Windward House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection in 2019 under the previous provider we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulations in relation to, care planning, safe care and treatment, and consent.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

By the end of our assessment, the service had transferred all of peoples’ care plans and risk assessments from the previous provider IT format onto the present providers IT format. When the assessment began 23 of the 30 care plans had already been transferred. This transfer greatly assisted consistency between this service and the providers other services and organisational processes. The care plans generally contained the information necessary to deliver care and support. However, because the previous care planning had not been up to date and accurate it was taking time to ensure that the new care planning was complete. We found some significant inaccuracies remained in care plans which could impact on the appropriate delivery of people’s care. For example, one person’s skin pressure area wound classification had not been correctly recorded at the classification level given by the District Nurses.

The provider had not planned and delivered people’s care and treatment with them. They had not followed legislation and current evidence-based good practice and standards.

People using the service had experienced significant skin tissue pressure sores in the months immediately before our assessment took place. During our first visit to the service we observed that a number of tissue viability pressure mattresses were incorrectly set for the present body weight of the person using the mattress. We also saw that daily checks of the pressure settings of pressure mattresses had not been carried out for a number of pressure mattresses, for a 6 day period in early December 2024 running into the day of our first visit to the service. These failures had not been identified by service management and were putting people at increased risk of their skin tissue breaking down.

The provider had not always worked well across teams and services to support people. They had not always shared their assessment of people’s needs when people moved between different services.

The service had not always maintained effective working with other professionals. However, there was increasing trust between other stakeholders and the service with the arrival of new leadership. Stakeholders such as the commissioning Local Authority, told us they could trust the new leadership to bring the necessary improvements in the quality of the service. There was improved communication between the LA and the service and provider level management. However, these new trusting relationships were yet to become embedded.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff had not always supported people to live healthier lives, or where possible, reduced their future needs for care and support.

The service had not always identified risks to people to prevent a deterioration in their health and wellbeing. Changes to practice had been made recently and had not had time to embed in routine practice. However, following management changes the service was seen to be supporting people to manage their general health and wellbeing where able, so people could maximise their independence, choice and control. For example, one person told us how the service had positively supported them to lose weight and that this weight loss had improved their general quality of life. We also heard that all health appointments were now being raised at all staff shift handover meetings so that external and internal health appointments were always supported and kept.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

Although the service did monitor most of people’s care and treatment, such as through weight monitoring, they had not always ensured appropriate medical advice was sought. For example, a severe Grade 3 pressure sore was identified by staff late in October 2024 but was not reported to healthcare professionals for 7 days for assessment and treatment. We were told by the new management, such incidents would no longer take place due to much closer management of information coming from staff. Staff shift handover meetings were now routinely taking place, and these were now recorded so that information about peoples changing care needs was always available and recorded for the service management to see.

There was limited organised social and stimulation activity taking place in the home, and some people said they felt isolated. However, the new service management said they were bringing in a programme of structured activities, and they had already taken action to make mealtimes more of a communal activity for some people.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The service told people who had the mental capacity to consent about their rights and respected these when delivering person centred care and treatment. However, many of the people that lived in the care home lacked the capacity to consent. We saw occasions where people’s lack of capacity was not taken into consideration.

During 2024 the service had not been assessing people under the Mental Capacity Act 2005 to see if an application for Deprivation of Liberty Safeguards (DoLs) should be made. There were a number of people living at the home who were known to lack capacity due to dementia and their movements were restricted for their own safety. They had not had their capacity assessed by the service, or had an application made under DoLs to protect their human rights.

Similarly, Best Interest processes had not taken place to protect peoples’ rights regarding restrictions placed on them within the home for their safety and wellbeing. For example, the use of equipment such as pressure alarm mats.