Winchester House

Winchester House is a care home registered to support up to 123 people with nursing and care needs. It is divided into six units. One unit was for people with complex nursing needs and two were for people with dementia nursing needs. The home also had two residential units for people without nursing care needs, one of which was a residential unit for people living with dementia. The last unit was closed to admissions due to renovation At the time of our inspection 90 people were living at Winchester House.

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

There were enough staff to meet people’s needs. Records reviewed showed that there were appropriate numbers of suitably trained staff.

People told us that they felt safe, One person we spoke with, told us, "Oh yes it's safe here, and they always check on me." Another told us that, "[staff] are professional and do what I ask of them."

Safeguarding incidents and accidents/concerns were investigated thoroughly, and the registered manager worked closely with local authority safeguarding teams to prevent the risk of reoccurrence and identify the causes. The frequency of safeguarding alerts had reduced significantly since our last inspection.

People’s care plan files were up-to date and contained the information needed to support people. However, the care plans we reviewed were difficult to read and follow. They contained a large amount of information, were handwritten and did not contain a summary of the person's needs. This could pose a risk to people as new or agency staff may find it difficult to access the most up to date information needed to care for people safely.

Feedback on activities available to people was mixed. Some people were observed completing hobbies they were interested in, such as gardening however, on two nursing units there was a distinct lack of engagement for people who were cared for in bed.

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 who were receiving support from external healthcare professionals had updates to their care plans and there was clear guidance in place for staff to support people appropriately.

People were supported to take their medicines as prescribed. Staff were given training they needed to perform their roles and the registered manager had a team structure in place for supervision and reporting, whilst fostering and open-door culture that encouraged staff to go to them.

There had been improvements in the quantity and frequency of quality assurance checks since the last inspection. The registered manager had implemented several changes 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 January 2020) where multiple breaches of regulations were found. 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.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, people’s risk assessments and the culture of the service. A decision was made for us to inspect and examine those risks. We carried out an unannounced comprehensive inspection of this service on 12 November 2019. 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 person centred care, safe care and treatment, good governance, and staffing.

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, Responsive and Well-led which contain those requirements.

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 requires improvement 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 Winchester House on our website at www.cqc.org.uk.

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.

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.

Winchester House is a care home registered to support up to 123 people with nursing and care needs. It is divided into five communities. One community was for people with complex nursing needs and two were for people with dementia nursing needs. The home also had two residential communities for people without nursing care needs, one of which was a residential community for people living with dementia. At the time of our inspection 120 people were living at Winchester House.

People’s experience of using this service

People told us and our observations confirmed their experience of care was negatively effected by the staffing levels within the home. People told us there were not enough staff and we found staffing levels were based on inaccurate dependency assessments.

The provider had recently changed their corporate admissions policy. Prior to this Winchester House had made local changes to their admissions process. This was in recognition that they had admitted people whose needs they were not able to meet. People were at risk from each other and did not always feel safe. The measures in place to mitigate risks faced by people were not effective and were not updated after incidents. There was not enough information available about people’s medicines.

People’s preferences were not captured in their care files, including their wishes for their support should they reach the last stages of their life. Records of care were task focussed and did not show that people’s choices and preferences were being respected.

The governance systems in place had identified there were shortfalls in the quality of care plans and risk assessments. They had not identified the dependency assessments were not being used correctly. Despite issues with the quality and safety of the service being well known by the provider, the actions in place had not been effective in driving improvement.

People and relatives told us there had been recent improvements in the activities provision within the home. However, this was not yet being felt by everyone in the home and some people still felt bored. Some people were able to access representatives of their faith and attend religious services.

People’s experience of mealtimes varied and some relatives felt they had to attend at mealtimes to ensure their family members got the support they needed to eat their meals. People were not always offered choices.

People were supported to attend healthcare appointments and access external healthcare professionals and other agencies. It was not always clear that the advice of these professionals was incorporated into people’s care plans.

People were supported to take their medicines as prescribed. People and relatives knew how to make complaints, however, they did not feel issues raised were always resolved in a timely way.

Staff were given the training and supervision they needed to perform their roles, and people told us they thought staff were working hard. However, staff had not received specialist training in supporting people with complex needs related to dementia.

People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to Person Centred Care, Safe Care and Treatment, Staffing and Good Governance 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.

Winchester House is a care home for older people. The home is set out in five separate units and comprises the Peter Mews unit which provides care for people with a physical disability; the Marconi suite for people with residential dementia care needs; the LaFarge suite for older people with nursing care needs; and Shorts Terrace and Cathedral Square suites which provide dementia and nursing care. At the time of our inspection 118 people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility, a number of people were cared for in bed.

The service had a registered manager. 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.

At our previous inspection on 26 and 28 January 2016, we found breaches of Regulation 10, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the home was not clean in all areas. Medicines administered were not adequately recorded to ensure that people received their medicines in a safe manner. People were not always treated with dignity and respect. Decoration of the home did not follow good practice guidelines for supporting people who live with dementia. Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. We asked the provider to take action to meet the regulations.

We received an action plan on 06 May 2016 which stated that the provider would be meeting regulations 10 and 12 by 10 May 2016 and regulations 15 and 17 by 30 May 2016.

