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Windsor Court Residential Home Good

Reports


Inspection carried out on 18 September 2018

During a routine inspection

This inspection took place on 18 September 2018 and was unannounced, which meant the staff and registered provider did not know we would be visiting.

Windsor Court is a care home. 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 look at during the inspection. The service is registered for 32 people and at the time of inspection there were 28 people living at the service.

Following our last inspection the service had appointed a new registered manager and they have been registered with the Care Quality Commission since May 2018. A registered manager is a person who has registered with the CQC 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 last inspection of the service was carried out in December 2017 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated regulations. We found concerns relating to risks to people arising from their health and support needs not always being completed or robustly reviewed. Medicines were not always managed safely and people’s dining experience did not meet the expected standards, their needs or promote people’s wellbeing.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

At this inspection we found that the provider had worked to drive improvements within the service. Audits were now taking place with a full action plan along with any lessons learnt. Medicines were being managed more safely. Risk assessments relating to the health, safety and welfare of people using the service were completed and regularly reviewed.

We found that people’s dining experience had improved with the cook presenting food that was much more appetising for people who required pureed diets. Speech and Language Therapy (SALT) referrals were being actively made.

People were happy and told us they felt safe. The staff had a good understanding of safeguarding, what their responsibilities were and could clearly tell us what action they would take if they had any concerns about the way people were supported. Staff received safeguarding training and had access to information about the different types of abuse, how to prevent abuse and how to respond to an allegation.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people's needs. The management team closely considered people's needs and ensured sufficient staff were on duty each day and night.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work.

People's care needs were assessed, and clear plans were now in place to meet people’s individual needs. People were cared for by staff who knew them very well and understood how to support them.

A training programme was in place that enabled staff to provide the person-centred care and support people needed. New staff completed a service induction programme and undertook the care certificate, this meant that they had the knowledge and skills required to meet people’s needs. Staff also received regular supervision sessions, which assisted the registered manager to identify areas for development.

Staff had a basic understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and had received training. The provider had appropriately requested Deprivation of Liberty Safeguard (DoLS) and ensured that these were regularly reviewed.

We observed that staff had positive relationships with the people who used the se

Inspection carried out on 19 December 2017

During a routine inspection

This inspection took place on 19 December 2017 and was unannounced.

Windsor Court 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. At the time of inspection there were 32 people living at the service.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in December 2004. 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 last inspection of the service was carried out in September 2015 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We found concerns relating to when required medicines and topical medicine administration and recording. We asked the registered provider to take action to make improvements in relation to the management of medicines. We received an action plan outlining how the provider was going to meet this regulation.

At this inspection we found that the provider had made improvements however we found further improvements were required to become fully compliant with the Fundamental Standards of Quality and Safety. In particular we found concerns with a prescribed pain relief patch application for one person, medicine counts, carried forwards of medicine stock and where permission had been granted to administer a medicine outside the prescribed times in certain circumstances, staff had not recorded what these circumstances were.

We found concerns around the decisions made to put people on pureed diets.

Plans were not in place to minimise all risks to people who used the service. For example, people on a pureed diet.

Audits were taking place, however the in house audits were mainly tick boxes and were not robust enough to highlight the issues we found during our visit.

People enjoyed the food provided and were offered a choice of meal. People who were on a pureed diet had limited choice and the full meal was liquidised together, therefore not enabling individual tastes.

Care staff had received the training they needed to carry out their roles effectively. However, we recommend the registered manager and cook needed training and support on current guidelines and best practice for example when to refer people to specialist healthcare professionals and how to prepare food in alternative ways . Staff were fully supported from supervisions and a yearly appraisal.

People told us that they felt safe at the service and that they trusted staff. Safeguarding training was completed by staff and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. Staff knew what was meant by abuse and said they would not hesitate to report any kind of abuse which they were told about, suspected or witnessed..

A number of recruitment checks were carried out before staff were employed to ensure they were suitable.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and demonstrated a basic understanding of the requirements of the Act. 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 The registered manager understood their responsibilities in relation to the DoLS. Evidence of consent was sought, however many were dated 2014 and no checks had been made to make sure the person still consented.

