Windsor Care Centre

Windsor Care Centre is a purpose-built residential care home providing personal and nursing care for up to 72 people across 2 separate adapted floors. The service provides care to older adults some of whom live with dementia. At the time of our inspection there were 39 people living at the service.

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

Some significant improvements had been made, however, further improvements were still required to ensure people were safe.

We found whilst some aspects of medicines management had improved, other areas needed further improvements. Where people temporarily left the home, the provider did not have systems in place to ensure the continuity of medicines administration. This put people at risk of possible missed medicines. Where people were prescribed when required (PRN) medicines, person specific guidance was not in place to aid staff when making decisions to administer the medicine. Therefore, we were not assured that staff would consistently assess the residents need for PRN medicine administration.

Risks related to fire were not always managed safely. Recommendations made following fire inspections were not always considered or actioned. The provider’s auditing systems were not used effectively to manage fire risks and we identified some missed opportunities where learning could have occurred.

People’s risk of pressure damage was not always managed safely. There was no process in place to ensure mattress settings were checked and were correct. This put people at potential risk of pressure damage.

Whilst some improvements had been made with the provider’s quality assurance systems, we saw further improvements were still required. Quality assurance audits failed to pick up some of the concerns found during this inspection.

We acknowledged the provider had introduced new systems and processes, however, at the time of our inspection we were not assured of their effectiveness. Some of the processes had only been introduced for just over a month.

The provider had made some significant improvements such as staffing, staff training and communication. We saw these changes had made a positive impact on people’s outcomes. Staff genuinely looked happy and focused on making further improvements.

People told us they felt safe living at Windsor Care Centre. Staff knew how to identify and report any concerns. The provider’s recruitment and selection processes in place had improved and were safe.

People had an improved dining experience which offered a variety of appetising food choices that suited people’s preferences. People were supported to meet their nutritional needs and complimented the food at the home.

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, we saw the provider had identified some recording shortfalls which staff were working through.

The culture of the service had improved and was now open and inclusive, people felt communication from the new manager was good. Staff told us they felt supported and listened to. The manager sought feedback from people and staff and used this to improve the service. The manager and provider were committed to improving people’s quality of life. There was a clear management structure in place and staff worked well as a team. The provider had sought support from a consultancy company with the aim of continuously improving staff and people’s experiences. The provider had better oversight of the service. Staff worked well with external social and health care professionals.

Rating at last inspection and update

The last rating for this service was inadequate (published 11 October 2022). This service has been in Special Measures since 11 October 2022. During this inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

At our last inspection we recommended that the service implemented a plan to check people’s DoLS application statuses at regular intervals. We also recommended the provider made sure all staff were aware of the importance of offering people a choice of meals and they had enough support to enable them to have adequate nutrition and hydration. At this inspection we found the provider had acted on the recommendations and had made improvements.

Why we inspected

We carried out an announced focused inspection of this service on 17 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent, person centred care, safeguarding service users from abuse and improper treatment, premises and equipment, good governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

At this inspection we found whilst some improvements had been made, further improvements were still required as the provider remained in some breaches of regulations. You can see what action we have asked the provider to take at the end of this full report.

We undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to fire risk management, medicines management and quality assurance systems 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Windsor Care Centre can accommodate up to 72 people across two floors, each of which has separate adapted facilities. The service provides care to older adults. This also includes people who require respite care and people who are waiting discharge from hospital and need help to move from hospital back home or to another setting speedily, effectively, and safely. At the time of our inspection, there were 67 people living at the service.

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

Even though people and relatives felt the service was safe, we found people were placed at risk of avoidable and significant risk of harm.

We found unsafe practices in several areas relating to safeguarding adults at risk of abuse, identifying, assessing and managing risks, staffing levels, medicines management, safety of the premises and infection control. We have made a recommendation about recruitment.

The service did not always do everything reasonably practicable to make sure people who used the service received person-centred care. Assessments did not always consider current legislation. People and relatives said staff were well skilled to provide care and support. We found there was a lack of specialist training on how to manage people living with dementia, delirium and mental health issues. People’s nutritional and hydrations needs were captured but some staff did not always offer people a choice of meals and we observed staff rushing people and taking away their food when they had not finished. We have made a recommendation about this.

Improvements were required to ensure effective working with relevant health care practitioners, to ensure people, especially those with poor mobility have good health outcomes.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; The registered manager did not work in accordance with the Mental Capacity Act 2005 and its Codes of Practice. We have made a recommendation about this.

