Archived: Winterbrook Nursing Home

At the previous inspection we found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had made improvements and met the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although the provider was meeting the regulations we have rated the service as Requires Improvement as we need to be sure the service can sustain the improvements.

Winterbrook Nursing Home 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. Winterbrook Nursing Home accommodates up to 41 people in one adapted building. At the time of the inspection there were 26 people using the service.

At the time of the inspection the manager was not registered with CQC. However, they had submitted an application to register. 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.

We found significant improvements in the culture of the service. There was a cheerful atmosphere, where staff were friendly and welcoming. People and relatives were positive about the improvements and were complimentary about the management team. The management team were approachable and promoted an open culture.

Improvements made had resulted in people feeling safe in the service. Risks were assessed and there were plans in place to manage the risks. People's medicines were managed safely and people received their medicines as prescribed.

Methods of communication with people, relatives and staff had improved and they were confident to raise any concerns. Everyone was reassured that concerns would be responded to effectively.

The management team had introduced effective systems to monitor and improve the service and continued to look for ways to improve the care of people living in the service.

Improvements had been made in the way people were treated. People were supported by staff who were kind and caring, treating people with dignity and respect.

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.

People were positive about the food and enjoyed sufficient food and drink to meet their nutritional needs.

The service had employed additional activity staff to ensure people had access to a range of activities to interest them. The activities we saw were enjoyed and created a warm atmosphere with people laughing.

People’s care records had improved and included information recognising people as unique individuals. Reviews had been completed which involved people and relatives. Relatives were positive about the reviews and the improvement in the care plans.

There were sufficient staff to meet people's needs. The manager recognised the challenge of recruiting enough permanent staff and worked with agencies to provide consistent agency staff to provide continuity of care for people.

Staff support had improved. There were regular opportunities for staff to access training and the management team gave staff the opportunity to influence developments in the service through team meetings.

The service worked closely with health care professionals and had developed positive relationships with them. This ensured people received appropriate support to maintain and improve their health and well-being.

The inspection was prompted in part by concerns raised by the provider with the local authority safeguarding team relating to the alleged abuse of people living at the service. The concerns are subject to a criminal investigation and as a result this inspection did not examine the circumstances of the concerns. However, the information shared with CQC about the alleged abuse indicated potential concerns about people's safety. This inspection examined those concerns.

Winterbrook Nursing Home is a care home providing accommodation and nursing care for up to 41 people. On the day of the inspection there were 32 people using the service.

There was a registered manager in place at the time of the inspection. However, the registered manager was not present during the inspection. 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. The registered manager was not present at the inspection.

The provider had taken prompt action when concerns were raised with them. However, we found there was a lack of effective management. Systems in place to monitor and improve the quality of the service had not identified the issues we found during the inspection.

A culture that did not treat people with dignity and respect had developed and people were not always treated in a kind and caring manner.

People were not always protected from abuse and improper treatment and were not confident to raise concerns.

Medicines were not always managed safely and risks to people were not always assessed and managed.

People were not protected from the risk of infection and equipment was not always maintained to ensure it was clean and safe to use. The environment was not always clean and there were no effective systems to monitor the cleanliness of the service.

The provider did not ensure people were supported by staff who were suitable to work with vulnerable adults. Records showed that appropriate recruitment checks and risk assessments were not always carried out. Staff were not supported through regular supervision and did not receive training in line with the provider’s training guidance to ensure they had the skills and knowledge to meet people’s needs. There were sufficient staff to meet people’s needs.

People were not always supported to have the maximum control over their lives. The service did not always support people in line with the principles of the Mental Capacity Act 2005.

Care plans were not always accurate and did not provide guidance to staff to ensure people’s needs were met.

People did not always feel confident to make a complaint. Where complaints were received they were not always responded to and managed effectively.

People were positive about the activities and enjoyed participating in group activities. People enjoyed the food and nutritional needs were met.

We identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Winterbrook Nursing Home provides accommodation for up to 41 people requiring nursing or personal care. At the time of our inspection there were 29 people using the service.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager promoted a person-centred culture and ensured people were at the centre of all the service did. There was a cheerful, relaxed atmosphere throughout our inspection. People were spoken to with kindness and compassion and were able to spend their day as they chose. Staff were caring and respected people's choice. People were encouraged to maintain and improve their independence.

