Windle Court

Windle Court is a residential care home and provides accommodation and personal care for up to 76 older people, including people living with dementia. At the time of the inspection, 68 people were living at the service.

The service accommodates people across three separate units: Jasmine, Poppy and Sunflower. Both Poppy and Sunflower units are located within the main building. Jasmine unit is a three-storey building adjacent to the main building.

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

People told us they felt safe living at Windle Court. Staff had been recruited following relevant checks being completed, and there were enough staff to provide safe care. Staff had completed safeguarding training and understood their responsibilities to report any concerns to protect people from harm and abuse. Risk assessments were completed to identify and mitigate risks to people. The management of medicines was safe, and people received their medicines as prescribed.

Staff received on-going training, supervision and appraisal to enable them to fulfil their role and responsibilities and meet people’s care and support needs. 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 supported this practice. People were supported with their dietary needs and were supported, where required, to access health care professionals.

Staff knew people well and were kind and sensitive to their needs. They treated people with dignity and respect and promoted their independence. A holistic approach was taken to assessing, planning and delivering care and support, and people were fully involved in how their care was to be provided.

People knew how to raise a complaint and felt confident any issues would be addressed. Where there had been incidents or complaints, these had been responded to appropriately and the provider had systems to monitor and learn from these.

The culture of the service was person-centred, open and transparent. The registered manager was visible around the home and staff had a clear understanding of their roles and responsibilities. People were encouraged to express their views on the service they received and to be involved in the running of the service. There were effective quality assurance systems in place to drive continuous improvement.

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 requires improvement (published 25 September 2018).

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our previous inspection undertaken on the 23, 24 January and 8 February 2018, we found breaches with regulatory requirements. These related to Regulation 9 (Person centred care), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 14 (Meeting nutritional and hydration needs), Regulation 17 (Good governance), Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 (Notifications of other incidents) of the Care Quality Commission (Registration) Regulations 2009 (Part 4). The service was rated inadequate and was placed in Special Measures. We requested an urgent action plan from the registered provider confirming to us what they were going to do immediately to address our concerns. You can read the full report from our last inspection by selecting the ‘All reports’ link for Windle Court on our website at www.cqc.org.uk.

Services in Special Measures are kept under review and 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, and the rating of Inadequate remains 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.

During this inspection in August 2018, we checked the actions and improvements the provider told us they would make to achieve and maintain compliance with the fundamental standards under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Our findings showed that although improvements had been made, further improvements were required. Furthermore, where improvements had been made, further time was required to ensure these were fully embedded and sustained within the service. As the service is no longer rated as ‘Inadequate’ overall or in any of the key questions, it is now out of Special Measures.

Windle Court is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to 76 older people across three separate units: Jasmine, Poppy and Sunflower. Jasmine unit is a three-storey building which is separate from the main building. Poppy unit is situated on the ground floor of the main building and Sunflower is situated on the first floor. There were 62 people living at Windle Court when we visited the service on 21 August 2018, of which two were in hospital.

There had not been a registered manager in post at the service since October 2017. A manager had been recruited following our inspection in March 2018 and was in the process of registering with the Care Quality Commission. 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.

People felt safe living at the service. Improvements had been made around the management of medicines, staffing numbers and deployment of staff. However further improvements were required to ensure people’s care records, including any associated risks, were up to date and reflective of their current care and support needs. Improvements were also required to ensure effective infection control. Staff had received training in safeguarding adults from abuse and understood their responsibilities and the actions they should take if concerns were identified. Safe recruitment systems were in place to ensure new staff were safe to work with adults. There were systems in place to learn from when things had gone wrong, and these were used as an opportunity to improve the health, safety and well-being of people.

Newly appointed staff received an induction relating to their roles and responsibilities. Staff received support, guidance and the training they needed to enable them to fulfil their role and responsibilities. Although staff felt well supported, further improvements were required to ensure staff received regular supervision. People had sufficient food and drink and were provided with choices at mealtimes. Where required, people were supported to access health care services to maintain their health and well-being. Although people were supported to have choice and control over their lives and there were systems and policies in place to support this, improvements were required to ensure the service is acting in accordance with the Mental Capacity Act 2005 and associated Code of Guidance.

