Windsor Court

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.At our last assessment we rated this key question requires improvement. We found a breach of regulation relating to poor governance. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. The service is no longer in breach of regulation.

This service scored 75 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.The provider and registered manager had worked hard to improve the culture in the service. Promoting a shared vision across the staff team and leading with openness and honesty.Staff told us they felt empowered and that they were all working to a shared goal. One staff member said, “I am proud of how friendly everyone is, the atmosphere is better, and everyone is helpful.” Another staff said, “Everyone has worked really hard, we all know our roles now and are comfortable.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.The registered manager and deputy manager were passionate about providing good care to people. People and staff told us the management team were capable and inclusive, leading with an ‘open door’ policy. One staff member said, “[Registered manager] is very good, she is approachable, and we can go to her with anything, she will sort it out.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.Opportunities were given to all people to share views openly across the service. Staff attended regular meetings to discuss the care, share best practice and give their opinions on how they could improve. One staff member told us, “We are always asked to have our say.”Records reflected that people’s voices were heard by the management team and action was taken when needed to implement change.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.There was an inclusive and fair culture with equality and equity for staff. All staff were positive about working at Windsor Court and felt they were treated with respect.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.The registered manager had good oversight of the service and was supported by the deputy manager to review care and safety at all levels. A series of audits were taking place which covered all areas within the service and meetings were held to review care standards. Action plans had been developed when indicated, these were reviewed and signed off as complete. Further governance was in place from the Area Director who completed unannounced checks to ensure the service was running at a continued good standard. The senior leadership team collected information surrounding risk, analysing this for common trends so the service could improve. Staff had clear roles and responsibilities and were confident in using the systems in place to manage risks, review care and act when things went wrong.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The management team expressed an open positive attitude to receiving support and understood how and where they could access support, to ensure continuous improvement to the service. Appropriate referrals were made to local authorities to support where needed. Links within the community were continuing to grow with the help of the activities coordinator who approached local schools and churches.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.The provider had made investments into the service to help it improve and innovate the care. For example, a new electronic care record system had been introduced with the aim of improving recording while allowing more time for staff to spend with people. Further investment plans were in place which included the upgrading of the call bell system to help ensure care was timely and continued to meet people’s needs.The registered manager had oversight of accidents and incidents in the service. Staff knew how and when to report events and escalate concerns. A system was in place for the investigation, review and debrief process which helped ensure improvements were made if indicated and people could reflect and learn from when things went wrong.