Winton House

Winton House is a residential care home providing accommodation and personal care for up to 36 people. The service provides support to older adults, some of whom are living with dementia. At the time of our inspection there were 20 people using the service.

Winton House accommodates people across two floors and each person has their own bedroom. People had ensuite toilets. Some people had ensuite showers. There are communal bathrooms, a dining room, various lounges, a hairdresser, activities area and large garden to the rear of the building.

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

Changes were made to improve the safety of care people received. Policies and procedures were replaced. People’s risk assessments and care plans were also replaced, updated and more individualised. Falls risks were better assessed, and incidents and accidents were analysed for learning to prevent recurrence. Sufficient staff were deployed to meet people’s needs. Recruitment files did not always contain all of the information required, however work was progressing on this. Incidents and accidents were logged, there was consistent recording and follow up. Infection prevention and control remained satisfactory. People were protected against abuse and neglect Premises risks were assessed, and mitigation of risks was satisfactory.

There were improvements to systems and processes in place to ensure safe, compassionate, well-led care. The service is compliant with regulations, however further improvement is required. The service’s action plans were being used to track progress. The service had liaised with people. Relatives, staff and the local authority to drive improvement. There is evidence of a programme of audits, completed at different intervals, however more time is required to review the system of audits and checks. There is evidence of meetings with people, relatives and staff. The oversight by the the management team is good and they are proactive at following up actions required. Staff reported an improved workplace culture. We made a recommendation about visits by the provider’s trustees.

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 requires improvement (published 4 September 2021).

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.

At our last inspection we recommended that the provider improved policies and procedures for safeguarding and sought advice regarding safe recruitment of staff. At this inspection we found the provider had improved policies and procedures; work on ensuring fit and proper persons were employed was ongoing.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 June 2021 and 16 June 2021. Breaches of legal requirements were found. We issued two warning notices and the provider completed an action plan after the last inspection to show what they would do and by when to improve. This included safe care and treatment, sending notifications, openness and honesty and management systems.

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 contain 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. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all inspection reports and timeline’ link for Winton House 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.

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

People were not routinely and consistently protected from avoidable harm. We found improvement were required in the management of risks posed to people. For instance, people who had fallen previously did not always have a risk assessment in place to advise staff on how they should be supported to prevent a reoccurrence. Risks associated with the environment were not routinely managed to reduce harm to people. Improvements were required in water safety management.

When accidents or incidents occurred, these were not routinely investigated to understand how to minimise a repeat event.

People were not routinely supported with their prescribed medicines by staff who followed best practice guidance or who had been assessed as competent to administer medicines. We found the registered manager had delegated competency assessments to other staff and had no process in place to check if they had been completed. Records relating to people’s medicines were not always accurate.

People were supported by a service that was not well-led. There was a lack of managerial oversight from the provider and registered manager. Systems were either not in place or ineffective to drive improvements in the service.

We found a number of breaches of the regulations.The provider and registered manager lacked knowledge on how to comply with the regulations The provider and registered manager failed to ensure they reported important events to us when required.The provider’s policy and procedures did not always reference or follow best practice. Internal audits carried out did not pick up the issues we found.

We have made a recommendation about the provider’s management of potential abuse. People were supported by staff who had received training on how to recognise abuse. However, the providers policy and procedures did not reference best practice guidance.

We have made a recommendation about ensuring staff are recruited safely. We found references for new staff were not always verified or came from a professional address.

We found mixed evidence on how well the service had managed through the Covid-19 pandemic. We have signposted the provider to resources to develop their approach with regards to following government guidance on use of PPE and social distancing for staff. However, people told us, “It’s a nice place. It’s clean and well maintained”, “It’s clean and modern”, “It’s a nice environment. The staff know her well and she’s well looked after”.

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 did not always support this practice. Documentation did not consistently follow the principles of the mental capacity act code of practice.

People told us they felt staff looked after them and they were kind and caring. Comments from people included, “The carers are very good and kind”, “I definitely feel safe living here” and “They [staff] treat you and approach you the right way”.

People were supported to keep in contact with family and friends. Comments included, “When we had her new great grandson, we used Zoom to speak to her. A member of staff was very good and sat with her”, “My daughter came into the home to see me yesterday for the first time since Covid-19 started. I didn’t want her to come in, I’m happy with Skype but she brought my great grandchild and we had great fun”.

