Windsor Court

Windsor Court is a residential care home providing personal and nursing care to 48 people aged 65 and over at the time of the inspection. The service can support up to 77 people. The service is split into four units across two floors.

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

Systems in place to monitor and improve the quality of the service had not always been effective. Areas identified at this inspection had not been addressed. Improvements were required to ensure effective communication with people’s relatives and staff.

There was not always enough staff to meet people’s needs. Systems in place to assess the staffing levels and rota staff on shift were not always accurate.

The environment was not suitably maintained, for example attention was required to some flooring and carpets.

Records were not always fully detailed or accurate. This included medication records, care plans and risk assessments.

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.

A new senior management team was supporting the service. They were in the process of auditing the service and making improvements but required further time for these to be embedded and sustained.

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 inspection was a targeted inspection therefore the service did not receive a rating (published 18 March 2020). This meant the provider kept the rating of good from the previous inspection published 20 November 2018.

Why we inspected

We received concerns in relation to infection control and from our internal monitoring systems. 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 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 Windsor Court 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 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 the maintenance of the building, staffing levels and systems to monitor and improve the quality of the service 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.

Windsor Court is a residential care home providing personal and nursing care to 60 people aged 65 and over at the time of the inspection. The service can support up to 77 people. The service is separated into four separate units over two floors.

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

Care plans were in place for pressure area care on two of the nursing units. However, they were not always in place on the residential units. The management team were in the process of reviewing all care plans.

Staff had recently received training in specific areas, including pressure area care. The management team completed competency assessments on staff to ensure they were providing safe, effective care.

The provider was supporting the service and had completed a recent audit to identify improvements. An action plan was being used to ensure the identified improvements were made. Significant work had been carried out on the nursing units, but further work was required on the residential units.

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

Rating at last inspection

The last rating for this service was good (published 24 November 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about skin care. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Windsor Court is a purpose-built care home within the town of Goole. It provides accommodation and care for up to 77 older people, people with a physical disability and people who have a dementia related condition. The home is divide into four units across two floors which are accessible by stairs or a lift. At the time of our inspection there were 72 people living at the home and receiving a regulated service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The registered manager was clear about their role and responsibilities and had submitted the required notifications to the CQC about important events.

Systems and processes were maintained and staff had received appropriate training to ensure people were protected from avoidable harm and abuse.

Assessments of risks associated with people’s care and support and for their environment had been completed. Support plans provided information for staff and other health professionals to ensure people received safe care and support without undue restrictions in place.

Staff recruitment included pre-employment checks that meant only suitable employees were recruited to work in the home.

Systems and processes ensured safe management of medicines and infection control.

People received appropriate care and support to meet their individual needs because staff were supported to have the skills, knowledge and supervision they needed to carry out their roles.

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 supported this practice.

The registered provider was committed to providing people with a positive caring partnership with staff who were clear about the importance of paying attention to people’s well-being, privacy, dignity and independence.

The provider ensured everybody received care and support that reflected their wishes and preferences and this information was recorded.

People continued to be involved in shaping their care and support. Records were evaluated for their effectiveness and amended to ensure they were up to date and reflective of the person’s current needs. Support plans continued to be person-centred.

Staff supported people to live as they choose and to enjoy a variety of meaningful activities.

Systems and processes were in place to support people should they need to raise a complaint.

A quality assurance system remained effective. Oversight by the registered manager ensured outcomes were evaluated for their effectiveness with timely action implemented where improvements were required.

Further information is in the detailed findings below.

Windsor Court is a purpose built care home within the town of Goole. It provides accommodation and care for up to 77 people. The service has four units and looks after older people, people with a physical disability and people who have a dementia related condition.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who was registered with the Care Quality Commission (CQC). 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.

Services that provide health and social care to people are required to inform the CQC of important events that happen in the service. The registered manager had not informed the CQC of all significant events. This meant we could not check that appropriate action had been taken. This was a breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s assessed needs. Staff had been employed following appropriate recruitment and selection processes and we found that the recording and administration of medicines was being managed appropriately in the service.

We found assessments of risk had been completed for each person and plans had been put in place to minimise risk.

The home was clean, tidy and free from odour and effective cleaning schedules were in place. It was decorated to a high standard and people’s rooms were personalised.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the home deemed essential, such as, safeguarding, moving and handling and infection control and also home specific training such as dementia awareness.

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act (MCA) (2005) guidelines had been fully followed. The home did not use restraint but the registered manager understood the process to ensure that any restraint was lawful.

People’s nutritional needs were met. People told us they enjoyed the food and that they had enough to eat and drink. We saw people enjoyed a good choice of food and drink and were provided with regular snacks and refreshments throughout the day.

People told us they were well cared for and we saw people were supported to maintain good health and had access to services from healthcare professionals.

We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living in the home. People were able to make choices and staff supported them to maintain their independence.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported.

The home employed activity coordinators and offered a variety of different activities for people to be involved in. People were also supported to go out of the home to access facilities in the

local community.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were appropriately actioned.

We found the provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. The food offered to people was well cooked and offered them a choice of meals. Care was personalised and reflected people's choices and decisions. Care records were up to date.

The home was designed to meet the needs of people who lived there and the provider ensured equipment used to assist people with their daily lives was regularly maintained, safe and fit for purpose. One person who used the service told us 'Staff use the hoist to help me with my personal care, they are competent and I feel safe at all times.'

Staff received an induction and attended training to ensure that their skills and knowledge remained up to date. The manager also regularly supervised their work practice.

The provider had an effective quality assurance system in place and people's views and opinions of the service were listened to and acted on where necessary.

We found that improvements had been made to both infection control and medication practices within the service. The provider and manager had acted on the information in the report from September 2012 and made positive changes to working practice, staff training and the environment.

People told us that they had a good choice of social activities to take part in and the meals provided at the service offered them lots of choice and variety. People said they enjoyed living in the home and the staff were friendly and supportive.

People said that they had good access to outside healthcare professionals and they were satisfied with the level of medical support given to them. They said staff were good at giving them their medication on time and when they needed it.

People understood about safeguarding of adults and told us that they felt safe within the service. They told us there was an open door policy within the service which worked well and they were confident of using the complaints system if they needed to.