, "My aim for the people living at Wisteria House is to firstly reduce stress and anxiety, by creating a world that is calming, friendly, affectionate and familiar. Then promote choice and control over one's life that adds meaning and purpose. Introducing activities, stimulation and independence to a level where individual's can experience living positively with dementia." The national care homes review website had many positive reviews from relatives of people using the service. Most rated the service as excellent. We saw that people received outstanding care and were supported to have the best quality of life possible.

Wisteria House Dementia Care Limited had achieved a Level 1 (Level 1 being the highest) Butterfly award in January 2018. The Butterfly award is awarded by "Dementia Care Matters" a leading UK organisation inspiring culture change in dementia care across the UK. This was reported as being a tremendous achievement 'The team demonstrates an approach that is spontaneous, skillful and committed to creating wellbeing with lots of positive social interactions. The team share caring and warm relationships with the people who live at Wisteria House Dementia Care Limited and there is a real sense that the priority is 'being' with people.' We found this to be the case during our inspection and noted that this was the fifth year in a row, showing a long standing commitment and embedded ethos to ensure a high level quality of life. This home and the provider's other home Wisteria House (Plymstock) are both Level 1 status, making them two out of the eight awarded this level nationally.

There was a full time registered manager supported by two deputies. These deputies worked 12 hour shifts over seven days a week for continuity with a handover day in the week. They also had two days allocated to complete paperwork. They worked closely with people, relatives and the staff team, being visible and working 'on the floor'. They knew people very well. The registered manager said, "We have time to oversee how people's needs are being met and are able to take a step back. The people living here give me back

more than I give to them. We eat together to create a social event and we all enjoy the 'family' atmosphere." 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.

There was a very detailed daily dependency tool which enabled the provider to plan high staffing levels which supported outings, escorts and quality staff time for people, gave staff time to complete paperwork, organise events and further champion role projects which directly benefitted people and families.

People were living a full life and were enjoying the company of the staff. Visitors enjoyed being at the home and stayed for long periods as there was lots to see and do. They said they enjoyed doing things with their loved ones and seeing the staff who they saw as friends. Relatives' meetings had further promoted friendships between families of people living with dementia which they said was very supportive.

There was a friendly and relaxed atmosphere within the service when we arrived, each person engaged with staff, each other and many different activities, depending on people's abilities and cognition. As the day went on people were busy and enjoying a wide selection of activities and interaction from the staff led by a quality of life lead care worker on each shift. An allocated staff member was responsible for managing people's quality of care each day. People were encouraged to live active lives and were supported to participate in community life where possible and build relationships with each other. Activities were meaningful and reflected people's interests and individual hobbies, including achievable individualised goals that had been devised between people and their key worker. For example, one person's list they were working through included, experimenting with jewellery and make up, enjoying a sherry, looking at family photos, using colourful paper, making craft butterflies and furthering their love of whales.

The environment had been tailored for people living with dementia to promote their independence. Each communal area was adapted for people moving through various stages of dementia. People, relatives and professionals were very happy with the care the staff provided. Everyone spoke about the staff and the care provided with positive enthusiasm, "Staff are very kind and accessible, they impress me no end", "Staff are very kind, will talk to me and listen to me" and "They know me well and are very quick to help me when I can't do something for myself."

They agreed staff had the skills and knowledge to meet people's needs and learning from extensive training supporting the ethos of person centred care and relationship care was evident throughout the inspection. This included sharing their learning about dementia care and especially understanding the Mental Capacity Act, with relatives who found this extremely helpful. Their learning in dementia care then enabled them to understand how their loved ones experienced the world. The provider told us how important it was that people had positive experiences when their relatives came to visit which had positive outcomes for both people and relatives. Relatives were now able to understand any triggers to behaviour which could be challenging and minimise risk and distress, making their time with loved ones a positive experience for all. For example, not to ask what people had for lunch or repeat questions that a person may not be able to answer. The provider had devised a bespoke training for relatives about the Mental Capcity Act 2005 (MCA) and associated Deprivation of Liberty Safeguarding (DoLS). People who did not have capacity to make decisions for themselves were supported by staff to make sure their legal rights were protected and staff worked with other professionals in their best interest. The registered manager had sought and acted on advice where they thought people's freedom was being restricted and had acted as advocates to ensure people's rights were protected. This ensured that relatives understood how people were still able to make decisions for themselves as much as possible. For example, if a person did not want to shave that day, this

was their decision. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives and take considered risks to promote independence and inclusion in the wider community. There were excellent examples of innovate and thoughtful shared decision making involving compromises and outcomes for people that they were happy with.