Relatives told us they were happy with the support their family member received. Relatives told us “There’s always someone there. We can sleep at night now.” And “It’s a nice environment. The staff know her well and she’s well looked after.” Another relative told us “It has taken such a weight off my shoulders to know she is safe and happy here”.

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

Rating at last inspection

The last rating for this service was good (published 23 August 2018).

Why we inspected

The inspection was prompted in part due to concerns about the effectiveness of the provider’s risk management systems and good governance. A decision was made for us to undertake a focused inspection to examine those risks and review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 Winton House on our website at www.cqc.org.uk.

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 risk management and good governance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There were sufficient supplies of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser. Staff had received training in infection prevention and control, PPE including donning and doffing and hand hygiene.

PPE was kept in and near people's rooms for staff to easily access when they were supporting people with personal care. PPE was disposed of safely in clinical waste bins which helped reduce the risk of cross contamination.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if any positive results were received.

The home was clean and well maintained.

The environment had been adapted to encourage social distancing. Communal areas were arranged to enable enough space between people. We saw people engaged in social activities in a safe environment.

A visitor's hub had been created for people to meet with family and friends. This was accessed separately from the home to minimise the risk of infection spread. An easy booking system was in place to stagger visitors to minimise contact with staff and people using the service. After a visit the room was cleaned.

Cleaning and infection control policies and procedures had been updated in line with Covid-19 guidance to

help protect people, visitors and staff from the risk of infection

Infection control audits and checks were carried out. Managers spoke positively about the commitment and dedication staff had shown, which had helped to minimise the impact of the pandemic on people's health and wellbeing.

Winton House can accommodate up to 36 people across two floors, each of which has separate adapted facilities. The service provides care to older adults. People live in their own bedrooms and have access to communal facilities such as bathrooms, lounges, activities areas and garden access. Two of the bedrooms is reserved for respite. Winton House can offer day care facilities for non-residents by arrangement. At the time of our visit there were 33 people using the service.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a registered manager in post.

The service was previously inspected on 31 October and 1 November 2016. The provider was rated ‘Good’ in the key questions ‘Caring’ and ‘Responsive’. However, we found breaches in the regulations relating to staffing, fit and proper persons employed and good governance. We asked the provider to take action to make improvements in the key questions of ‘Safe’, ‘Effective’ and ‘Well-led. This was because staff were not appropriately trained to carry out their job roles; recruitment practices were not robust and quality assurance systems did not identify where quality was being compromised. We asked the provider to send us an action plan to show the what improvements would be made, by 28 March 2016. The provider submitted the action plan by the specified date.

We found the service had made the required improvements to address the concerns found at our previous visit on 31 October and 1 November 2016.

People said staff treated them with kindness and compassion. Comments included, “Extremely good staff, friendly, happy, always smiling and polite” and “They are mostly kind, considerate and available if you need assistance.”

People told us staff made sure those close to them felt like they mattered. Staff knew people’s care needs, preferences, personal histories and backgrounds. People said staff protected their privacy and their dignity was respected. Training records confirmed staff had attended the relevant training. People were supported to be independent. Information about people were kept secure.

People felt safe living at the service. Comments included, “No issues at all. If I had a concern I would speak to a member of staff, all lovely people” and “Yes, I feel quite safe.”

Staff were aware of their responsibilities to safeguard people from abuse. Safe recruitment practices were in place and the service followed national and local safeguarding guidance. There were sufficient staff to care for people. Risks to people’s safety were assessed and medicines were administered safely.

We have made a recommendation in relation to medicine errors.

People received care from staff who were appropriately trained to effectively carry out their job roles. People were supported to have maximum choice and control of their lives. The service acted in accordance with the Mental Capacity Act (2005). People’s nutritional needs were met and they were supported to maintain good health and receive ongoing healthcare support.

The service did not consistently carry out reviews of care. People said they were involved in the planning of their care. Staff demonstrated a good understanding of how to deliver person-centred care. The service was compliant with accessible information standard. People had the opportunity to participate in a wide variety of activities and were aware of how to raise concerns.

We have made a recommendation in relation to reviews of care.

People and staff were complementary about the management of the service. A new management structure had been in place three months before our visit. An overhaul of quality assurance systems was in progress. We saw improvements had been made to ensure the quality of the service did not compromise people’s safety. We found quality assurance systems were assessed in line with current legislation. Care records clearly documented discussions held with people’s relatives. The service sought the views of people and responded appropriately to feedback received.

