Archived: Windsor Park Nursing Home

Windsor Park Nursing Home is a care home registered to provide personal care for up to 19 people who have nursing care needs, including people living with dementia. At the time of our inspection, there were 14 people living at the service. Accommodation was provided over two floors and a passenger lift was available.

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

People were at risk of harm. Risks associated with people's care and treatment needs, including how clinical needs were assessed, monitored and managed were of significant concern. Guidance for staff about how to meet people's individual care and treatment needs either lacked detail or was not available for staff.

Clinical leadership and oversight at the service was insufficient as a result of both the registered manager and clinical lead being away from the service for prolonged periods due to the Covid-19 pandemic. The new director of the provider company and nominated individual had only recently taken over management of the service. There was some evidence of clinical supervision and competency assessments of nursing staff, however, these were not always documented sufficiently. This impacted on people receiving safe care and treatment.

There were no systems or processes in place to review incidents or any analysis completed that may have identified any themes or patterns to reduce reoccurrence. A failure to take action to learn from incidents impacted on people’s safety.

People’s dependency needs had not been assessed since 2019. This meant it was difficult to establish if staffing levels were sufficient to meet people’s individual needs and safety.

Staff lacked specific training in some areas, impacting on people’s care needs being fully known, understood or effectively met by staff at the service. Safe staff recruitment and induction procedures had not always been completed, exposing people to potential harm.

The procedures for staff to exchange information about people’s care and treatment needs was not safe or effective.

The environment, including furnishings were worn and needing redecoration and refurbishment. The Provider identified this issue within their action plan and planned to refurbish the home within the next six -twelve months. Infection prevention and control procedures reflected the Covid-19 pandemic guidance. People received their prescribed medicines when they needed them.

Systems and processes to assess and monitor quality including health and safety had not been fully kept up to date. This included audits and checks in relation to medicines, care plans and risk assessments.

Following the inspection, the provider sent us an action plan based upon the main issues found at this inspection. The impact of the planned actions will be assessed at our next inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (Published 28 December 2018). The rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

Why we inspected

We received concerns in relation to the management, oversight and governance of the service, including staffing and clinical competency. Many of these issues had occurred as a result of the Covid-19 pandemic. We raised these concerns pre-inspection with the provider, but were not sufficiently assured. As a result, we undertook a focused inspection to review the key questions of 'Safe' and 'Well-led' only

We received concerns in relation to the management, oversight and governance of the service, including staffing and clinical competency. We raised these concerns pre-inspection with the provider, but were not sufficiently assured. As a result, we undertook a focused inspection to review the key questions of ‘Safe’ and ‘Well-led’ only.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe, and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this report.

Enforcement

We have identified two breaches in relation to safe care and treatment and good governance.

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'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

This comprehensive inspection took place on 31 October and 1 November 2018. This was the fourth inspection of the service. At the last inspection on 30 August 2017 the service was rated as ‘Requires Improvement’ and was found to be in breach of regulation 12, safe care and treatment, regulation 17, good governance and regulation 20, duty of candour. We asked the provider to complete an action plan to show what they would do to ensure people’s safety and welfare and compliance with the regulations. We received an action plan which described how improvements would be made which we reviewed at this inspection. We found at this inspection, the service had improved their systems so that the breaches of regulations were met.

A registered manager was in post. This is a condition of the registration of the service. 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.

People using the service and the relatives we spoke with said they thought the home was safe.

People's risk assessments provided staff with information on how to support people safely. Lessons to prevent incidents occurring had been learnt from past events. Staffing levels were sufficient to ensure people's safety.

Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area. Staff were subject to checks to ensure they were appropriate to work with the people who used the service. People were protected from the risks of infection.

Relatives told us that medicines were safely given to their family members. We found this to be the case.

Staff had been trained to ensure they had the skills and knowledge to meet people's needs. Staff understood their main responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives and they were aware of their responsibilities under this law.

People had plenty to eat and drink. Their health care needs had been protected by referrals to health care professionals when necessary.

People and relatives thought that staff were friendly, caring and compassionate. We saw many examples of staff working with people in a friendly and caring way. People’s representatives had been involved in making decisions about people’s care, treatment and support.

Care plans were individual to the people and covered their health and social care needs. Activities were organised to provide stimulation for people.

Relatives’ told us they were confident that if they had any concerns these would be followed up.

