Windmill Care Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 57 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.
We observed some staff did not always interact with people in a person-centred way. For example, we observed an interaction where one staff was observed telling a person, “Let’s have a seat, no I’m not going to talk to you. Let’s sit down, you will fall down, end up in hospital” We observed the person did not want to sit down, and staff said, “You do what you want” This type of language did not demonstrate a positive person-centred culture was always promoted. We received mixed feedback from staff and people using the service about person centred care provision. One person told us, “They talk about going out, going out on a day trip or something; it doesn’t happen. They can be all talk and no action.”

Staff did not always feel the organisation and coordination of the workforce supported them to deliver most effective person-centred care. For example, one staff member told us, “Staff moving from floor-to-floor changes can affect residents’ mood, and behaviour such as becoming aggressive and uncooperative and refusing to eat.” This demonstrated the service did not always ensure support was managed and co-ordinated in a way in which everyone worked well together to ensure people’s needs were at the centre of care.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.
One person was assessed by the tissue viability nurse (TVN) as requiring two-hourly support with repositioning to maintain the healing of a sacral ulcer and to prevent further skin breakdown. However, care records demonstrated that this clinical guidance was not consistently followed, with multiple documented occasions where repositioning was delayed for over three hours. This failure to adhere to an essential pressure area care intervention placed the individual at risk of further skin deterioration, infection, pain, and long-term complications. This meant people’s care and treatment was not always delivered in a way that met their assessed needs from partnership services. The provider failed to ensure care was always joined up, and in continuity with the recommendations set out from partnership healthcare professionals.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.
People did not always feel informed and up to date with their care delivery. We received mixed feedback from people and their relatives. One person told us, “They don’t really ask if you’re happy with things, I’m not sure about a review”. Another person told us “I’ve no idea how to make a complaint, I have plenty of criticisms”.
The registered manager told us accessible information standards were available if requested, such as large print or braille according to people’s individual needs. However, care plans lacked detail how information could be best provided for people where they required greater support with their communication needs. For example, one person was assessed as having communication support needs. Despite this, there was no guidance for staff how to best communicate with them, apart from verbal communication methods. Another person was to have all their needs anticipated and decisions made in their best interest, as they were not always able to communicate their needs effectively. Their care plan did not demonstrate what alternative provisions of information was available for this person to ensure support was provided according to their individual needs. The provider did not demonstrate they always explored alternative communication methods and techniques to best support people according to their individual needs.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.
Feedback from relatives demonstrated they did not always feel involved in decisions about their relative’s care and treatment. One relative told us, “communication is not good”.
We also received mixed feedback from people using the service. One person told us, “I think they do listen, although things don’t always get sorted out”. Another person told us, “We try to get things done. Look at the carpet – it’s filthy and needs replacing”. People also told us they were not always aware of the management team. One person told us, “Sometimes it is very difficult to find out who the management are”.
The service had opportunities for people to become ‘Resident Representatives’. One representative told us, “There’s a meeting once a month. Because I’m one of the ambassador’s I go to the meeting, it is solely for residents.”

People were supported to access the care, support and treatment they needed. People we spoke to told us they could access doctors, opticians and chiropodists who visited the service. The registered manager told us how they worked together with staff and implemented an on call system to ensure staff cover would always be available, so people could always access care, support and treatment.
We saw some people were supported to access the community and participate in activities which were meaningful to them, such as gardening and shopping.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.
We found the environment of the service did not always support people who are most likely to experience inequality in experience or outcomes. The home environment was not adapted to the needs of people living with dementia. This did not ensure people were supported in line with nationally recognised best practice guidance on environments supporting people living with dementia. For example, we found the toilet seats and taps were not distinctive in colour, handrail colour choice blended into the wall colour. There was a lack of seating along long corridors, and the ends of the corridors did not have distinctive artwork to signify this. We observed the garden area presented with some hazards, making this difficult to navigate some areas and presenting a risk when doing so. We noted large display clocks were not accessible in every lounge and dining room, and we did not observe clear and distinctive signage to the toilets in the corridors. This meant people’s care was not always tailored in response to their needs. These elements of the environment did not ensure people with dementia were supported to experience better outcomes.
 

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.
The manager told us they were supported by the GP with future planning and requested additional training for staff to support them with these discussions with families. The manager told us, “You need to slowly introduce [families] to the topic but in a way that it’s just to let them understand the cycle of life.” People had individualised end of life care plans which detailed their preferences for the location of care and who should be involved in their care and any decisions taken.