Archived: Windsor Rest Home

We found the following examples of good practice.

The service facilitated in-person visits in a manner which minimised the risk of infection spread. Relatives were required to undertake Lateral Flow Devices (LFD) COVID-19 tests before the visit commenced.

Staff wore PPE when undertaking any personal care and around the home; this was disposed of safely. Many people who were living with dementia were unable to understand the restrictions imposed by the COVID-19 pandemic. Staff supported them sensitively and carefully to ensure social distancing guidelines were adhered to in a way that protected them and others at the home.

The home was clean and hygenic throughout. A structured cleaning schedule was in place and cleaning regimes were adhered to so that all areas of the home were cleaned effectively.

Risk assessments had been carried out with people and staff to identify those individuals who were more vulnerable of exposure to COVID-19. Additonal safety measures had been taken to support those who had been identified as higher risk.

People were well supported by staff to maintain contact with their family and loved ones. People had been supported with video calls when visiting was not possible. Staff had sent daily photographs to family members for reassurance and had organised a secure social media page for families to view activities that their loved ones had participated in.

Staff had carefully considered the impact on people’s emotional wellbeing of additional PPE being worn at the start of the pandemic. Staff used dolls and toys to demonstrate, to those living with dementia and other mental health issues, what staff would be wearing so that anxieties would be eased.

Windsor Rest Care Home provides accommodation with personal care for up to 13 older people. Staff provided personal care for older people who were frail or were diagnosed with dementia or mental health. The property was originally two separate houses and spanned two floors. A lift was available for people to travel between floors. There were 12 people living in the service when we inspected.

Windsor Rest Home was rated as good at the last inspection at this inspection we found the service remained Good

The registered manager was also an owner of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the last Care Quality Commission (CQC) inspection on 27 July 15 the service was rated as Good. At this inspection we found the service had remained good

People were assessed as individuals and staff had a very good understanding of how people’s care should be provided to maintain their safety, health and wellbeing. Risks were assessed within the home, both for individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk and report any new risks that they identified.

The registered manager had plans in place for PEEP (personal emergency evacuation plans) for each person living at the home. These were individual plans which gave information about how many staff would be needed to evacuate the person and what equipment should be used.

Incidents and accidents were recorded and checked by the registered manager to prevent these happening again and improve the home offered.

People were kept safe by staff who understood their responsibilities to protect people living with dementia and mental health illness. Staff had received safeguarding training and knew how protecting people from abuse. The staff team had access to and understood the safeguarding policies of the local authority which they must follow. Staff understood what whistleblowing meant and all said they would report another member of staff if they believed they were abusing people in any way.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to a range of health care professionals such as dentists, chiropodists and when required arrangements were made for people to attend outpatients appointments at the hospital. People also had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Staff had been trained to assist people to manage daily health challenges they faced from conditions such as diabetes and dementia.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough nutritious food to eat and sufficient drinks to maintain their hydration.

The home was welcoming and friendly, with people engaging easily with the people they lived with and staff. Staff provided friendly compassionate care and support. People were encouraged to do what they can for themselves to maintain their independence. Staff enabled people to participate in community life, both within the home and in the wider community.

The deputy manager was the appointed person for infection control. The home looked clean and there were no unpleasant odours. Staff wore appropriate PPE (personal proactive equipment) for example gloves and aprons when providing personal care. These were removed and disposed of correctly between each person they cared for.

Staff upheld people’s right to choose who was involved in their care and people’s right to refuse care and support. People were consulted and asked what they wanted to do each day. When entertainers came into the home people were made aware and could choose whether to take part.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. They had submitted applications however due to a back log these have not yet been approved.

The recruitment procedure was followed to ensure people were not put at risk from staff that had not undergone all the necessary checks. These checks made sure perspective staff were suitable to work with vulnerable people. New staff were given an induction that included time to read the home policies and procedures. New staff who had previous experience were also observed providing care and the registered manager or deputy then signed a work book staff had completed to show they were competent giving various aspects of care. Staff new to care would undertake the Skills of Care, Care certificate.

Staff received supervisions, appraisals and training to assist them to provide good quality care and to develop their skills further.

