Archived: Windsor House

At the last inspection in July 2016 we were concerned that risks had not been managed safely, including the risks associated with medicines and the frequency of fire alarm tests and fire drills. We issued a requirement in respect of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that medicines were managed safely. Risks had been assessed and fire alarm tests and fire drills were taking place. The provider was no longer in breach of this regulation.

At the last inspection in July 2016 we were concerned that staffing levels did not allow staff time to engage people in meaningful activities and that staff could not always respond to people’s needs promptly. We issued a requirement in respect of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that staffing levels were sufficient to meet people’s individual needs and that people received prompt attention from staff. The provider was no longer in breach of this regulation.

At the last inspection in July 2016 we were concerned that there was a lack of consistent evidence that people’s capacity to make informed choices had been considered when seeking consent. We issued a requirement in respect of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that records evidenced people’s capacity to consent had been assessed and people were supported with decision making. The provider was no longer in breach of this regulation.

At the last inspection we recommended that the registered provider continued to review staff training needs and that staff training was kept up to date. At this inspection we saw that staff had completed appropriate training. People told us they felt staff had the skills to carry out their roles effectively.

At the last inspection we recommended that the registered provider continued to develop support for people to engage in meaningful activities. At this inspection we saw that the availability and variety of activities had improved.

At the last inspection we recommended that the quality assurance systems needed to improve to ensure concerns were identified and action was taken to address these concerns. At this inspection we saw that the manager carried out numerous audits each month. Any shortfalls had been identified and there was evidence these had been considered and improvements made.

At this inspection we found there was a manager in post who was registered with the Care Quality Commission (CQC) and that they were being supported by an acting manager who ran the service on a day to day basis. People who lived at the home, relatives and staff reported that the service was well managed.

Staff had been recruited following the organisation’s policies and procedures and people told us they felt safe living at the home.

People told us they were happy with the choice of meals provided at the home. Nutritional needs had been assessed, people’s special diets were catered for and food and fluid intake was being monitored when this was an area of concern.

Staff were kind, caring and patient. They encouraged people to be as independent as possible and respected their privacy and dignity. It was clear that staff knew people well and this helped them to provide person-centred care.

Staff received training on safeguarding adults from abuse. They were able to describe different types of abuse they may become aware of and the action they would take to protect people from harm.

Accidents and incidents were recorded appropriately and had been analysed to identify any patterns or trends, and any areas that required improvement.

People understood how to express any concerns or complaints and were encouraged to feedback their views of the service provided. We received positive feedback from everyone who we spoke with.

Staff told us they were well supported through supervision and staff meetings.

The service is purpose built and accommodation is provided across two floors with lift access. There is some parking on site. The home is situated in a residential area of York to the west of the city centre.

We inspected this service on 22 and 26 July 2016. The inspection was unannounced. On the first day of our inspection, there were 24 people using the service; 18 people living at the home and six people using the service’s respite beds.

The service was last inspected in September 2014 at which time it was compliant with the regulations in force at the time.

The registered provider is required to have a registered manager as a condition of registration for this service. The service did have a manager registered with the Care Quality Commission (CQC); however, they were not at work at the time of our inspection. We were supported during our inspection by the head of service and two registered managers from other homes run by the registered provider. A registered manager is a person who has registered with the 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 our inspection, we found that medicines were not always kept securely or stored at the correct temperature. The registered provider had not effectively risk assessed the safe storage of medicines. More frequent fire drills were needed and records showed that weekly fire alarm tests had not been consistently completed.

We identified concerns regarding staffing levels within the home. Staffing levels impacted on the time available for staff to support people with meaningful activities and staff felt they were not always able to quickly respond to people's needs. Staff raised concerns about the lack of time they had to support people with meaningful activities.

We identified concerns around how the registered provider evidenced consent to care and treatment. Records did not consistently evidence that people's capacity to make informed decisions had been considered when seeking consent.

There had been a number of different managers since our last inspection of the service creating uncertainty amongst staff. Staff morale was low as there was uncertainty about the future. Feedback about the new registered manager was positive although they were not at work at the time of our inspection.

Staff completed risk assessments to identify risks and plans were put in place to manage these risks to keep people who used the service safe. We found that staff understood their role and responsibilities with regards to safeguarding vulnerable adults.

