The Winsor Nursing Home

The Winsor Nursing Home is a residential care home providing personal and nursing care to up to 40 people. The home specialises in the care of older people.

At the time of the inspection there were 30 people living at the home.

People’s experience of using this service and what we found

People were very happy with the care and support they received at The Winsor Nursing Home. People felt safe and respected by staff.

Since the last inspection there had been improvements to social stimulation offered to people. There was a variety of activities and events which people could join in with.

Staff morale was good which created a nice atmosphere for people to live in. People told us staff were always happy and friendly. Visitors said they were always made welcome.

People received their medicines safely from trained nurses who had their competency assessed on a regular basis.

There were enough staff to ensure people received care and support promptly when they needed or requested it.

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 were able to make choices about their day to day lives and follow their preferred routines.

Each person had a care plan which had been personalised to take account of their needs and wishes. This helped to make sure staff had the information they needed to provide person centred care.

The provider had effective systems to monitor quality and plan ongoing improvements.

Rating at last inspection The last rating for this service was good (published 19 October 2018.)

Why we inspected

This inspection was prompted by a review of the information we held about this service and the length of time since the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This was a focused inspection to look at the key questions of safe, responsive and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed from good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Winsor Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff were following up to date infection prevention and control practices to help keep people safe.

The provider had systems to enable people to see visitors. There was a dedicated indoor space for visitors to see their loved one in a safe and socially distanced way. Where people were too frail to leave their rooms then visitors were escorted to people without coming into contact with other people living at the home. This highlighted an individual approach to people’s social needs.

People continued to have access to activities and entertainment to promote their well being.

The acting manager ensured that new admissions were carried out in a safe and individualised way. Rooms were prepared with the appropriate signage and all staff were aware of the procedures to follow when caring for the person. The acting manager told us rooms were allocated with the individual in mind. For example, the most recently admitted person was allocated a room with a view of the surrounding countryside which they thought the person would enjoy because of their background.

The acting manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of the precautions being taken and how to keep people safe.

Staff felt well felt well supported and said the acting manager was “Doing a marvellous job.” One member of staff said, “It has been an emotional rollercoaster but [acting manager’s name] has been so supportive.”

Further information is in the detailed findings below.

At our last inspection in June 2016 we rated the service good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. During this inspection the rating for the responsive key question changed to ‘requires improvement’, however this does not affect the overall rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good

People felt safe at the home and with the staff who supported them. The provider had systems and processes that minimised the risks of abuse to people. One person told us. “I’m safe here. There’s no unkindness.”

People’s nursing and personal care needs were met by staff who were well trained and competent in their roles. One visitor said, “The girls [staff] here are marvellous. They are very skilled and definitely know what they are doing.”

People told us staff who supported them were kind and caring. We observed staff showed patience and understanding when assisting people. One person told us, “Staff here are very kind, you can’t fault them on that.”

People’s health was monitored by trained nurses and they had access to other healthcare professionals to meet their individual needs. People received their medicines safely.

Staff had received training and knew how to protect people’s legal rights when they lacked the capacity to make a decision for themselves or give consent to their care.

The management team kept up to date with good practice to make sure people’s care was provided in accordance with best practice guidelines and current legislation.

People lived in a home where the provider and management team were committed to making ongoing improvements. There were quality assurance systems which monitored standards of care and addressed any shortfalls in the service.

Some improvements were needed to make sure care provided to people was person centred. People did not always receive social stimulation or have opportunities to take part in activities in accordance with their interests and hobbies. We have therefore recommended that the provider reviews their activity programme.

Further information is in the detailed findings below

The Winsor Nursing Home provides nursing care to older people. The home is situated in a convenient location close to the sea front, shops and cafes. A maximum of 40 people can be accommodated and some bedrooms are large enough to accommodate people who wish to share a room. The home is staffed 24 hours a day and registered nurses are on duty at all times.