The registered manager produced information about how to complain and this was seen displayed in the home. People were frequently asked if they were unhappy about anything in the home. People, families, health professionals and other regular visitors were sent a survey every six months to seek their opinions so, where possible, staff could improve the service they provide.

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

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

Is the service caring?

We observed staff interaction with people who lived at the home and saw this was caring, compassionate and kind. Staff were attentive and spent time with people chatting and playing board games. People told us they were happy living at Windsor Rest Home and that staff were 'Wonderful' and 'Kind'.

Is the service responsive?

We found that the service was not always responsive. Staff told us they tried their best but sometimes people had to wait to receive the care they needed due to staffing levels within the home. The call bell alarm panel was in the kitchen which could only be heard when staff were in the kitchen or close by. This was confirmed during our observations.

Is the service safe?

We found that the service was not safe in relation to staffing and cleanliness. Staffing levels were not sufficient to enable staff on duty to carry out all tasks expected of them, such as cleaning, cooking and laundry, as well as care for people in a way that ensured their safety and met their needs. There was a risk that the staff member administering medicines could be interrupted when they were one of two staff members on duty.

Some areas of the home, such as the kitchen and bathrooms, were not clean. During our visit we called the Environmental Health Officer to discuss our concerns. They attended the home to check the cleanliness of the kitchen and found a number of concerns.

Clinical waste procedures were unsatisfactory and meant there was a risk of cross contamination within the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. When asked, staff we spoke with were not able to explain about DoLS which meant that people were at risk of being deprived of their liberty unlawfully.

Is the service effective?

Assessments of people's needs, potential risks to them and corresponding care plans had been regularly reviewed and updated when necessary. People we spoke with confirmed their care needs had been regularly reviewed and also when their needs or wishes had changed. One person said, 'They ask me what I want'.

We saw that health professionals were involved in people's care when required. For example, the chiropodist, optician and GP.

Is the service well led?

We found that the service was not always well led. On the day of the inspection we were told the registered manager was away on holiday but there was no delegated responsibility for running the home. Staff told us they all worked together to get everything done, but no-one had overall accountability or responsibility for the service in the manager's absence. Staff were unable to show us all of the evidence we asked for on the day. Following the inspection, the registered manager contacted us to inform us that there was delegated responsibility during their absence and how this was achieved. They sent us additional evidence in relation to staffing and monitoring systems and policies. However, we noted that systems for monitoring the quality of the service were not always effective and some day to day practice we observed did not match that which was written in the home's policies.

People told us that they were happy in the home and said staff were kind and friendly. One person said 'I feel safe and secure here'.

People told us that staff understood their needs and provided appropriate care and support. One person told us 'Staff understand my care needs, absolutely.'

Our inspection of 07 November 2012 found that people's care was planned using inconsistent formats; that some areas of the home posed an infection control risk and the provider did not have robust quality monitoring procedures. We visited the home to see whether improvements had been made. We found that these areas identified as non-compliant in the previous inspection had been attended to.

The provider had introduced new care plans and revised the daily log. Additionally, the provider had refurbished the laundry room, communal bathroom and toilet facilities. The provider had also introduced a new quality monitoring process. This demonstrates that the provider has taken action to address the issues identified at the last inspection.

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

People said that they had choice in how they spent their days and there were activities available for people. People said they felt safe living at the home and told us they felt confident that any concerns were always quickly addressed.

Feedback from relatives included statements such as, 'We feel it's an excellent home, well run home. The staff are very caring, friendly and helpful.' Another person stated that their relative was treated like one of the family. They said, 'I can't praise the owners and staff enough, they are wonderful.'

However the three care plans we looked at did not evidence that peoples' care needs were being appropriately recorded, regularly reviewed and updated. People's needs were assessed but for some parts of the care plan there was no written guidance for staff to follow on how needs should be met.

There was a lack of risk assessments to address potential hygiene risks and risks from cross infection. We found that potential risks in the environment to people's safety had not been identified and addressed in a timely manner. There were not adequate systems in place to assess and monitor the safety of the environment and the care provided.