People, relatives and staff were satisfied with how the home was run by the registered manager. Management carried out audits and checks to ensure the home was running properly to meet people's needs and provide a quality service.

The service cooperated well with other healthcare professionals. They shared information with relevant organisations to develop and deliver care.

The registered manager was aware of the need to report certain incidents, such as alleged abuse or serious injuries, to the Care Quality Commission (CQC), and had systems in place to do so should they arise.

The provider had a legal requirement to inform the public of the home's inspection rating, which was displayed in the home.

Windsor Park Nursing Home provides residential and nursing care to older people including people who are living with dementia. Windsor Park Nursing Home is registered to provide care for up to 19 people. At the time of our inspection there were 15 people living at the service.

A registered manager was in post. 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 2008 and associated Regulations about how the service is run.

We last visited the home in February 2016. We found that the provider had to make improvements in safe, caring and well led.

On this visit we found that there were breaches in providing adequate infection control, effective systems were not in place to assess and monitor the quality of care and notifications. We found a number of infection control issues throughout the service and documents relating to people’s health and safety were not managed or reviewed. Notifications which the provider is duty bound to send us had not been forwarded.

Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staff understood their role in caring for people with limited or no mental capacity under the Mental Capacity Act 2005.

People were provided with a choice of meals that met their dietary needs. The catering staff were aware of people’s dietary requirements, and people’s opinions were sought about the menu choices in order to meet their individual dietary needs and preferences. Some activities tailored to people’s interests were provided by staff and external professionals on a regular basis. Staff had had access to information and a good understanding of people’s care needs. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

Relatives we spoke with were complimentary about the managers’, nurses and staff, and the care offered to their relations. People were involved in the review of their care plan, and when appropriate their relatives were included. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans included changes to peoples care and treatment and people were offered and attended routine health checks.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the service. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

Staff were aware of the reporting procedure for faults and repairs and had access to the maintenance contractors to manage any emergency repairs. The provider had a clear management structure within the service, which meant that the staff were aware who to contact out of hours if an equipment repair was necessary.

The provider carried out quality monitoring checks in the service supported by the deputy manager and service’s staff. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives.

You can see what action we told the provider to take at the back of the full version of the report.

Windsor Park Nursing Home is a care home which is registered to provide nursing care for up to 19 older people living with dementia. At the time of this inspection there were 19 people using the service. The service is located in the Littleover area of Derby.

There has been no registered manager at the service since November 2014. 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 2008 and associated Regulations about how the service is run.

Since the previous inspection we saw that the provider had made some improvements but further improvements were needed in some areas.

The provider was not clear on reporting safeguarding incidents to relevant agencies, which did not provide assurance that people living at the service were protected from harm. Staff understood their responsibility in protecting people from the risk of harm. Sufficient staff were available to meet people's needs.

Recruitment procedures were still not robust, as all the required pre-employment checks were not in place. This did not provide assurance that suitable staff were employed to work with people who used the service.

Staff were not always caring in their approach when providing care. One person told us that staff handled them roughly whilst being supported.

The leadership and management of the service were not robust, which impacted on the quality and consistency of care being provided and impacted on the development of the service.

The provider did not have effective systems in place to audit the quality of the service being provided.

The provider had not notified us of the outcome of referrals which they had made to the supervisory body for authority to deprive a person of their liberty.

Risk assessments and support plans had been developed with the involvement of people. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way.

People received their medicines as prescribed and safe systems were in place to manage people’s medicines.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. Staff knew about people’s individual capacity to make decisions and supported people to make their own decisions.

People were given choices with regard to food and drink preferences and appropriate support was given when needed.

People had access to health support and referrals were made to relevant health care professionals as required.

People received care from staff that were respectful and caring and ensured that people’s privacy and dignity was maintained.

Staff supported people to maintain and develop their interests and hobbies.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People and their representatives knew how to make a complaint.

There were 15 people using the service at the time of our inspection visit. People at the service were unable to communicate their views about their care due to the level of their dementia. However we were able to observe interactions with care staff and also spoke with two visitors.

Is the service safe?

The provider and staff were not clear about their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (Dols). Although no Dols applications had been made, some staff were not aware of the circumstances when an application should be made and did not know how to submit one. Where people lacked capacity and decisions needed to be made in their best interests, the provider had not acted in accordance with legal requirements.

Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

Medication was not always being stored at the correct temperature and there was the potential for their efficacy to be reduced. There were no clear protocols for administering medicines in a covert manner. One person's care records contained no medication care plan.

We also saw one person being assisted to move using an unsafe underarm technique and brakes were not always applied to wheelchairs when stationary. This meant there was the potential for an injury to occur.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staff recruitment, medication management and capacity and best interest decision making.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was limited evidence of people being involved in assessments of their needs and planning their care. We found that one person's risk assessment had not been reviewed since March 2012. This meant there was the potential for unsafe care.

People had access to a range of health care professional which included doctors, opticians and dentists. This meant peoples health needs were addressed.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to updating risk assessments.

Is the service caring?

People at Windsor Park Nursing Home were living with dementia. We spent time observing staff interacting, assisting and supporting people and saw that they mostly did this in a caring manner.

Our observation showed us there was little activity taking place during our inspection visit. We saw that people who were unable to move were remained seated throughout the day, including mealtimes.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the care and treatment people received.

Is the service responsive?

We saw that some improvements had been made since the last inspection visit in November 2013. These included further developing people's care plan records to reflect their individual care needs.

The induction program was not thorough, which did not ensure staff were properly trained and was not in line with recognised standards within the care sector.

Staff had not received specialist training in dementia and were not aware of some of the best practice guidance in relation to dementia care.

The staff were trained in the MCA and the Dols. However staff had a limited understanding on how to support people who could not make decisions for themselves when required.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to support workers with regards to induction and training.

Is the service well-led?

Staff understood their role and responsibilities for meeting people's care needs and reporting any concerns or changes in people's health and safety needs.

There was a lack of clarity in the arrangements in place for the day to day management of the service. The provider told us that the registered manager had reduced the days they worked at the service, however it was not clear what the current management arrangements were.

The service has a quality assurance system, however this was not robust. It did not manage risks to the health, safety and welfare of people using the service and others.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

There were 17 people using the service at the time of our inspection visit.

People at the service were unable to communicate their views about their care due to the level of their dementia. We were able to observe interactions with care staff and also spoke with some people's relatives.

We spoke with two visitors at the service they told us they were happy with the care and supported their relatives received at the service. They also told us that they were able to report any concerns they may have to staff or the manager.

Since the last inspection some improvements had been made in staff training. We found that some staff had undertaken training on the Mental Capacity Act 2005 (MCA) and on Deprivation of Liberty Safeguards (DOLs), which was lacking at our last inspection. However we saw no confirmation that the remaining staff had been booked on to training in this area.

The provider did not have effective systems in place to assess and monitor the quality of service that people receive, and to identify and manage risks to people using the service and others.

People's care records did not include all essential information and provide a clear account of the care and treatment provided to each individual. This did not protect people against the risks of unsafe or inappropriate care and treatment.

We found that care records did not include all the essential information or provide a clear account of the care and treatment provided to keep people safe. Assessments did not confirm people's level of understanding in making day to day decisions and the support they need to make these decisions. This meant that people's ability to make decisions when possible was not being promoted.

Since our last visit we saw that some signage had been put on display to help support people with orientation.

We found that medicines were not being given to people safely. This demonstrated that the provider did not have effective procedures in place in managing medicines safely and did not ensure people received medicines in a safe way.

Training information showed that some progress had been made in this area since our last visit. Some staff had received training in key areas, whilst others had been booked onto future training. We did not see any evidence to confirming whether or not staff had received training on the mental capacity act and deprivation of liberty safeguards. This did not ensure that all staff were familiar with potential restrictions of liberty.

Visitors told us 'staff are very friendly' and 'the staff are understanding, there always seems to be enough staff around.'

When support was required by people at the service, staff provided this in an unhurried manner.

Three people we spoke with stated the food was good and told us they enjoyed their meals.

The environment was limited in providing orientation and memory objects to support people with dementia, which can be used to promote the wellbeing of people.

There was no recorded evidence on the care plans we looked at that people's mental capacity was being considered in relation to their decision making.

One person, who had been at the service since December 2012, did not have a care plan. This meant that staff did not have sufficient information to support this person.

Records demonstrated that people accessed health care professionals as and when needed. This showed that arrangements were in place to meet people's health care needs.

Not all areas of staff training were in place or up to date. This did not ensure people's health and welfare needs were met by a competent staff team.

Effective systems were not in place to identify, assess and manage risks to the health, safety and welfare of people using the service.