The Windmill Care Home Ltd

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service since the service name change. The provider has remained the same. At our last assessment of this key question we rated this key question good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to person centred care.

This service scored 36 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s strengths and aspirations were not documented in their care plans. Many of the people living in the service were unable to tell staff what their needs were due to the conditions they were living with. Staff did not ensure they involved family and others close to people to form a picture of their individual needs and wishes. One relative told us they had not been involved in the planning of their family member’s care. Many care records we reviewed stated they were waiting to speak to people’s relatives to gather further information. For example, 1 person’s safeguarding care plan stated staff were waiting to speak with a family member to gather further information for a more person-centred approach to their care.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

Training compliance was poor and staff did not always complete training in topics associated with the group of people the service supported. For example, the provider supported many people with complex needs who lived with both dementia and behaviour that challenged. Our observations and records of incidents demonstrated staff had a limited understanding of people’s needs. Furthermore, we saw examples of where the provider had failed to understand the importance of prompt referrals to healthcare professionals, including serious safeguarding incidents, to ensure people’s health, safety and wellbeing in relation to the conditions they were living with. For example, we saw from behaviour records one person’s behaviour was increasingly putting others and themselves at risk. Additional resources such as increased observations had not been put in place, or referrals made for further advice.

Regular team meetings were not in place and staff told us these happened around every 6 months, and one staff member told us, “Only seem to have a meeting when something has happened or gone wrong.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Most people living in the service were living with dementia or a cognitive impairment and people’s communication needs had not been adequately assessed. Whilst there was a service user guide in place, we could not see these were readily available in alternative formats such as easy read versions. Training records showed only 62% of staff had completed training in accessible information.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

Meetings for people who used the service and their relatives did not take place. One person told us, “No, we don’t have any meetings.” They went on to tell us they had raised concerns multiple times about needing more staff, but no action had been taken, and they have also not been involved in their care planning.

Staff we spoke with told us they had raised concerns but have not felt listened to.

Reviews of people’s care did not involve them or those significant to them and this was a missed opportunity to feedback on the care they received.

The provider had a complaints policy in place and these were responded to inline with the policy.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We saw evidence that people’s treatment and care had been delayed due to the provider’s lack of prompt identification of changes to people’s care needs. For example, we saw one person’s breathing had been described as, ‘abnormal’ and ‘chesty’, but they were not seen by a healthcare professional for 4 days. Therefore, referrals had not been made in a timely manner, and in some cases not at all.

We had concerns about the number of staff on duty and their ability to safely care for people. One person told us how they soiled themselves as staff did not respond quickly enough. They added, “It’s not dignified.”

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Despite supporting older people living with dementia and/or behaviour that challenges, the provider did not demonstrate they understood and consistently met the needs of the people they supported. For example, one person’s risk assessment in relation to their dementia did not detail their care needs in relation to this and instead the record focused on their mobility. There was no evidence to show people, or their representatives were involved in the planning and review of their care records. Furthermore, the provider had not proactively sought out ways to address barriers for people living with dementia and behaviours that challenge to improve their experience and ensure positive outcomes.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw there was a lack of detail in people’s care records regarding their future wishes, including at the end of their life. One person’s future wishes care plan stated they had not expressed detailed or specific wishes in relation to their funeral arrangements or end of life care preferences. This did not demonstrate an attempt had been made to discuss this with them or their representative.

In 2 people’s ‘last wishes/ funeral plan’, it was documented to; speak with family, but these discussions had not taken place. This demonstrated the provider was not proactive in obtaining information about people’s end of life preferences. This increased the risk of individuals not being cared for or supported in line with their wishes or preferences.