Winslow House

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.

Winslow House is a residential care home providing accommodation and personal care to 28 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 two floors. Each person has their own bedroom (of various sizes), 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

Despite the shortfalls we identified, people told us they felt safe. Health care professionals worked closely with the service and said staff worked positively with them, seeking advice and following their recommendations. Many relatives said they trusted the service and felt reassured.

Safe practices were not always followed to ensure people received their medicines as prescribed and were protected from risks relating to medicines. Risks to people had been assessed, however, improvement was needed to ensure risk assessments and related support plans accurately reflected people’s needs and provided relevant guidance for staff. The provider was implementing an electronic care records system to address challenges they had identified with record keeping.

Safeguarding incidents were not always identified and reported to keep people safe from harm.

When people were unable to make decisions about aspects of their treatment and the level of supervision they received, staff were not completing mental capacity assessments or making referrals under Deprivation of Liberty Safeguards (DoLS) as required. The service was not meeting MCA requirements as DoLS authorisations had not always been sought appropriately.

The provider had made some improvements to their recruitment processes following our last inspection. However, further improvement was needed to ensure these processes were robust and suitable staff would always be recruited. Staffing levels had been kept under review.

The provider's quality monitoring system was still not fully established or effective in identifying where improvement action needed to be taken. The provider had policies and procedures however, these were not always suitable, fully understood or followed.

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 22 December 2021) and there were 2 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 the provider remained in breach of regulations.

At our last inspection we recommended the provider review how they determine their staffing numbers. At this inspection we found the manager was using a dependency tool and checking call bell response times. The manager was identifying a suitable care home staffing model.

At our last inspection we recommended the provider source appropriate advice and training for staff in recognising and monitoring the deterioration in people's health. At this inspection we found additional training was needed before use of early warning tools could be implemented.

At our last inspection we recommended the provider source appropriate training for staff, in line with current best practice, for the provision of preparing textured altered food and thickened drinks. At this inspection we found this training had been completed.

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

Why we inspected

We carried out an unannounced inspection of this service on 3, 4 and 5 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve fit and proper persons employed and good governance.

We undertook this focused inspection 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.

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 not changed and remains requires improvement. 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 Winslow House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, recruitment, good governance and notifications at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

Winslow House is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 35 people.

The care home accommodates people in one adapted building across two floors. Each person has a single bedroom (various sizes), each with its own 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 overlooking a mature garden which is accessible by wheelchair.

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

People told us they felt safe with the staff who looked after them. They also felt secure within the building.

Action was taken to assess and manage risks associated with older people’s needs, such as how they needed to be moved, their mobility and potential falls and damage to their skin.

Improvement was needed however, in the assessment of risks associated with Legionella infection and the control of substances hazardous to health. Some actions had been taken to mitigate risks associated with these areas, but an assessment record of those actions had not been completed to ensure, the actions taken, were enough to keep people safe. This is required in accordance with the Health and Safety Executives (HSE) guidelines on these matters.

We were not fully assured that the care home had in place all necessary arrangements and practices which would enable them to effectively manage a potential outbreak of COVID-19 infection. Following this inspection, the service engaged with local infection, prevention and control (IPC) specialists to start improving their IPC arrangements.

Some protection against COVID 19 was in place, which included relevant checks on visitors to the care home, regular COVID-19 testing for staff and service users and a fully completed program of service user COVID-19 vaccinations.

People were supported to take their medicines as prescribed, however, some improvement was required to the monitoring of the medicines system to ensure, all practicable actions were taken, to protect people from potential medicine errors.

Managers had faced unprecedented challenges in staffing the care home and retaining staff. When there had been additional needs to support, this had not resulted in an increase in staffing numbers. People told us their care needs were met but some people’s calls bells had not been responded to in a timely way to ensure their safety. An analysis of these delays had not taken place to see what action could be taken to avoid further delays.

We have made a recommendation in relation to how the provider determines and monitors staffing numbers.

People’s personal care needs were met. People told us when staff could not support them immediately, they always returned later, and arrangements were made for their care to be delivered.

People told us their privacy and dignity were maintained.

People were supported to eat, and drink and they were able to make choices. People were provided with textured altered foods and drink when they were at risk of not being able to swallow safely. The practices in the home, in relation to the preparation of this food, needed improvement so that these were consistently in line with best practice guidance.