At this inspection people told us they received safe, effective, caring and responsive care from staff.

Medicines were well managed. Medicines were stored and administered appropriately. Some medicines were prescribed on a ‘when required’ basis. There was guidance in place for each person’s when required medicine. However, details of the dose of medicines and frequency did not always match with what was printed on medicines administration records. We made a recommendation about this.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.

The provider followed safe recruitment practice. Essential documentation was in place for all staff employed. Gaps in employment history had been explored to check staff suitability for their role. There were suitable numbers of staff deployed on shift to meet people’s assessed needs.

The premises were well maintained, clean and tidy. The home smelled fresh. Areas of the home had been decorated to help people orientate in their environment. More improvements were planned.

Staff had undertaken training relevant to their roles. Staff were supported to gain qualifications and were supported in their roles. They had received regular supervision meetings.

Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.

Staff had a good understanding of the Mental Capacity Act 2005 and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the registered manager.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. Feedback from healthcare professionals was positive.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed. Staff treated people with dignity and respect.

People’s care was person centred. Care plans detailed people’s important information such as their life history and personal history and what people can do for themselves.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People’s views and experiences were sought through surveys and meetings. People were listened to. People and their relatives knew how to raise concerns and complaints.

There were quality assurance systems in place. The registered manager and provider carried out regular checks on the home. Action plans were put in place and completed quickly. Staff told us they felt supported by the registered manager.

The registered manager demonstrated that they had a good understanding of their role and responsibilities in relation to notifying CQC about important events such as injuries, safeguarding concerns and deaths.

The report is based on our observations during the inspection, talking with two people who used the service, four relatives, one visitor, five staff who were working in the home, and reviewing records. We also talked with the manager, deputy manager and the HR administrator.

Winchester House includes five different units catering for people with specific needs such as dementia and nursing care.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff told us that they understood their responsibilities for reporting adult protection concerns and we saw that appropriate training and guidance was in place to ensure that people were protected from harm. We saw that a whistleblowing policy was in place, for staff to be able to report concerns about the service, and information about this was on display.

The CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the manager about the applications they had made to the court of protection under the Deprivation of Liberty Safeguards. They demonstrated a sound understanding of the circumstances that would mean an application needed to be made. This meant that appropriate applications were made when necessary.

Is the service effective?

We saw that people's needs were assessed and care was delivered to meet their documented care needs. Staff we spoke with understood people's care needs and demonstrated that they knew how to meet people's needs and what to do if they noticed any changes or concerns. We found that the home worked proactively to meet the needs of a range of people.

Is the service caring?

People were supported by staff who were kind and attentive. We saw positive interactions between staff and the people they supported. People were supported to eat and drink at their own pace. People with mobility difficulties were supported to move at their own pace when staff helped them to move around the home. We saw comments from one person in a survey that stated 'The staff all know me and are very kind and understanding'.

Is the service responsive?

We found that the managers of the home acted to address concerns as soon as they were noted. When referrals to other professionals were required these were made in a timely manner. People had access to activities they enjoyed and they were able to make suggestions concerning what they would like to do at residents' meetings. People were given forums for making their views known and suggestions were acted on when possible.

Is the service well-led?

Staff we spoke with told us that the managers of the home were approachable and they were able to seek advice and guidance whenever it was required. We looked at the way the quality of the service was assessed and monitored. We found that a number of audits, visits and checks were made by the managers within the home and they also received support from a regional manager and clinical specialist. This meant that management was overseen to ensure the service was well-led and met the needs of the people who lived at the home.

People we spoke with told us that staff were "Kind and caring".

People who used the service, or their relative, had been asked for their consent, and their views and wishes had been considered and acted upon when care was delivered.

We saw that people who used the service received consistency of care and support that met their needs; as staff were knowledgeable about individuals care plans and supporting risk assessments.

People who used the service were protected from the risk of abuse, because reasonable steps had been taken to identify the possibility of abuse and prevent abuse from happening.

There were appropriate arrangements in place to manage medicines safely and effectively.

We saw that there was sufficient, well-maintained equipment to meet people's needs.

Staff received training and support appropriate to their role.

There was an effective system to regularly assess and monitor the quality of service that people received.

We saw that accurate and appropriate records were maintained.

At this visit we discussed staffing levels with the manager, and went to view both units during lunch time. We found that staffing levels had been increased, and the units were operating calmly and efficiently.

We visited all five units of the home, and spent time in each unit talking with people living in the home, relatives and visitors, and staff members. We viewed care plans and inspected medication in each unit. In one of the units (Shorts Terrace) we carried out a Short Observational Framework Inspection (SOFI) for forty minutes.

During the day we had meaningful conversations with 12 people living in the home, and also spent time chatting with other people who had dementia. We talked with nine relatives and visitors, and with 16 staff as well as the management. These included staff from different job roles, including nurses, care staff, domestic staff, laundry staff, the head chef and activities staff.

People living in the home and most visitors spoke positively about the standards of care. However, some people felt that concerns they had raised had not been fully addressed; and some relatives and staff did not think there were 'enough staff' for some of the units.

Comments from people living in the home included:

"It is all very good. Everyone is always friendly.'

'I've got a lovely home here.'