Windmill Care Centre

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 good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service was in breach of legal regulation in relation governance at the service.

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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.
We received mixed feedback regarding shared direction and culture of the service. Leaders did not always ensure there was a shared vision and strategy and that staff in all areas knew, understand and supported the vision, values and strategic goals and how their role helped in achieving them. The registered manager told us, “When it comes to opportunities for development and career progression, I always inform staff what is always available as long as they are determined to progress”, “they know I am always here to support them.” However, some staff expressed there was inequity in access to learning and training opportunities, with some staff completing courses which were not offered to others. Not all staff we spoke to told us they had regular and effective supervisions. This did not demonstrate the provider embedded a shared culture and direction within the workforce.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.
We received mixed feedback from staff regarding the leadership and accessibly to management. For example, one staff told us “Our manager doesn’t know much about the residents, only what’s on paper”, and “it’s not an open door and it’s not easy to speak to the manager”. We observed staff were frequently coming into an office to find the deputy manager for support, this did not ensure leaders were always visible and present across the service floors for staff and people. We observed examples where some staff became frustrated with repeated questions being asked from one resident, we gave this example to the management team and shared how this observation could have been noted by management had they been more present and visible for staff on the floor. We were not assured that leaders always maintained effective oversight of people’s care and staffing.
 

Staff did not always feel they could speak up and that their voice would be heard.
We received mixed feedback from staff. One staff told us, “Concerns [are] listened to, and manager tries to resolve.” Another staff told us, “Meetings [are] on Teams, not many attend, staff are scared to speak up”.
The provider had a whistleblowing policy in place, detailing guidance and the process of speaking up. The registered manager told us, “With staff I would say I am very approachable…it’s always about being human and knowing their feelings and what they are going through. If this whistle blowing didn’t happen, we wouldn’t have been able to correct what needs to be corrected.”
 

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.
Leaders demonstrated they took action to prevent and address bullying and harassment at all levels and for all staff. The registered manager told us, “We just had bullying and harassment training. Staff are aware how they can report it. Sometimes it’s more about investigating as it could be a misunderstanding. I am in close contact with HR (human resources), she comes regularly and speaks to staff.”
The provider had an equality and diversity policy in place. This included ensuring recruitment processes were inclusive to all persons, focusing on the skills, experience, alignment to values, and qualifications needed to perform the role. Staff told us, “We speak to [managers] all the time. They ask us if we need anything. They are very open.”
 

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.
The service did not demonstrate effective oversight or governance in managing people’s individual risks and behaviours. For example, staff reported feeling intimidated by one person using the service. However, the regional director said, “There was no risk of physical behaviour from this individual”. This was inconsistent with the person’s care plan, which clearly described behaviours such as frequent verbal threats to kill others, slamming doors, and entering other people’s rooms and closing the door behind them. This lack of awareness and disconnect between frontline experiences, care planning, and senior leadership response demonstrated ineffective governance and oversight. The registered manager did not ensure that multiple risks were being adequately monitored or managed. For example, risks around people’s behavioural needs, choking, pressure area care. This placed both staff and people at risk of avoidable harm or abuse.
There was a lack of effective oversight and governance in relation to staff bringing children into the service, which posed potential risks to the children themselves, as well as to the quality and safety of care provided to people. A new policy was being introduced following whistleblowing concerns, however, some staff continued to ask whether they could bring their children to work.
The registered manager did not ensure staff had completed safeguarding children training, nor did they demonstrate that risks associated with the presence of children had been adequately assessed. These included risks related to the administration and storage of medicines, safe evacuation in the event of fire, and appropriate supervision in communal areas. One member of the activities team told us that children were present in the lounge with residents and were only intermittently supervised by carers or activity staff. There was no evidence the manager had oversight of these occurrences or had considered their impact on residents’ experiences and wellbeing.
 

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.
We found some issues relating to people’s care and treatment which demonstrated care was not always delivered in line with partnership services. For example, one person’s care plan noted they had unstable diabetes; yet the service did not demonstrate they worked in partnership with community diabetes teams to support people in the service.
One professional told us, “Since they have recruited a new lead nurse, there have been some positive changes with regard to wound management and following recommendations.” We saw evidence of clinical meeting minutes, which demonstrated when community teams were involved with people’s care and wellbeing as part of collaborative working.
The provider had systems and processes in place to collaborate and work in partnership with health partners, social services and the local authority contracting teams. We reviewed people’s care records and found the service worked in partnership with external services and healthcare professionals to support people’s individual needs. For example, we found one person required regular support from the community mental health team to ensure their medicine was administered in line with their needs. We found their care plan contained detailed information around this to ensure all involved in this person’s care could refer to this.
 

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.
Quality assurance systems did not always identify the issues we found during our visit, for example expired medicines still in use for people. The registered manager told us they completed monthly medicines checks and involved nurses with these audits. However these audits failed to identify our findings, and therefore did not provide assurance of continuous learning and improvement across the service.
We also received mixed feedback from professionals around continuous learning and improvement in the service. One professional told us, “Staff actively participated in training and had a positive attitude to [a] quality improvement project”. However, another professional told us “We have consistently been inviting the home to all our training webinars, but they have not engaged.” This did not demonstrate the service always actively focused on continuous learning, innovation and improvement. Furthermore, this did not ensure staff and leaders engaged with external work, including research, and embedded evidence-based practice in the organisation to drive improvement.