Windmill Lodge Care Home

Windmill Lodge Care Home is a care home providing personal and nursing care for up to 93 people. At the time of our inspection, there were 85 people using the service. The service supported older people living with dementia and nursing needs. The home is arranged over three floors, each with their own separate adapted facilities.

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

People felt safe living at the service. Staff completed comprehensive risk assessments that included mitigating strategies to keep people safe. Although a few people told us that staff were in a rush sometimes, there were enough staff to meet people’s care needs as necessary. People received their medicines as prescribed. Staff had the necessary support and equipment to effectively manage risks in relation to COVID-19 and hygiene requirements.

The home was adapted to meet the needs of people living there. Although some staff missed the date for their refresher courses to be completed, they had a good level of knowledge to ensure people’s well-being. Legal requirements were followed in making a best interest decision for people, but the provider had agreed to review their processes to ensure that mental capacity assessments were completed appropriately. People’s nutritional needs were thoroughly assessed so that staff could meet people's care needs.

People described staff as caring, polite and respecting their dignity. Events in the home took place to encourage and support people’s diverse care needs. Staff worked with people to understand their choices and wishes which were reflected in care records.

Care plans were robust and reviewed regularly to reflect people’s changing care needs. Individual needs were considered to ensure effective care delivery, including the activities people wanted to take part in. Staff were aware and supported people with their communication needs. People felt able to raise any concerns they had if needed.

There was a good leadership at the service with set values for inclusion and empowering of people. The staff team had support to carry out their responsibilities effectively and safely. Quality assurance processes in place were used to improve the care delivery and lessons were learnt quickly to prevent repeated incidents. The service developed close contacts and good communication with the healthcare professionals for partnership working.

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 overall rating for this service was requires improvement (published 02/05/2019). We also undertook a focused inspection to review the key questions of Safe and Well-led (published 26/08/2020).

Why we inspected

We carried out the inspection to check whether the provider had embedded and sustained improvements that we had noted at our previous inspection.

Follow up

We will continue to monitor the service and information we receive about them. If we receive any concerning information we may inspect sooner.

Windmill Lodge Care Home accommodates up to 93 people in one adapted building.

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

Medicines were managed and administered in line with best practice guidance. Staffing levels were calculate to meet people's care needs and staff responded to people in a timely manner. Suitable systems were in place to ensure people were protected from the potential risk of abuse. Risk management plans clearly identified people's needs and the support staff needed to offer to support them safely. Incidents and accidents were promptly investigated and any lessons learnt were shared. Effective measures were in place to support good infection control practices.

A new registered manager was in post who had made improvements to the home environment. The home was now dementia friendly, with a positive atmosphere throughout. One person told us, “I have lived here a very long time and I do love it here. The staff are marvellous.”

Quality assurance systems were effective in identifying areas of improvement. The registered manager notified the Commission of important incidents as they occurred. Important relationships were maintained with people, relatives and partnership agencies to ensure continuity of care. Staff were well supported, with the introduction of a staff award to recognise good practice and contributions.

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 02 May 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this focused inspection to check they had followed the action plan they sent us and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Is the service Safe and Well-led?, which contain those requirements.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as Requires Improvement. However, Safe and Well-Led have both improved to Good. This is based on the findings at this inspection.

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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.

• Windmill Lodge Care Centre 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.

• Windmill Lodge Care Centre accommodates up to 93 people in one adapted building across four separate wings, each of which has separate adapted facilities.

People’s experience of using this service:

• Staffing levels were not always safe to ensure that people’s needs were met in a timely manner.

• Risks were not always sufficiently assessed and recorded so that staff were clear on how to support people safely.

• Improvements were needed to ensure that medicines were managed in line with best practice guidance.

• People were not always suitably supported with eating, however they told us they liked the food on offer to them.

• The provider had identified gaps in staff training, supervision and appraisal.

• Quality assurance systems were not always conducted effectively in order to identify and drive improvements.

• We received mixed views from people and relatives as to the care received, some people felt staff always displayed compassion whereas others found some staff to be abrupt.

• The provider had identified that the environment and activities needed improvement so that it was better suited to the needs of the people living at the home.

Rating at last inspection:

• At our last inspection we rated the service ‘requires improvement’ with breaches in relation to the need for consent, and good governance. (Report published 24 April 2018)

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

• At this inspection we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and staffing. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

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

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

Windmill Lodge Care Centre 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.

Windmill Lodge Care Centre accommodates up to 93 people in a purpose built home. The home was set across four floors across three separate units, each of which had separate adapted facilities. One of the floors specialised in providing residential care to people living with dementia, whilst the other three floors provided nursing care. The home had been offering care to people living with dementia for six weeks, with the ground floor a mix of residential and those with dementia. At the time of our inspection 88 people were using the service.

A registered manager was in place at the time of our 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 provider did not ensure that accurate, complete and contemporaneous records were kept in relation to each person using the service. Quality assurance systems did not identify issues that we found at our inspection.

The home did not always follow the principles of the Mental Capacity Act 2005 (MCA). Some people using bedrails were unlawfully deprived of their liberty as Deprivation of Liberty Safeguards (DoLS) applications had not always been made to the local authority.

These failings represent two breaches of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s risk assessments did not always contain guidance for staff on how best to mitigate risk. Care plans did not always reflect people’s like and dislikes and personal preferences in relation to their care.

