Winchester House

Updated 28 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors carried out the inspection

Service and service type

Winchester House is a ‘care home’ without nursing care. People in care homes receive accommodation and nursing or 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 service had a manager registered with the Care Quality Commission, but they had left the service and were not in day to day control. This meant that the provider was legally responsible for how the service was run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced

What we did before inspection

Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. This information helps support our inspections. We reviewed information and data that we hold and spoke with partner agencies, such as the local authority.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and three relatives about their experience of the care provided. We spoke with some people verbally. Other people who used the service who were unable to talk with us used different ways of communicating such as Makaton (a spoken and signed language for people with communication difficulties). We spoke with seven members of staff including the manager, senior carers and care staff.

We also spent time observing people and the care they received.

We reviewed a range of records. This included three people’s care records and 10 medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with one professional who visited the service.

Updated 28 April 2022

About the service

Winchester House is a residential care home providing personal care to 11 people with a learning disability and autism at the time of the inspection. The service can support up to 11 people.

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

People were not consistently kept safe from risk of harm. We found risks relating to constipation, epilepsy, choking, and behaviours that may challenge that could have been managed more safely.

Staff did not always have the right training to carry out their role. Staff had not received regular supervision and appraisal, although the new manager had started to address this. Some agency staff had not read people’s care plans and some did not know about safety information such as fire safety procedures.

Some restrictions had not been assessed via the Mental Capacity Act 2005. One person sometimes could not access their room as the door was locked and there was no MCA assessment for this. Another person had access to the kitchen restricted but this was no in an MCA assessment or included in their DoLS.

Some people were diagnosed with autism but did not have effective assessments of their sensory needs. The service had a sensory room but this was not fit for purpose and had fallen out of use. Care plans did not always reflect people’s individualised needs.

People did not have end of life care plans, and the manager acknowledged the need for these to be completed. We have made a recommendation about this.

There were not robust governance systems in place to ensure that care and support was safe, effective or high quality. Shortfalls we identified had either not been highlighted by audits, or effective action to remedy them had not been taken. The manager reflected that these concerns had not been picked up in previous audits.

People told us they liked their staff and that they were kind and caring. One person said, “The staff are really, really, good. They're always helpful and there if I have a problem.” We observed some caring support from staff who knew people’s needs.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to consistently demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

More work was needed to ensure that people could receive support that enabled them to meet their goals and aspirations. Some people were non-verbal but their relatives had not received a copy of their care plan despite asking. This left people at risk of not having person-centred goals. Improvements were needed to ensure that the environment was homely, clean, and well-maintained.

Right Care

The provider had not always ensured that risks faced by people had been assessed and planned for. Staff tried to provide personalised support to people, but this was difficult at times as there was not enough guidance around people’s communication or sensory needs.

Right culture

Some staff were not able to provide the support people needed with their sensory needs, and with needs associated with autism as they had not had the correct training or guidance. Some relatives told us that management changes meant there was not always consistency, although all relatives we spoke with were happy with the new manager and their approach.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 21 September 2020 and this is the first inspection.

The last rating for the service under the previous provider was good (published on 14 December 2019).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to person centred support, consent, safe care, good governance, and staffing at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.