White Windows

Updated 22 August 2023

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 Health and Social Care Act 2008.

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

This inspection was carried out by 4 inspectors and 2 Experts by Experience. One Expert by Experience made telephone calls to people living at the service and their relatives and another visited the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

White Windows is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. White Windows is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The manager had submitted their registered manager application to CQC. We are currently assessing this application. We have referred to them as ‘the manager’ in this inspection report.

Notice of inspection

This inspection was unannounced. Inspection activity started on 5June 2023 and ended on 19 July 2023. We visited the service on 8 and 19 June and 7 July 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service including Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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 this information to plan our inspection.

During the inspection

We spoke with 11 people using the service and 7 of their relatives about their experience of the care provided. We observed care in the communal areas to help us understand the experience of people. We spoke with 8 members of staff including the manager, deputy manager, care staff, the area manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included 6 people's care plans, risk assessments and associated information. We also reviewed multiple medication records. We looked at 3 staff files in relation to recruitment. A variety of records relating to the management of the service were also reviewed.

Updated 22 August 2023

About the service

White Windows is a residential care home providing personal care to 25 people at the time of the inspection. The service can support up to 25 people. White Windows supports people with physical and learning disabilities in one adapted building. White Windows is also registered to provide personal care to people in their own houses and flats but were not providing this service at the time of the inspection.

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

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 could not show how they met some principles of right support, right care, right culture.

Right support

Risk assessments were not always followed to make sure people were safe. Medicines were not always managed safely and people’s abilities in managing their own medicines had not been routinely assessed. Environmental risks were not always identified and addressed through audit systems. Staff were recruited safely but there were not always enough staff to meet people’s needs and maintain a clean and safe environment for people. People were supported in the least restrictive way possible but where people had Deprivation of Liberty Safeguards (DoLS) in place, there was no evidence of conditions with the DoLS being met. We also found care records were unclear in relation to people’s capacity and there were inconsistencies in the ‘best interest decision’ process.

Right Care

People were not fully supported to meet their social and recreational needs and there were times when their dignity needs were not fully met. People were not always protected from risk because some risk assessments were not being followed by staff. People told us they were happy with the staff who supported them. We observed some kind and caring interactions between staff and people. Staff knew people well but there were missed opportunities to fully involve people in their care and to promote people’s independence. People’s families felt involved in the care and support of their relatives.

Right Culture:

The provider’s audit systems did not always identify and drive improvements in the quality of care and the safety of the environment. Although regular meetings were held, there were limited opportunities for people’s views to be heard. At the time of the inspection, views of people’s relatives about the service, were being sought but the outcome of this was not yet available.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 October 2022), and there were breaches of regulation. 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 the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for White Windows on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, medicine management, staffing, need for consent and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.