The registered manager has been registered since February 2014. 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 and associated Regulations about how the service is run.

The service was previously inspected in August 2013 where it was found to be compliant with regulations. This is the first inspection of the location under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and rating required by the Care Act 2014.

We have made a recommendation for the service to seek current guidance on national and local safeguarding arrangements.

We found safe recruitment practices and best practice guidance in relation to recruitment were not consistently followed. This meant the service did not have appropriate processes to ensure potential candidates were competent, skilled and experienced to undertake their job roles.

Risks to people’s personal safety had been assessed and plans were in place to minimise identified risks. People said they felt safe living in the service. Comments included, “I have a call bell in my bedroom and one in the bathroom and this makes me feel safe. I know that nobody can get at us” and “I have a walker with an alarm attached to it, which makes me feel safe.”

People received care from staff who were not appropriately trained to effectively carry out their job roles.

The service did not act in accordance with the Mental Capacity Act (2005). The Act protected people who lacked the capacity to make specific decisions and enabled them to take part, as much as possible in decisions that affected them. We found no mental capacity assessments were undertaken where people were unable to make specific decisions and the service obtained consent from people who did not have legal power to give it. We have recommended the service see the MCA for current guidance in relation to this.

We found people were supported to maintain good health and receive on-going healthcare support.

Quality assurances systems in place to monitor and improve the quality and safety of the services provided failed to identify where quality was being compromised. Care records did not always accurately record discussions held with people’s relatives.

During our visit we observed major structural refurbishment was being undertaken. The registered manager explained a lot of their time had been spent overseeing the building works which had commenced some months prior to our visit. They told us the deputy manager was able to ensure the welfare and safety of people and provided additional support to staff.

People were positive about the caring nature of staff. The atmosphere of the service was calm and relaxed despite the on-going building works. Staff had established good working relationships with people and spoke confidently about their care and support needs. People could be as independent as they wanted to be. We heard various comments such as, “They help me to be as independent as I can, like I get myself washed and dressed.”

People and their relatives felt the service was responsive to their needs. One person commented, “They (staff) are very good at responding to needs promptly.” Care plans reflected how people’s needs should be met. There were a wide variety of activities on offer to meet people social needs.

The service sought the views of people and responded appropriately to feedback received.

We found a number of 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 this report.

At an inspection on 1 May 2013 we found the provider did not have an effective record keeping system to monitor staff training, supervision and appraisal. This meant they were not assured that people who use the service were supported by staff who were suitably trained or assessed. Records could not be located promptly when required. Managerial staff were not fully aware of how or where information was stored.

At our inspection on 30 August 2013 we found the provider had a system in place to support and monitor staff. This allowed the provider to monitor whether staff completed mandatory training and kept up to date with their learning. One care worker we spoke with told us 'The managers make sure you know what you're doing.'

The manager ensured staff were supported appropriately through group and individual supervision meetings and annual appraisals. Records we requested were found promptly and stored appropriately. Managerial staff were fully aware of the information available, and stored this suitably to maintain confidentiality.

We observed staff asked people for consent before they assisted or supported them. Care plans contained a consent form signed by the person receiving care agreeing to their planned treatment and support. One care worker said 'We listen to the residents and act accordingly.' One person who uses the service told us 'I can't fault the staff in any way.'

We saw the home was clean. There were cleaning schedules and guidance to ensure people were protected from the risk of spread of infectious illness.

Staff told us their training was mostly up to date, but we did not see a suitable method of recording staff training, or ensuring this was maintained in date.

We did not see evidence of planned or recorded supervisions or appraisals for staff. Staff we spoke with told us they did not have regular supervisions. One care worker told us 'The managers listen', and all staff we spoke with said the interim manager was approachable and supportive.

We noted that most records were maintained, stored and disposed of suitably. Managers ensured only those who should have access to documentation could access this. However, there were no records of staff training or supervisions, or of regular checks made of cleaning schedules.

We found that there were activities available should the people living in the home want to participate. The views and opinions of people living there were sought, and changes made if required.

We found that people living in the home remained part of the local community and accessed local services and facilities where possible, and that members of the community were invited in to support people living there and thereby enhanced the quality of their days.

The home was clean and well maintained and furniture was arranged that maximised a sense of homeliness whilst remaining safe and arranged in a way that minimised the risk of falls.

We found care planning and documentation was found to be comprehensive but noted that there was some duplication and some forms not completed. During the inspection we observed good engagement between people living in the home and the staff.