We carried out a review of the data available to us about Winchcombe Place on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Winchcombe Place, you can give feedback on this service.
Winchcombe Place is a residential care home providing personal and nursing care for up to 80 people. The home is in one building and provides care and support facilities over three floors. The first floor specialises in providing care for people living with dementia, whilst the second floor supports people who require nursing care. People have their own bedrooms with en-suite facilities and use of a private garden. At the time of inspection, the service was supporting 56 people in the home.
People’s experience of using this service and what we found
Staff and visiting health and social care professionals had raised concerns about unsafe staffing levels. The provider had responded by significantly increasing staffing levels. At the time of our inspection the provider had also doubled the number of registered nurses being deployed and significantly overstaffed other staffing on each shift. The provider needed time to demonstrate that increased staffing levels had become embedded and the staffing situation had stabilised.
People experienced safe care and were protected from avoidable harm by trusted staff, who had completed safeguarding training and knew how to recognise and report abuse. Staff identified and assessed risks to people effectively and managed them safely. Staff completed a robust selection process, including their conduct in previous care roles, to assure their suitability to support people. People received their medicines safely from staff, in accordance with recognised guidance. Staff maintained high standards of cleanliness and hygiene in the home, which reduced the risk of infection. Accidents and incidents were recorded and reviewed daily by the management team, who took prompt action to implement any lessons learned.
Staff assessed all aspects of people’s physical, emotional and social needs and ensured these were met to achieve good outcomes for them. Staff were supported to develop and maintain the required skills and knowledge to effectively support people. Staff emphasised the importance of eating and drinking well and reflected best practice in how they supported people to maintain a healthy balanced diet. Staff worked together with healthcare professionals to ensure care and treatment met people’s changing needs and achieved good outcomes. The home had been purpose built, with bright spaces bathed in natural light to help orientate older people and those living with dementia, to the time of day and time of year.
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.
The management team promoted a strong, person-centred culture where people felt valued. Staff were passionate about their role and placed people at the heart of the service, demonstrating the caring values of the provider. The registered manager understood their responsibilities to inform people when things went wrong and the importance of conducting thorough investigations to identify lessons learnt to prevent reoccurrences. The governance structure ensured there were robust measures to monitor quality, safety and the experience of people within the service. Quality assurance had been embedded within the culture and running of the service, to drive continuous improvement.
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
The last rating for this service was Requires Improvement (published on 22 October 2020). There were breaches in Regulation 12 (Safe care and treatment) and Regulation 17 (good governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
The inspection was prompted in part by notification of a specific incident, following which a person using the service died. The information the Care Quality Commission (CQC) received about the incident indicated concerns about the management of choking risks. This inspection examined those risks. However, this incident is being reviewed separately under our specific incident guidance and consequently this inspection did not examine these events. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.
We had also received concerns in relation to unsafe staffing levels and high use of agency staff. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
However, we have found evidence that the provider needs to make improvement. Please see the safe section of this full report.
You can read the report from our last inspection, by selecting the ‘all reports’ link for Winchcombe Place on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Winchcombe Place is a residential care home providing personal and nursing care for up to 80 people. The home is in one building and provides care and support facilities over three floors. One floor specialises in providing care for people living with dementia. People have their own bedrooms with en-suite facilities and use of a private garden. At the time of inspection, the service was supporting 47people in the home.
People’s experience of using this service and what we found
The service had systems and processes to safely administer, record and store medicines. However, we found that the records to support the use of medicines were not always available or detailed enough to effectively support staff when administering medicines. The information provided was not always accurate between different types of documents. Staff were provided with medicines training. Competency checks were completed annually or after an error. The service had two staff members who were ‘medicine champions’. These staff would be involved in the ordering and receiving of medicines to the home as well as supporting other staff in medicines management.
Where potential risks were identified through the providers audit systems, action had not always been taken. For example, records showed that thermostatic mixing valves had not been serviced or fail safe checked. However, other routine servicing of equipment and facilities had been completed, such as lift and hoist servicing and maintenance.
Systems in place were not always effective in identifying when the fundamental standards were not met. We found that records were not always up to date, accurate, and complete. Action had not always been taken following identified areas of improvement that was required. The registered manager demonstrated a keen willingness to make further improvements and told us they would review documentation and audit processes to make sure any concerns were addressed.
Whilst we found some quality assurance systems were not always effective, other systems were operated effectively to maintain the quality and safety of the service. People were at the heart of the service. The registered manager and staff were passionate and continuously strived to achieve positive outcomes for people. The registered manager and staff team had a good understanding of their roles and staff were empowered to make suggestions to keep improving the care. People said the registered manager and staff were approachable, listened and responded to them and acted on feedback they shared with them.
