Winton House is a residential care home providing personal care up to 36 people aged 65 and over. At the time of the inspection 21 older people with physical frailty were living at the home. Each person had an individual room with en-suite facilities. People had access to a dedicated dining room and lounge. Around the home there were many different seating options for people to choose. The home had its own hair dressing room, which we observed was popular on the day of inspection.People’s experience of using this service and what we found
People were not routinely and consistently protected from avoidable harm. We found improvement were required in the management of risks posed to people. For instance, people who had fallen previously did not always have a risk assessment in place to advise staff on how they should be supported to prevent a reoccurrence. Risks associated with the environment were not routinely managed to reduce harm to people. Improvements were required in water safety management.
When accidents or incidents occurred, these were not routinely investigated to understand how to minimise a repeat event.
People were not routinely supported with their prescribed medicines by staff who followed best practice guidance or who had been assessed as competent to administer medicines. We found the registered manager had delegated competency assessments to other staff and had no process in place to check if they had been completed. Records relating to people’s medicines were not always accurate.
People were supported by a service that was not well-led. There was a lack of managerial oversight from the provider and registered manager. Systems were either not in place or ineffective to drive improvements in the service.
We found a number of breaches of the regulations.The provider and registered manager lacked knowledge on how to comply with the regulations The provider and registered manager failed to ensure they reported important events to us when required.The provider’s policy and procedures did not always reference or follow best practice. Internal audits carried out did not pick up the issues we found.
We have made a recommendation about the provider’s management of potential abuse. People were supported by staff who had received training on how to recognise abuse. However, the providers policy and procedures did not reference best practice guidance.
We have made a recommendation about ensuring staff are recruited safely. We found references for new staff were not always verified or came from a professional address.
We found mixed evidence on how well the service had managed through the Covid-19 pandemic. We have signposted the provider to resources to develop their approach with regards to following government guidance on use of PPE and social distancing for staff. However, people told us, “It’s a nice place. It’s clean and well maintained”, “It’s clean and modern”, “It’s a nice environment. The staff know her well and she’s well looked after”.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Documentation did not consistently follow the principles of the mental capacity act code of practice.
People told us they felt staff looked after them and they were kind and caring. Comments from people included, “The carers are very good and kind”, “I definitely feel safe living here” and “They [staff] treat you and approach you the right way”.
People were supported to keep in contact with family and friends. Comments included, “When we had her new great grandson, we used Zoom to speak to her. A member of staff was very good and sat with her”, “My daughter came into the home to see me yesterday for the first time since Covid-19 started. I didn’t want her to come in, I’m happy with Skype but she brought my great grandchild and we had great fun”.
Relatives told us they were happy with the support their family member received. Relatives told us “There’s always someone there. We can sleep at night now.” And “It’s a nice environment. The staff know her well and she’s well looked after.” Another relative told us “It has taken such a weight off my shoulders to know she is safe and happy here”.
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 (published 23 August 2018).
Why we inspected
The inspection was prompted in part due to concerns about the effectiveness of the provider’s risk management systems and good governance. A decision was made for us to undertake a focused inspection to examine those risks and review the key questions of safe and well-led only.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Winton House on our website at www.cqc.org.uk.
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 people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to risk management and good governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.