People felt safe in the service and were supported by staff who understood their responsibilities to report any concerns relating to abuse. There were sufficient staff to meet people's needs and people benefitted from a consistent staff group. There were recruitment processes in place, however the provider had not always obtained two references before staff started work in the service.

Medicines were managed safely. People received their medicines as prescribed by staff who had the skills to do so.

People had personalised care plans that detailed the support they needed. Staff were knowledgeable about people's needs. Where risks were identified there were plans in place to manage the risks.

People were supported in line with the principles of the Mental Capacity Act 2005 (MCA). However there was not always evidence to show people's capacity had been assessed and a best interest process followed.

Food provided was appetising and people were complimentary about the quality of the food. Individual dietary needs were met. People had access to health professionals when needed and any guidance given was followed.

Staff felt supported and listened to. Staff had training to ensure they had the skills and knowledge to meet people's needs. Staff were supported to improve their skills and were offered development opportunities.

The provider sought feedback from people and their relatives about the quality of the service and feedback was used to improve the service. There were effective systems in place to monitor and improve the quality of the service.

We found that the provider had taken appropriate action. Medicines were kept safely. For example, we noted that both of the home's medication rooms were securely locked. A third room, which contained creams and dressings, was also secured. The keys to the medication rooms were held by the nurse on duty and all rooms were locked when not in use. We spoke to two nurses, both who told us that all medication rooms were locked when not in use. One nurse told us, 'They are always locked, after the last inspection we were reminded of the importance of this".

We noted that the nurses at the home maintained good records for the homes monitored dosage systems (MDS). For example, nurses accurately recorded when they had administered each person's medicines.

We saw that the nurses at the home maintained good records of people's controlled drugs. We noted that the records for two people accurately reflected the amount of controlled drugs for each of these people.

The home had appropriate systems in place to account for the amount of medicines given and left in stock. The provider had appropriate audits of their medication systems. We saw monthly medication audits were undertaken by the home.

People told us they were happy at the home. One person told us, 'I'm happy. The food is good'. Another person told us, 'I like it very much. I've got a lovely room. I feel looked after'.

Medicines were not always secured safely. One clinical room contained two medication cupboards, one of which was unsecured.

We found that the premises were in need of refurbishment; however we noted that the provider was aware of this and had a refurbishment schedule in place for carpets to be replaced by the end of September 2013.

We found that staff received appropriate training and professional development. For example we spoke to a senior care worker and three care workers who told us they could access training when they needed.

The provider demonstrated how the views of people, their representatives, staff and external stakeholders had been sought. The provider had completed a survey to find the views of people regarding the home and had acted on their comments.

People's personal records, including medical records were accurate and fit for purpose. We looked at the care files of six people who lived at the home. All care assessments and risk assessments in people's files had been reviewed appropriately.

We spoke with eight people, three care workers, a nurse and additional staff. One person said 'I like it here, I'm looked after'. Another person said 'the staff are good'. Care workers told us how they respected people's independence. One care worker told us "I take in two towels, one for me and one for them; they like to wash and dry what they can, while I assist where they can't'.

People's needs were not always assessed as they should be. Care and treatment was not always planned in accordance with their needs, and was not always delivered in line with their individual care plan. People were therefore at risk of receiving inappropriate care.

One person told us 'I get quite a good meal'. One person told us 'there is not really a choice, but food is varied', and 'it is good food'. We saw that people had choice regarding meal options, but not all people were aware of these choices.

People's personal records including medical records were not always accurate. We looked at the care records for ten people. We saw that sometimes significant information was not documented in on-going records or in care assessments. This meant that people could be at risk of inappropriate care.

We reviewed the care records of four people living in the home. These were comprehensive and contained relevant information to each persons care and welfare. Each person was assessed in terms of their care needs within the home and any risks that were posed to their welfare.

The clinical lead for the home took daily responsibility for maintaining the safe administration of medication. This entailed ensuring staff received appropriate training and undertaking a monthly audit of the medication administration record (MAR) sheets to monitor their accuracy.

People we spoke to were very complimentary about the staff. One person said about the staff 'they are all very kind and helpful', another one said 'I really like it that there are a lot of younger staff here and they all can have a laugh with us'.

We saw that the home had an up to date complaints policy and procedure in place and a copy was available in the entrance hall and that the information was clear and guided people through the procedure should they wish to make a complaint.