Windermere House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all the quality statements in safe and there was evidence of good practice. People were enabled to take positive risks and were involved with managing their care and support. People told us they felt safe and were protected from the risk of harm and abuse. Staff demonstrated an understanding of how and who to report concerns to. People were supported by enough skilled and trained staff; some had worked at the service for a long time and knew them well.

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 told us they were listened to if they had concerns or suggestions and one person told us how staff, “Respected their space”. The manager had recently joined the service and spoke of how they were keen to drive improvements through continual learning. They were working with staff to provide more detail within peoples records to evidence the choices people were offered and the decisions they made. Processes were in place to review incidents. We saw action had been taken to ensure incidents were reported in a timely manner and referred to external partners when required.

People’s wishes and needs were assessed prior to moving into the service. People had health and social care input, the management team liaised with the relevant professionals before, during and after the admission process. One person told us, “It was difficult to adjust from hospital, took a few months but it's been fantastic the carers are helpful and I’m getting lots of support.” A health professional provided positive feedback on how the service liaised with them supporting people’s changing health needs, and told us, “We feel the queries from the home are relevant and appropriate at most times. They are appropriately seeking support and also appropriately contacting ambulance services where people need to be conveyed to hospital, for example a recent hospital admission for a patient [with a potentially urgent health risk]”.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. People told us they felt safe and that they would speak to staff if they had any concerns. Their comments included, “I feel very safe”. And, “If I didn’t feel safe, I could talk to the carers”.

Staff had received safeguarding training and demonstrated an understanding of types of abuse and how they would report concerns. Staff knew to escalate concerns within the service and if required, to external agencies. A staff member told us, “We've completed safeguarding training. If I saw any unexplained injuries, I must document them, we have a duty of care to report to the nurses and manager.” The manager understood their responsibilities where safeguarding concerns were identified and had ensured senior staff and nurses were clear on their regulatory responsibility to notify CQC of any allegation of abuse. Safeguarding concerns were investigated and lessons learned were shared with staff.

We observed staff supporting people safely. Staff understood people’s needs and demonstrated their understanding of people’s rights to make their own decisions. For example, we observed staff helping a person with a number of choices about what to have to eat. Staff respected the persons choices and gave the person time to consider the options and communicated with them respectfully.

Staff and management were improving their understanding of working within the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The manager had identified there were some shortfalls in how this had been previously managed, which included some applications made in error as some people had been assessed as having capacity to make decisions themselves. These applications were not authorised and we have not identified evidence of harm. Where people had an authorised DoLS in place, conditions were being met. The manager tracked DoLS authorisations to ensure they were in date and remained relevant. The provider’s systems to safeguard people from the risk of harm or abuse were followed. The provider’s policy was clear for staff to understand should they have a safeguarding concern.

People were enabled to take risks and were involved in decisions about their support. However, where some people chose to not always follow health advise, records did not always include actions staff had taken to ensure the person had access to all the information and what the different choices might mean for them. People told us staff respected their choices to take risks. One person said, “Staff respect my decisions and don't force their will regarding health advice”. Staff told us risk assessments and the associated care plans for people provided enough information on how to safely support them. One staff member told us how they encouraged people with support with repositioning, “I am trying to tell them it is effective to change position regularly to avoid complications. I say to work together so you can heal quicker.” People lived with health conditions and some required equipment to help them, risk assessments and care plans guided staff on how to support people safely. We observed the mealtime experience, a person’s care plan and risk assessment stated they required their food to be cut up small. Staff followed the risk assessment by making sure the person’s food was cut up as required and they were discreetly monitored whilst eating to avoid choking risk. The manager took action to improve how staff recorded decisions people made.

People had appropriate equipment and mobility aids to safely access areas in the service. People could access a gym with specialist equipment supported by trained staff who advised people on mobility and repositioning needs. One person spoke of regularly using the gym. People could access additional facilities supporting their wellbeing and sensory needs, this included a salt cave. The manager informed us this was particularly helpful for people with breathing conditions. Processes were in place to ensure the safety of the premises and equipment. Health and safety checks were completed, including the general environment, equipment and water checks. Specialist beds and mattresses were visually checked over with documentation to report any concerns. Risk assessments were completed for fire safety.

People spoke positively about staff. Their comments included, “I can call for staff help if needed I press the buzzer they respond quickly and they can have a chat with me.” And “They are good at coming when I press my bell. They help me and don’t rush me, there is time for a natter”. Staff were recruited safely, pre-employment checks had been carried out prior to their employment, this included references, background checks and the right to work in the UK. Registered nurses had their PIN numbers checked to ensure they were up to date and legally allowed to practice nursing. New staff were expected to complete the care certificate. The care certificate is a set of standards for health and social care professionals, which gives everyone the confidence that workers have the same introductory skills, knowledge and behaviours to provide compassionate, safe and high-quality care and support. Staff skills and knowledge were monitored through competency checks and supervisions to ensure their knowledge was practiced and embedded. Some staff had worked at the service for a long time which meant people benefitted from consistent care, people and staff knew each other well. One staff member told us how managers had supported them, “Supervisions, we get every few months. I find them helpful because if they are unhappy or happy with what I am doing they let me know. It's nice to know we are doing our jobs properly.” We observed there were enough skilled and experienced staff to support people. Staffing levels were calculated based on the needs of people including some who received one to one support and rotas confirmed staffing provision in accordance with these assessments. Call bells were answered promptly and staff responded to people’s requests in a timely way. A senior staff member told us, “We are working as a team here, fantastic team, there is enough good staff and staffing levels are good we're hardly using agency now. I love working for this company”.

People told us they were happy with the cleanliness at the service. One person said, “Everything is to a high standard”. The service was clean, housekeeping staff followed schedules to ensure bedrooms, bathrooms and communal space were cleaned on a regular basis. Staff had received training in infection prevention and control and practised what they had learned. A staff member told us, “I had training for infection control and [managers] check we have completed our training and watch to see if we do it properly”. Regular checks and audits were completed to ensure the service was complying with the provider’s infection prevention and control (IPC) policy.

People received their medicines as prescribed, in a way they preferred. Staff monitored people for adverse effects of medicines and liaised with professionals where needed. A person told us, “Staff keep an eye on my health, the nurses give medicines every day.” Medicine management was completed safely. Medicine Administration Record (MAR) charts included details to ensure staff were aware of what medicine to administer people. PRN (medicine to be administered as needed) protocols provided guidance on the criteria for staff to give PRN medicines, monitor reactions and risks. For example, the PRN protocol for a person living with diabetes outlined the need for them to receive differing levels of medicine dependent on the result of the blood glucose check and included actions to take in the event of concerns. Only staff who had been trained and assessed as competent were able to administer medicines to people. Records were accurate and showed how issues of consent had been addressed in line with relevant legislation.