There were 39 people living at the home when we visited. Many people were able to tell us about their experiences of life at the home however; some people were living with dementia and found communication difficult. We therefore used our observations of care and our discussions with staff to help form our judgements.

There was a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run.

The registered manager had a good knowledge about the needs and preferences of the people who lived at the home. They were committed to ensuring people received the best possible care. The registered manager regularly worked on the floor providing registered nurse cover which helped them to observe the quality of care people received.

The atmosphere in the home was relaxed, cheerful and welcoming and staff communicated with people in a very kind and respectful manner. Without exception all the people and visitors we spoke with were very complimentary about the care they received and of the staff who supported them. A person who lived at the home told us “The staff are all so kind. We have a laugh and they take time to talk to you; even at night.” Another person said “The staff are very kind to me. I have my favourites but they are all lovely.”

People told us they felt safe living at the home. One person told us “I see this as my home now and I feel very safe indeed.” Another person told us “They [the staff] look after me very well. I have no worries at all.” A visitor said “I am very content with everything. Most importantly; I don’t go away feeling concerned about [Person’s name].” There were policies and procedures in place to minimise risks to people and to help keep them safe. These were understood and followed by the staff team.

There were enough staff to help keep people safe and meet their needs. One person who lived at the home told us “If I ring my bell the staff come pretty quickly really. I don’t have any concerns there.” A visitor said “There always seems to be plenty of staff about when I visit.” The service made sure staff were appropriately trained and supported.

People received effective care and support which was adjusted to meet their changing needs. People had access to appropriate healthcare professionals to make sure they received effective treatment when required. One person told us “I can’t stress enough how wonderful it is here. The staff know all about my medical conditions and they help me in just the right way so that I am not in pain.” A visitor said “I think the staff are very good from what I have seen. It’s not an easy job and they really know what they are doing.” There were systems in place to make sure people received their medicines when they needed them.

People had their nutritional needs assessed and food was provided in accordance with people’s needs and preferences. People told us they were provided with plenty to eat and drink and were positive about the choice and quality of the food. One person said “The food is lovely and it’s nicely served.” Another person told us “I get plenty to eat and there’s always a choice. It’s very good.”

People had opportunities to take part in social activities. An activity worker was employed. We observed that care staff also engaged in activities with people.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor and improve safety and quality of care.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We found the service to be safe because they had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.

We observed that staff were competent and professional in their interactions with people who lived at the home. During our inspection we observed people were relaxed and appeared very content with the care and support provided.

We observed staff assisting people to transfer to/from wheelchairs with the aid of a hoist. We saw people were assisted in a safe and dignified manner. Staff took time to explain what they were going to do and offered constant reassurance to the people they were assisting. People appeared relaxed and comfortable when being assisted.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

Staff received appropriate levels of support which enabled them to care for people safely and to an appropriate standard.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We saw that all medicines had been stored securely and had only been administered by registered nurses.

Is the service effective?

We found the service to be effective because people's care treatment and support achieved good outcomes. We also found that people's rights and choices were respected by staff.

We saw staff recorded information about each person on a daily basis. Information included how people had spent their day and how they had responded to activities of daily living. This meant the effectiveness of people's care plans could be fully reviewed.

We saw that people's prescribed medicines had been regularly reviewed by their GP or specialist health care professional. This meant that people received medicines which were appropriate to their needs.

Is the service caring?

Staff interacted with people in a gentle and kind manner. The people we spoke with were very complimentary about the care they received and the staff who supported them. Comments included 'I am so satisfied with everything. Honestly, things couldn't be any better' and 'I have nothing to grumble about. All the staff are very nice and kind.' The visitors we spoke with told us 'The care and attention couldn't be better. I visit most days and all I see is kindness' and 'Everyone is so friendly and welcoming. I have no complaints at all.'