People were treated with warmth, compassion and respect. Staff knew people well and were sensitive to their needs. People's independence was promoted and people were encouraged to do as much as they could for themselves. People were treated with dignity and respect and staff ensured people's privacy was maintained at all times.

Improvements were required to ensure care plans reflected people's current care and support needs. Improvements were also required to ensure that there was accurate record keeping. The registered provider employed an activities coordinator who supported people to participate in group and/or one to one activities. Information on how to raise concerns or complaints was available, and people and their relatives were confident any concerns would be listened to and acted upon.

People, relatives, staff, and health and social care professionals spoke positively about the manager who was committed to making improvements and providing good quality care. Staff were valued and well supported. The manager actively encouraged feedback about the quality of the service and saw this as an opportunity to reflect and make improvements. There were systems in place to regularly assess and monitor the quality of the service, however some of the auditing processes required improvements to enable a more robust approach to monitoring and oversight of the service.

Further information is in the detailed findings below.

Windle Court 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.

The service accommodates up to 76 people across three separate units, Jasmine, Poppy and Sunflower. Jasmine unit is a three storey building which is separate from the main building. Poppy unit is situated on the ground floor of the main building and Sunflower unit is situated on the first floor. There were 74 people living at Windle Court when we visited the service on 23 January 2018. When we returned to the service on the 8 February 2018, 71 people were living at Windle Court.

At our inspection we identified a lack of governance, and people were at risk of unnecessary harm. The systems in place to effectively monitor and improve the quality of the service were not robust. The provider had not taken appropriate steps to ensure they had clear scrutiny and oversight of the service which ensured people received safe care and treatment. The lack of managerial oversight had impacted on people, staff and the quality of care provided and had failed to identify and address concerns and breaches of regulatory requirements we found during our inspection.

There had not been a registered manager in post at the service since October 2017. A manager had been recruited who was not yet registered with the Care Quality Commission. 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.

Improvements were required to ensure sufficient numbers of staff were effectively deployed, so that people’s individual care and support needs were met in a timely way.

The standard of record keeping was of a poor standard. Care records were not accurately maintained to ensure staff were provided with clear up to date information which reflected people’s current care and support needs. Risks to people had not always been identified. Where risks had been identified people’s care records had not always been reviewed and, where appropriate, updated to mitigate these.

People told us they felt safe living at the service, however they were not fully protected from the risk of abuse and harm. Although staff could tell us about the different types of abuse and the actions they would take if they suspected abuse, we found the service had not always raised safeguarding alerts to the safeguarding team.

Although appropriate recruitment procedures were in place to check staffs’ suitability to work with vulnerable people before they started work, improvements were required to make sure these were robustly completed for all prospective staff to ensure safer recruitment.

Staff completed the provider’s mandatory training but had not received specialist training to equip them with the skills, support and knowledge they needed to provide effective good quality care to people with specific health needs.

Improvements were required to ensure people received their medicines as prescribed, and the service had appropriately trained staff available at all times to administer people’s medicines.

Although staff felt supported by the manager, not all staff had received regular supervision. Staff were not always being routinely assessed or checked to ensure they continued to have the right skills and competencies to support people living at the service.

People were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way as possible.

People were generally positive about the meals provided. There was a choice of food and drinks each day however people did not always receive their preferred food choices. Moreover, documentation used to monitor people’s food and fluid intakes were not always being completed, placing people at risk of dehydration and/or poor nutritional intake.

Although people were supported to access healthcare services, improvements were required to ensure appropriate and timely referrals were made to healthcare professionals to support people to maintain their health care needs and well-being.

Whilst staff were kind and caring towards the people they supported and treated people with dignity and respect, they were often task orientated due to staffing numbers and the deployment of staff .

People were supported to maintain relationships with people who were important to them.

At this inspection we found breaches of Regulations 9 [Person centred care], 12 [Safe care and treatment], 13 [Safeguarding service users from abuse and improper treatment], 14 [Meeting nutritional and hydration needs], 17 [Good Governance], 18 [Staffing] and 19 [Fit and proper persons employed] of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

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.

