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Inspection carried out on 11 September 2018

During a routine inspection

This inspection took place on 11 September 2018 and was unannounced.

Winchley Home was last inspected on 19 April 2017 and was rated as Requires Improvement. At that inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well Led to at least Good.

Winchley Home 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. Winchley Home provides personal care for up to 41 people. At the time of our inspection, there were 35 people living there. Winchley Home provides personal care to people living with a range of health conditions, including people living with dementia.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. egistered 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.

Staff knew how to keep people safe from abuse. Staff were confident that if they had any concerns they would be addressed quickly by the registered manager. Risks to people had been assessed and regularly reviewed. Actions had been taken to mitigate these where necessary. Checks had been made on the environment to ensure the service was safe. Equipment to support people with their mobility, such as hoists had been checked to ensure they were fit for purpose and safe for people. The management of people’s medicines was safe and robust and people received these as the prescriber intended. People were protected from the risks associated with cross infection and the premises were clean and odour free.

There were enough staff to ensure people were safe and had their needs met in a timely way. Staff had the skills and knowledge to carry out their roles and were supported by a system of induction, relevant training, one-to-one supervision and appraisals.

Staff understood their responsibilities under MCA, people's capacity had been assessed and when required best interest’s meetings had been held and recorded.

People told us that they enjoyed the food. People had a choice of meals and were supported to maintain a healthy diet in line with their choices, preferences and any healthcare needs. People's health was assessed and monitored. Staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

Staff encouraged people to make decisions about their day-to-day care and remain as independent as possible. People's dignity and privacy was maintained by staff. People told us staff were kind and caring. Staff maintained people's dignity and encouraged choice. Staff supported people to maintain friendships and relationships. People's friends and family could visit when they wanted with no restriction to this.

There was a programme of meaningful activities available for people to enjoy. Care records were personalised detailed how people wished to be supported. They provided clear information to enable staff to provide appropriate and effective care and support. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm.

Information about how to complain wa

Inspection carried out on 19 April 2017

During a routine inspection

We carried out an inspection of Winchley Care Home on 19 April 2017. The inspection was unannounced.

Winchley Care Home is registered to provide accommodation and personal care for up to 41 older people, some of whom may be living with dementia. At the time of the inspection there were 36 people living at the home.

At our last inspection of this home, we judge the home to have on overall rating of "Good". At this inspection the expected standards had not been maintained and that improvements needed to be made. We found two 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.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection people said they felt safe and that staff treated them well. Safeguarding adults' procedures were in place and staff understood how to protect people from the risk of abuse. Most risks to people’s safety had been assessed however, actions had not always been taken to protect people from the risk of avoidable harm. Staff did not always provide support or monitoring of people’s safety as identified in these plans.

There were sufficient staff numbers on duty to keep people safe and to meet people's needs. Robust staff recruitment procedures were in place which ensured only those staff deemed suitable to the role were in post.

Policies and procedures were in place to guide staff with the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely by trained staff.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. The registered manager and staff completed training in the main principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. However, not all people had assessments of their mental capacity completed where required. Review of some people’s assessments did not take place regularly.

There were appropriate arrangements in place to support people to have a healthy diet, but there was limited choice and flexibility at mealtimes. People had access to a GP and other health care professionals when they needed them.

Records to monitor people who were at risk of not eating and drinking enough were not always completed accurately by staff. Changes in people’s support needs were not always updated in all of the records provided for staff to use.

Staff provided people with care in a respectful, caring, kind and compassionate way, however people were not always provided with enough activity and stimulation on a daily basis.

Staff consulted people living in the home about their care needs and involved them in the care planning process. People were comfortable and relaxed with staff. Although staff knew what people liked, they did not always offer people choices.

The service had a complaints procedure available for people and their relatives to use and staff were aware of the procedure. The registered manager took action to address people’s concerns and prevent any potential for recurrence. There was an open culture within the service and people were freely able to talk and raise any issues with the registered manager and staff team.

Systems were in place to monitor the quality of the service provided but they were not all effective in identifying issues around the home. Although regular checks were undertaken on all aspects of care provision, these did not always iden

Inspection carried out on 27 April 2015

During a routine inspection

Winchley Home is registered to provide accommodation and non-nursing personal care, for up to 41 people, some of whom live with dementia. At the time of our inspection there were 36 people living at the home. The home is an older-style domestic building, with extensions, and has enclosed gardens. It is located in the Norfolk village of West Winch, close to the town of King’s Lynn.

