Wintofts Residential Home

Wintofts Residential Home is a residential care home providing personal care for one person aged 65 and over at the time of the inspection. The service can support up to six people. The care home is based in a rural location and is adjacent to a farmhouse. The "care home" is purposely adapted to provide care, with a stair lift to access the upper floor. There is a kitchen area, two dining rooms and bedrooms with a shared bathroom.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Medicines were not always managed in a safe way. Prescribed nutritional supplements were left in communal areas and decisions to reduce some supplements had been made by the provider without consultation with relevant professionals.

Although the service was clean and tidy throughout, the provider didn’t always provide care and support in a safe environment. Government guidance in relation to Covid 19 was not always followed, cleaning schedules were not in place and outbreak management plans were not thorough. They did not demonstrate how the person would be cared for in the event of an outbreak.

The provider supported the person to have the maximum possible choice and independence and they had control over their own lives. The provider focused on the person’s strengths and promoted what they could do, so they had a fulfilling and meaningful everyday life.

Right Care:

Staff understood how to protect people from poor care and abuse. However, the provider did not have up to date safeguarding training.

The person was able to communicate with the provider and volunteers because staff supported them consistently and understood their individual communication needs.

The provider encouraged and enabled the person to take positive risks.

Right Culture:

Staff turnover was very low, which supported the person to receive consistent care from staff who knew them well. The person had been supported by the provider and the same two volunteers for a number of years.

The person led an inclusive and empowered life because of the ethos, values, attitudes and behaviours of the provider. However, they were not involved in any focus or engagement groups and best practice guidance in relation to supporting people with learning disabilities and autistic people. Best practice guidance was not always followed in relation to terminology and dignified terms.

The providers knowledge and skills in relation to regulations, legislation and best practice was lacking which impacted on improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (report published 1 June 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 24 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wintofts Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines, infection, prevention and control and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wintofts Residential Home is a residential care home providing personal care for one person aged 65 and over at the time of the inspection. The service can support up to six people. The care home is based in a rural location and is adjacent to a farmhouse. The "care home" is purposely adapted to provide care, with a stair lift to access the upper floor. There is a kitchen area, two dining rooms and bedrooms with a shared bathroom.

The service is not required to have a separate registered manager, because the registered provider is an individual who is registered with us. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s experience of using this service and what we found

The service did not have robust infection, prevention and control systems in place to manage the risk of COVID-19 within the service. Visitors were not screened for COVID-19 and the provider did not have systems to allow essential visitors to attend the service.

Medicines were not always safe where non-prescribed medication was given against medical advice.

Volunteer carers were not vetted to make sure they were of good character to work with vulnerable people.

The service ensured that the person’s care needs were met and provided a “home from home” approach to give person centred care. The provider knew the person very well and had a close working relationship with the person living at the service and their relatives.

Care planning was person centred and detailed the support the person needed. The provider understood the person’s non-verbal communication method and was able to understand when additional support was needed. For example, if the person was distressed and required additional support.

The person living at the service was supported to have maximum choice and control of their life. Volunteer carers supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

The person was supported to live in an environment which had a homely approach, with support being tailored around what the person wanted. Care planning was person-centred, and it promoted the person’s dignity, privacy and human rights. The provider demonstrated their person-centred values, attitudes and behaviours to ensure the person was confident, felt included and empowered.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (30 April 2018).

Why we inspected

We received concerns in relation to an alleged incident which had taken place in the property, involving one of the volunteer carers. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. Therefore, we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that the person was at risk of harm from this concern. However, we have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep the person safe as a result of this inspection. We will continue to monitor the service to keep the person safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to regulation 12: safe care and treatment, regulation 18: good governance and regulation 19: fit and proper persons employed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wintofts Residential Home is a residential home for up to six people who have a learning disability. Accommodation is provided in one adapted building over two floors. This service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service is not required to have a separate registered manager, because the registered provider is an individual who is registered with us. 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.

People were protected from the risk of harm. Risk assessments were in place where required. Staff were able to describe action they would take if they suspected abuse was taking place. There was enough staff on duty to provide the support needed. However, contingency plans required further information and clarification to ensure appropriate support could be sourced in the event of staff sickness.

Medicines had been administered and stored safely. Staff had completed appropriate training to ensure they were competent within their roles.

