Windmill Manor

Windmill Manor is a care home providing personal and nursing care to 50 people with nursing needs, most people living at the service were living with dementia. The service is registered to support up to 60 people. People received care in one purpose-built building with communal areas and outdoor spaces.

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

People, relatives and staff said there were not always enough staff to meet people’s needs. We observed instances where low staffing numbers impacted on people’s care, particularly at mealtimes. There were limited checks in place to monitor staffing and the tool to calculate staffing numbers did not always reflect people’s needs. Records relating to creams and topical medicines were not accurate, we received confirmation of action taken after the inspection to address this.

People said they felt safe with staff and plans were in place to assess and mitigate risks. Medicines were administered to people by trained staff. The home environment was clean and staff were trained in infection control. Background checks had been carried out on new staff to ensure they were suitable for their roles.

Staff worked closely with healthcare professionals to meet people’s needs and we received positive feedback from professionals about staff competence and communication. People liked the food that was prepared for them and their dietary needs were met. 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 got on well with staff and we made observations of pleasant caring interactions which showed kindness and compassion from staff. Staff respected people’s privacy and dignity when delivering care and people were encouraged to do tasks themselves to promote their independence.

There was a range of activities at the service which were suited to people’s needs. Care was planned in a personalised way with regular reviews, which people and relatives said they were involved in. People’s wishes and preferences regarding end of life care were documented. People knew how to complain and any complaints had been investigated and responded appropriately.

There was a variety of checks and audits in place and aside from where we found shortfalls in records relating to staffing and creams, audits were effective in identifying and addressing any issues. People and staff had regular meetings to involve them in the service and we saw evidence of work with the community and other organisations to improve people’s care experiences.

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 17 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to staffing numbers. 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.

This was an unannounced inspection that took place on 19 April 2017.

The home 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

We carried out an inspection to Windmill Manor in July 2016 where we identified some breaches of

regulation in relation to staffing and good governance as well as a breach of the registrations regulations in respect of notifications. As these breaches of regulation were continued breaches we took enforcement action against the registered provider in order that they took immediate action. We also made recommendations to the registered provider in respect of activities and person-centred care. We carried out this inspection to see if the registered provider had taken appropriate action to address our concerns. We found at this inspection action had been taken and therefore we found the registered provider had met the warning notices and breaches of regulations. Although improvements had been made to activities and person-centred care we fed back to the registered manager during our inspection that continued work was needed in both areas to sustain these improvements.

In the event of an emergency where the home would have to close there was a contingency plan in place and there was evacuation information for each person. Staff were able to evidence to us they knew the procedures to follow should they have any concerns about abuse or someone being harmed.

There were a sufficient number of staff to care for people. Safe recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home.

Staff had completed decision specific assessments in relation to the Mental Capacity Act 2005 and applications where people’s liberty was being restricted had been made. Staff were heard to obtain people’s consent before they supported them.

There was a pleasant atmosphere in the home where people and staff interacted in an easy-going manner. People and relatives were happy with the care provided and they were made to feel welcome when they visited. Staff supported people to take part in various activities and work was on-going in relation to developing meaningful, individualised activities for people.

Care was provided to people by staff who were trained and received relevant support from their manager. This included regular supervisions and appraisals. Staff told us they felt more supported by the registered manager since our last inspection. People knew how to make a complaint if they felt the need to. They told us any concerns they raised were dealt with immediately by the registered manager.

Care plans contained information to guide staff on how someone wished to be cared for. Information included detail around people’s mobility, food and personal care needs. However, there were some areas where additional information may have been useful for staff. Where people had risks identified guidance was in place for staff to help reduce these risks. Staff followed correct and appropriate procedures in administering medicines and medicines were stored safely.

Quality assurance checks were carried out by staff to help ensure the environment was a safe place for people to live and they received a good quality of care. Staff were involved in the running of the home as regular staff meetings were held. Relatives were asked for their views about all aspects of the care that was being provided to their family members.

People were provided with a choice of meals each day and those who had dietary requirements received appropriate food. Staff maintained people’s health and ensured good access to healthcare professionals when needed.

This was an unannounced inspection that took place on 18 July 2016.

The home 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

We had carried out an inspection to Windmill Manor on 20 May 2015 where we identified a number of concerns. These related to a lack of qualified staff, staffing failing to follow the requirements of the Mental Capacity Act 2005, people not receiving respectful care from staff and a lack of good governance within the home. Following that inspection the provider sent us an action plan which detailed how they were going to address these concerns. We have carried out this inspection to check whether or not the provider had completed the actions in line with their action plan.

There were an insufficient number of staff to care for people and the premises were not always well-maintained because of a lack of housekeeping staff. Staff morale was low mainly due to the lack of staff. People may not always receive responsive care as care records for people were not always accurate.

People did not always have to access to meaningful, relevant activities particularly those people living with dementia.

Although quality assurance checks were carried out by staff these did not always identify shortfalls in the recording of information in people’s care plans. The registered manager was not always aware of their responsibilities in relation to CQC.

Care was provided to people by staff who were trained and received regular supervisions and appraisals from their line manager.

There was a good atmosphere in the home where people and staff interacted in an easy-going manner. People were cared for by staff who were kind, caring and supportive. People and relatives were happy with the care provided and they were made to feel welcome when they visited.

Staff followed correct and appropriate procedures in administering medicines and medicines were stored safely and appropriately.

Care plans were written in a person-centred way and where people had risks identified guidance was in place for staff to help reduce these risks. People’s care would continue in the event of an emergency and staff helped safeguard people from abuse as their understood their roles in this regard. Safe recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home.

Staff completed assessments in relation to the Mental Capacity Act 2005 and where people had restrictions in place to keep them safe, the registered manager had submitted the appropriate DoLS applications.

People were provided with a choice of meals each day and those who had dietary requirements received appropriate foods. Staff maintained people’s health and ensured good access to healthcare professionals when needed. For example, the doctor, dietician or district nurse.

People and staff were involved in the running of the home and complaint procedures were available to people should they feel the need to complain.

During the inspection we found one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two new breaches. We have also made some recommendations to the provider. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they were encouraged to express their views regarding their care and treatment and that they were included in discussions when their care was reviewed.

People who used the service told us that the staff were kind and caring and that they were treated with dignity and respect.

People who used the service told us that the food was "fantastic", and that there was a wide choice available at every meal.

Relatives visiting the home told us that they always found the care was excellent and that staff were kind and considerate. They also said that they were kept informed and included in their relative's care.

People who used the service told us that there was always something to do to keep them occupied. They told us that it was their choice what activities they decided to participate in, and they sometimes chose their own company.

Staff told us that they enjoyed working in the home and that they felt that they had the training and support necessary to enable them to undertake their roles.

People told us that they were consulted about their views regarding the home and relatives told us that they could remember completing a survey.

People had access to the home's complaints procedure.