Archived: Windsor Lodge

We carried out an unannounced comprehensive inspection of this service in December 2015. Breaches of legal requirements were found. We found staff had a lack of understanding of the Mental Capacity Act (MCA) (2005); there was no evidence of MCA assessments for particular decisions and care records lacked detail. This inspection found improvements had been made.

Windsor Lodge is registered to provide accommodation and personal care for up to 11 people with a learning or physical disability. The home is separated into self-contained flats and a residential area. The home is situated in a residential area of Exmouth. At the time of our inspection there were nine people living at Windsor Lodge.

The service is currently in the process of changing to a supported living unit. An application has been received by the Care Quality Commission (CQC) to change their registration to provide the regulated activity of ‘personal care’. The service is currently working with commissioners and advocates to review people’s placements and the amount of hours they are supported.

There was no registered manager at the service. 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. The current manager had started the process of registering with the CQC.

People were safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate. People engaged in a wide variety of activities and spent time in the local community going to specific places of interest.

There were effective staff recruitment and selection processes in place. Staffing arrangements were flexible in order to meet people’s individual needs. Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately.

Staff spoke positively about communication and how the manager worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received and make continuous improvements.

At the time of this inspection there were ten people living at Windsor Lodge. During this inspection we met and spoke with six people who lived there and a relative who was visiting that day. We also spoke with two care staff and the manager. We looked at two care plan files, daily reports, medicines administration records and records of savings and cash handled by staff on behalf of people who receive the service.

At the time of this inspection the manager was not registered. However, an application for their registration has been received by the Care Quality Commission and will be processed in the near future. The manager told us about the work they had carried out to improve the records and the checks that were in place to make sure the records were well maintained and up-to-date.

The question we asked on this visit was:

Is the service safe?

The service was safe because the records had been improved and were well organised and up to date. People told us they were involved in drawing up and reviewing their care plans and they were confident the information in their care plan was correct. Comments included 'Yes they sat down and talked to me about it'.

Staff told us they were confident the records had improved. They were able to access relevant records easily and important information was easy to find. People's needs were reviewed regularly. Staff had access to health care professionals' records stored in people's bedrooms and understood the information held in these files.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were 10 people living at Windsor Lodge with a learning or physical disability. Seven people lived in the main house with 3 people being individually supported in the separated annexes attached to the house.

The summary is based on our observations during the inspection. We spoke with six people using the service, the deputy manager, a member of the provider's management team and three staff supporting them. We also spoke to one health professional involved with people using the service to ask their views. They all helped 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?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. During the inspection we noted that staff promoted people's independence and inclusion into activities within the home and supported people to attend external activities.

People's care records were disorganised and were not easily accessible. Not all records could be located promptly when needed. We have judged this outcome as non-compliant. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records.

The deputy manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards ( DoLs). Although no DoLs applications had been made, the deputy manager was able to describe the circumstances when an application should be made and knew how to submit one.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

People's health and care needs were assessed with them and they were involved in writing and reviewing their care plans and assessments. Specialist advice had been sought regarding people's dietary and mobility needs and had been identified in people's care plans. This showed that people were having care delivered effectively or in accordance with their assessed needs.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. One person told us 'I have lived here for a long time, I am very happy'.

Is the service caring?

People were supported by staff who were understanding and sensitive to their needs. We saw that staff were discreet when supporting people they gave them reassurance and encouragement.

People's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the home regularly. Each person living at the home had an individual activity schedule.

People knew how to make a complaint if they were unhappy. People told us they were happy at the home. There were instructions in each person's care file to inform people how they could make a complaint.

We saw that learning from incidents and investigations took place and appropriate changes were implemented. Systems were in place to make sure the deputy manager and provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We spoke to a visiting healthcare professional who told us they did not have any concerns about the care delivered at the home.

Staff told us they were clear about their roles and responsibilities. Staff demonstrated a good understanding of the ethos of the home. This helped to ensure that people received a good quality service at all times.

During our visit we spoke with three people who use the service and three members of staff.

We made observations throughout the visit and saw people being offered choices as to when they received support with their personal care and what they wanted to eat for breakfast and lunch. Staff were observed to support people in a calm and respectful manner. People were also appropriately assisted with their mobility needs discreetly.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that support plans were not all fully completed and some risk assessments were overdue for review as per company policy. This meant that staff would not be able to consistently provide appropriate support to individual people.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. Records were not always maintained appropriately and stock levels were not accurate on checking them during this inspection.

People said that they had no complaints about the service and that if they did they would speak to their keyworker or their family.

On the day of inspection five people lived in the main house and two people lived in separate flats attached to the side of the home. During the inspection we met all seven people who lived at the home. We spoke with the manager and three staff as well as the service liaison manager for Networking Care Partnerships (SW) Limited (the provider).

During our observations we saw staff were respectful and treated people with dignity. For example staff offered help with personal care in a discreet manner.

We found care plans to be comprehensive and detailed. Plans were described as support plans and focused on the person as an individual. Photos, pictures and symbols were used so that the document was in a form that was accessible for the individual.

Staff told us and records confirmed that they had received training on safeguarding vulnerable people.

Staff we spoke with told us that they felt supported by their manager. Staff told us, and records confirmed that they received regular supervision.

People told us that they were always being asked for their opinions about their care either individually by staff or at house meetings. We spoke with the provider's service liaison manager who regularly visited the home to undertake a series of audits and produce a report.