People, staff and relatives worked together to run the home. People and families were very involved in care and risk planning, findings ways to access the community safely, organising events such as parties and recently Halloween. Families, staff and their children were all encouraged to dress up and join in. People and relatives were also involved in the lengthy recruitment process. There was also a thorough pre- assessment process for potential admissions and the provider made it clear that it was a two way process promoting "the importance of the ethos of helping people live in harmony together."

People had their privacy and dignity maintained. Staff were observed supporting people with understanding about how individuals living with dementia saw the world and patience and kindness. Compassionate care was really important to the values of the service and was clearly reflected in how staff cared for people. They used a 'relationship care' model of care which meant they also understood how people living with dementia often were expressing 'feelings' through their behaviour. Doll and soft toy therapy was supported by the whole team and relatives also interacted with the dolls and realistic furry pets in a way which made their loved ones happy and relaxed. Valuing people and enabling them to feel they mattered was important and staff enabled people to make their own drinks, do their own laundry and gardening which people were clearly enjoying. People were asked for their thoughts and ideas. For example, one person had noticed the fire alarm was not heard in the laundry room and that the conservatory got too warm so these had been addressed and the person thanked for their contribution.

People said they were very happy living at the service and staff found ways for people to enjoy accessing the community as they had done when living at home. For example, one person who had been the Chair of a football club still attended their meetings independently in their 90's.

People were protected from harm as staff demonstrated they had the knowledge and skills to recognise and keep people safe from abuse. Staff had safeguarding of vulnerable adults training and had the knowledge on how to report any concerns and what action they would take to protect people. The provider and staff worked hard to ensure relatives understood their loved ones needs and this had resulted in people being less anxious or displaying previous behaviour which could be seen as challenging.

People had their health needs met. People received visits from healthcare professionals, for example GPs and district nurses, to ensure they received appropriate care and treatment to meet their health care needs. Professionals confirmed staff followed the guidance they provided and it was policy for staff who knew the person's needs to accompany professionals. Their positive relationships were highlighted with the provider buying community nurses travel mugs so they could have a drink on their rounds. The provider also pro- actively sought audits from external agencies to further assess how the service was performing. Staff took on specialism roles in a meaningful way and ensured specialised knowledge was used to benefit people. For example, there were career enhancing opportunities for staff and specialisms in appointments, end of life care, mobility, record keeping and quality of life.

People's medicines were managed very safely and overseen by staff with medicines specialism. Medicines were managed, stored, and disposed of safely. Senior staff administered medicines and had received training and confirmed they understood the importance of safe administration and management of medicines. The provider worked to share their knowledge and good practice experience with other services

and primary and secondary care such as hospitals and GP surgeries. The regular care reviews with people and their representatives included a full medicines review.

People were supported to maintain a healthy balanced diet and adequate hydration. People told us they enjoyed their meals, there was plenty of food and we observed people were not rushed. Drinks and snacks were provided throughout the day and could be accessed freely by people. Taste testing sessions were organised to enable people to try different foods in a fun way and results were incorporated into the menu and snack table. For example, people had enjoyed tasting some new crisp flavours and the winner was chosen for the snack table. Staff understood how taste buds in the elderly could reduce flavour so they could monitor how people enjoyed different foods.

People received support from staff as necessary in a careful, dignified manner and all staff routinely ate and had coffee with people each day to promote a positive social environment. This had helped to forge close relationships between people and staff. For example, when one person's spouse did not arrive for lunch as usual, the staff rang them to check they were ok. The provider promoted a no 'them and us' ethos. For example, there was no uniform, staff area or bathroom and staff enjoyed relaxed time with people, often visiting out of work hours with their families and pets and attending events.

Feedback was constantly sought and ideas for improvement quickly implemented. People's care records were very personalised, comprehensive and detailed people's preferences including picture life history scrap books and achievable goals.

People, relatives and staff felt the service was very well led. People and staff described the registered manager, deputies and provider as very approachable, available and supportive. Staff talked very positively about their jobs and took pride in their work echoing the ethos of feeling 'proud and worthy'. The provider's values and ethos were seen throughout care, in language used in paperwork and discussions and excellent training. Therefore, people were consistently kept at the heart of how the service was managed.

The registered manager, deputies and provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment. The registered manager, deputies and provider were very passionate about the service. They had very robust quality assurance processes in place, including daily reviews of daily activities to ensure people felt noticed and cared for. The provider fed back the results to people living at the home, using tailored dementia care audit tools to monitor sleep and boredom ratios for example. The Dementia Care Matters Qualitative Baseline Observaiton Audit stated, "People received no negative (stress and anxiety) or controlling care throughout the observation." People's opinions were sought formally and informally. Audits were conducted to ensure the quality of care and environmental issues were identified promptly. Accidents were investigated and, where there were areas for improvement, these were shared for learning with people, staff, other services and health professionals.

Further information is in the detailed findings below

The five questions we ask about services and what we found