Windmill House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff meetings, group and individual supervision sessions were used as an opportunity to share learning, reflect on any events or concerns received by the service, and to support ongoing improvement. Staff told us they felt confident to self-report incidents such as medicine recording errors without fear of reprisals. This demonstrated positive changes within the culture of the service since our last inspection.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff worked closely with external health and social care professionals, including the local GP and pharmacist, to ensure people, particularly those living with long-term health conditions, received consistent standards of care and support. We spoke with the GP and pharmacist as part of our inspection, who both spoke positively about the staff team’s knowledge and understanding of people’s needs and told us they trusted the staff team’s judgements about changes in people’s health presentations.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe and well supported living at the service. People were clear they would feel comfortable speaking with staff or the registered manager if they had any concerns or felt at risk. Staff and leaders demonstrated a clear understanding and culture of openness in relation to escalating risk and allegations of abuse and following required reporting processes. This was an area of improvement since our last inspection.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were encouraged to be as independent as possible, which at times involved positive risk taking. Where people were assessed to lack mental capacity in this area of their care, we identified staff still ensuring they were fully consulted and involved in decision making processes linked to the management of risk. We identified improvements in the quality and level of detail recorded in people’s care and support plans in relation to the management and mitigation of risks. People and their relatives told us about additional safety measures put in place to manage risks, such as having sensor mats next to their bed to alert staff if they experienced a fall. Such measures made people and their relatives feel assured about their safety.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We identified some concerns in relation to the arrangements in place for people wishing to smoke at the service. The outside area used lacked signage and suitable disposal arrangements. We also found certain doors unlocked, increasing the risk of people accessing unsafe items. Immediate action was taken by leaders in response to our feedback, and subsequent assurances received of measures implemented to reduce the risk of reoccurrence.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff told us they felt they were well supported by leaders and colleagues, to meet the requirements of their roles. Staff told us they had access to required training and felt during the day and overnight there were sufficient numbers of staff on shift to meet and respond to people’s assessed needs and risks. Improvements to safe recruitment processes had been made since our last inspection.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was visibly clean throughout, with no presence of malodours. Our findings were reinforced by relative’s feedback received, which stated, “Rooms are nice and bright. It does not smell, and they keep it clean.” We observed the housekeeping team to work across the service to maintain high standards of cleanliness, with managerial spot checks and audits completed to ensure tasks were consistently completed to required standards. Arrangements were in place to effectively manage in the event of an outbreak, with access to personal protective equipment, hand washing facilities, arrangements for the management of laundry to reduce the risk of the spread of an infection. Staff had completed and demonstrated understanding of infection prevention and control training implemented. Arrangements were in place to manage the safe storage of cleaning products, to prevent unsupervised access by people, particularly those living with dementia to keep people safe. This was an area of improvement identified from our last inspection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Where people had as required (PRN) medicines, the corresponding guidance for staff lacked clear detail and we found them difficult to read as they were hand written. The guidance for a person requiring their medicines to be given to them covertly (hidden in food or drink without the consent of the person receiving them), required further consideration to ensure these medicines were given correctly, and the person consumed the required dosage.

Where people experienced constipation, their corresponding medication plans did not always give staff clear direction on when to escalate concerns to the GP. Staff were not always completing the paperwork in real time, where prescribed creams had been applied; this risked documentation not being accurate. Immediate action was taken by leaders in response to our feedback, and subsequent assurances received of measures implemented to reduce the risk of reoccurrence, as well as consultation by the service with external healthcare professionals.