People were protected from avoidable harm and abuse. People were supported by staff who understood the action to take should they have any concerns about people's safety. There were enough suitably recruited staff available to keep people safe and staffing levels were reviewed and changed to reflect changes in people's needs. People were protected from infection by staff that kept the premises clean and used appropriate protective equipment when needed. Lessons learnt were identified and shared appropriately with staff.
People received personalised care that was responsive to their needs. People were provided with information in a way they could understand which helped them make decisions about their care. There were effective systems in place to deal appropriately with complaints. People’s end of life wishes had been explored and care plans were in place to provide guidance to staff on people’s end of life wishes.
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)
The last rating for this service was Requires Improvement (published on 24 September 2019). There were breaches in Regulation 12 (Safe care and treatment), Regulation 9 (Person-centred care) and Regulation 17 (Good governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the provider was no longer in breach of Regulation 9 (person centred care). Not enough improvement had not been made and the provider was still in breach of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).
The service remains rated Requires Improvement.
Why we inspected
We carried out an announced comprehensive inspection of this service on 27 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person-centred care and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating has remained Requires Improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Winchcombe Place on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in relation to medicines management, risks relating to equipment and premises and systems and governance processes. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will ask the provider to provide us with regular updates on improvements made. We will work with the 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.
Winchcombe Place is a residential care home providing personal and nursing care for up to 80 people. The home is in one building and provides care and support facilities over three floors. One floor specialises in providing care for people living with dementia. People had their own bedrooms with en-suite facilities and use of a private garden. At the time of inspection, the service was supporting 64 people in the home.
People’s experience of using this service and what we found
Medicines were not always managed in a safe way. People did not always receive their medicines on time. Records relating to medicines were inconsistent and did not always provide sufficient guidance to staff administering medicines. We also saw positive practice relating to the management of medicines. Staff were passionate about driving improvements regarding the use of medicines. Medicines were stored correctly.
Records did not always reflect people’s individual needs and preferences. We could not be assured appropriate person-centred care and treatment was consistently delivered that was responsive to people’s needs. People’s end of life needs wishes, and preferences had not always been explored.
Quality assurance systems were not always effective which meant that areas for improvement were not always identified to ensure continuous learning and innovation. Audits were not always effective and did not always highlight concerns found during inspection. There were some audits in place that were effective including the review and analysis of call bell response times and falls analysis.
Accidents and incidents were investigated, and lessons learnt were disseminated to staff. However, we found that actions were not always undertaken in relation to safe serving temperatures of food and drink. We have recommended that the provider seeks guidance in line with best practice and legislation on food safety and update their practice accordingly.
People’s meal time experiences were positive. Staff were attentive, and people told us they enjoyed the food provided. However, we found that communication between staff about people’s specialist dietary needs was inconsistent. We have recommended the provider seeks guidance to ensure it sufficiently monitors and manages the risks associated with people’s dietary and nutritional specialist needs.
The provider used appropriate recruitment processes to ensure, as far as possible, they were suitable to work with people. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately by the registered manager.
People and their relatives knew how to complain and knew the process to follow if they had concerns. People, relatives and staff felt they could approach management with any concerns they had.
People had their healthcare needs identified and were able to access healthcare professionals such as their GP, when needed. The service worked well with other health and social care professionals to provide effective care for people.
People experienced support that was compassionate and caring, from staff they had developed meaningful relationships with and who knew them well. Staff knew people well and understood their likes and dislikes. We saw evidence of people going on outings that they chose and that were important to them.
Staff understood the principles of the Mental Capacity Act and the importance of people making their own decisions. 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.
The service had regular residents and relatives' meetings as well as staff meetings to ensure there was opportunity to feedback about the home and that there would be a consistency in action taken. The staff team had handovers and daily meetings to discuss matters relating to the service and people’s care.
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)
The last rating for this service was Inadequate (report published 22 March 2019).
We identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9 (Person-centred care), Regulation 10 (Dignity and respect), Regulation 12 (Safe care and treatment), Regulation 16 (Receiving and acting on complaints), Regulation 17 (Good governance), Regulation 18 (Staffing). The provider was also in breach of Regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009. The service was put into special measures and we imposed a condition on the providers registration.
During this inspection the provider demonstrated that improvements have been made. 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.
Why we inspected
At the last comprehensive inspection, the service was rated as Inadequate and was put into special measures. Services in special measures are kept under review and are required to have another inspection within six months. This inspection was undertaken to ensure that improvements had been made by the provider.
Enforcement
At this inspection we have identified continued breaches in Regulation 9 (Person-centred care), Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Please see the action we have told the provider to take at the end of this report.
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 in the service. 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.
Winchcombe Place is a care home with nursing which provides personal care and support for up to 80 people.
The registered manager of the home had left the service in December 2018, however was still registered with the Care Quality Commission (CQC). We were assisted by the management team during the inspection. The registered manager and registered provider are ‘Registered Persons’. Registered Persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People’s experience of using this service:
¿People did not receive a service that provided them with safe, effective and high-quality care.