The staff we spoke with had a very good understanding about the needs and preferences of the people they supported. They understood and responded to people's needs and requests where individuals were unable to make their wishes known verbally. This demonstrated that staff knew people well.

Is the service responsive?

The service was responsive to people's needs. We observed people were supported in accordance with their needs. For example we saw people were provided with soft diets and nutritional supplements where required.

People told us they did not have to wait long when they used their call bell to summon assistance. Throughout our visit we saw staff responded to call bells in a timely manner. The maximum time someone waited was five minutes.

The staff we spoke with were very knowledgeable about the needs and preferences of the people they supported. They knew about the things which were important to people. For example what drinks people preferred and how strong they like their coffee and how and where people preferred to spend their day.

We observed staff offering people choices throughout our visit and saw they responded promptly to any requests. The people we spoke with made the following comments 'the staff know me very well. They know I prefer to stay in my room. They respect that and they pop in regularly to see I am alright' and 'the staff know that I am frightened to go in the hoist so I don't like to have a bath. I prefer a bed bath and that's what I get. They are so lovely.'

Information about people's health needs and contact with health and social care professionals had been recorded. One person told us 'they are very good here. If you need the doctor, they get the doctor. No questions. Another person said 'I have no doubt at all that they would call the doctor if I wasn't well.'

Is the service well led?

The service was well led because there were systems in place which monitored the quality of the service provided. A manager was in post who had recently been registered by us. The manager was supported by a deputy manager and an administrator. We saw that registered nurses and senior staff were always available to support less experienced staff.

We asked staff what it was like working at the home. Some of the staff we spoke with had worked at the home for many years and some under a year. They made the following comments 'I am very happy here. There is really good team work and I feel we are able to give people really good care' and 'I love it here. I wouldn't want to work anywhere else. It's a great team and the support is really good.' We asked people who lived at the home and visitors for their views. They made the following comments 'the staff are wonderful. They couldn't be more caring if they tried' and 'there always seem to be plenty of staff about.'

People who lived in the home and their representatives were provided with opportunities to express a view about the quality of the service provided. Information about meeting dates for people's representatives had been clearly displayed in the reception area of the home.

We found procedures were in place to minimise any risks to the people who lived at the home. Regular internal audits had been carried out which monitored the on-going health and safety of people. Internal audits included checks on the home's fire systems, environment, care planning and the management of people's medicines.

We saw that staff had the opportunity to attend regular staff meetings. We looked at the minutes from a recent meeting. These showed that a range of topics had been discussed which included policies and procedures, staffing and information about the people they supported.

We met and spoke with seven people who used the service; seven visitors and six staff. Following the visit to the home we also obtained feedback from three health and social care practitioners and a GP practice who were regularly in contact with the service. We looked at three care records, two staff recruitment records and records for the management and administration of the service.

The people we spoke with told us they had the care and support they needed. One person told us 'I have no worries; I get the help I need.' We were told by visitors about their experiences of the care and support provided to their relatives by staff in the home. They used words such as 'wonderful,' 'caring' and 'supportive.' They also told us they had the confidence to leave their relative at the home and feel sure that all their needs would be met.

People told us they found the staff approachable, friendly and supportive. When we spoke with relatives visiting the home they told us how much they had appreciated and valued the support and care they had had from staff. We were told,' Could not have asked for better. The care given to X was above expectations. Above and beyond.'

We visited the home where we reviewed records and spoke with five people who used the service, one relative and seven staff including the deputy manager.

We saw that people had been assisted with their personal care, dressed in appropriate clothing with their hair and nails attended to. We were told by people that they thought that they had the help and support they needed including medical help when it was required.

We asked people about the support they were provided with for activities and maintaining their interests. We were told by two people that there was not always much to do and that they did not enjoy using the lounge area downstairs as there were not many people who could participate in a conversation. People told us that they thought the staff were, 'nice.' and that they were 'approachable and friendly'. They also said that there were usually enough staff on duty to meet their needs.