Archived: Windmill Lodge

Updated 14 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 December 2018 and was unannounced. The inspection was carried out by one inspector.

Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed the information we held about the service including previous inspection reports. We also looked at notifications about important events that had taken place in the service, which the provider is required to tell us by law. We used all this information to plan our inspection.

We spoke with three people about their experiences of living at the service and we observed care and support in communal areas. We observed staff interactions with people. We also spoke with three people’s relatives who visited the service. We spoke with six staff, which included support workers, senior support workers, the deputy manager and the provider.

We requested information by email from local authority care managers, commissioners and Healthwatch to obtain feedback about their experience of the service. There is a local Healthwatch in every area of England. They are independent organisations who listen to people’s views and share them with those with the power to make local services better. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. We received feedback from a local authority commissioner.

We looked at the provider’s records. These included three people’s care records, care plans, health records, risk assessments, daily care records and medicines records. We looked at two staff files, a sample of audits, satisfaction surveys, staff rotas, and policies and procedures.

We asked the provider to send additional information after the inspection visit, including training records, a statement of purpose, compliment letters and quality assurance information. The information we requested was sent to us in a timely manner.

Updated 14 February 2019

The inspection took place on 17 December 2018, the inspection was unannounced.

Windmill Lodge 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.

Windmill Lodge is a three-floor detached house. Windmill Lodge accommodates up to eight people with learning disabilities or autistic spectrum disorder on two floors. The third floor is used by staff. There were eight people with learning disabilities or autistic spectrum disorder living at the service when we inspected. Several people were experiencing mental health difficulties. One person required a wheelchair when mobilising longer distances, such as accessing the community.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had last been inspected on 26 May 2016 and was rated Good.

The service is owned and managed by a provider who is an individual and who is in day-to-day management of the service. They have been assessed as fit to carry on the service and a registered manager was not required. 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. During the inspection we identified that the provider was incorrectly registered as they were operating the service as a limited company and not as an individual. We are discussing further what action needs to be taken to remedy this.

Medicines were not always well managed. The provider was not following their medicines policies and procedures. People’s GP’s had not been consulted with about the use of over the counter homely medicines. Risks to people’s health and safety were not always well managed. Most people had risk assessments in place which detailed how staff should support people to keep safe. One person’s risk assessment had not been updated following an incident where they had wandered onto the motorway. Another person did not have any risk assessments in place at all.

Accidents and incidents involving people were recorded. However, the action taken by the provider following the incident/accident was not always clear or recorded. This was an area for improvement. The provider had carried out sufficient checks on all staff to ensure they were suitable to work around people who needed safeguarding from harm. The provider had not asked applicants for a full employment history and documented reasons for gaps in interview records. The provider agreed they needed to amend the application forms for future use and improve their recording of interview records.

People had access to food and drink which met their needs and to maintain good health and were supported to be as independent as possible at meal times. People were supported to put together a pictorial menu plan for the week. People were able to choose different foods from the menu plan when they wanted. The management team told us that people’s dietary intake was monitored to ensure people had a balanced diet. People’s care records did not contain a record of what food they had eaten.

It was not evident if each person was supported appropriately by a planned assessment and care planning process to make sure their needs were met. One person’s assessment who had recently moved to the service had not been completed.

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 did not always support this practice.

The provider did not have good systems in place to monitor the quality and safety of the service provided. The provider had undertaken quality audits in some areas but these had not been robust enough to capture the action required to improve the service.

Staff understood the various types of abuse to look out for to make sure people were protected from harm.

A number of new staff had been recruited in the last 12 months. Staff had not completed induction training. The training records evidenced that staff had not always received the training needed to give them the skills and knowledge to care for people. Staff confirmed they had received regular supervision with the provider. Staff told us they felt well supported by the provider.

People received medical assistance from healthcare professionals when they needed it. Staff recognised when people were not acting in their usual manner, which could evidence that they were in pain. However, action had not always been taken when sudden weight loss had occurred. One person had lost 7kg of weight between 01 March 2018 and 01 June 2018. This had not been reported to the person’s GP as a concern.

The building was suitable for the needs of the people who lived there. Some parts of the building looked a little dated and were in need of redecoration. This is an area for improvement.

Staff treated people with kindness and compassion. Staff knew people’s needs well and people told us they liked their staff and enjoyed their company. People and their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to be as independent as possible.

People received personalised care which met their needs and care plans were person centred and up to date. Where known, people’s wishes around their end of life care were recorded. People were encouraged to take part in activities they liked. There had not been any complaints but people could raise any concerns they had with the provider. The provider sought feedback from people, relatives, staff and health and social care professionals which was recorded and reviewed.

People knew the provider. Relatives had confidence in the management of the home. The provider had good oversight of the service. Some audits and checks were carried out by the provider. The provider told us they did not have any formal processes in place to audit and check people’s care plans, risk assessments and medicines practice. Quality assurance processes had not been successful in recognising all the issues we identified in this inspection.

The provider had purchased policies from an external company. Although policies and procedures were in place the provider was not always following these. People’s information was not always treated confidentially.

The provider kept up to date with good practice, local and national hot topics by attending provider and registered manager forums. Staff meetings were held on a regular basis to ensure that staff had opportunities to come together, share information and gain information from the management team.

The provider had notified CQC about important events such as safeguarding concerns, serious injuries and DoLS authorisations that had occurred. It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. The provider had displayed the rating in the service.

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