We have made a recommendation in relation to how the service keeps updated with best practice guidance.

Staff knew the people they cared for well and therefore could recognise changes in their wellbeing. However, staff had not received training in how to formally monitor people’s deterioration so that this could be effectively escalated to relevant healthcare partners. Following this inspection, we signposted the service for support in this area.

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. Although the policies and systems in the service supported this practice, in practice, staff were not completing mental capacity assessments or making referrals under Deprivation of Liberty Safeguards (DoLS) where always needed. This was resolved following this inspection and learning taken from this.

The provider’s quality monitoring system was not fully effective in identifying where improvement actions needed to be taken. The provider had policies and procedures however, these were not fully understood by the senior management team and not always followed.

Feedback had been sought from people and their relatives and responded to where needed to improve the overall service experience.

People had opportunities to join in social activities and they told us they enjoyed these. People enjoyed the ability to socialise and several people told us they had made friendships with others in the care home. Communication between staff and the people was friendly and people told us they felt cared for. An open, inclusive and person-centred culture was in place.

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 24 January 2020).

Why we inspected

We received a concern in relation to the care people received, staffing numbers, staff training and the management of the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

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.

We have found evidence that the provider needs to make improvements. 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.

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 previous comprehensive inspections 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 Requires Improvement. This is based on the findings at this inspection.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Gloucestershire. To understand the experience of social care Providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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 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 have identified breaches in relation to the processes required to ensure people’s health and safety and in the service’s quality monitoring system at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ The provider’s infection outbreak policy had been reviewed and infection control audits had been completed. A visitor policy was in place. COVID-19 related guidance was available for staff reference.

¿ COVID-19 related risks to people and staff had been assessed. Action had been taken to reduce these risks. This included regular COVID-19 testing of people and staff, use of personal protective equipment (PPE), use of shielding and self-isolation and the introduction of appropriate cleaning, waste and laundry arrangements.

¿ Staff had received relevant training and were competent in the practice of donning and doffing PPE.

¿ Admissions to the service were managed safely. The service was adhering to national COVID-19 guidance in relation to this. This had applied to one person transferred back to the care home after a stay in hospital.

¿ Adaptions had been made to how staff remained in contact with external healthcare professionals. Although some meetings and consultations took place virtually people still had access to health professional support as required and their health needs were reviewed when needed.

¿ Some changes to the environment had been made to support social distancing.

¿ Current and appropriate guidance was being followed regarding relative visiting and keeping people in contact with family members. Relatives were kept informed about necessary changes to the visiting arrangements and staff were supporting both people and their relatives during these times.

Further information is in the detailed findings below.

Winslow House is a residential care home providing personal care with accommodation in one adapted building. It can accommodate up to 35 people. At the time of the inspection 31 people aged 65 years and over were receiving support.

People had their own private bedrooms and there was plenty of additional communal space for people to use. The outside space was easily accessible and enjoyed by people in the good weather. The home was located near to the local town with its shops and other community facilities.

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

People told us they felt safe and well cared for. They told us they enjoyed living at the home and felt staff had their best interests at heart. Relatives who visited also felt it was a happy place and felt able to discuss any concerns they may have, about their relatives, with the staff. One relative said, “The staff are amazing.”

There were enough staff with the appropriate skills and knowledge to support people. Staff were valued and supported by the managers and many had worked for the provider for several years which helped secure continuity of care.

People were supported to take their medicines as prescribed and had access to healthcare professionals’ advice and support as needed.

People lived in a clean home which was well maintained and adapted to meet people’s needs.

People’s diverse preferences and beliefs were respected and met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive was possible and in their best interests. The policies and systems in the service supported this practice.

People had a choice in what they ate and drank, and specific dietary needs were met. People had access to snacks and drinks at any time of the day or night.

Staff provided people with support to pursue their hobbies and interests. Organised activities and social events were planned with people and something took place most days which people enjoyed. Efforts were made to reduce risks associated with self-isolation and loneliness.

People’s privacy and dignity was maintained during care delivery. Information about people’s care and treatment was kept secure and confidential.

There were arrangements in place to manage complaints and concerns and to resolve these.