Quality assurance systems used to assess, monitor, and improve service delivery were inadequate. There was a lack of scrutiny and oversight at board level. This would ensure established quality assurance systems remained effective and the registered manager met regulatory requirements. Quality assurance audits failed to pick up on the concerns found during this inspection. There was no evidence to show lessons had been learnt when things went wrong. We have made a recommendation about the Duty of Candour.

The registered manager did take prompt actions to address concerns that required immediate action. However, a view of their training records showed, the level of role specific training undertaken for them to work within the regulatory requirements, and to assess and support staff with delegated responsibilities, was insufficient.

The culture of the service was not always open and inclusive, and people felt communication from the registered manager was poor and some staff felt they were not listened to. The registered manager sought feedback from relatives’ and staff but not all feedback was responded to and there were missed opportunities to make improvements to ensure peoples’ welfare and safety.

Some people, relatives and staff gave positive feedback about care, support and management of the service.

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 rating for this service was good (published 15 June 2018).

Why we inspected

The inspection was prompted in part due to concerns raised by a local authority and concerning information received relating to the management of people's care, medicine management, quality of care and management of the service. A decision was made for us to inspect and examine those risks. So, we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

After our inspection the registered manager sent supporting evidence to show risks to people from faulty wheelchairs were now mitigated.

You can see what action we have asked the provider to take at the end of this full report.

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. This included checking the

provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from good to inadequate based on the findings of this

inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well- led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Windsor Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

You can see what action we have asked the provider to take at the end of this full report.

We have identified breaches in relation to quality assurance; risk management; building and premises, safeguarding management; consent; person-centred care; management of medicines and staff training

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care 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.

Windsor Care Centre can accommodate up to 72 people across two floors, each of which has separate adapted facilities. The service provides care to older adults. People live in their own bedrooms and have access to communal facilities such as a bathrooms, lounges and activities areas.

Windsor Care Centre is also part of the ‘Trusted Assessor’ scheme. The scheme aims to reduce the numbers and waiting times of people awaiting discharge from hospital and help them to move from hospital back home or to another setting speedily, effectively and safely. At the time of our inspection, there were 42 people living at the service.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a registered manager in post.

This is our first inspection of the service since the provider registered with us on 6 March 2017.

People and relatives told us staff were caring, kind and compassionate. Some of the comments included, “Staff are kind, considerate, helpful and usually cheerful” and “So far they (staff) have been very good, kind and understanding.”

Staff had good knowledge of people’s care and support needs. People were treated with dignity; respect and their privacy was protected. People’s independence was promoted and their family and friends told us they had free access to them with no restrictions.

People and relatives felt they were kept safe from abuse. Staff were aware of their responsibilities to keep people safe from harm and abuse. People’s personal safety had been assessed and plans were in place to minimise them. There were sufficient numbers of suitable staff to support people to stay safe and robust recruitment practices were in place. Medicines were administered safely by competent staff and people were kept safe from infection.

People were supported to have maximum choice and control of their lives. The service was compliant with Mental Capacity Act and its codes of practice.

People’s needs and choices were assessed and care; treatment and support delivered to achieve effective outcomes. Staff respected people’s religious and cultural beliefs to ensure they did not discriminate against them when making care and support decisions. We have made a recommendation for the service to seek current guidance in relation to protected characteristics under the Equality Act 2010.

People and relatives felt staff were skilled and experienced. Staff were appropriately inducted; trained and supervised. However, we have made a recommendation for the service to seek current guidance and best practice in relation to dementia training for staff. The service worked pro-actively with other health and social care professionals to ensure people’s nutritional and health needs were met.

Most people felt they were supported to follow their interests and take in social activities. However, we have made recommendation for the service to seek current guidance and best practice on the provision of activities for people living with and without dementia. People or those who represented them could contribute to the planning of care, treatment and support. This ensured people’s plans of care were developed to meet their specific care and support needs. We saw plans of care and identified risks were regularly reviewed for their effectiveness.

People and relatives knew how to raise concerns and complaints were responded to appropriately. The service was compliant with the accessible information but this did not occur on a consistent basis. We have made a recommendation for the service to seek current guidance on meeting all aspects of the accessible information standard (AIS). To enable them to meet the communication needs of people with disability or sensory impairments.

People, relatives and staff spoke positively about the management of the service. We observed management were visible and easily accessible to people, relatives and staff during our visit. There were effective quality assurance systems in place to monitor the safety and quality of the service provided. People were given the opportunity to express their opinions about different aspects of the service. A joined-up approach by all key agencies to ensure people who came to the service from hospital under the ‘Trusted Assessor’ scheme received safe, effective, caring, responsive and well-managed care.