Archived: 5 Winston Court

Updated 25 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was undertaken by one adult social care inspector, a specialist advisor (a learning disability registered nurse) 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. The inspection took place on 20 October 2016 and 21 October 2016 and was unannounced.

For this inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we already held about the service. This included previous inspection reports and notifications we had received. A notification is information about important events which the service is required to send us by law. We asked the local authority teams, clinical commissioning group (CCG), fire authority and environmental health for information to aid planning of our inspection.

At the time of the inspection, the registered manager was on leave. During the inspection we spoke with the assistant team manager, nominated individual and four care workers. We communicated with four people who used the service.

We looked at four sets of records related to people’s individual care needs. These included care plans, risk assessments and daily monitoring records. We also looked at one staff personnel file and records associated with the management of the service, including quality audits. We asked the provider to send further documents after the inspection. The provider sent documents to us after the inspection for use as additional evidence.

We looked throughout the premises and observed care practices and people’s interactions with staff during the inspection.

Updated 25 November 2016

The care home is operated by the local authority, the Royal Borough of Windsor and Maidenhead. The care home is located in a residential area on the edge of Maidenhead town, Berkshire. It is one of three care homes that the provider operates for people with learning disabilities or autism spectrum disorder. 5 Winston Court is registered to provide accommodation and personal care for up to eight adults.

At the time of the inspection, there was 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.

Since transitional registration under the Health and Social Care Act 2008 on 21 January 2011, 5 Winston Court has maintained compliance with the relevant regulations at each inspection by CQC. The most recent inspection was a routine planned visit on 20 January 2014. This inspection checked five outcomes, all of which were compliant. This inspection is the first visit under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the first rating under the Care Act 2014.

People were protected from abuse and neglect. Staff received safeguarding training and knew what actions to take if they suspected abuse or neglect had occurred. There was a whistleblowing procedure and staff could anonymously report issues to the provider or to other authorities.

Risks for people were assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection. We found some duplication across the two folders used by care workers for each person. The management of the care documentation required some improvement. This was to make it easier to find people’s important information when needed.

Proper maintenance of the premises and grounds was not evident. Repairs and maintenance were completed by an external contractor and sometimes the service experienced delays waiting for them. Staff and management complained that the maintenance system had a negative impact on the people who lived at the service. We found premises, grounds and equipment risks were mostly assessed. However, some risks were completely disregarded and were not considered, documented or mitigated. Some maintenance that required regular review or updates was overdue. The management of the maintenance was fragmented and communication between the service and contractor was not satisfactory.

Enough staff were deployed during shifts to ensure people’s safety. Care workers we spoke with were satisfied that there were sufficient staff and that they did not place people at risk when they were busy. Our observations showed that the service was busy at times, but overall calm and relaxed and staff were dedicated to the people they supported.

We found the service had strong recruitment and selection procedures that ensured suitable, experienced applicants were offered and accepted employment. A high percentage of staff had long periods of service for the provider. Personnel files contained all of the necessary information required by the regulations and no documents or checks were missing. We found this included criminal history checks via the Disclosure and Barring Service (DBS), checks of previous conduct in other roles, and proof of identification. We also checked the staff’s legal rights to work in the UK.

Medicines were safely managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. Storage of medicines and the management of room and refrigerator temperature checking and recording required review.

At the inspection, it was not possible to obtain information about staff training. We asked the service to send this to us afterwards, and reviewed the data they provided. Staff training was conducted, however required some improvement in attendance and overall management. We noted an inappropriate number of staff had completed training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This had resulted in staff we spoke with having limited knowledge of how this legislation was used in the support of people who used the service. Staff supervisions and performance appraisals were effective.

The service was not compliant with the requirements of the Mental Capacity Act 2005 (MCA). The standard of recording people's consent and best interest decisions meant the service did not comply with the MCA Codes of Practice. There was some confusion at the service regarding people’s applications, reviews and expiry dates for standard DoLS authorisations.

People received nutritious food which they enjoyed. Sufficient drinks were offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them. People assisted with shopping and cooking and had the right to choose their own meals. We found the kitchen required more comprehensive cleaning to ensure the safety of people.

The found the service was caring. We observed staff were warm and friendly. As staff had worked with most people over an extended period of time, they had come to know each person well. Many of the people who used the service had lived there for long periods of time. This reflected in the care that people received from staff. The environment was maintained as a house rather than a care facility.

Personalisation of bedrooms and communal areas was evident. External agencies we spoke with, such as commissioners, praised the service when we asked. We found people had the right to choose or refuse care or activities and this was respected by staff. People led the life they chose to and this was not changed by anyone at the service. We saw people’s privacy and dignity was respected at all times.

People were involved in the service in a number of ways and attended a wide variety of activities and events. This included the planning of social activities as well as normal functions of running the service.

Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated. Staff knew about the complaints procedure and people had the ability to complain. There were no complaints since our last inspection, although the management had the knowledge and skills to investigate if a complaint was raised.

The workplace culture at 5 Winston Court was good. Staff described a positive place to work and care for people. Staff told us they enjoyed their roles and found management approachable and reasonable. Insufficient audits of the service were conducted to check the quality of the care. However the service required more input and oversight of its day-to-day running and the care of people.