Archived: Windmill Lodge

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.

Windmill Lodge is a detached house, which is registered to provide care and accommodation for up to eight people with learning disabilities and complex needs. Accommodation is provided over two floors. There were seven people using the service on the day of the inspection.

There was a registered manager in place at the time of our visit. 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.

We found that people were happy at the service and person centred care was being provided in a homely environment.

The registered manager and staff were aware of what constitutes abuse and the action they should take if such an incident occurred. They received regular safeguarding training and policies and procedures were in place for them to follow.

There was enough staff to support people safely and to meet their individual needs.

Assessments were undertaken to assess any risks to people using the service and steps were taken to minimise potential risks and to safeguard people from harm.

There were suitable arrangements for the safe management of medicines.

Safe recruitment procedures were in place that ensured staff were suitable to work with people as staff had undergone the required checks before working at the service.

Staff completed an induction programme and mandatory training in areas such as, fire safety, health and safety, infection control and safeguarding.

Records showed that staff had received regular one to one supervision.. There was also evidence of regular annual appraisals being carried out with staff.

Two applications for Deprivation of Liberty Safeguards (DoLS) authorisation had been made to legally deprive people of their liberty. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005.

Staff showed dignity and respect as well as demonstrating an understanding of people’s individual needs. They had a good understanding of equality and diversity issues and care plans included information on how equality and diversity should be valued and upheld.

Staff knew how to support people to make a formal complaint and complaints were logged and dealt with effectively, demonstrating the outcome of the investigation and how learning was shared.

Audits and quality monitoring checks took place regularly and annual service user satisfaction surveys were undertaken to ensure the service was delivering a high quality, person centred service.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty with the appropriate skills and experience to meet the needs of the people living at the home. Staff provided care and support during the day, and at night people were supported by sleep-in staff, who had access to the call buzzer system.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While not applications have been submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us that they were happy with the care they received. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us "The staff help me go the shops and choose what I want'. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to make their own choices in their everyday lives. Our observations confirmed this. One person told us 'The staff are very kind".

Is the service responsive?

People's needs had been assessed before they moved into the home. There was evidence that staff regularly discussed any changes related to people's care with them. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. One person told us that staff had stayed with them during a recent surgical procedure and had provided reassurance.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in a quality survey. They confirmed they had been listened to and as a result of the survey, changes to the menu had been made. Staff told us they were clear about their roles and responsibilities. They said the management had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.

People expressed their views and were involved in making decisions about their care and treatment.

Two people we talked with said that they were happy with the care and support that they received. A person we talked with said, 'The staff are lovely and they always help me'.

We looked at some of the monthly feed back surveys that had been completed by people who use the service. People were asked about whether or not they liked various aspects of the service they were receiving.

We found that staff had a good understanding of people's means of communication. We saw a member of staff communicating with a person who used makaton sign language. An array of information was available including pictorial menus, a service user guide and policies and procedures such as a complaints procedure.

A member of staff told us that people now participated in more activities such as going for meals out and trips to the cinema were arranged. People we talked with told us that they were in the process of planning their holiday. A person we talked with said, 'I am happy living here, I help with cooking and I have a bus pass and I go shopping'.

We saw that the garden was well kept and we were told that one of the people who used the service liked to get involved in keeping the garden tidy.