People had access to food and drink and were provide with home cooked meals of their choosing. People were able to access to their own GP’s and were supported to receive annual health checks. It was not always clear if relevant professionals had been consulted when people’s mobility needs changed.

Positive caring relationships had been developed and it was clear the provider and staff were familiar with people’s like dislikes and interests. Staff communicated well with people using their preferred communication techniques.

Care plans were person-centred and contained required information. Where possible relatives and advocates had been involved in the development of care plans.

A complaints procedure was in place and was available to people if needed. Relatives told us they were confident any concerns would be addressed appropriately.

The provider was responsible for completing all care documents and ensured this task was completed each day. People were asked their views and wishes with regards to day to day activities. Informal discussions took place to ensure people were satisfied with the service provided.

We found that complete and accurate records had not been always been kept. The provider did not clearly record activities that had taken place and contingency plans were in place but did not contain enough information.

The provider was a member of the Independent Care Group and was able to seek advice and guidance when needed to ensure they followed best practice.

Further information is in the detailed findings below.

Wintofts Residential Home is registered to provide residential care and support for up to six people with a learning disability. The service is located in a rural area close to a range of community amenities and facilities in Pickering. At the time of our inspection there were two people living there.

A registered manager was in post. 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. The majority of care and support was provided by the registered manager and her husband who lived on site.

Wintofts Residential Home provided good care and support for the people that lived there. People were encouraged to lead fulfilling lives in line with their own preferences and choices. People were involved in making decisions about their care and how the service was run. Care and support plans contained up to date and personalised information about how people wanted their needs met. There were good opportunities for people to discuss any concerns or ideas that they had.

People were supported to have their day to day health needs met. Health services such as dentists, doctors and opticians were used as required and there were close links with other specialist services where required.

Staff were knowledgeable about the needs of each person and how they preferred to live their lives. Staff received training to support them in their roles, although we identified that some staff would benefit from updated training to make sure they were aware current best practice. There were safe recruitment practices in place for staff and there were a sufficient number of staff on duty to meet people’s needs.

There were systems in place to keep people safe. Staff were confident about their responsibilities in relation to safeguarding and also knew who they could contact regarding any concerns they had about the service. There was a positive approach to risk taking so that people could be as independent as possible. Risks in peoples’ day to day lives had been identified and measures put in place to keep people safe. The focus was on how each person benefited from the activity undertaken.

The staff team were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are safeguards put in place to protect people where their freedom of movement is restricted. Staff had been trained in the MCA and had a good awareness of issues relating to capacity and consent.

The service was well led. The registered manager had been at the service for a long time and knew the people that lived there very well. Staff told us that the service was well managed and that there was good support. The registered manager promoted a culture of respect, involvement and independence. The registered manager had a good oversight of the service to make sure that the quality of care was maintained.

People had a care plan for nutrition which was individual to them. This stated what they liked to eat. People had specific routines at meal times and we observed that the manager tried to ensure that those routines were maintained to suit the wishes of each person. On the whole the people who used this service ate a healthy, nutritious diet which contained all food groups.

People who used the service had their own care files that showed input from other healthcare professionals. Information in the care files suggested that information was shared appropriately between the service and other professionals.

We observed that people were given the correct medication at the right time. We looked at medication records and found that these were up to date.

We looked at the service's policies and procedures and found that there were plans in place for emergency situations.

We saw that people had their views taken into account both when reviews were carried out by the local authority and also when service questionnaires were completed with the help of staff. One person who used the service told us,"I like it here."

People indicated that they were happy with the way staff cared for them and that they were supported to live well in the community. One person told us 'I go out to Morrisons for something to eat. I like Morrisons at Scarborough best. We go there because I like it."

People's consent to care was gained and we saw evidence that people received the care they needed. Staff had training in the Mental Capacity Act (2005) and Deprivation of Liberty safeguards (DoLS) to ensure people's rights were protected.

We saw up to date plans of care which considered individual physical, emotional and mental health care needs. We saw risk assessments and that all documentation was kept up to date to ensure people had their changing needs met. We saw that the home consulted with specialists to make sure people had the benefit of expert advice.

People were protected from harm and the risk of harm through staff training and risk assessments.

There were sufficient staff on duty at all times to ensure people had their care needs met.

We saw that the home had an effective system to deal with complaints.