Archived: Windsor Court Care Home

This inspection took place on 27 and 28 January 2016 and was unannounced.

The service had 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. At the time of our inspection, the deputy manager who had stood down from the lead role still held the registered status as the new manager’s application had not yet been accepted by the Care Quality Commission.

The people living in the home told us that they felt safe with the support from the care staff. Relatives we spoke with confirmed this. Policies and procedures were in place to protect people from harm and to ensure staff understood all of their responsibilities.

Accidents and incidents were investigated promptly and where appropriate the manager had informed the local authority and the Care Quality Commission. Records were analysed by the manager and used to review people’s care needs, risk assessments and implement control or preventative measures.

Risks associated with the health, safety and wellbeing of the people who lived in the home were managed well, including carrying out checks of the premises and equipment in line with their legal responsibilities. People’s care needs had been assessed and we saw evidence in records which demonstrated this was monitored and reviewed regularly.

The service safely managed people’s medicine and medicine administration records were detailed and accurate. Medicine was stored safely and securely. The staff followed policy and procedures with regards to receiving, storing and disposing of medicine. All other records which related to the management of the service were well maintained.

Staff told us there was enough staff employed by the service to operate it safely and to meet people’s needs. Staff files showed the recruitment process was safe and staff had been appropriately vetted. Training was up to date, and the staff had a range of skills and experience. The manager gave staff the opportunity to gain qualifications in care by liaising with an external provider.

Supervision and appraisals were held regularly and documented by the manager or a senior nurse. Staff and relatives’ meetings were also held and notes were taken. This demonstrated that stakeholders had an opportunity to speak to the manager regularly. Task based competency checks were undertaken by senior staff to assess staff’s suitability for their role.

Evidence showed the manager and staff had an understanding of the Mental Capacity Act (MCA) and their own responsibilities. The senior staff had assessed people’s mental capacity and reviewed it. Care records showed that wherever possible people had been involved in making some decisions, but significant decisions regarding people’s care were made in people’s best interests and had been appropriately taken with other professionals and relatives involved.

People were encouraged to maintain a balanced diet. We observed people in the dining room at lunchtime; staff endeavoured to make this a positive and interactive experience. People had some choice around their meal and often chose from the planned menu, some people and their relatives told us they could choose something else, which the cook was happy to prepare.

People’s general healthcare needs were met by staff involving external healthcare professionals whenever necessary. For example, we reviewed care needs records containing input from district nurses, the tissue viability team and speech and language therapists. Staff told us they worked closely with healthcare professionals and followed their instructions and advice to assist them to care and support people appropriately.

Staff displayed kind, caring and compassionate attitudes and people told us the staff were friendly and nice. We observed people’s privacy being upheld and they were treated with dignity and respect.

A newly appointed activities coordinator was employed to enhance people’s socialisation skills. People engaged with activities on a one to one basis and also in groups. A new programme of activities was being developed which included trips out and bringing local community services into the home.

The manager kept a record for complaints and told us how the complaints procedure was managed. During the inspection people and their relatives told us they had nothing to really complain about but would tell staff or the manager if something was wrong.

Quality monitoring took place regularly which involved people, relatives and staff being asked for their feedback via meetings and surveys. The manager undertook audits to ensure the quality and safety of the service. The provider oversaw this and also audited the records. Action plans were drafted to improve the service following audits and surveys.

The staff team were consistent. Staff told us they felt valued and they enjoyed their job. The manager and provider promoted staff recognition schemes which staff told us boosted their morale.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans were individualised and contained information about each person's support needs and how their care should be delivered. For example, areas covered included, personal care, continence, dementia and medications. Each care plan was broken down into sections which covered people's needs, the support required, risk, action plan and the outcomes.

The provider had guidance in place for staff for ordering, administration, disposal and safe storage of medications. The records showed all staff had completed training on administering medicines and two members of staff confirmed this. Visitors told us they felt the home was safe and people were well cared for.

