Archived: The Windmill Care Home

The Windmill Care Home is a residential care home providing personal care to up to 35 people. The service provides support to older people who may be living with dementia. At the time of our inspection there were 31 people using the service.

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

Since the last inspection the provider and management team had made improvements, with support from the local authority, which had benefitted the people and staff who worked there. The governance structures were in place to oversee and manage the service and take forward actions identified following the last CQC inspection and from quality and infection prevention and control visits from the local authority.

There had been a major refurbishment programme which included two new shower rooms and people’s bedrooms gradually being upgraded and the kitchen soon to be refurbished.

Staff understood how to protect people from harm or discrimination. There were sufficient numbers of staff deployed to meet people’s needs and ensure their safety. Risks to people were assessed and their safety monitored and managed.

Staff enjoyed working at the service and acknowledged the improvements which had been made. One said, “The home has come on leaps and bounds and I am proud to be able to work here and be part of the team.”

People who used the service were happy with the care and environment. One person said, “There’s not a great difference between the Ritz and here.” A relative was happy with the staff and how they treated people. They said, “The staff are very friendly, caring and approachable. They are polite to [person]. When I take [them] out, [they] can’t wait to go back. [They] give more affection to the staff than [they] does to [their relatives]! [They] always looks immaculate.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published on 21 July 2021). The service had breaches of regulations. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contained those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Windmill Care Home is a residential care home providing personal care and support for up to 29 people aged 65 and over. Some of the people were living with dementia. At the time of the inspection there were 25 people living at the service.

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

We identified some risks to the management of long term conditions such as for people with diabetes and for people requiring changes in their position to manage risks to the condition of the skin. Staff were not always sourcing medical advice and guidance to maintain people’s health and wellbeing, and not always following the guidance in place in people’s care records. However, these concerns were acted on after our inspection visit to maximise people's safety.

Information about people’s care and support needs and risks was recorded in multiple places, this did not ensure staff always had access to accurate and consistent guidance to maintain people’s safety. However, these concerns were acted on after our inspection visit.

People were supported to participate in a range of group and one to one activities to maintain social contact with others, and reduce isolation, particularly during the pandemic. Arrangements were in place for relatives and friends to complete face to face visits with people, with testing procedures and use of personal protective equipment in place to maintain safety.

The care environment was clean and comfortable, and the service had an ongoing refurbishment plan in place. People were involved in creating the weekly menus and were able to choose what they wished to eat. People received their medicines as prescribed, given to them by staff with the required levels of training and competency.

There were sufficient numbers of staff on each shift, who had completed training relevant to their roles. People and relatives gave positive feedback about the standards of care provided, and overall level of improvements being made at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection (and update) The last rating for this service was Inadequate, (published on 09 October 2019). The service had breaches of regulations, and 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 improvements had been made and the overall number of breaches of regulation had reduced. There remained a breach of regulation relating to good governance, safe care and treatment.

This service has been in Special Measures since 20 November 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work with the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Windmill Care Home is a residential care home providing personal care to up to 29 people. At the time of the inspection there were 19 people living in the home.

The building has been adapted to include extensions to both floors of the original building. There is an extended lounge area and kitchen and dining facilities on the ground floor. The home has two lifts to the upper floor.

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

People were waiting too long to receive the support they needed to keep them safe due to a lack of available staff. One person told us, “Not much to drink here, only two cups a day if you’re lucky, three sometimes.” Staff were allocated to complete a mid-morning and mid-afternoon drinks trolley but we were told it was frequently missed as staff were not available to do it. Where people were injured or risks to them increased they were not appropriately assessed and managed to ensure people received the support they needed.

We saw staff were safely recruited and people received their medicines on time. The provider had taken steps to address some concerns from the previous inspection but there were still areas which required action.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The new extension was clean and spacious but the remainder of the home required urgent attention to bring it up to standard. Those in receipt of specific support with their nutrition and hydration did not always receive it in line with their care plans. However, the quality of the food had much improved and people were much happier with the food they were presented with. Staff told us they were better supported and team meetings and supervisions, which gave them a better understanding for delivering the support people needed.

Staff’s interactions with people were predominantly task focused due to their not being enough of them and the staff we spoke with were clear they wanted to be able to deliver more. There was evidence of people’s involvement in their care plans and people we spoke with told us they were asked what they liked and didn’t like and what they wanted. Resident and relative meetings had begun to take place and people felt more involved with decisions about their care.

