Archived: Windsor House

Windsor House is a residential care home for up to fourteen adults with a learning disability. At the time of the inspection there were eleven people living at the service.

Windsor House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The accommodation was spread over two floors of a converted house in a residential area. There was a large kitchen, a lounge and a dining room. People living at the service had a range of learning disabilities. Some people also required support with behaviours that challenged and physical disabilities.

At the last inspection the service was rated overall as requires improvement. In that we found that activities for profoundly disabled people required further development. And there had not been enough time for the new manager to embed improvements at the service. However, there were no breaches of the regulations. At this inspection we found that the service had improved, and the service is now rated Good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. 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.

Risks to people had been assessed. There was clear and detailed guidance for staff to enable them to minimise risks. People’s needs were appropriately assessed before they moved to the service. These assessments were used to plan people’s support. Medicines continued to be managed safely and people received their medicines on time and when they needed them.

There were systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Staff had regular discussions with people about their safety to protect them from the risk of abuse.

Staff knew how to keep people safe from the risks of infection and took the appropriate actions to do so. The service was clean and free from odour. The environment had been adapted to meet people’s individual needs and was personalised to reflect the people that lived there.

There were sufficient numbers of staff to meet people’s needs and support people effectively. Staff had the training, skills and knowledge they needed to support people with learning disabilities. Spot checks were carried out to monitor staff performance and staff had regular supervision meetings and annual appraisals. New staff had been recruited safely and pre-employment checks were carried out.

Peoples support was personalised to them and met their needs. There was information on people’s goals, preferences and their plans for the end of their life. Support plans were reviewed regularly and updated when their needs changed. People’s support records were complete and up to date and the registered manager regularly audited the service to identify where improvements were needed.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and were involved in decisions about their support.

People continued to be supported to maintain their health and wellbeing. Where people needed access to healthcare services, this was in place. When people needed to go to hospital there was information for people to take with them about their support needs so that hospital staff had access to this information.

People were treated with respect and kindness. Staff took the time to listen to people and understood how people preferred to communicate. People were supported to communicate their wishes and express their feelings. Privacy was respected, and levels of dignity were maintained. People were encouraged to do things for themselves and their independence was promoted. Staff supported people to maintain their relationships.

The registered manager continued to monitor the quality of service provided by seeking feedback from relatives and health and social care professionals. There was a complaints system in place if people or their relatives wished to complain. There were annual surveys of relatives, staff, professionals and people and feedback was positive.

Staff, relatives, community health and social care professionals told us the service had continued to improve. The registered manager had a clear vision and values for the service and there was an open culture. Staff and the registered manager understood their roles and responsibilities. The service worked in partnership with other agencies to develop and share best practice.

Windsor House is a care home registered to provide accommodation and personal care for up to 14 people. 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. People living at the service had a range of learning disabilities and required support with behaviours that challenged.

Downstairs there were two lounges, a kitchen and dining room. There were 14 bedrooms and some bathrooms spread across the remaining two floors. At the time of the inspection there were 10 people living at the service.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

We last inspected Windsor House in May 2017, we found significant shortfalls and the service was rated inadequate and placed into special measures. There was no registered manager in post. There were not enough staff to keep people safe. Conditions on people’s Deprivation of Liberty Safeguards authorisations (DoLS) had not been met and appropriate action had not been taken when safeguarding alerts had been raised. Risks relating to people’s care and support were not always adequately assessed or mitigated. People’s needs had not always been assessed before they moved into the service. Complaints had not been adequately investigated or responded to. The quality assurance audits were not effective to ensure that all shortfalls in the service were identified and acted on. The provider had failed to notify CQC in a timely manner of important events that had happened in the service.

We took enforcement action and issued a warning notice relating to ‘Good Governance.’ We required the provider to make improvements. This service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. We received an action plan from the provider, and they told us they would be compliant with all regulations by 31 August 2017.At this inspection we found that improvements had been made in many areas. A new registered manager had been employed and there were no breaches of the regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At our previous inspection we found that the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At this inspection we found that many improvements been made, however, there was still further work to ensure that people were encouraged to be as independent as possible and formalise goals for people to work towards. People with profound learning disabilities required more specialist support from staff regarding their sensory needs. We made a recommendation regarding this.

