Winterfell Care Home

Winterfell Care Home is a residential care home providing accommodation and personal care for up to 41 people. The service supports older and younger adults living with dementia, mental health support needs, learning disabilities and people with physical disabilities. At the time of our inspection there were 32 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

The provider did not always mitigate environmental risks such as windows, trip hazards, radiators, fire safety, and items that could injure people. People did not always have safe equipment to help them mobilise. Recruitment checks needed to be improved to ensure safer practices in relation to obtaining references and right to work documentation. People were safeguarded from the risk of abuse, and lessons were learnt following incidents and accidents. People were supported by staff to receive their medicines safely. There were sufficient infection prevention and control arrangements in place.

Audits completed by managers to ensure the environment was safe were not always accurately completed. Care plans were not always accurate and up to date. We received mixed feedback from relatives concerning how well the service communicated and engaged with them. However, staff received supervision, team meetings were held, and there was evidence the service worked in partnership with external professionals.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were two people using the service who have a learning disability and who are autistic.

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 09 March 2022).

Why we inspected

We received concerns in relation to safeguarding and management oversight. As a result, we undertook a focused inspection to review the key questions of safe 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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The provider took action to mitigate risks to some of our concerns during the inspection, however concerns remained in other areas.

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

Enforcement

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. We have identified breaches in relation to people’s safety and good governance at this inspection.

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 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.

Winterfell is a residential care home providing accommodation and personal care to older people and younger adults living with dementia, mental health needs and/or physical disabilities. The service can support up to 41 people. At the time of our inspection, there were 22 people living at the service. The home can accommodate people over three floors of the building accessible by lifts and stairs. There are various large communal areas for eating, relaxation and activities. The home has a garden and enclosed smoking area. The majority of rooms have ensuite facilities.

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

People received safe care, their health needs were monitored, and risk assessments were in place which reflected people’s changing needs. Care plans were detailed and covered people’s physical and mental health.

Accidents and incidents were monitored and reported. Staff had a good understanding of how to protect people against abuse and were knowledgeable about their needs and how to support them.

Staff received effective training and there were enough staff to meet people’s needs. Recruitment processes were in place to ensure appropriate staff were employed.

The service was clean and followed current infection control guidance. The environment was well maintained.

Medicines were managed safely, and people received the medicines they were prescribed.

Quality assurance systems assisted the registered manager to effectively monitor the service. The registered manager was well supported by assistant managers and directors.

Incidents were analysed, and lessons learnt. The service engaged the views of staff and people to continue improvements to 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 (and update)

The last rating for this service was Inadequate (published 5 October 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since October 2020. During this inspection the provider demonstrated that 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.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to a potential criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Winterfell Care Home is a 41-bedded residential care home situated in a residential area of Nottingham. The home provides accommodation and personal care to older people and younger adults living with dementia, mental health needs, and/or physical disabilities. At the time of our inspection there were 19 people using the service.

The care home accommodates people over two floors in an older style adapted building.

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

People living in the service were not safe and were placed at risk of harm. The environment, poor infection control processes and lack of consideration of fire safety measures at the service put people at risk.

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. The provider had not ensured that their systems and processes were effective in enabling staff to provide safe and effective care for people. Lessons were not learned, and improvements were not made when things went wrong.

Records relating to people's care did not always contain information and guidance to enable staff to provide the safe care and support people required. Risk management was not in place for some people who were at a high risk of falls and who may present a risk to others from their behaviour.

We received mixed feedback from both people and their relatives regarding their opinions of the quality of the care and support they received and the response to any concerns they had raised. Although we observed positive interactions between staff and people using the service during the inspection.

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 January 2020).

Why we inspected

We received concerns in relation to a lack of governance and oversight of the service, a failure to safeguard people, infection control, falls, diabetes management, palliative care, risk assessments and care planning. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full

report.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have identified breaches in relation to fire safety, safeguarding of people, infection control, records, improving the quality of the service, and other risks at this inspection. After the inspection we wrote to the provider and requested that they provided us with urgent information regarding poor standards of care and record keeping, staffing, issues relating to infection control, the management of falls and fire safety concerns to ensure people were safe. The provider responded and took action to address some of the areas of concern that we had identified, however concerns remained in several areas.

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.

We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will work alongside the provider and the local authority to closely monitor the service. 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 therefore remains 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 once it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Winterfell Care Home is a 41-bedded residential care home situated in a residential area of Nottingham. The home provides accommodation and personal care to older people and younger adults living with dementia, mental health needs, and/or physical disabilities. At the time of our inspection there were 27 people using the service.

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

People were happy at the home. They felt safe and made many positive comments about the friendly and caring nature of the registered manager and staff.

People had personalised care plans telling staff how to keep them from harm and meet their needs. Staff knew people's likes, dislikes and preferences. People enjoyed daily activities and going out into the local community.

The home was well-staffed, and the staff well-trained and competent. Staff interacted with people in a kind and respectful way.

The premises were decorated and maintained to a high standard and were homely and comfortable, Facilities were good, with a range of lounges, a café-style dining room, and a well-equipped games room. All areas of the home were clean, tidy and fresh.

People’s healthcare needs were met. Staff worked closely with local GPs, district nurses and other healthcare professionals to ensure they had the care and support they needed. The food provided was wholesome and multicultural and people said they enjoyed their meals.

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.

The home had an open and friendly atmosphere. The registered manager listened to people and staff and made improvements to the home based on their ideas. Audits were carried out to ensure the home was running well and providing good quality care and support

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 12 October 2018 and this is the first inspection.

Why we inspected

This was a planned first inspection of the home.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.