Windsor Court Care Home

We found the following examples of good practice.

There was a clear process in place to welcome visitors to the home, this included rapid result COVID-19 testing, health questions and temperature checks. Visitors were asked to wash their hands or use hand gels and put on Personal Protective Equipment (PPE). These measures contributed to keeping visitors, people and staff safe.

There were designated areas within the home for staff to put on, take off and dispose of PPE correctly. The registered manager and deputy manager carried out hand washing audits for staff to ensure correct techniques were used. This practice was supported by posters around the home showing hand washing and reminders for social distancing.

The communal areas within the home such as lounges and dining rooms had been changed to encourage social distancing. For example, chairs and tables had been rearranged to have safe distances between them. People enjoyed visits from their loved ones and there was a dedicated visitor’s room with an external entrance and hand washing facilities. Relatives were kept up to date on changing visiting restrictions through telephone call or email.

The home had plans in place for managing outbreaks and had considered how they used staff teams safely in the event that someone needed to isolate. This included ensuring people were not socially isolated during these times by offering one to one activities in their own room.

The home was participating fully in the COVID-19 testing and vaccination programme. Infection prevention was supported by regular cleaning of the home including those areas frequently touched such as door handles and light switches. Staff had received infection prevention and control training including how to put on and take off PPE correctly.

The registered manager and deputy manager kept themselves up to date with changing government guidance and communicated this to people and staff.

Windsor Court Care Home is registered to accommodate up to 48 people and provides care and support for older people. The service is split over three floors which were all accessible by stairs or a lift. There were 24 people using the service at time of inspection.

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

Improvements had been made since the last inspection to meet the regulations. However, we found that further improvements were needed to ensure these were embedded within the service.

The home had risk assessments for people and general assessments for the home. These had indicated a risk of legionella in the water system. The home was working in partnership with the environmental health office and an external water specialist to mitigate the risk. The home had made improvements to the cleanliness of the home and this included refurbishment and decoration of the main building. However, we found that there was an issue with the clinical waste collection which the registered manager sought to resolve during the inspection.

Improvements had been made in medicines management. Guidance was in place for medicines which are taken occasionally but the guidance needed to be developed further as it was not specific to the person. This meant that individual signs and symptoms could be missed. There were clear instructions and body maps for the application of prescribed creams. However, some labels were unclear due to handling and therefore instructions could not be read. The registered manager put immediate plans in place to address these concerns.

Staff had the necessary checks to work in a caring role and received training and ongoing supervision and support to do their job. Staff told us they felt supported and were proud to work at Windsor Court Care Home. People had regular access to healthcare services and health professionals told us they worked well with the home.

People felt safe and happy living at the home. Relatives were complimentary, and everyone felt involved in decisions within the home. Regular meetings were held, and satisfaction surveys were sent, and actions carried out.

Improvements had been made to care plans which were personalised and clear in supporting staff to meet people’s needs. End of life wishes, and preferences had been considered and people knew who to speak to if they wanted to make a complaint.

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 home supported this practice.

People were supported to maintain contact with those important to them including family and friends. Staff understood the importance of these contacts for people’s health and well-being. Staff knew people well and what made them individuals.

Quality and safety checks helped ensure people were safe and protected from harm. This meant the home could continually improve. Improvements in audits helped identify areas for development and this learning was shared with staff through handovers and meetings. The management of the home were respected.

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 28 November 2018) and there were two 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Windsor Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Windsor Court does not provide nursing care. The home is registered to accommodate a maximum of 48 people who require support with personal care. There were 27 people living in the home at the time of our inspection.

Windsor Court was registered with a new provider in May 2017 and this was therefore the first inspection of the service since this took place.

Accommodation is provided in individual bedrooms on the ground, first and second floors. Some rooms have ensuite facilities. There is a lounge and a dining room on the ground floor and two further lounges on the lower ground floor. Following the purchase of the home by the new registered provider in 2017, a comprehensive refurbishment programme had been started. This involved some major building and structural works, the addition of a new through floor passenger lift and redecoration. At the time of the inspection the building works had been paused to allow people living in the home, and staff, a break from the disruption. The registered manager advised that the completion of the works was planned but that the total number of people living in the home was at the maximum until the work was completed.

The service was led by 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.

People said they were happy living at Windsor Court and they felt safe and well cared for. They also told us their care and support needs were met and that the staff were kind, caring and respectful. Staff spoke knowledgeably about people's needs and how to support them. People were treated with dignity, respect and kindness. Their independence was promoted. However, we identified that there were a number of issues which needed to be addressed.

The building was part way through a major refurbishment but work had been halted temporarily at the time of our inspection. Work started within some areas of the home had not been fully completed. We found that some areas of the building were not clean and that infection control standards had not always been maintained.

The administration of prescribed topical medicines was not always fully effective. Some items were not stored securely, appropriately named and labelled and opening dates were not always recorded This meant that some people may not be receiving their prescribed medicines correctly especially where items may become less effective after being open for a period of time.

A new computerised care records system had been introduced and not all of the required information was being recorded because staff had not found ways to do this. For example, there was no record of total fluid intake per day and no care plans for specific conditions such as Parkinson’s disease or diabetes. The home also had six interim care beds for people who were medically fit to leave hospital but not yet able to return home. Assessments and care plans were not in place and ready for people’s admission to the home and in some cases, records were not in place a number of days after their admission. This meant that staff may not have the information they needed to fully support people.

Governance systems and audits were in place to monitor quality of work which included infection prevention and control, risk assessments and medication compliance. However, these had not identified the shortfalls we found at this inspection.

The care records for one person contained conflicting information which meant that it was not clear what the person’sneeds were and how these were to be met. Again, audits of care plans had not identified this..

People were protected from abuse and neglect. Staff knew how to raise concerns about poor practice and suspected wrongdoing under the provider's whistleblowing procedures.

People's rights were protected because the staff acted in accordance with the Mental Capacity Act 2005, including the deprivation of liberty safeguards. Where people could give consent to aspects of their care, staff sought this before providing assistance. If there were concerns that people would not be able to consent to their care, staff assessed their mental capacity. Where they were found to lack mental capacity, a decision was made and recorded regarding the care to be provided in the person's best interests. Staff worked in line with the requirements of the Mental Capacity Act 2005. The registered manager understood the requirements of the Deprivation of Liberty Safeguards.

There were sufficient staff on duty to keep people safe and provide the care they needed. Staff had the training and supervision they needed to perform their roles effectively. Robust recruitment processes helped ensure that only suitable staff began working at the service. These

included obtaining references and a Disclosure and Barring Service (DBS) check before candidates started working with people.

Staff were positive about their roles and told us they were well supported by the registered provider and registered manager.

Further information is in the detailed findings below.