Winslow House

Updated 11 November 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a focussed inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 13 (safeguarding service users from abuse and improper treatment) and Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Winslow House is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Winslow House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post. The manager had been managing the service (initially as acting manager) since 4 January 2022. The manager intended to register with CQC and had completed required police checks prior to submitting their application to register.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from commissioners. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 14 people who used the service and observed people interacting with staff. We spoke with 10 people's relatives and 3 professionals about their experience of the care and support provided by the service. We spoke with 7 staff including the nominated individual, the manager and deputy manager, 4 care staff, the maintenance person and the head housekeeper. The nominated individual (NI) is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included people's care records and records of incidents and accidents. A variety of records relating to the management of the service, including the service's action plan and recent audits were reviewed.

Updated 11 November 2023

About the service

Winslow House is a residential care home providing accommodation and personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 35 people.

The service accommodates people in one adapted building across 2 floors. Each person has their own bedroom with a toilet and washing facilities. There are lounge and dining areas on both floors with additional communal toilets and adapted bathrooms. Outside there is a large terrace, which is accessible by wheelchair, overlooking a mature garden.

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

The service had improved since our last inspection, but more time was needed for improvements to be completed, evaluated and embedded into ways of working.

People were not always protected from risks associated with medicines as the provider’s systems were not always followed, and medicines audits were not robust enough to identify this.

Improvements to care records and use of universal assessment tools, (to support staff to identify and manage risks to people), were underway. However, the provider’s new electronic records system, (introduced to support these improvements), had yet to ‘go-live’. The go-live date had been delayed, as a significant amount of work was still needed to update risk assessments and improve support plans as they were entered into the system.

Staff had received training in the use of universal assessment tools. However, most staff found them difficult to use and people had yet to benefit from this proactive approach. Managers anticipated use of the e-system would help resolve this.

Care records staff had access to, were not always complete or up to date, and lacked important information to guide staff in managing people’s needs. Staff lacked confidence in managing some risks to people, including risks associated with diabetes, and insulin use.

All the above meant risks to people may not always be recognised or managed in a timely way to ensure people always received safe and effective care.

The provider had revised their systems to monitor the quality and safety of the service, however these systems were not yet established. Time was needed to fully implement, evaluate, and adapt these, (reduce duplication and address gaps), to ensure they were effective.

We were unable to check whether improvements to recruitment practices were effective at this inspection as recruitment records were not available. We will follow this up at our next inspection.

Despite the shortfalls we found, people and their relatives were positive about the service and told us they felt safe and well cared for. Response to safeguarding incidents, managing falls, and managing weight loss had improved. The service worked closely with health and social care professionals, seeking advice, and following recommendations.

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. People told us their views were listened to and they were happy with how managers responded to their complaints.

The provider had notified us of significant events as required and were working openly and transparently with other agencies to improve 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 requires improvement (published 1 April 2023) and there were 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 some improvements had been made and the provider was no longer in breach of regulation 13 and regulation 18. However, the provider remained in breach of regulation 12, regulation 19, and regulation 17.

The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

We carried out an unannounced focussed inspection of this service on 3 November 2021 and 2 breaches of legal requirements were found. The provider completed an action plan after the inspection to show what they would do and by when to improve fit and proper persons employed and good governance.

We carried out an unannounced focussed inspection of this service on 23 January 2023 to check they had followed their action plan and to confirm they had met legal requirements. The provider had not met legal requirements in respect of fit and proper persons employed and good governance. We also found 3 new breaches in relation to safeguarding service users from abuse and improper treatment, safe care and treatment, and notifications of other incidents.

Enforcement action was taken in relation to good governance and safeguarding service users from abuse and improper treatment, and the provider was informed what action they must take by when to meet legal requirements. The provider completed an action plan to show what they would do and by when to improve safe care and treatment, fit and proper persons employed, and notifications of other incidents.

We undertook this unannounced focussed inspection to check whether the Warning Notices we previously served in relation to Regulation 17 (good governance) and Regulation 13 (safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Also, 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.

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

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

We found evidence that a number of improvements have been made. However, the provider needs to make further improvements to become compliant with regulatory requirements. Please see the safe, effective, 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.

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

Enforcement

We have identified ongoing breaches in relation to safe care and treatment, fit and proper persons employed and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.