¿Risks to people's safety and well-being were not managed effectively and this placed people at risk of harm.
¿Infection control was not always managed in an effective way.
¿Incidents and accidents were not managed safely to prevent a reoccurrence.
¿People's needs and preferences were not always assessed or person-centred plans developed to guide staff on how to meet people's needs.
¿Staff did not always complete training in meeting people's needs and this meant people were at risk of inappropriate care and treatment.
¿People were not always treated respectfully or in a way that promoted their privacy and dignity.
¿Staff were not always deployed effectively.
¿The service was not well-led and the governance system were not always effective and did not always identify the risks to the health, safety and well-being of people or actions for continuous improvements.
¿Complaints had not always been managed appropriately.
¿Appropriate referrals were no made to the local authority in a timely way.
¿We were not always notified, as required by law, of notifiable safety incidents.
¿Medicines management was not always safe.
¿People told us staff were caring, although feedback received was that meaningful engagement was limited.
There is more information about this in the full report.
Rating at last inspection:
Good (Published on 4 August 2017).
Why we inspected:
This was a responsive inspection due to information we received of risk and concern regarding the safety and welfare of people living in the home.
Enforcement:
We have told the provider to take immediate action to address some of the concerns we found. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up:
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.
Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
At the last inspection, the service was rated Good. At this inspection we found the service remained Good.
The service continued to work to keep people as safe as possible, by the way care was delivered; in terms of health and safety; premises maintenance and the provision of competent staff. The service had a robust recruitment process to ensure as far as possible, suitable staff were employed. Ongoing work was being undertaken to maintain and maximise premises safety. There was a need for additional staffing on the second floor at key times of day and in key areas.
People’s rights and freedom were protected. 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 supported this practice.
Staff received effective induction, training and ongoing support to help them deliver a good service and encourage their development.
In some areas such as the provision of activities, the service exceeded fundamental standards. A wide range of creative opportunities were provided and new initiatives were being introduced by a motivated team of lifestyle coordinators.
Healthcare needs were well met and health issues were monitored. However, we found room for some further development in terms of recording with regard to fluid intake and turning records for some people. Some additional specialist equipment was needed. For example, additional 'crash mats' were required to replace the pressure mattresses currently being used, in some rooms, to reduce the risk of injury from falls.
The service had experienced several changes in key management posts and an unsettled period. The new manager had applied to become registered manager of the service. He was supported by the newly appointed deputy manager, the recently appointed customer relations manager and other key senior staff. Feedback from staff was positive and staff felt Winchcombe Place was a good place to work.
A range of monitoring and audit systems helped ensure that an effective overview of the service was maintained by the management team. Issues had been identified and addressed, or were in the process of being addressed. The management team had already identified further areas they wished to develop.
This inspection took place on the 16 and 17 April 2015 and was unannounced. Winchcombe Place is a purpose built care home for older people and for people who live with dementia. It is situated near the centre of Newbury and opened in April 2014. The building, grounds and furnishings have been completed to a high standard. Accommodation is divided over three floors and arranged to create a comfortable and welcoming environment. Shared areas include library, salon, cinema, coffee shop, arts and crafts room, large lounges and smaller themed lounges.
The service does not have a registered manager, but was actively recruiting to the position. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
An area manger within the organisation is managing the service in the short-term until a permanent manager is recruited. The service is registered to provide nursing and personal care for up to 80 people. However, as a new service the provider had placed a voluntary embargo on admissions until they had built up a permanent staff team to meet people’s needs. At the time of our inspection 37 people lived in Winchcombe Place.. The manager told us that they were now in a position to lift the embargo as more permanent, experienced and trained staff were employed.
People’s care plans detailed how the person wanted their needs to be met. These were being further developed to promote individualised person centred care. Risk assessments identified risks associated with personal and specific health related issues. They helped to promote people’s independence whilst minimising the risk identified.
We spoke with people and their families. They spoke enthusiastically about the services provided, making reference to residents and relatives meetings and the openness and friendliness of staff. They told us that this makes people feel relaxed and comfortable. Comments included: "we came to visit the home twice and spoke with staff before mum moved in and on our second visit we picked her room; it's wonderful". "They run courses for relatives and staff on living with dementia and always call me, even with a little concern for example, if she's not eating enough”. People told us they felt safe and secure and would approach staff if they were worried about their safety or about the services provided. They said they felt they would be listened to.
The recruitment and selection process helped to ensure people were supported by staff of good character. There was a sufficient amount of qualified and trained staff to meet people’s needs safely. Staff knew how to report any concerns they had about the care and welfare of people to protect them from abuse.
The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm.
Staff were supported to receive the training and development they needed to care for and support people’s individual needs. People received good quality care. We found that the provider had an effective system to regularly assess and monitor the quality of service that people received. There were various formal methods used for assessing and improving the quality of care.