The home was without an activity coordinator which meant people had little to do during the days. The staff had taken steps to address risks to keep more vulnerable people safe by applying certain safety steps to all people. E.G. everybody’s food was cut up. A complaints procedure was in place and available to people but complaints were not formally responded to in line with the provider’s complaints procedure. End of life care continued to develop with care plans in place for those who wished to record their views and wishes when the time arrived.

Governance procedures were still being developed and whilst we could see some audits and monitoring had begun to take place they were yet to be used to drive improvement. The provider had begun to ask people if they were happy with the support they received and the feedback had been mostly positive. Staff felt more valued but wanted to work in an established and permanent staff team to allow professional relationships to build and to deliver a better service.

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

Rating at last inspection and update - The last rating for this service was inadequate (20 November 2018), where multiple breaches to the regulations were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 20 November 2018. During this inspection the provider demonstrated that some improvements have been made but it remains rated as inadequate overall and for three key questions. Therefore, this service remains in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Windmill Care Home on our website at www.cqc.org.uk.

Enforcement: We have identified breaches in relation to staffing, supporting people living without capacity including consent, managing risk and complaints, governance and monitoring systems and delivering person centred care.

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

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.

We will continue to monitor the monthly information we receive from the provider on improvements they have made.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains 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 timeframe. 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.

We last inspected the home in December 2017 where we found eight breaches to six of the regulations. At this inspection we found 13 breaches to 10 of the regulations. At both inspections some regulations were breached more than once. Some action had been taken to address previous concerns but we found six continuing breaches. The provider had taken enough steps to meet the regulations regarding the cleanliness of the home and upholding people’s dignity. At this inspection we have also made two recommendations as to how areas of the regulations can be improved.

The Windmill care home 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 looked at during this inspection.

The Windmill care home supports up to 29 people with residential care needs. At the time of the inspection there were 28 people living in the home. The home was set over two floors with communal areas to the ground floor. At the time of the inspection an extension was being built which had reduced the available space used by people in the home. People had access to a large dining room, a much smaller lounge and a marquee which had been erected in the garden to the rear of the home. The marquee was carpeted and heated and had ample seating for people who chose to use it.

The home had a registered manager. 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.

In December 2017 we found the provider had not provided appropriate activities to people living with dementia. At this inspection there were no activities being delivered.

At the previous inspection we found people’s care records did not identify their needs and preferences and were not regularly reviewed. This inspection found this area had considerably deteriorated. We found care plans were not reflective of people’s current needs and some had not been reviewed for nearly 12 months.

The last inspection found lawful consent was not gained from those people living with dementia. Action had not been taken to ensure consent was acquired in line with the principles of the Mental Capacity Act 2005 when people lacked capacity to consent to their care and treatment.

In December 2017 we found evidence to show the provider was not assessing the risks to people’s health and wellbeing. Where risks were identified action was not taken to reduce the risks and the records held did not reflect the support provided. This was still the case during this inspection.

Good governance regulations require providers to regularly assess and monitor the service provided. This is done to ensure both the service is meeting the requirements of the people being supported and to ensure standards are kept. During December 2017 we found the systems ineffective as they had not picked up the concerns noted by the inspection team. During this inspection we found systems had not been used for two months and those that had been used prior to that remained ineffective.

Staffing had been a concern at the inspection in December 2017 and a breach was evidenced. The provider told us they had trialled additional staff through the night but had felt they were not needed. This inspection clearly showed a lack of available staff. Communal areas were left unsupported for long periods of time and people told us they had to wait for support. We saw people required support with their personal care needs long before it was offered.

During this inspection we found management and staff were not trained or equipped to confidently deliver the service expected. The manager often found themselves delivering frontline care. This meant the home was not adequately managed. Staff were delivering support which they were not competent to do. There was no evidence to show staff had been adequately trained, supervised or appraised on the service they delivered.

People were not supported to have maximum choice and control of their lives and staff did not appropriately assess people’s needs to ensure they were supported in the least restrictive way possible; the policies and systems in the service did not support good practice.

Refurbishment works were being completed to the building. This had led to changes around the environment. Risk assessments were not available on the day of the inspection for the environment. After the inspection we were provided with risk assessments for some aspects of the building and will monitor this moving forward.

The provider supported older people many of whom were living with some form of dementia. Research continues to be undertaken to develop best practice and to share the impact different environments can have on people living with dementia. During this inspection we did not find any best practice guidance had been followed either in the development of the extension or within the main body of the home.

Throughout this inspection we found the records of the service delivered, to be poor. Daily records were task focused and did not identify when people were last bathed or had a shower. Care plans and risk assessments were not updated, to show when people’s needs had changed, meaning staff did not have the information they needed to support people effectivity. Contemporaneous records were not kept of the support, care and treatment delivered to people as required.