Since our last inspection the new registered manager and new deputy manager had made many improvements. There was now enough staff to keep people safe. The registered manager had employed more staff and there was now a cook and cleaner in place so care staff could focus on supporting people and not on other tasks. People were able to go out when they wished and when people had conditions on their DoLS to access the community regularly these were now being met.

No one new had moved into the service since our last inspection, however, the registered manager and deputy manager had re-written each person’s care plan. These contained detailed guidance for staff on how to support people effectively and risks relating to people’s care and support were now fully assessed and mitigated. There was clear, person centred information regarding how people liked to be supported and how they communicated. Staff had made referrals to appropriate healthcare professionals to ensure they had up to date guidance on how to support people safely when moving or with eating and drinking. People received support to manage their health care needs.

The registered manager had a good knowledge of the regulatory requirements. They completed regular checks and audits to ensure that the improvements they had implemented were being continued by staff, The registered manager had only been in post since July so we were unable to assess if the improvements they had made had been fully embedded. The registered manager had informed CQC of any important events that occurred at the service, in line with current legislation. Any potential safeguarding issues had been discussed with and when necessary reported to the local authority safeguarding team. The registered manager worked closely with other professionals and was open and transparent, seeking advice and guidance when necessary. When incidents had happened they had been fully analysed and action had been taken to reduce the risk of them happening again. The registered manager told us they had learnt from each incident that occurred.

The registered manager had worked to change the culture of the service. They had encouraged to staff to be open to change and there was now a positive, inclusive culture at the service. Staff told us they felt well supported by the registered manger and felt that things were changing for the better. Staff received the training, support and supervision from the registered manager to carry out their roles effectively. Staff were kind and caring and knew people well. Some people needed support to communicate and staff were able to interpret their non-verbal communication. People were treated with respect and dignity.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had an understanding of The Mental Capacity Act (2005) and any restrictions on people’s liberty had been legally authorised.

The registered manager had made changes to the décor and layout of the service. They had moved their office downstairs, so they had more oversight of the service and were a visible presence. There was now a dining room, which meant people had more space to eat, and they did not have to eat in the lounge. People were supported to plan their meals and were supported to eat and drink safely. People’s rooms were personalised and people had been involved in choosing the decoration of their rooms.

The registered manager had sought feedback from people, their relatives, staff and other stakeholders regarding their views on the service. They had followed up on complaints that we had identified at our last inspection and ensured people were happy with the outcome. The provider had displayed their rating clearly and legibly on their website and at the service.

Medicines were managed safely and people received their medicines as and when they needed them. Staff were recruited safely. The environment was safe. Equipment had been regularly serviced and staff knew how to support people to leave the service in the event of a fire. The service was clean and people were protected from the spread of infection.

The service was not currently supporting anyone at the end of their life. The registered manager had arranged for one person to have support from an advocate when planning the end of their life, but other people’s needs had not been considered.

Windsor House is registered to provide accommodation and personal care for up to 14 people. People living at the service had a range of learning disabilities and required support with behaviours which challenged.

Downstairs there were two lounges, a kitchen and dining room. There were 14 bedrooms and some bathrooms spread across the remaining two floors. At the time of the inspection there were 11 people living at the service.

There was no registered manager working at the service. 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 and associated Regulations about how the service is run. We were supported during the inspection by the quality lead person for the organisation, who had recently started overseeing the service and two service support managers. These were registered managers from other services run by the provider, who were providing support as needed.

We last inspected the service in June 2016. We found significant shortfalls in the service. We found that there were not enough staff on duty to meet people’s needs and enable them to access activities in the community. Some people had Deprivation of Liberty Safeguards (DoLS) in place because their liberty was restricted. The conditions of the DoLS had not always been met. Full assessments had not always been carried out before people moved to the service. Risks relating to one person’s health and wellbeing had not been assessed to protect them from harm. Notifications of significant events within the service had not been sent to the Care Quality Commission (CQC), in line with current guidance.

