Winchester House accommodates a maximum of nine older people, including people who live with dementia or a dementia related condition, in one residential style building which has been adapted for that purpose. Winchester House is a large detached house situated on a main road in a residential area of Kirby Cross, Frinton on Sea, and is close to local shops. The premises is set out on the ground floor of the building with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service. At the time of our inspection eight people were using the service.
At the last inspection in February 2018, we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 and the service was rated 'Requires Improvement' overall. The registered manager sent us an action plan detailing the actions that they were going to take to make the necessary improvements. At this inspection we found the service had made all the required improvements and has now achieved an overall rating of ‘Good'.
A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from risks relating to their physical and mental health and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.
Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence.
Recruitment procedures were in place to help ensure only people of good character were employed by the service. Staff underwent Disclosure and Barring Service (DBS criminal record) checks before they started work.
Staffing numbers at the service were sufficient to meet people's needs. Staff received regular supervision and appraisal.
Staff supported people to take their medicines safely and staffs' knowledge relating to the administration of medicines was regularly checked.
Staff received thorough training in all areas relating to people's individual health needs and holistic activities. Staff also received support from external healthcare professionals about how to best care for people.
Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put this into practice. People were involved in all aspects of their care and were supported by staff to communicate their wishes, likes, dislikes and decisions. People were supported through the use of verbal communication, pictorial forms and accessible communication formats.
People were supported to have enough to eat and drink in ways that met their needs and preferences. Meal times were social events and people were supported to ensure their specific needs around food and drink were met.
Staff demonstrated to us they cared strongly about people's wellbeing in every aspect of their lives and worked towards improving each person's happiness and wellbeing. Staff promoted people's equality, diversity and ensured their human rights were upheld. Staff spoke confidently to us about how they upheld people's rights and gave us examples which demonstrated they put people's individuality and personal wishes first.
Staff treated people with respect and kindness. There was a warm and pleasant atmosphere at the service where people and staff shared jokes and laughter. Staff knew people and their preferences well.
The people who lived in Winchester House were provided with high quality, safe, caring, person centred support which was responsive to their needs. People received personalised support and there was a clear understanding that staff saw each person as an individual, with their own social needs.
People had access to health care professionals as and when needed and when people moved into the service staff assessed their needs in order to help ensure they could provide appropriate care. Staff worked in conjunction with external agencies to provide suitable and responsive care to people.
Staff. people and relatives told us they felt comfortable raising concerns. People, staff and relatives felt involved in the service and we heard that people felt the service was well managed. Where ideas and suggestions had been raised these were listened to and relatives told us the registered manager was approachable and managed the service well.
Staff told us they felt supported and valued by the registered manager and enjoyed working in the service. The registered manager was aware of their statutory duties in relation to registration with CQC and as such had notified us of any significant events. The registered manager had a clear vision for the service and the care they wished to provide.
People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.
Further information is in the detailed findings below.
Winchester House accommodates a maximum of nine older people, including people who live with dementia or a dementia related condition, in one residential style building which has been adapted for that purpose. Winchester House is a large detached house situated on a main road in a residential area of Kirby Cross, Frinton on Sea, and is close to local shops. Each person using the service has their own individual bedroom and adequate communal facilities are available for people to make use of within the service. At the time of our inspection eight people were using the service.
A registered manager was in post. The registered manager was also the registered provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
At the last inspection in October 2015, the service was rated 'Good'. At this inspection we found the service had achieved a rating of ‘Requires Improvement’’ This inspection was brought forward in response to concerns we had received from the local authority. We have detailed these further in the background section of this report.
During this inspection, we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of registration. For adult social 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.
Although people raised no concerns with us regarding the care they received, we found records relating to people were not sufficiently well maintained and people were not always being cared for by an adequate number of staff. Although the provider carried out pre-employment checks for care staff, we found sufficient checks had not always been completed to ensure they were suitable to work at the service.
Individual risks to people had not been identified and action taken by staff to satisfy themselves that people were kept free from potential risks was not always carried out. Risk assessments in place did not contain clear guidelines for staff on how to support people and minimise risk levels.
People were protected from the risk of abuse. Staff had received training around this. There were recruitment systems in place however; procedures for these were not always followed consistently. People lived in an environment that, although clean, posed some potential safety risks.