A registered manager was in post at the time of the inspection. 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 inspection took place on 27 April 2015 and was unannounced. Our last inspection of this service was carried out on 10 April 2013 when the provider was meeting the regulations that we assessed against.

People were safe living at the home as staff were knowledgeable about reporting any abuse. However, procedures to report a safeguarding concern were not consistently followed. There were sufficient numbers of staff employed and recruitment procedures ensured that only suitable staff were employed. Arrangements were in place to ensure that people were protected with the safe management of their medicines.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS applications had been made to ensure that people’s rights were protected. Staff were supported and trained to do their job.

People were supported to access a range of health care professionals and were supported to maintain their health. People were provided with adequate amounts of food and drink to meet their individual likes and nutritional and hydration needs.

People’s privacy and dignity were respected and their care was provided in a caring and attentive way.

People were supported to take part in a range of in house activities. People’s care records were kept up-to-date and people and their relatives were actively involved in making decisions about people’s individual care needs. A complaints procedure was available and people could raise concerns with the staff at any time.

The provider had quality assurance processes and procedures in place to improve the quality and safety of people’s support and care.

A staff training and development programme was in place and there was also a system to review the standard of staff members’ work performance.

Inspection carried out on 10 April 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service because people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of two people who used the service and two visiting health-care professionals. We also used the Short Observational Framework for Inspection (SOFI) as this is a specific way of observing care to help us understand the experience of people who could not talk with us.

We found documented evidence where people did not have capacity to consent to care and treatment. This meant that the provider acted in accordance with legal requirements.

People's standard of health and welfare was maintained. Staff had access to detailed care records to ensure that they provided people with safe care and support. A health-care professional told us that, �Care (was) delivered very professionally.�

People were protected from the risk of infection spreading as there were effective systems in place to reduce the risk.

Effective staff recruitment was in place to make sure that people received support and safe care from suitable, skilled, and knowledgeable staff.

We found that the provider managed risk effectively through care records; this was because we found evidence which demonstrated to us that the provider maintained and monitored personalised care records for people who used the service.

Inspection carried out on 28, 29 November 2012

During an inspection looking at part of the service

During our inspection of the 28 November 2012 we did not speak with any people using services at Winchley Home. However, during our last inspection of 09 May 2012, people were satisfied with the quality and standard of their support and care.

During this inspection, improved standards of care records indicated that people were better supported with their personal care and support. People living at the home were protected against the risks of receiving inappropriate care.

We found that the provider did not manage risk effectively through care records, this was because during our visit we found evidence which demonstrated to us that the provider did not always maintain and monitor personalised records and medical records for each person who used the service.

Inspection carried out on 9 May 2012

During a routine inspection

During our inspection on 09 May 2012 we spoke with several people who were able to discuss their views. We also spent time in the communal areas of the home, observing how staff interacted with people and how care was provided.

People told us that they were always spoken to politely and treated with respect. One person told us, "If staff want me to do something they ask, they don't demand." Another person explained to us how the staff enabled them to be independent, which they considered to be very important. We noted that staff involved people by explaining to them what they wanted to do and asking their permission. We saw that staff provided support sensitively and in a way that promoted people's dignity.

People told us that they were happy with the care they received and said that it met their needs. One person said, "Staff are willing to help with anything and everything." A family carer we spoke with told us that staff were good at communicating with people using the service.

We saw that staff were attentive and responded whenever anyone asked for help. They spoke with people when they were passing through the lounges and there were periods of time when staff sat chatting to people.

People were satisfied with the amount of activities on offer. One of the people we spoke with told us that they had some really good activities in the home and they regularly joined in. One of the people who preferred to remain in their room told us, "They pop in to see if I'm OK and sometimes stop for a chat."

People whom we asked told us that they felt safe and comfortable at Winchley Home. They told us that they got on well with all of the staff. We were told that staff were patient and kind. One person told us, "Staff have patience with people; they look after and care for everyone." A family carer said that their relative was settled at the home and they had never had any concerns about their safety.

One of the people we spoke with said that staff always asked them if everything was all right. One person said, "If I wasn't satisfied with something I could tell them and I know it would change."

Reports under our old system of regulation (including those from before CQC was created)