We have made a recommendation to the home to audit people’s risk assessments to ensure that there is up to date information to mitigate risks and to review care plans to ensure that people’s preferences are reflected.

People and their relatives were positive about the care that they received from staff and the management team. Staff respected people’s privacy and dignity and considered people’s preferences when supporting them. End of life care planning was in place the service had maintained the Beacon level as part of the Gold Standards Framework for the past nine years.

People and their relatives were supported to express their views through regular residents and relatives meetings. A complaints policy was accessible to all and people felt comfortable approaching management and staff with any issues that they may have.

Staff were clear on how to recognise abuse and the provider had appropriate systems in place to monitor and investigate any incidents as they occurred. Health and safety checks for the premises were maintained and infection control was routinely monitored. There were enough staff to meet the needs of people at the home and people’s medicines were managed safely.

Staff received appropriate training in order to fulfil their roles and received regular support from management through supervision and appraisals. People were supported to maintain a nutritious balanced diet and received support from other healthcare professionals where required.

Windmill Lodge Care Centre provides nursing and personal care to 93 people. At the time of our inspection, 88 people were using the service. The home is on four floors. The ground floor provided residential support for people. The other three floors provided nursing care for people.

The service was last inspected on 19 September 2013. The regulations inspected were met by the service.

At this inspection we found that staff had knowledge and skills to ensure people’s safety. Staff were aware about potential signs of abuse and they managed risks as required. People were involved in identifying and planning their support around the risks. Risk management plans were specific to people’s individual needs and were regularly reviewed. This ensured that people received the care they needed. Sufficient numbers of staff were available to ensure people’s safety. However, people told us that sometimes the care was delayed because there were not enough staff. Staff shortages had an impact on people’s routines, but the majority of people we spoke with did not mind this. People had support to take their medicines safely and as prescribed. The medicines were stored and reviewed regularly as required.

Staff received regular training courses that were relevant to their role. This ensured effective care provision for people. Staff attended induction to ensure they had knowledge to support people with their needs. Regular supervisions and appraisals were carried to discuss staff’s performance and training needs which meant that staff were supported to develop in their role. The service followed effective staff recruitment processes to ensure that staff had the required level of knowledge to provide good care for people. Staff supported people to make decisions and where required a mental capacity assessment was carried out, followed by a best interest meeting to ensure that decisions made on people’s behalf were in their best interests. People had a choice of what and when to eat. Staff worked together with health professionals, including speech and language therapists and dieticians to ensure continuous care for people. People had support to attend their health appointments as required.

People felt they were treated with respect. Staff ensured that people’s privacy was maintained. People told us they were provided with support to fulfil their spiritual needs and follow religious beliefs. The service provided choice of activities for people. Staff supported people to go out in the community when they wished to. This meant that people were encouraged to socialise as appropriate. The service supported people to maintain relationships with their friends and families. People had their preferred communication methods identified and staff helped them to make decision for themselves. People received support to make decisions and plan their care as appropriate.

The service supported people with their changing needs to ensure they received the care required. Staff were aware about people’s individual needs and preferences. Care records had information about people’s care needs and how they wanted to be supported. People and their relatives were encouraged to give feedback about the services provided. People told us they knew how to complain and were confident that actions would be taken to manage a complaint they had as required.

Staff were involved in developing the service which ensured their participation in people’s care planning. The registered manager provided guidance to the staff team. This meant that staff were supported to carry out their roles effectively. Staff were encouraged to undertake additional duties and the gained knowledge was shared with the team to ensure good practice. The service used effective quality assurance systems to monitor the care and support provided for people. People’s personal information was stored securely and staff shared the information on a need to know basis.

A person that lived at the home for some years said, "I still enjoy living at Windmill Lodge Care Centre, I feel they do things well, life gets better for me, there are lots of interesting things going on here to keep one entertained.".

Another person who used the service told us "I cannot speak highly enough of staff, they always seem to be available when I need them, they are excellent".

We found care and treatment was planned and delivered in a consistent way that helped to promote people's safety and welfare. The care needs of people using the service were kept under review. When staff identified concerns about a person's health they took prompt action by involving external health professionals. Staff followed up on the recommendations made by health professionals. This helped to ensure the health and wellbeing of individuals was promoted.

Staff were supported in their roles and had their work appraised. Training and development programmes were tailored according to staff professional development needs.

One relative told us "staff keep me up to date with my mother's progress", and 'we are pleased with the care provided'.

Where people were unable to contribute to care plan development staff worked closely with relatives to plan and arrange person centred care. Two relatives spoken with said that people received the care and support they needed.

People living at the home described the environment as warm and inclusive. They said they experienced stability and consistency as they had familiar staff that understood their needs and preferences.

A person living at the home for some years said 'I like living here at Windmill Lodge, staff are interested in me and the others that need care and support, staff have the caring qualities and an empathy with people which I appreciate'.

A person living at the home told us they very happy with their care. They said "my food is important, the cook endeavours to provide African food I like such as Jollof rice and Palm oil soup a couple times a week".

Another person said they enjoyed doing interesting activities and that they were able to do this, they visited places like the London Eye and London zoo.

Another person spoken with required frequent repositioning in bed, they said "Staff are lovely and they regularly change my position so that I am made comfortable".