Windmill Care Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.
This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulation in relation to consent.

This service scored 50 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
We received mixed feedback from people and relatives. One person told us, “They don’t really ask if you’re happy with things – I’m not sure about a review.” A relative told us “The admittance process was not good. I would have appreciated even a brief meeting with the manager. The deputy manager visited my relative in hospital and was there for all of five minutes”. Another relative told us, “We would very much like more input regarding our relative’s care. Because the meetings tend to be during the week and we work, we can’t make them. We would like to be more involved.”
We found care plans were updated when people’s needs changed. However, we did not always see evidence people’s needs were discussed with them to ensure people were involved in the assessment of their needs, and support was provided where needed to maximise their involvement.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.
One person was diagnosed with dysphagia, a condition which involves swallowing problems. This person required a modified diet prepared to pureed consistency to ensure safe swallowing and to reduce the risk of choking. However, records and observations showed that this person was provided with food in a range of unsafe textures, including liquidised, regular, and soft consistencies, which did not align with their assessed needs. This demonstrates a failure by the provider to ensure that care and treatment were delivered in a safe and person-centred way. The inconsistent preparation of food for a person with swallowing difficulties placed them at significant and ongoing risk of serious harm, including choking, aspiration, and potential hospital admission. The provider did not demonstrate staff always followed clinical guidance and care plans to ensure people received safe care and treatment.

The provider did not always work well across teams and services to support people. The provider did not always ensure staff were supported when providing care for people. Staff did not always feel there was consistency to ensure they were able to work effectively together when providing care. One staff told us, “There are three floors with different teams and numbers. It takes time to support people to eat and [not all staff] offer much help. It’s difficult.
We observed one staff was left alone to support 4 residents with high levels of needs. During this time, we observed people experiencing distress and wanting to leave the communal area. We observed leaders were not always visible and present and therefore were not always able to identify examples such as this where staff required additional support, and to identify how effectively teams worked together. Staff also told us, “Not enough [staff] on the first floor. No regular staff anywhere. We’re moved around which affects consistency.” This did not ensure care was always provided with continuity, and staff felt supported to work together.
 

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.
The registered manager told us how team meetings were used to discuss pending referrals and updates with staff. The service had a GP and pharmacist visit each week to support people with their health and wellbeing needs.
People’s independence was actively encouraged, and they had a choice regarding what they wanted to do to support their own wellbeing. People told us they were able to participate in activities, which helped people to maintain their wellbeing. We observed one person was supported to play music, and other people we spoke to told us about their gardening projects at the service. One person told us, “There are two activities people and they’re both really nice. One of them brings in a video tape and we do exercises to it.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and
consistent, or that they met both clinical expectations and the expectations of people themselves.
One person with high blood pressure required staff support to measure their blood pressure regularly and to report any abnormal reading to their GP. The person’s care plan did not specify important details to ensure staff could monitor, support and identify outcomes safely and effectively. For example, the care plan did not note what how frequently the blood pressure should be measured, and what ‘abnormal’ was for this person. This person’s care record showed their blood pressure was not regularly and consistently checked, and when some raised readings were measured, staff did not evidence they reported this to the GP. Therefore, the records did not always reflect care was being delivered in line with people’s assessed needs to ensure they could be monitored and improved.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. Where people lacked capacity to make decisions in relation to their care and support needs, we identified the principles of the Mental Capacity Act had not been adhered to, this included ensuring people were supported to make their own decision.
People’s rights were not fully protected when they needed covert medicines. There were 4 people receiving medicine covertly; this involves giving medicine to a person without their knowledge or consent. The provider’s policy noted this process would only be needed if people were actively refusing medicine. One person’s protocol stated the person did not have capacity, yet their care plan stated they could make simple decisions and would inform staff.
The provider did not keep complete accurate records of capacity, consent and decisions made by people or on their behalf in their best interests. Capacity assessments were carried out after the staff had already been using covert administration. There was a lack of evidence to show clear and meaningful meetings were held to discuss best interest decisions for people.