Winslow

Winslow is a nursing home and accommodates up to six people with a learning disability and/or autistic people. Some of whom have additional needs relating to their mental health. People had their own individual apartments and received high levels of staff support. On the day of our inspection, six people were living at the service.

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

Fire safety was not always regularly monitored and managed, and this put people at risk of harm. We shared our concerns about fire safety with Fire Prevention Officer. Processes for reporting and responding to safeguarding concerns was not always effective which resulted in delays in referrals to the Local Authority. Governance systems were not fully embedded in the service which lead to shortfalls in the overall quality of the service. Regular feedback from people and their relatives was not regularly sought.

People had person centred and detailed support plans and risk assessments to guide staff on how to safely support them. Care plans reflected people's current needs and had been regularly updated. People had received their medicines as prescribed. Infection prevention and control processes were in place and were effective. Staff were recruited safely, and pre-employment checks were completed.

People were supported and encouraged to have good and fulfilled life. People were supported by staff who knew them well. People’s physical and mental health was monitored and when it was needed, help from external healthcare professionals was requested. People’s apartments were person centred and decorated based on their likes and preferences.

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, however, the policies and systems in the service did not always support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, effective and well-led key questions the service was able to demonstrate how they were meeting underpinning principles of Right support, Right Care, Right Culture. People were encouraged to access local community with and for some people without staff support, and to be as independent as this was possible. People were offered choices about their day to day life. For example, people made decisions about what they would like to do during the day or what food they would like to eat. Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives. The registered manager and staff were passionate about improving people’s quality of life.

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

Rating at last inspection (and update)

The last rating for this service was good (published 9 October 2019).

Why we inspected

We received concerns from Local Authority in relation to reporting and managing safeguarding concerns and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective 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 full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to fire safety and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Winslow is a nursing home and accommodates up to six people with a learning disability and or autism and mental health needs. People had their own individual apartments and received high levels of staff support. On the day of our inspection, six people were living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Staff had received an induction and ongoing support and training. However, mental health awareness training was limited in detail. Action was being taken by the management team to improve staff training. Nursing staff had not consistently monitored a person's physical health needs. Action was taken to improve this.

People had complex needs and received high levels of staff support. The use of agency staff had greatly reduced, people were receiving continuity and consistency in care and this was having a positive impact. Robust recruitment procedures were in place to ensure only staff suitable to care for people were employed.

People's medicines were managed safely, staff followed national best practice guidance. Risks associated with people needs had been assessed and planned for. Information to guide staff in the use of physical intervention lacked specific detail in places. However, staff were aware of risks and the action to reduce and managed these. Record keeping was an area the management team had identified needed improvement and had taken action to address this.

The internal and external environment was clean, well maintained and met people's individual needs and choices.

Staff were knowledgeable about people's needs and what was important to them, including diverse needs. Staff were kind, caring and supported people with a positive and respectful approach. People received a variety of ways to discuss their care and treatment needs and received support from an independent advocate. Improvements were being introduced about the involvement of people and their relatives or advocate, in formal meetings.

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. However, mental capacity assessments had not been completed in the use of physical intervention. The management team were aware of this and had plans to address this.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Some people had successfully moved on to live more independently. People told us they were happy with the care and treatment they received.

People were encouraged to make choices for themselves. Each person had their communication needs assessed and staff used effective communication and listening skills. People participated in hobbies and interests of their choice and supported to develop new friendships, which helped avoid isolation. Systems and processes were in place to monitor, analyse and manage complaints. People’s end of life wishes had not been discussed with them, but the management team were aware this needed to be completed.

Staff were positive about their role and shared the registered manager’s values in providing person centred, open and transparent care. Staff were clear about their role and responsibilities and governance systems were in place that continually monitored the quality and safety of the service. People, relatives and staff received opportunities to give feedback and this was used to develop the service. The provider and registered manager had met their registration regulatory requirements.

Rating at last inspection

The last rating for this service was Requires Improvement (published 11 September 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Winslow is a nursing home and accommodates up to six people with a learning disability and or autism and mental health needs. People had their own individual apartments and received high levels of staff support. On the day of our inspection, six people were living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

A registered manager was in place but they were not based at the service and were not available at this inspection. On the day of our inspection a new manager was in place who was due to take over as registered manager. 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.

Staffing levels were sufficient but concerns were identified in the staff skill mix. Agency staff were frequently used to cover staff shortfalls whilst new permanent staff were recruited, but this could have been better planned for. Safe staff recruitment practices were followed.

There were insufficient systems and processes in place to ensure the management of medicines and infection control measures, were effectively and safely monitored and managed.

Adult safeguarding policies and procedure were in place and followed to protect people. Risks associated with people’s needs, including the environment had been assessed and planned for. People had complex mental health needs and positive behavioural support plans were used, to provide staff with guidance of how to manage behaviours safely and effectively.

Accidents and incidents were recorded, monitored and analysed to ensure people received safe support and if lessons could be learnt to reduce further risks.

People had received an assessment of their needs that also considered their protected characteristics under the Equality Act, to ensure they did not experience any form of discrimination. People were involved in agreeing the plan of visits to the service before they moved to the service permanently. This is known as a transition plan.

Staff received an induction and ongoing training relevant to people’s needs and support, to enable them to provide effective care and treatment.

People received sufficient to eat and drink, they were involved in menu planning and staff encouraged health eating and independence was promoted.

People’s physical and mental health needs were assessed, planned for and monitored. Staff worked effectively with external health care professionals to support people with good health outcomes.

People lived in an environment that met their individual needs and preferences. They had opportunities to spend time with others in communal areas if they choose.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of the principles of the Mental Capacity Act 2005.

People were supported by a core staff team, who were caring, compassionate and who knew their needs, preferences and what was important to them. Staff respected people’s privacy and dignity, encouraged people with choice making, and promoted independence. Independent advocacy support was provided. People who used the service were involved in their care and treatment as fully as possible. Relatives and external professionals were involved in meetings to discuss and agree how care and support was provided.

People’s diverse needs, routines, preferences and what was important to them had been assessed and support plans provided staff with detailed information of how to support people. Staff had a person centred approach in how they supported people and social inclusion was promoted. Plans were being developed to support people with individual goals and aspirations.

People who used the service, relatives, staff and external professionals were positive about how the service met individual needs. There was an open and inclusive, person centred approach with a clear vision and plan of how the service was to further develop. The systems and processes in place that monitored quality and safety, needed to be further developed within the service.

During this inspection we found one breach of the Care Quality Commission ((Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.