Winchcombe Place

Updated 10 December 2021

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 Care Act 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 an inspector, a bank inspector and a specialist advisor. The inspection was supported remotely by 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

Winchcombe Place is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

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 used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with ten people who use the service and five relatives of other people. We spoke with 33 members of staff including the registered manager, clinical lead, regional director, operations support manager, customer services manager, five nurses, an agency nurse, five team leaders, eight care assistants, the lifestyle enrichment manager, two lifestyle enrichment assistants, the head chef, maintenance manager, a housekeeper and three agency staff.

We observed care during mealtimes, social activities and medicine administration rounds to help us understand the experience of people who could not talk with us. We reviewed a range of records. This included nine people’s care records, medicine records and daily notes. We looked at six staff files in relation to recruitment, staff training and supervision. A variety of records relating to the management of the service were reviewed, including the provider’s policies, procedures, accidents and incidents and quality assurance audits.

After the inspection

We spoke with four relatives of people who live in the home to get feedback on the family member’s experience of the care provided. We continued to seek clarification from the provider to corroborate evidence found. We looked at training data and quality assurance records. We received feedback from five professionals who have regular contact with service.

Updated 10 December 2021

About the service

Winchcombe Place is a residential care home providing personal and nursing care for up to 80 people. The home is in one building and provides care and support facilities over three floors. The first floor specialises in providing care for people living with dementia, whilst the second floor supports people who require nursing care. People have their own bedrooms with en-suite facilities and use of a private garden. At the time of inspection, the service was supporting 56 people in the home.

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

Staff and visiting health and social care professionals had raised concerns about unsafe staffing levels. The provider had responded by significantly increasing staffing levels. At the time of our inspection the provider had also doubled the number of registered nurses being deployed and significantly overstaffed other staffing on each shift. The provider needed time to demonstrate that increased staffing levels had become embedded and the staffing situation had stabilised.

People experienced safe care and were protected from avoidable harm by trusted staff, who had completed safeguarding training and knew how to recognise and report abuse. Staff identified and assessed risks to people effectively and managed them safely. Staff completed a robust selection process, including their conduct in previous care roles, to assure their suitability to support people. People received their medicines safely from staff, in accordance with recognised guidance. Staff maintained high standards of cleanliness and hygiene in the home, which reduced the risk of infection. Accidents and incidents were recorded and reviewed daily by the management team, who took prompt action to implement any lessons learned.

Staff assessed all aspects of people’s physical, emotional and social needs and ensured these were met to achieve good outcomes for them. Staff were supported to develop and maintain the required skills and knowledge to effectively support people. Staff emphasised the importance of eating and drinking well and reflected best practice in how they supported people to maintain a healthy balanced diet. Staff worked together with healthcare professionals to ensure care and treatment met people’s changing needs and achieved good outcomes. The home had been purpose built, with bright spaces bathed in natural light to help orientate older people and those living with dementia, to the time of day and time of year.

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 management team promoted a strong, person-centred culture where people felt valued. Staff were passionate about their role and placed people at the heart of the service, demonstrating the caring values of the provider. The registered manager understood their responsibilities to inform people when things went wrong and the importance of conducting thorough investigations to identify lessons learnt to prevent reoccurrences. The governance structure ensured there were robust measures to monitor quality, safety and the experience of people within the service. Quality assurance had been embedded within the culture and running of the service, to drive continuous improvement.

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 on 22 October 2020). There were breaches in Regulation 12 (Safe care and treatment) and Regulation 17 (good governance). 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 by notification of a specific incident, following which a person using the service died. The information the Care Quality Commission (CQC) received about the incident indicated concerns about the management of choking risks. This inspection examined those risks. However, this incident is being reviewed separately under our specific incident guidance and consequently this inspection did not examine these events. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

We had also received concerns in relation to unsafe staffing levels and high use of agency staff. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

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 inspections for those key questions 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.

However, we have found evidence that the provider needs to make improvement. Please see the safe section of this full report.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Winchcombe Place 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.