We looked at staffing levels and although on the day of inspecti

Inspection carried out on 22 October 2015

During a routine inspection

This inspection took place on 22 September 2015 and was unannounced, which meant the staff and registered provider did not know we would be visiting.

Windsor Court is a 32 bedded care home providing personal care to older people and older people living with a dementia. It is situated close to the centre of Stockton-on-Tees, close to local amenities and a park. The service is located within a row of converted terraced houses.

The service had a registered manager in place and they have been registered with the Care Quality Commission since December 2004. A registered manager is a person who has registered with the CQC 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 looked at the management of medicines. We found that people received their medicines appropriately. However there were concerns with when required (PRN) medicines and topical medicine administration and recording.

We found that supervisions and appraisals had taken place for staff members and training was fully up to date.

We saw that people were involved in activities.

We found that records of people’s dietary needs which were stored in the kitchen were in need of updating. People we spoke with told us they received enough nutrition and hydration. People were given choice which reflected their individual preferences,

Staff we spoke with understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow [raise concerns about the home, staff practices or provider] if the need ever arose.

Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service and others. Plans were then put in place to reduce the risks identified. One care plan looked at did not document an identified need for wound care. Care plans provided evidence of regular access to healthcare professionals and services.

There were sufficient numbers of staff on duty to meet the needs of people using the service on the day of inspection. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.

Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.

The home was clean, spacious and suitable for the people who used the service. However some bathrooms contained personal toiletries, which can increase the risk of cross contamination and impact upon infection prevention and control procedures.

Certificates relating to the safety and security of the building and equipment needed for the day to day running of the service were all up to date.

The registered provider had knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager understood when an application should be made, and how to submit one. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the registered provider was following the requirements in the DoLS. Staff we spoke with had a clear understanding of DoLS.

All of the care records we looked at contained written consent for example people had signed to consent to have photographs taken and signed to consent to the care provided. During our observations of care and support, we could see that staff asked for people’s permission before any care and support was given

People who used the service, and family members, were complimentary about the standard of care provided by the service. Staff told us that the home had an open, inclusive and positive culture.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into the service.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment. However these were not always robust such as not including an action plan which would evidence any issues highlighted had been completed.

The registered provider had a complaints policy and procedure in place and complaints were documented with a full outcome.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Inspection carried out on 12 February 2014

During a routine inspection

We spoke with twelve people who use the service, two relatives and one visitor on the day of the inspection. Not everyone we spoke to could express their views, but those that could, told us they were satisfied with the service they received. People felt that the staff supported them and met their needs. One person told us, “This place is good; I have my own room with my own things in it.” One visitor we spoke to said that they had received a warm welcome, they also said, "Staff have been very helpful and the people seem happy."

We found records to show how people's needs had been assessed and that care plans were put in place to address these needs. One relative told us that their family had been involved with their relatives care plans. This meant that the home was able to provide the care and support that people wanted.

We saw that the home provided a good selection of food and refreshments in sufficient quantities for people living there.

We observed most rooms throughout the home and found them to be clean and tidy with no odours. One person told us that staff keep their room tidy for them.

We found that the home had generally good procedures in place for the management of medication.

The provider held meeting for people using the service and their relatives and also completed regular checks on the service provided, this ensured that the quality of the service was regularly monitored.

Inspection carried out on 25 September 2012

During a routine inspection

We spoke with three people who lived at Windsor Court and had informal discussions with others throughout the day. We also spoke with two relatives, the manager and three staff. Some of the people living at Windsor Court were unable to verbally communicate their views and experiences to us. We were able to observe people's experiences of living in the home and their interactions with each other and the staff. We observed staff interacting with people, giving appropriate support and supervision. We saw staff engaging in a positive way with people and there was a lot of smiles and signs of wellbeing.

We saw that people had their needs assessed and care records were in place. People were satisfied with the care provided by the staff. One person we spoke with said, "The manager went through the care records when I first came in." A relative said, "She is receiving the care that she needs and is being cared for as she would want." We spoke with staff about the needs of people whose care records we looked at. One relative said, "The staff are really good, attentive and conscientious, he/she is getting the care they need."

People were provided with information that would assist them if they needed to raise concerns or make a complaint, although the complaints records needed more information.

You can see our judgements on the front page of this report.

Reports under our old system of regulation (including those from before CQC was created)