We asked the provider to provide an action plan to explain how they were going to make improvements to the service. At this inspection we found that no improvements had been made to the service. Four breaches of regulations identified at the last inspection continued and there were three additional breaches of regulations.

There had not been a registered manager in post since the beginning of 2017. There had been no structured leadership and oversight of the service since then. Shortfalls found at this inspection had not been identified; however, some action was taken during the inspection. There was an action plan in place to address the breaches of regulations found at the last inspection. There were 25 actions but only eight had been completed. Audits and checks had not been completed since March 2017. Quality assurance surveys had not been sent to staff, people, relatives and other stakeholders, such as GP’s, since 2015.

Full assessments had not been carried out before people moved into the service. Risks relating to one person’s mobility had not been assessed and there was no guidance for staff about how to safely support the person with their mobility. During the inspection it was identified by inspectors that staff had been supporting the person in an unsafe way since they moved to the service in November 2016. The service support managers reported this as a safeguarding issue and contacted the local safeguarding team immediately.

Some accidents and incidents had been recorded and these were analysed to identify patterns or trends. This analysis was used to update people’s risk assessments or report incidents to other authorities. However, one incident had not been identified, recorded and analysed, the incident highlighted poor practice by staff and placed people at risk.

People said that they felt safe; however, there was not enough staff to meet people’s needs. People were limited with the activities they could do, both in the service and the community. Some people had a DoLS authorisation in place, with a condition that they go out into the community weekly. This condition had not been met because there had not been enough staff. Recruitment for more staff had been started but there was no date for when additional staff would be in post.

Some people had recently had DoLS applications authorised by the local authority. The service is required by law to inform CQC about the outcome of DoLs applications, this had not done in line with current legislation. Some people’s DoLS had expired and applications had not been re-submitted. There was a risk that people’s liberty was restricted without authorisation.

Staff understood the principles of the Mental Capacity Act 2005 (MCA), people were given choices and best interests meetings had been held regarding people’s care and support decisions.

There was a complaints procedure displayed in the service in a format that people could understand. However, complaints received by the service had not been responded to and investigated in line with the provider’s procedure.

Some staff had received supervision to support them to carry out their roles. Staff had received training appropriate to their roles; however, this training had expired including moving and handling and how to safely administer people’s emergency medicine. Refresher training had recently been booked.

People were involved in planning their meals. A visual menu was in place but not used as the pictures were missing. Some people had Speech and Language Therapy (SaLT) guidelines in place. Staff followed these so people could eat and drink safely. Prompt referrals had been made to healthcare professionals when required.

There was a safeguarding policy in place and staff knew how to recognise and respond to different types of abuse. Staff knew how to recognise different types of abuse but action was not always taken when staff reported concerns to management. Medicines were stored appropriately. People received their medicine when they needed it and were encouraged to be as independent as possible when taking their medicines.

Staff were kind and caring and knew people well. They treated people with respect and dignity. Some people required additional support with their communication and their needs and preferences were understood by staff. The quality lead for the organisation who was acting as the manager had an open door policy, people were happy to stop at the office and chat to whoever was in there at the time.

Checks had been made on the environment to ensure that people were safe. Fire drills had been held so that staff and people know what to do in an emergency. Each person had a personal emergency evacuation plan (PEEP). A PEEP sets out specific physical and communication requirements that each person has so they can be evacuated safely.

We found breaches of seven regulations. You can see what action we told the provider to take at the back of the full report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Windsor House is registered to provide accommodation and personal care for up to 14 people. People living at the service had a range of learning disabilities. Some people had physical disabilities and occasionally required support with behaviours which challenged.

Downstairs there was two lounges, a kitchen and dining room. There were fourteen bedrooms and several bathrooms spread across the remaining two floors. At the time of the inspection there were 14 people living at the service.