Staff had regular training and supervisions and appraisals were completed to support staff development. However, there were some gaps in staff training.

We received positive feedback about the food and drinks provided at the home. We observed that people were supported and encouraged to eat and drink regularly. People were supported to access healthcare services where necessary.

There was a system in place to gather feedback and respond to complaints. We received positive feedback about the caring staff. People were encouraged to make decisions. Support was provided to maintain people’s privacy and dignity. People who used the service provided generally positive feedback about the home.

Care plans were in the process of being updated using a new care plan format. The new care plans were more detailed and person centred to support staff in providing responsive care.

Quality assurance systems needed to be improved to ensure issues and concerns were identified and action consistently taken to address concerns.

We found breaches of regulation in relation to medicines, staffing levels and consent to care. You can see what action we told the registered provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People were safe because the staff at Windsor House respected their rights and dignity. People were consulted and included in how they spent their day to day lives.

People's dignity was respected when they displayed distressed reactions or responses because staff dealt with these incidents in an effective way. This helped to ensure people's human rights were respected.

When people were at risk the staff followed effective procedures and sought expert help promptly. This minimised the risk of harm to people and helped to keep people safe.

People's records about their care needs provided sufficient information to enable staff to provide the right care to people. This promoted people's safety and enabled staff to provide more individualised care, in line with the person's preferences and wishes.

Is the service effective?

People and their representatives were involved and included in the assessment of the person's needs. This enabled people to talk about the help they wanted and what was important to them. People's preferences, choices and interests were explored with people so that activities and interactions could be more focussed on matters that interested people.

People's health and well-being was kept under review and advice and guidance was sought promptly when people's needs changed. This meant staff were alert to changes in people's health, so that referrals to the relevant health services were made promptly.

People's nutritional likes and dislikes were known to the staff team and the catering staff, so their meal preferences could be respected. The service identified and monitored those people with risks associated with their nutrition and/or hydration in order to promote and maintain their well-being.

Is the service caring?

People were treated with kindness and respect by the staff team. Staff showed concern for people's welfare and a keenness to get things right. Staff knew about the people they were supporting, including their past lives and preferences. This helped to make sure people received the care they wanted.

Healthcare professionals told us the staff provided good care to people living at Windsor House. They had confidence in the staff's ability to provide quality care and to notify them promptly if they were concerned about an individual's health.

Is the service responsive?

Staff made sure people were given the time to make their own decisions, wherever possible. Staff listened to what people told them and acted on this, wherever possible.

People received care and support that was in line with their preferences and interests. People were encouraged and supported to maintain friendships with families and friends.

Whilst the provider had a robust complaints procedure there was no displayed information about this that was in an appropriate format for the people living there.

Is the service well-led?

The service worked well with other visiting professionals to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home.

Whilst there were some quality monitoring processes in place the senior management were reviewing these and making some changes because they had identified this aspect of the service delivery required strengthening. We will keep this area of care under review and may ask for more evidence of monitoring arrangements in the coming months. This will help to show that these improvements have been maintained and built on.

People received safe and appropriate care and expert advice was sought promptly when needed.

People were encouraged and supported to take adequate and varied food and drink.

People received their medication in a safe way and at the times they needed them.

Staff were provided with support and enabled to gain the skills and knowledge to carry out their work safely and appropriately.

Whilst care staff knew about people's care needs, the records about this care were not always accurate or up to date.

We observed that people received care that met their needs and promoted their independence and rights. One person said 'They (staff) look after us well. They get the doctor if I'm ill.' A visitor told us 'They (the care staff) all seem to understand my relative's needs. We can go on holiday without worrying. We know our relative will be well looked after.'

The service had systems in place to control and prevent the spread of a healthcare associated infection. Ensuring any such outbreak were managed in a safe, consistent way could help to minimise the risk of harm to people.

Whilst the building overall was suitable for the people living there, monitoring checks on the security systems could be considered so the provider was satisfied they were fit for purpose.

We spoke with staff who understood their roles with regard to supporting people with dementia care needs. The staffing numbers were monitored to ensure there were enough care staff to support people safely and in a timely way.

The service had a complaints policy and complaints were taken seriously and looked into properly.