Medicines management procedures were not always followed in line with best practice and the legal requirements in relation to the storage and documentation of medicines. Quality assurance processes in relation to care records and the monitoring of the service being provided were not robust. This included a lack of routine audits on areas such as medicines management.
The service provided to people was effective in meeting their needs, however staff did not all have the relevant skills and had not all received appropriate training and supervision to enable them to support people to meet their needs. Not all staff received good support from management through regular training, supervisions and appraisals.
Although people were cared for by staff who were kind, attentive and respectful to them, the multiple failings in regulation did not reflect a caring service overall and the provider did not ensure that people’s care met their needs at all times.
Care plans did not clearly reflect the needs of people or the care provided for them. The design of people's care plans made it difficult for staff to obtain up to date information. The health and safety audits of the service and reviews of people's care plans had not picked up on concerns or ensured people's care plans were up to date. There was no evidence to demonstrate the registered manager and registered provider had oversight of these processes.
Activities for people at the service did not meet the varied needs of people living at the home. People and relatives knew how to raise any concerns and told us they would feel confident to raise issues if they needed to.
The service was not well-led. Quality assurance checks and audits were not completed regularly and therefore did not identify the shortfalls within the service. During this inspection we found that systems and processes to maintain the quality and the standard of care being provided had not been effectively implemented and sustained. Records were basic and did not evidence the most relevant information in relation to the support needs of the person.
Audits systems and checks were not being used effectively as there were not any measures in place to monitor, assess or improve the delivery of care being provided. Audits/checks which were in place did not effectively measure the quality or standard of support being provided. Feedback from people who were being supported or their relatives about the quality of the service provided had not been formally gathered. This meant there were not any systems in place to gather feedback about what the service does well or what areas needed to be improved on.
We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and have made three recommendations with regard to recruitment procedures, dementia friendly considerations for the environment and social activity provision.
Despite the failings in the service, people felt safe living at Winchester House and staff were aware of their responsibilities to ensure that if they had any concerns about the way people were being cared for they should raise this. In the event of an emergency people's care would continue in the least disrupted way possible.
People were encouraged to make day-to-day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the registered manager and staff had not always acted in accordance with legal requirements. Where required, people and relevant professionals were involved in planning their nutritional support. People were support to access a variety of healthcare professionals and appointments were arranged.
People and their relatives gave us very positive feedback in relation to the staff and the way they treated them. We observed gentle, caring interactions between staff and people and it was clear staff knew people and their family members well. Staff, people and their relatives spoke positively about the staff and registered manager. There was a united team culture within the service and staff demonstrated a caring and good understanding of the people they cared for.
You can see what action we told the provider to take at the back of the full version of this report.
The inspection took place over two days on 16 October 2015 and 21 October 2015 and was unannounced.
Winchester House provides accommodation and personal care for up to nine older people. The service does not provide nursing care. At the time of our inspection there were seven people using the service.
The service was managed on a day-to-day basis by the provider, who is also the registered manager, with the support of an assistant manager. 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.
People were safe because the management team and staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.
There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.
The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.
People’s health and social needs were managed effectively with input from relevant health care professionals and people had sufficient food and drink that met their individual needs and preferences.
The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.
People were treated with kindness and respect by staff who knew them well.
Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.
There was an open culture and the management team encouraged and supported staff to provide care that was centred on the individual.
The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.
As part of our inspection we checked on the standard that was not met at our last inspection in January 2013. This related to the management of medicines. At this inspection we found that the provider had made improvements in this standard and we found that it was now met.
People we spoke with told us they were happy with the way the service managed their medicines. But we found people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. There was insufficient guidance for staff on the use of some medicines.
One visiting health professional who responded to a recent satisfaction survey about the home commented, 'I would recommend Winchester House to anyone needing residential care. It is like visiting a home not an institution.'
People were generally very happy with the standard of meals and mentioned the fresh vegetables every day. They appreciated the fact that they could have a glass of sherry before and wine with their lunch if they wished. They told us that there were always choices and that staff were good at meeting their individual dietary needs. One person said that food was not always as hot as it should be. Two people considered that the home would benefit from a dedicated cook, rather than have care staff fitting in the cooking around their caring and cleaning roles. Some people said that they would like more activities and opportunities to go out.