The service had a registered manager in post. A registered manager is a person who is 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.

People said they felt safe, however there was not enough staff to meet people’s needs. Three new people had moved in recently and staffing levels had not been increased. People sometimes had to wait for support. The registered manager was recruiting for new staff but said, “Right now we are not able to give people the opportunities to do things that they want to do.” Detailed, relevant references had not always been gained before staff started work.

People were not always able to access the activities they wanted outside of the service. The registered manager and staff told us there was not a formalised activity timetable in place due to a lack of staff.

Some people had Deprivation of Liberty Safeguards (DoLS) authorisations in place because they were being restricted. The conditions on these DoLS were not always met. One person had a DoLS granted on the condition they regularly accessed activities outside of the service. They had not done so for the past four weeks. The registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA) and best interest meetings had been held regarding people’s care and support.

Full assessments were not always carried out before people moved into the service. Risks relating to one person’s health and wellbeing had not been assessed to protect them from harm. Staff were not clear about how to support a person who had recently moved in as a result.

The dishwasher and washing machine had been out of use for some time. Staff had to do the washing up by hand. The registered manager had to take dirty and soiled laundry to another service to wash them. This was disrupting the normal running of the service and the registered manager had not notified the Care Quality Commission (CQC), in line with current legislation.

People were involved in planning and preparing their meals. A visual menu was in place but not used as the pictures were missing. Some people had Speech and Language Therapy (SaLT) guidelines in place. Staff followed these so people could eat and drink safely.

The registered manager and area manager carried out regular audits. However, staffing levels had not increased as needed to meet people’s needs and gaps in people’s care plans had not been identified. People and health care professionals had been asked their opinions on the service recently, but relatives had not.

The registered manager carried out regular health and safety checks to the premises and equipment. Regular fire drills occurred to ensure people and staff knew what to do in an emergency.

There was a safeguarding policy in place and staff knew how to recognise and respond to different types of abuse. The registered manager was clear on their responsibilities with regards to safeguarding and was in regular contact with the local safeguarding co-ordinator. Medicines were stored appropriately. People received their medicines when they needed it and were encouraged to be as independent as possible when taking it.

Staff received the training and supervision needed to be carry out their roles. People had a range of healthcare needs and there was detailed information available for staff to support them with this. Prompt referrals were made to healthcare professionals when it was needed.

Staff were kind and caring and knew people well. They treated people with respect and dignity. Some people were unable to communicate verbally but their needs and preferences were understood by staff. It was important to one person that they wore their slippers when inside and staff made sure they did.

People had the opportunity to raise concerns or ideas for improvement at regular meetings with their keyworkers. There had not been any recent complaints about the service.

The registered manager was a visible presence within the service and worked with staff regularly to maintain an oversight of the service. Staff were clear about what was expected of them and their roles and responsibilities and felt supported by the registered manager.

You can see what action we told the provider to take at the back of the full report.

There were enough skilled and experienced staff to meet people's needs as the staffing levels had been increased. Staff were supported and supervised and supported people in a discreet respectful manner.

Care records were in the process of being reviewed and updated. Staff records were available and organised as well as being accurate and up to date. This meant that people were protected from the risks of unsafe or inappropriate care and treatment.

People were now being encouraged to be involved in the running of the service including taking part in the cooking. People maintained good health as the service worked closely with health and social care professionals. People now had the support they needed to meet their spiritual needs.

People were not fully supported in promoting their independence and community involvement. Opportunities to take part in activities when at home or outside the home were limited.

Choice and decision making was not well supported which meant that people with communication needs had limited opportunities to lever change and make choices. Records were not up to date and lacked review so may not have been accurate

Cultural and religious needs were not fully supported. Staff were not aware of the details of people's religious beliefs so were unable to give the right support.

Health needs were recorded but staff were not aware of what these health needs were and so how to give the right support. This placed people at risk of inappropriate care and treatment.

There were not enough, trained competent staff to meet people's needs. There was a new manager in post. She had recognised the shortfalls that we found and had produced an action plan to improve the service.