Archived: Winterton House

This service is not required to have a manager registered with the Care Quality Commission, as the service is provided by an individual who is the manager and registered person. 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 inspection took place on 17 March 2017 and was unannounced. At our previous inspection on 4 November 2016 we found that the provider did not meet legal requirements relating to safeguarding people from abuse, maintaining a clean and safe premises, staff training, appraisal and supervision, maintaining privacy and dignity, and quality assurance. We imposed conditions on their registration to restrict admissions and to provide us with monthly updates in relation to risk assessments and infection control. The overall rating for this service was ‘Inadequate’ and the service was therefore in ‘special measures’. The provider wrote to us to say she had taken action and was now meeting legal requirements. However, she did not adhere to the conditions requiring her to send us monthly updates, and during this inspection we found that the provider was still not meeting legal requirements and therefore the service has been rated inadequate overall and remains in special measures.

Shortfalls in the leadership of the service remained. There were ineffective systems in place to monitor the quality of care delivered. The provider lacked oversight on issues such as accidents and incidents and managing risk, and did not ensure there was an open culture which enabled staff, people using the service and their relatives to openly express their views about the service.

Records were not always accurate, were not always kept securely and could not be easily found when needed.

Although people told us they felt safe, they were not always safeguarded from avoidable harm and unnecessary restrictions. Staff had not attended any safeguarding training and were unsure of the process to follow if they were concerned a person was being abused. The safeguarding policy in place needed to be updated in order to reflect up-to-date information.

The provider and staff were aware of some of their responsibilities but demonstrated a lack of knowledge about the Mental Capacity Act (2005) and how it applied in practice. People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Medicines were not always managed safely leaving people at risk of not receiving their medicines as prescribed.

Staff had not yet received appropriate training, appraisal and supervision. This resulted in people receiving care that was not always evidence based or effective.

People were not always involved in planning their care, or in the way in which the service was run. They were not always offered choices. Activities provided did not always meet people’s needs particularly those living with dementia.

People were not always treated with dignity and respect as their wishes were not always respected. People were not always encouraged to maintain their independence.

There was a complaints procedure in place which was also available in pictorial format, however the provider could not show us she had appropriately recorded and responded to complaints.

We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Winterton House provides care to nine people some of whom may be living with dementia. On the day of our visit, there were eight people using the service.

The service is not required to have a manager registered with the Care Quality Commission (CQC) as the service is provided by an individual who is the manager and registered person. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and if we have not taken immediate action to propose to cancel the provider’s registration, the service will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or their overall rating, we will take action in line with our enforcement procedures, to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found shortfalls in the leadership of the service. There were ineffective systems in place to monitor the quality of care delivered. Records were not always accurate and were not always kept securely.

People told us they felt safe. However, we found that people were not always safeguarded from avoidable harm. Medicines were not always managed safely. In addition, infection control guidelines were not always followed leaving people at risk of acquiring infections.

The premises and equipment were not clean and properly maintained. There were several health and safety risks. Appropriate steps had not been taken to ensure identified risks were addressed and managed.

Staff had not received appropriate appraisal, supervision and training. This resulted in people receiving care that was not always evidence based or effective.

People were not always involved in planning their care and were not always offered choice. Food and activities provided did not always meet people’s needs.

People were not always treated with dignity as their wishes were not always respected. The way in which care was delivered did not always ensure people’s dignity was preserved.

Staff were aware of some of their responsibilities but demonstrated a lack of knowledge about the Mental Capacity Act (2005) and how it applied in practice.

You can see what action we told the provider to take at the back of the full version of the report in relation to the multiple breaches we found.

Our last inspection in January 2014 found that the service had improved, and met essential standards relating to the management of medicines, safety and suitability of the premises and supporting workers.

The service is not required to have a manager registered with the Care Quality Commission (CQC) as the service is provided by an individual who is the manager and registered person. 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 manager lives on site and provides much of the day-to-day care including the cooking and cleaning.

The service was calm and we saw people talking with each other over breakfast when we arrived. We observed that the manager and staff were kind and knew people very well.

People told us they felt safe and they had enough to eat and drink and that the food was good. They told us that staff were kind and caring. They told us they would tell the manager of any concerns and she would listen. The staff were caring and friendly in their attitude and approach. People liked the quietness of a small home environment. They told us that staff always knocked on their doors before entering.

People were helped to have health care checks and appointments were made for them as required. Relatives told us that the manager and staff were caring and kept them informed about their relatives. They told us they felt welcomed when they visited.

However, we found that people were not always safe in the service as fire exits and call bells were not appropriately maintained, and people were not protected against the risks of infection due to inadequate infection control practices. We found there were enough staff to meet people’s basic personal care needs, but not enough to ensure people had a range of stimulating activities from which to choose. We also found that the manager did not have an effective system in place in which to assess, monitor and improve the quality of the service people received, and staff did not always have appropriate training to ensure their skills and knowledge were up-to-date. We found three breaches of the Health and Social Care Act 2008 (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.

In November 2013 we made a follow-up visit. We found that the required standards were not met. We issued a formal warning that improvements must be made by 20 December 2013.

On this visit we found people received support in premises which were suitably maintained, clean and free from trip hazards. People's medication administration records had been fully completed which meant they received their medicines safely. All of the staff who worked at the service had received support with their professional development and an evaluation of their training needs.

The provider had made the necessary improvements. The required standards were met.

We asked the provider to take action to improve the service. On this follow-up visit we found that some renovations been made to the premises, but there continued to be electric cables on the living room floor. This meant that people continued to be at risk of injuring themselves by tripping over.

We found that medication was still not being safely and effectively administered because, although the provider told us she had given people their evening and night time medication on the previous day, this had not yet been recorded. The provider had not undertaken individual supervision or evaluation of the training needs of nine of ten staff. There continued to be a risk that people were supported by staff who did not have the skills to deliver their care to an appropriate standard.