Windward House is a care home which provides accommodation and personal care for up to 42 people who may have care needs related to their dementia. People who live at the home receive nursing care through the local community health teams.
The home had a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
This inspection took place on 5 and 6 October 2015 and was unannounced. At the time of our inspection there were 37 people using the service. People had a range of needs with some people being independent and others requiring more support with their mobility and care needs. A significant amount of people who lived in the home were living with dementia.
The service was last inspected in May 2014 and was found to be meeting all the regulations.
The service was not always well-led. People’s care records were not always accurate and the quality assurance systems in place had not found a number of concerns identified during this inspection. We found concerns relating to risk management, mental capacity assessments, medicines management, the environment and stimulation for people. Feedback from people, relatives, visitors and healthcare professionals told us staff and management did their best to care for people in a caring way but we found the service did not provide an effective and caring environment for people living with dementia.
People who lived in the home were not always safe. People’s medicines were not always well managed. For example, one person was dispensed medicines prescribed to someone else. It was not possible for the provider to assure themselves people were receiving their medicines as prescribed by their doctor. The home had procedures in place relating to disposing of medicines and conducting audits but these had not been followed.
Risks to people were not always well identified, assessed and managed. For example, one person had diabetes and required their blood sugars monitoring twice a day. Their readings fluctuated but staff did not have access to information about what the person’s blood sugar range should be in order to maintain good health. This meant staff were unable to identify whether the person was at risk or if their readings were outside of the norm for them. After the inspection the registered manager consulted with a doctor who provided guidance for staff and undertook diabetes training.
Although staff and the manager felt there were enough staff to meet people’s needs, people and their relatives did not always agree. This was particularly so at weekends and we have asked the manager to review this.
People were protected from abuse as staff had been provided regular training in safeguarding vulnerable adults. Staff knew how to identify abuse and how to report it should they have any concerns.
At least half the people who lived in Windward House had some degree of dementia. The environment was not suitably adapted for people living with dementia. For example, there was no signage to help people find their way around the home and the carpet caused people confusion. People did not benefit from suitable activity to promote their wellbeing. People spent long periods of time sitting in silence and relatives expressed their loved ones were bored.
Staff could not assure themselves that people were getting enough to drink as records were not accurate. People were not always encouraged to drink, for example, one person was provided with three drinks over four hours which were left untouched and removed by staff once they were cold. Staff did not encourage this person to drink. People enjoyed the food but did not feel they had a choice of meal. There were no menus and although staff asked people for their choice in the morning people did not have any memory of this. Staff supported people to eat and the chef catered for specific requirements.
The provider had not followed the principles of the Mental Capacity Act 2005 for those people who did not have the capacity to make their own decisions. Some people did not have mental capacity assessments in their care plans where these were required. It was not clear how people’s care and treatment was carried out in their best interest where they lacked capacity to make decisions about their care themselves. The registered manager did not have a thorough understanding of the Deprivation of Liberty Safeguards (DoLS), they had not applied the ‘acid test’ to determine whether further application needed to be made to the relevant authority. The acid test is where a person is subject to continuous supervision and control and is not free to leave.
People were cared for by staff who had received a thorough induction and were provided with regular training, Staff received a yearly appraisal and regular supervisions.
People were not always treated with dignity and respect. For example, one person, who was proud of their appearance, was left in communal areas in their night clothes for four hours. For three of those hours they were placed in their wheelchair at a table facing the wall with no stimulation or companionship. When staff moved the person from that position they did so by pulling their wheelchair from behind without first speaking to the person or telling them what they were doing. On other occasions we saw very positive interactions between people and staff and people, relatives and healthcare professionals gave consistently positive feedback about staff.
Care plans lacked personalisation and many did not contain information about people’s personal histories, their preferences, likes and dislikes. Staff, however, demonstrated they knew people well.
People and relatives had access to the complaints procedure and felt comfortable approaching the staff and the management with any concerns they may have.
Records were not maintained accurately, for example, one person had been living in the home for almost three weeks at the time of our inspection and did not have a care plan. Staff did not have instructions on how best to care for this person.
Audits had not always been carried out in order to identify possible issues. For example, a medicines audit had not been carried out and we found some discrepancies with quantities and disposal of medicines.
People, relatives, staff, visitors and healthcare professionals spoke very highly of the registered manager and felt they were approachable. Feedback was sought from people and their relatives in the form of questionnaires and meetings. Staff were asked for their feedback during meetings, handovers and supervisions.
We have made a recommendation for the provider to review their staffing numbers.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.