Where people were at risk of malnutrition or dehydration we found information used to support people was not monitored to identify if there were ongoing and unmanaged risks to people. Some people continued to lose weight without appropriate support.

We looked at the personnel files for staff recruited at the home. Safe and equitable recruitment procedures had not been followed. Staff had changed roles without completion of a fair recruitment process. References were not always checked and when missing, appropriate risk assessment had not been completed.

Staff told us they felt supported by each other and the manager at the home and someone from visiting clergy told us the home had a great atmosphere. We did find the home was supported by staff who showed us they cared for people in the home. However, they did not have the information they needed to safely care for them.

People in the home told us they liked the staff but they were so busy. Staff were keen to develop and were patiently waiting for new staff to be recruited to enable them to better fulfil their roles.

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 of the service, will be inspecting 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 so that there is still a rating of inadequate for any key question or overall, we will act 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 if they do not improve

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.

You can see what action we told the provider to take at the back of the full version of the report.

At our previous inspection in October 2014, we rated the service as good overall.

During this inspection, we found that the registered provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staffing, governance, consent, safe care and treatment, person centred care, and privacy and dignity. You can see what action we told the provider to take at the back of the full version of the report.

There was 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.

The provider and registered manager had failed to recognise potential harm to people using the service. Quality assurance and auditing mechanisms did not identify concerns we found during the inspection. Accidents and incidents were not analysed sufficiently to identify trends and patterns and to ensure people were kept safe.

Infection prevention and control procedures were ineffective and we found that hygiene was poor across the service. Environmental risks had not been identified by the service.

Improvements were needed where people were receiving medicines on an ‘as required’ basis to ensure these were only given when needed. Covert medicines also required clarity as to the method of administration, and how regularly they should be reviewed.

Staffing levels were not sufficient in order to meet the needs of people in a timely manner and keep them safe at all times.

Care plans contained detailed information reflecting people's individual needs and preferences. However, two of the care plans we looked at had not been recently reviewed in all areas, and not all guidance was in place to help staff support people effectively.

People’s privacy and dignity was not always upheld. We observed some practices' which compromised people's privacy and dignity.

The registered manager had not applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. Best interests documentation was not always in place where decisions had been made on behalf of people who lacked capacity.

Improvements were needed with the mealtime experience, and we have made a recommendation about this.

There was an activity co-ordinator in the service. However, the provision of activity was not sufficient to meet the individual and specialist needs of all people using the service.

The provider had not maximised the suitability of the premises for the benefit of people living with dementia, and we have made a recommendation about this.

There was a complaints procedure in place. People and their relatives felt able to complain if they had concerns they wanted to raise.

People's nutritional needs were monitored, and people received support to manage a healthy diet where required. People were referred to other health care professionals in a timely manner to maintain their health and wellbeing.

Staff were aware of their responsibilities in relation to safeguarding people, were aware of the types of abuse they may come across. Appropriate recruitment checks had been carried out on new staff, to ensure they were of good character and suitable to work with people in the service.

Two people we spoke with had only lived in the home for a short while and both people told us that they were settling in well. One person said, "The staff are marvellous. Very good. They come very quickly when you need them. I pressed my call bell and they were here - as quick as that!"

The staff we spoke with told us that the training was excellent now. One member of staff said: "I've never done so much training, every time you look, there's something else to do - but it's really good!"

Another member of staff we spoke with told us that all the staff thought that the manager was a good leader. They also said that the manager provided 100% back up and support to the staff team. This member of staff said that the manager's door was always open and that they listened to everyone. All the staff we spoke with confirmed that they found the manager to be very approachable.

People who lived in the home were able to give their views on how the service was run by way of regular discussions with the manager and staff. One person we spoke with told us that they hadn't been 'too happy' about something earlier that morning but that they had spoken with the manager and felt that the situation had been explained clearly and subsequently resolved.

At the time of our inspection, we saw that there were enough members of staff on duty to keep people safe and meet their care and welfare needs.

During our inspection on 05 October 2012, we spoke with the provider's son who had a lead role in overseeing the management of this home and four members of day staff. All four staff we spoke with said they felt things had improved a lot over the past few weeks and that the new manager was making good progress with ongoing improvements.

Following on from our inspection on 05 October 2012, we received further information of concern regarding the lack of appropriately trained staff working the night shifts.

We investigated this concern further with the provider's son and the new manager, who explained that there had recently been the need to dismiss some members of staff, which had resulted in a short term impact on the night duty rota.