We inspected The Windmill care home on the 24 and 25 September 2018. The first day of the inspection was unannounced.

We last inspected the home in December 2017 where we found eight breaches to six of the regulations. At this inspection we found 13 breaches to 10 of the regulations. At both inspections some regulations were breached more than once. Some action had been taken to address previous concerns but we found six continuing breaches. The provider had taken enough steps to meet the regulations regarding the cleanliness of the home and upholding people’s dignity. At this inspection we have also made two recommendations as to how areas of the regulations can be improved.

The Windmill care home 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 Windmill care home supports up to 29 people with residential care needs. At the time of the inspection there were 28 people living in the home. The home was set over two floors with communal areas to the ground floor. At the time of the inspection an extension was being built which had reduced the available space used by people in the home. People had access to a large dining room, a much smaller lounge and a marquee which had been erected in the garden to the rear of the home. The marquee was carpeted and heated and had ample seating for people who chose to use it.

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 2008 and associated Regulations about how the service is run.

In December 2017 we found the provider had not provided appropriate activities to people living with dementia. At this inspection there were no activities being delivered.

At the previous inspection we found people’s care records did not identify their needs and preferences and were not regularly reviewed. This inspection found this area had considerably deteriorated. We found care plans were not reflective of people’s current needs and some had not been reviewed for nearly 12 months.

The last inspection found lawful consent was not gained from those people living with dementia. Action had not been taken to ensure consent was acquired in line with the principles of the Mental Capacity Act 2005 when people lacked capacity to consent to their care and treatment.

In December 2017 we found evidence to show the provider was not assessing the risks to people’s health and wellbeing. Where risks were identified action was not taken to reduce the risks and the records held did not reflect the support provided. This was still the case during this inspection.

Good governance regulations require providers to regularly assess and monitor the service provided. This is done to ensure both the service is meeting the requirements of the people being supported and to ensure standards are kept. During December 2017 we found the systems ineffective as they had not picked up the concerns noted by the inspection team. During this inspection we found systems had not been used for two months and those that had been used prior to that remained ineffective.

Staffing had been a concern at the inspection in December 2017 and a breach was evidenced. The provider told us they had trialled additional staff through the night but had felt they were not needed. This inspection clearly showed a lack of available staff. Communal areas were left unsupported for long periods of time and people told us they had to wait for support. We saw people required support with their personal care needs long before it was offered.

During this inspection we found management and staff were not tr

This inspection took place on 25 October 2017 and was unannounced. The Windmill Care Home is a residential home for up to 29 older people, some of whom may be living with dementia.

At our previous inspection in October 2014, we rated the service as good overall.

During this inspection, we found that the registered provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staffing, governance, consent, safe care and treatment, person centred care, and privacy and dignity. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post. 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.

The provider and registered manager had failed to recognise potential harm to people using the service. Quality assurance and auditing mechanisms did not identify concerns we found during the inspection. Accidents and incidents were not analysed sufficiently to identify trends and patterns and to ensure people were kept safe.

Infection prevention and control procedures were ineffective and we found that hygiene was poor across the service. Environmental risks had not been identified by the service.

Improvements were needed where people were receiving medicines on an ‘as required’ basis to ensure these were only given when needed. Covert medicines also required clarity as to the method of administration, and how regularly they should be reviewed.

Staffing levels were not sufficient in order to meet the needs of people in a timely manner and keep them safe at all times.

Care plans contained detailed information reflecting people's individual needs and preferences. However, two of the care plans we looked at had not been recently reviewed in all areas, and not all guidance was in place to help staff support people effectively.

People’s privacy and dignity was not always upheld. We observed some practices' which compromised people's privacy and dignity.

The registered manager had not applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. Best interests documentation was not always in place where decisions had been made on behalf of people who lacked capacity.

Improvements were needed with the mealtime experience, and we have made a recommendation about this.

There was an activity co-ordinator in the service. However, the provision of activity was not sufficient to meet the individual and specialist needs of all people using the service.

The provider had not maximised the suitability of the premises for the benefit of people living with dementia, and we have made a recommendation about this.

There was a complaints procedure in place. People and their relatives felt able to complain if they had concerns they wanted to raise.

People's nutritional needs were monitored, and people received support to manage a healthy diet where required. People were referred to other health care professionals in a timely manner to maintain their health and wellbeing.

Staff were aware of their responsibilities in relation to safeguarding people, were aware of the types of abuse they may come across. Appropriate recruitment checks had been carried out on new staff, to ensure they were of good character and suitable to work with people in the service.

We observed and chatted briefly with a number of people, while they were spending time in various areas of the home. We also met and spoke with three people while they were in their own rooms.

Two people we spoke with had only lived in the home for a short while and both people told us that they were settling in well. One person said, "The staff are marvellous. Very good. They come very quickly when you need them. I pressed my call bell and they were here - as quick as that!"

The staff we spoke with told us that the training was excellent now. One member of staff said: "I've never done so much training, every time you look, there's something else to do - but it's really good!"