Systems were in place to make sure that managers and staff learnt from events such as accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service continually improve.

The home had policies and procedures in place related to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to help ensure people were appropriately assessed and to make sure that people are cared for in a way that does not inappropriately restrict

their freedom. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded as and when required.

Is the service effective?

People's health and care needs were assessed and care plans were developed with people and their representatives. The care plans provided staff with information about how each person's care needs should be met. Guidelines were in place to inform staff of the

actions to be taken in certain situations and these were monitored by the manager.

The staff we spoke with were able to describe the individual needs of the people they cared for and how these needs were met.

People who were able to speak with us said they enjoyed the food served to them. Comments included, "We always have nice meals," "There is nothing to complain about," "We get enough to eat and it's nice" and "I like my dinners, they are nice." Relatives who were present said, "She was ill when she came here and had lost a lot of weight but after a few weeks she is putting weight on so we are very pleased," "He never complains about the food" and "He is used to my cooking but they do their best."

Is the service caring?

We observed the interactions between staff and the people they cared for. We saw staff had good relationships with people and were sensitive and attentive to their needs. We saw staff were spending time talking with people and we saw some people were supported to access the garden.

Two relatives we spoke with felt there were not enough activities taking place in the home. The operations manager and the manager told us that they were in the process of recruiting an activities organiser as the previous one had resigned from their post to become a care worker. We were shown information about programme that was being introduced to the home to improve the quality of life for people with advanced dementia. The programme aims to provide holistic person centred care seven days a week by providing meaningful activities. The activities provided were very personal to each person and some relatives had already completed questionnaires about the things that would give the most pleasure to the person, such as, favourite music, smells and favourite tastes.

We spoke with four people who used the service and their comments included, "They treat me well" and "It's champion here.

Is the service responsive?

We saw evidence to show there was a complaints procedure available. Relatives told us they knew how to make a complaint and they felt confident that if they made a complaint it would be properly investigated and taken seriously. One person had recently complained and they told us that the manager was in the process of carrying out an investigation.

We saw referrals were made to health care professionals when required and appropriate training was provided for the staff to help meet individual needs.

Is the service well-led?

The provider had systems in place to monitor the quality of the service people received. The manager told us that surveys were issued to service users and relatives. No replies had been received from the latest survey so the manager had started to ask people to complete these when they visited the home. Two recent questionnaires returned by relatives contained the following comments, "I would definitely recommend Windsor Court. The staff are lovely and very friendly," "A friendly and homely care home run by dedicated staff" and a thank you card stated, "Thanks for caring so well for my sister."

We saw records that showed the manager was responsible for audits of incidents, risk assessments, medications, health and safety issues and infection control. Each audit file contained a form to be completed if any corrective action was necessary.

The staff and visitors told us the manager was approachable if they wished to raise concerns or suggest new ideas.

Some people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with six people who used the service and one visitor. People told us they were asked for consent before they received care and treatment and a relative said "They always keep me informed about my mother's care". People said the staff were very caring and the manager very approachable. They said they would be confident to make a complaint if necessary and said they felt this would be taken seriously. Comments included, "The staff are always there to help if I need them", "The staff are great", "I pick my clothes and the staff are used to the way I am, I'm happy here", I find the staff very attentive and caring and yes they protect dignity and privacy".

Some parts of the premises were showing signs of wear and tear and the manager has submitted a plan of refurbishment to the provider. A meeting with them has been arranged to plan when the work will commence.

Systems in place to ensure appropriate staff were recruited to care for people. There were sufficient staff on duty to care for the people and they were well trained and supported to carry out their roles efficiently.

The provider had effective systems in place to assess and monitor the quality of service that people received.

We looked in detail at four care records and saw that care and support was being provided in line with individual plans of care. The care we observed during our visit was provided in a way which promoted independence, choice and respect.

We talked to four care staff employed by the service and looked at three staff records. The staff we observed during our visit provided person-centred care and found that care staff were trained and supported to meet people's needs safely and effectively.