Winscombe Care Home

Winscombe Care Home offers accommodation for up to 28 people with a physical or learning disability. The property is set back from the road in large grounds with car parking available. All accommodation is on ground level.

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.

We previously inspected Winscombe Care Home on 7 December 2016 and found the provider did not always follow the requirements of the Mental Capacity Act 2005. We also found quality assurance systems were not effective. We issued a breach of Regulation 11 of the Health and Social Care Act 2014, Need for consent and a breach of Regulation 17 of the Health and Social Care Act 2014, Good governance. At this inspection we found improvements had been made and the provider had met the regulations.

There is a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Safe arrangements were in place for the selection and recruitment of staff.

The provider had safe arrangements in place to support people with their medicines.

There were effective arrangements were in place to reduce the possibility of infection.

Staff received training appropriate to peoples’ needs and were regularly monitored by a senior member of staff to ensure they delivered effective care.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and worked with advocacy agencies, healthcare professionals and family members to ensure decisions made in people’s best interests were reached and documented appropriately

People were not unlawfully deprived of their liberty without authorisation from the local authority. Staff were knowledgeable about the Deprivation of Liberty Safeguards (DoLS) in place for people and accurately described the content detailed in people’s authorisations.

People were protected from possible harm. Staff were able to identify the different signs of abuse and were knowledgeable about the home’s safeguarding processes and procedures. They consistently told us they would contact CQC and the local authority if they felt someone was at risk of abuse. Notifications sent to CQC and discussions with the local authority safeguarding team confirmed this.

Staff interacted with people and showed respect when they delivered care. Relatives and healthcare professionals consistently told us staff engaged with people effectively and encouraged people to participate in activities. People’s records documented their hobbies, interests and described what they enjoyed doing in their spare time.

Records showed staff supported people regularly to attend various health related appointments. Examples of these included visits to see the GP, hospital appointments and assessments with other organisations such as the community mental health team.

People received support that met their needs because staff regularly involved them in reviewing their care plans. Records showed reviews took place on a regular basis or when someone’s needs changed.

The service had an open culture where people told us they were encouraged to discuss what was important to them. We consistently observed positive interaction between staff and people.

There were effective arrangements were in place to investigate and respond to complaints.

The provider was open and honest about the improvements they wanted to make and provided examples where they had learnt lessons and implemented change.

Appropriate arrangements were in place to support people towards the end of their life.

People were supported to participate in a wide range of activities they had chosen.

Winscombe Care Home offers accommodation for up to 28 people with a physical or learning disability. The property is set back from the road in large grounds with car parking available. All accommodation is on ground level. At the time of our inspection there were 28 people using the service.

The service had a registered manager in place. 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.

Staff had received training on Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS) and demonstrated an understanding of how to support people who may lack capacity to make their own decisions. Four people were subject to DoLS authorisations at the time of the inspection but we found that one authorisation had expired. Evidence of consent was not always present in records.

There were some systems in place for monitoring and assessing the quality of the service but they had not picked up on all of the issues that we found. Feedback was regularly sought from relatives of people who used the service but action plans were not formulated to ensure this feedback was acted on.

There were systems and processes in place to protect people from the risk of harm. Staff had received safeguarding training and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing (telling someone) procedures and all said they felt confident to report any concerns without fear of recrimination. The registered provider had up to date safeguarding and whistle blowing policies in place.

A new electronic system had been introduced for the management of medicines. Staff had been trained in the use of this system and daily reports were available to the registered manager to check people were receiving their medicines as prescribed. Staff had received medicines training but had not had their competency checked regularly.

There were sufficient numbers of staff on duty to meet the needs of people who used the service.

Safe recruitment and selection procedures were in operation and appropriate checks had been undertaken prior to staff starting work.

We saw that environmental risk assessments had been carried out. Safety checks and certificates were in place for items that had been serviced and checked such as fire equipment, gas and electrical safety. There was a contingency plan in place in case of an emergency.

Staff had all received mandatory training and demonstrated they had the skills and knowledge to provide support to the people they cared for. Staff received supervision but had not received annual appraisal.

The records we viewed showed us that people had appropriate access to health care professionals such as dentists and opticians and the service was visited regularly by a GP.

We saw that people were provided with a choice of healthy food and drinks to help ensure their nutritional needs were met. People were involved in the menu planning and kitchen staff were happy to accommodate changes to the menu if people requested it.

During our inspection we saw people engaged with staff in a positive way and there was a relaxed feel around the service. Staff knew the people who lived at the service well and we saw that they responded to their care needs appropriately. People told us that staff encouraged independence and respected their privacy and dignity.

We observed that people were encouraged to participate in a variety of activities that were meaningful to them. People were supported to go out into the local community on a regular basis and also went on outings of their choice, for example to the beach, zoo and cinema.

We looked at care plans and found that they covered all aspects of care and were person centred. However care plans for people on respite did not always include sufficient information.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Is the service safe?

People had individual risk assessments. Where a risk or need had been identified, there was a written plan to inform staff as to how to reduce the risk. We saw people had access to medical support as necessary. The service had improved on infection control procedures and was clean and hygienic. People told us they felt safe at the service. We saw there were procedures in place to maintain their safety. Staff had been trained to recognise abusive practices and respond to any concerns they may have. There were enough staff to support people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found staff had been trained to understand when an application should be made, and how to submit one. There were proper policies and procedures in place and these had been followed.

Is the service effective?

We observed people were happy with the care they received and they told us they were happy. It was clear from what we saw and from speaking with staff they understood people's care and support needs and they knew them well. People assessed as not having capacity to make decisions were supported to ensure decisions were made in their best interest.

Is the service caring?

We observed that staff had a good understanding of people's support needs. They were supportive and were available when people needed them.

Is the service responsive?

Records showed people's preferences, interests had been recorded and care and support had been provided to meet their wishes. People were supported to maintain and increase their independence.

Is the service well-led?

People were asked their views and these were listened to. The provider had been proactive in making improvements to the service. There were systems to record, monitor, evaluate and improve the service, care and support that people received.

We saw at this inspection that changes had been implemented to ensure staff received appropriate training and support. There was a plan for training and the provider had invested in a training package to ensure staff received the training they required.

People were not fully protected from the risks of cross infection. This was because systems were only in the process of being implemented to assess the risk of, and to prevent, detect and control the spread of health associated infection. However we saw that some improvements had been made to the environment, such as the replacement of stained flooring for flooring that was easier to keep clean.

We had received some concerns about recruitment practices at the home. We looked at the recruitment practices and saw that recruitment checks were completed before new members of staff commenced employment at the home.

We saw that people's care and welfare was promoted with the use of personalised care plans. They were supported to attend health care appointments and where appropriate they were able to consult with heath care professionals in private.

People were protected from the effects of abuse by a staff team who had a good understanding of safeguarding procedures.

The environment of the home was maintained to an adequate and safe standard; however some areas of the home were shabby in appearance, notably the carpets. There was a plan to refurbish and develop the home. People were not fully protected from the risks of cross infection. This was because there was not an effective operation of systems to assess the risk of, and to prevent, detect and control the spread of health associated infection.

People expressed that they were confident that staff had completed relevant training. We were told that staff 'know what they need to do and are on the ball'. However, records of staff training were not up to date and there was no plan for staff training.

People who used the service knew how to make a complaint and were confident that the registered manager would respond promptly and appropriately to any complaints made.