Background to this inspection
Updated
17 September 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection took place on 7 and 8 January 2019 and was unannounced. The inspection team on the first day consisted of three inspectors, a medicines inspector and an Expert by Experience. An Expert-by-Experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the second day the team consisted of three inspectors
Service and service type
White Windows 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.
The service did not have a manager registered with the Care Quality Commission at the time of the inspection. A manager was in place and they were in the process of applying to the Care Quality Commission for registration. A registered manager alongside the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection-
We spoke with ten people using the service and three of their relatives. In addition, we spoke with ten members of staff including support workers, nurses, the cook, the activities organiser, the manager, the quality lead and the regional manager.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
17 September 2019
This inspection of White Windows took place on 7 and 8 August 2019 and was unannounced. At the last inspection in January 2019, the service was rated as Inadequate and identified six breaches of regulation which related to safe care and treatment (medicines management and risk assessment), staffing, consent, person centred care, dignity and respect and good governance.
We took enforcement action in relation to the breaches of regulation.
During this inspection the provider demonstrated that improvements have been made. We found the service had achieved compliance in four regulations but was still in breach of regulations relating to safe care and treatment (medicines management and risk assessment) and good governance.
White Windows is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. White Windows has four floors with living accommodation on two floors which are accessible by a lift. The home is registered to provide accommodation for up to 25 people and there were 20 people living in the home during our inspection
People’s experience of using this service and what we found
Systems for managing medicines were not always safe. Medicines were not being stored at correct temperatures and one person had not received their topical medicine. There were no audits of medicines management.
Systems for auditing the safety and quality of the service were not sufficiently robust to identify issues which could affect people’s safety.
Risks to people’s health and wellbeing were not consistently well managed. Risk assessments were in care files but identified risks had not always been addressed.
There were enough staff available to meet people’s needs but improvements were needed in relation to delegation of staff to make sure people received the support they needed in a timely way. Some improvements were needed to make sure all staff received the training they needed.
There was a lack of evidence of actions taken to comply with the Accessible Information Standard (AIS), which sets out a specific approach to meeting the information and communication support needs of people with disabilities, impairment or sensory losses.
Staff had received training in safeguarding people and knew what to do if they thought someone was at risk. Safeguarding issues were recognised and reported appropriately.
Accidents and incidents that happened in the home were managed well.
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.
People said there had been significant improvements in their ability to make choices about their care and support. However, improvements were needed to support people being able to independently leave and access the service.
People’s healthcare needs were met effectively. Some improvements were needed to make sure care documentation consistently reflected people’s up do date needs.
People said the food was very good and plenty of choice was available. People were able to make drinks, access snacks and use cooking facilities independently.
People praised the service’s own staff for their caring and supportive approach. However, several people reported issues with agency staff working at the service.
People said they were involved in their care planning and this was done with a person centred approach. Staff did not always provide support in line with people’s needs and preferences as detailed in their care plans which meant people’s dignity needs were not consistently met.
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)
This service has been in Special Measures since January 2019. During this inspection the provider demonstrated that improvements have been made. We found the service had achieved compliance in four regulations but was still in breach of regulations relating to safe care and treatment (medicines management and risk assessment) and good governance. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.