People’s care was person-centred and delivered in a way which met their needs, and which was adapted depending on people’s daily preferences.

Staff knew people’s needs well and other arrangements in place ensured the care delivered was always appropriate to people’s levels of risk and health needs.

A quality monitoring system was in place and some processes were effective in driving improvements. There were some audits which needed to be more comprehensive so that the registered manager and provider received enough information, for them to determine where improvements were needed.

We made a recommendation in relation to the provider’s quality monitoring system.

Managers were committed to providing a good service which resulted in good outcomes for people. The home had worked towards higher standards in end of life care and was applying for accreditation with the Gold Standards Framework for end of life care.

Staff were provided with strong leadership but also nurturing support which encouraged reflection, further learning and a positive working culture.

Managers provided opportunities for people, their relatives and staff to give feedback and they acted on the feedback they received to support improvement of 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

The last rating for this service was Good (report published 10 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an improvement plan from the provider to understand what they will do to improve their monitoring system. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were safe. Staff received safeguarding adults training and knew what to do if bad practice was witnessed, alleged or suspected. The registered manager was aware of the need to report events promptly to the local authority and CQC. There were safe recruitment procedures in place to ensure unsuitable staff were not employed. The appropriate steps were in place to protect people from being harmed.

Any risks to people’s health and welfare were assessed and then measures put in place to either reduce or eliminate the risk. These plans were then regularly reviewed. The premises were well maintained and all maintenance checks were completed. The management of medicines was safe and people received their medicines as prescribed.

The registered manager monitored the staffing levels and based the staffing numbers on the care and support needs of each person in residence. The different shifts the care staff did ensured that the busiest times of the day were covered and people’s needs could be met. People were not put at risk because staffing levels were low.

There was a programme of mandatory training all staff had to complete, enabling them to carry out their job roles. New staff had an induction training programme to complete and there was a programme of refresher training for the rest of the staff. Care staff were encouraged to complete nationally recognised qualifications in health and social care. The staff team were well supported to do their jobs.

People were encouraged to make their own choices and decisions and to remain as independent as possible. Staff asked people to consent before they provided care and support. When people lacked the capacity to make decisions, best interest decisions were made involving healthcare professionals. We found the service to be aware of the principles of the Deprivation of Liberty Safeguards. They had acted accordingly when there was a need.

People were provided with sufficient food and drink and any specific dietary requirements were catered for. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to.

Staff had a kind and caring attitude towards the people they were looking after and would recommend the home to family members. Their interactions with people were friendly and meaningful. People were able to participate in a range of different activities and external entertainers visited the home.

People were involved in making decisions about how they were looked after and agreed the way that care and support was delivered. Their care needs were regularly reviewed and the staff listened to what they had to say. People were encouraged to have a say about their daily life and how Winslow House was run.

‘Resident’ and relatives meetings and staff meetings enabled everyone to express their views and make suggestions about how things could be done differently. The provider had a regular programme of audits in place. Some of the checks were completed on a daily basis, others on a weekly, monthly or quarterly basis. The information collected from the audits was used to make improvements.

The registered manager linked with other health and social care agencies to ensure that best practice was followed and people received a safe and good quality service.

People received the care and support they needed because assessment and care planning took account of each person's needs, choices and preferences. There was a rolling six week menu plan, which was adjusted in line with the different seasons.

People were cared for in a clean, hygienic environment. We found high standards of cleanliness. They were protected from the risk of infection because appropriate guidance was followed.

There were effective recruitment processes in place and appropriate checks were undertaken before staff began their employment. Written references and Criminal Records Bureau (CRB) (now Disclosure and Barring Service (DBS)) checks had been completed.

There were enough staff on duty to meet people's needs and staffing levels were reviewed monthly by the general manager and adjusted accordingly. The home was fully occupied when we visited.

People said they felt they would be able to raise any concerns or complaints they may have with the managers or any of the staff, and were confident that they would be listened to.

People told us the meals were good, they were offered choice and they had plenty to eat and drink.

We found that the systems in place for the management of medicines were satisfactory.

People were complimentary about the staff, some of whom had worked at the home for many years. 'Everyone is very good at their jobs' and 'we could not ask for better staff'.