Another member of staff we spoke with told us that all the staff thought that the manager was a good leader. They also said that the manager provided 100% back up and support to the staff team. This member of staff said that the manager's door was always open and that they listened to everyone. All the staff we spoke with confirmed that they found the manager to be very approachable.

People who lived in the home were able to give their views on how the service was run by way of regular discussions with the manager and staff. One person we spoke with told us that they hadn't been 'too happy' about something earlier that morning but that they had spoken with the manager and felt that the situation had been explained clearly and subsequently resolved.

We observed staff going about their duties during our inspection at The Windmill Care Home on 05 October 2012. We saw that when people were being supported by staff, they were given time to respond and were not rushed. We found the atmosphere in the home to be calm, relaxed and comfortable.

At the time of our inspection, we saw that there were enough members of staff on duty to keep people safe and meet their care and welfare needs.

During our inspection on 05 October 2012, we spoke with the provider's son who had a lead role in overseeing the management of this home and four members of day staff. All four staff we spoke with said they felt things had improved a lot over the past few weeks and that the new manager was making good progress with ongoing improvements.

Following on from our inspection on 05 October 2012, we received further information of concern regarding the lack of appropriately trained staff working the night shifts.

We investigated this concern further with the provider's son and the new manager, who explained that there had recently been the need to dismiss some members of staff, which had resulted in a short term impact on the night duty rota.

We did not speak with people who used the service on this occasion, as the purpose of this inspection was to follow up on concerns raised about staffing levels.

We carried out two visits to The Windmill Care Home as part of this inspection and used a number of different methods to help us understand the experiences of people using the service.

One of the methods we used during our second visit to the home, on 19 June, was the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not speak with us. Our observations using this method showed us that staff were warm, friendly and caring towards the people they were caring for.

The comments we received from people who were able to speak with us were all positive. They included: "They're a lovely lot here." "The staff are wonderful." And, "They look after us well, I couldn't ask for more".

People we spoke with told us that they enjoyed their meals and one person told us: "We get marvellous food here, everything's always so tasty."

One person we spoke with told us: "I have a lovely room." Another person said: "This is a lovely home, I'm glad I live here now."

During our second visit, one person told us that they liked sitting near the French windows because: "It's nice to watch the world go by."

People told us that they enjoyed living at this home. They said the staff were kind and friendly and supported them when they needed help. They told us they could spend their day as they wished and were given choices around their daily living. These choices included when they got up and went to bed, joining activities, food and making friends.

People told us that the staff were very caring and were always ready for a chat and a laugh. Staff were described as friends and people felt able to talk to them if they had any worries.

This inspection was undertaken on 29 and 30 October 2014 and was unannounced.

The Windmill Care Home is registered to provide accommodation and personal care for up to 29 older people, some of whom may be living with dementia. The home was fully occupied when we inspected.

The provider is required to have a registered manager in post. At the time of this inspection the provider was recruiting for a registered manager as the person who was registered as the manager left the home in August 2014. 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.

All of the people we spoke with, who were living in the home, confirmed that they felt safe living there. The relatives we spoke with also confirmed that they had no concerns about their family members’ safety.

People’s care records contained detailed risk assessments, which covered relevant aspects of their daily lives. These ensured that people were supported and cared for safely and that risks to their health, welfare and safety were minimised.

Staff knew how to identify abuse and understood the reporting procedure if they suspected abuse was taking place. Staff had received training in safeguarding and protecting people.

Sufficient numbers of staff were on duty during both days of our inspection and we noted that the provider was actively looking to recruit additional permanent staff, in order to fill the current vacancies.

Medicines were stored, managed and administered safely.

All areas of the home were clean and well maintained and there were no hazards to people’s safety.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Head of Care told us that there was no-one in the home who was being deprived of their liberty and we were satisfied, having met and observed people living in the home, that this was the case.

Staff told us that they received regular support and supervision from senior staff or management. Staff also told us that they received regular training that was relevant to their roles.

People’s individual dietary needs were catered for in line with their care plans and they were offered a choice of hot and cold drinks at regular intervals. Where people needed assistance or encouragement with eating or drinking, this was undertaken in a dignified manner.

People were involved in planning their own care and care plans provided clear information regarding their histories, as well as their needs, preferences and choices.

Throughout both days of our inspection we saw that staff’s attitudes towards people living in the home were warm, caring, kind and patient.

Activities and events were regularly organised by staff, which people could choose to take part in. People were able to choose when and what they wanted to do and where they wanted to spend their time.

Everyone we spoke with said that they could speak with the provider or any of the staff at any time and no-one had any cause for concern or complaints.

Although the registered manager had recently left the service at the time of our inspection, the provider had taken appropriate steps to ensure the home continued to be effectively managed.

Regular audits and reviews were being completed within the home, covering areas such as health and safety, medication, care plans, accidents, incidents, falls and nutrition. These helped to ensure that service continued to operate well and meet people’s needs appropriately.