Windle Court is registered to provide accommodation with personal care for up to 76 older people, some of whom may be living with dementia related needs. There were 75 people receiving a service on the day of our inspection. The service does not provide nursing care.

The service had a registered manager. 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.

People’s capacity to consent had been assessed however not all staff were able to demonstrate a good knowledge and understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) despite having received training. ‘Best interest’ decisions for the use of covert medication had not involved pharmacists in the decision making process.

People told us the service was a safe place to live. The registered provider’s recruitment procedures ensured that only suitable staff were employed. People were supported by staff that had the skills and experience needed to provide effective care and there were enough staff to help keep people safe, meet their needs and protect them from harm and abuse. Medication was dispensed by staff who had received training to do so.

Staff knew people well and were kind and sensitive to their needs and ensured their privacy and dignity was respected. People told us they were happy with the care and support they received. Staff encouraged people to maintain their independence as much as they were able to.

People’s nutritional needs were met and people were supported to maintain a healthy and balanced diet. People received support to access health care professionals when required.

People were provided with the opportunity to participate in activities which interested them. There were systems in place to effectively deal with concerns and complaints.

The registered manager was committed to continuous improvement and there were systems in place to regularly assess and monitor the quality of the service provided. People living and working in the service had the opportunity to say how they felt about the home and the service it provided.

This is a summary of what we found;

Is the service safe?

When we arrived at the service the registered manager greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to available to meet their needs.

We reviewed staffing records regarding The Mental Capacity Act (MCA) 2005 in relation to Deprivation of Liberty Safeguards (DoLS) and saw that some training had been provided and further training planned. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw policies and procedures were in place.

Is the service effective?

There were systems in place to audit medication and care plans which ensured effective organisation in the delivery of care.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were reviewed monthly and updated appropriately which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, respectful and professional manner. One person told us, 'The staff are very kind.' Another person told us, 'I like the meals they are of a high standard.'

Is the service responsive?

The service had an effective complaints procedure in place. We examined the care records of six people who used the service and noted that risk assessments were reviewed and updated in in response to events. This ensured people received safe and appropriate care.

Is the service well-led?

The manager visited each of the units when on duty and staff informed us was they supportive and approachable. We inspected monitoring records of the care people received regarding turning their position while in bed and fluid balance charts. We saw there was a system in place for staff to record this information and this was checked by the respective units managers while on duty. The service worked well with other organisations and services such as health and social care professionals to make sure people received their care in a joined up way.

During our inspection we spoke with seven people in the home and five relatives who were visiting during our inspection. The feedback was very positive. One relative said: 'It's nice to go home and not worry as X is looked after so well.'

During the past year there had been periods when there was a high turnover of staff, high sickness levels and use of agency staff. This had an impact on people living in the home. Prior to our inspection we were contacted by two relatives who had concerns about fluctuating staffing levels and the impact this had on the care provided. However, an effective recruitment drive had taken place. Additional staff had been recruited and people we spoke with were complimentary about the staff currently employed.

People were treated respectfully and their independence was supported and encouraged. They received care and support that generally met their needs but care records were not being used to promote consistent care. People's nutritional needs were not being consistently met. The systems in place to protect people from abuse were being strengthened. Staff needed additional support and training to enable them to meet people's individual needs. The service had systems to monitor the standards within the service but some of them needed further development.

People were very complimentary about the manager, describing her as 'approachable' and 'very hands on'.

A number of people were not able to tell us directly about their experiences. However, we observed that they were relaxed and they interacted positively in different ways with the staff. For example, we heard and saw people singing together with staff and people enjoyed the gentle way staff assisted them to eat their lunch.

There was a range of daily activities on offer and people could get involved as much as they wanted. People liked the food and the choices available. One person said, "The food is lovely here and I always get a choice. I don't have to eat what is on the menu if I don't fancy it

Windle Court had all the necessary policies and procedures, quality assurance and monitoring systems in place for the safeguarding and protection of people who lived at the home. Staff carried out their caring responsibilities well and people and their families were involved in their care arrangements and in volunteering in the home.

One person said, 'We are well looked after. We can talk to somebody if we have a problem. If I have a problem I wave my hand and they come to me.'