The Winsor Nursing Home 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. It is registered to provide accommodation and nursing care for up to 40 people. The home specialises in the care of older people but is also able to provide care to younger adults with nursing care needs. At the time of the inspection there were 37 people living at the home.

At our last inspection in June 2016 we rated the service good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. During this inspection the rating for the responsive key question changed to ‘requires improvement’, however this does not affect the overall rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good

People felt safe at the home and with the staff who supported them. The provider had systems and processes that minimised the risks of abuse to people. One person told us. “I’m safe here. There’s no unkindness.”

People’s nursing and personal care needs were met by staff who were well trained and competent in their roles. One visitor said, “The girls [staff] here are marvellous. They are very skilled and definitely know what they are doing.”

People told us staff who supported them were kind and caring. We observed staff showed patience and understanding when assisting people. One person told us, “Staff here are very kind, you can’t fault them on that.”

People’s health was monitored by trained nurses and they had access to other healthcare professionals to meet their individual needs. People received their medicines safely.

Staff had received training and knew how to protect people’s legal rights when they lacked the capacity to make a decision for themselves or give consent to their care.

The management team kept up to date with good practice to make sure people’s care was provided in accordance with best practice guidelines and current legislation.

People lived in a home where the provider and management team were committed to making ongoing improvements. There were quality assurance systems which monitored standards of care and addressed any shortfalls in the service.

Some improvements were needed to make sure care provided to people was person centred. People did not always receive social stimulation or have opportunities to take part in activities in accordance with their interests and hobbies. We have therefore recommended that the provider reviews their activity programme.

Further information is in the detailed findings below

This inspection took place on 17 May 2016 and was unannounced.

The Winsor Nursing Home provides nursing care to older people. The home is situated in a convenient location close to the sea front, shops and cafes. A maximum of 40 people can be accommodated and some bedrooms are large enough to accommodate people who wish to share a room. The home is staffed 24 hours a day and registered nurses are on duty at all times.

There were 39 people living at the home when we visited. Many people were able to tell us about their experiences of life at the home however; some people were living with dementia and found communication difficult. We therefore used our observations of care and our discussions with staff to help form our judgements.

There was a registered manager who is responsible for the home. 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 had a good knowledge about the needs and preferences of the people who lived at the home. They were committed to ensuring people received the best possible care. The registered manager regularly worked on the floor providing registered nurse cover which helped them to observe the quality of care people received.

The atmosphere in the home was relaxed, cheerful and welcoming and staff communicated with people in a very kind and respectful manner. Without exception all the people and visitors we spoke with were very complimentary about the care they received and of the staff who supported them. A person who lived at the home told us “The staff are all so kind. We have a laugh and they take time to talk to you; even at night.” Another person said “The staff are very kind to me. I have my favourites but they are all lovely.”

People told us they felt safe living at the home. One person told us “I see this as my home now and I feel very safe indeed.” Another person told us “They [the staff] look after me very well. I have no worries at all.” A visitor said “I am very content with everything. Most importantly; I don’t go away feeling concerned about [Person’s name].” There were policies and procedures in place to minimise risks to people and to help keep them safe. These were understood and followed by the staff team.

There were enough staff to help keep people safe and meet their needs. One person who lived at the home told us “If I ring my bell the staff come pretty quickly really. I don’t have any concerns there.” A visitor said “There always seems to be plenty of staff about when I visit.” The service made sure staff were appropriately trained and supported.

People received effective care and support which was adjusted to meet their changing needs. People had access to appropriate healthcare professionals to make sure they received effective treatment when required. One person told us “I can’t stress enough how wonderful it is here. The staff know all about my medical conditions and they help me in just the right way so that I am not in pain.” A visitor said “I think the staff are very good from what I have seen. It’s not an easy job and they really know what they are doing.” There were systems in place to make sure people received their medicines when they needed them.

People had their nutritional needs assessed and food was provided in accordance with people’s needs and preferences. People told us they were provided with plenty to eat and drink and were positive about the choice and quality of the food. One person said “The food is lovely and it’s nicely served.” Another person told us “I get plenty to eat and there’s always a choice. It’s very good.”

People had opportunities to take part in social activities. An activity worker was employed. We observed that care staff also

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We found the service to be safe because they had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.

We observed that staff were competent and professional in their interactions with people who lived at the home. During our inspection we observed people were relaxed and appeared very content with the care and support provided.

We observed staff assisting people to transfer to/from wheelchairs with the aid of a hoist. We saw people were assisted in a safe and dignified manner. Staff took time to explain what they were going to do and offered constant reassurance to the people they were assisting. People appeared relaxed and comfortable when being assisted.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

Staff received appropriate levels of support which enabled them to care for people safely and to an appropriate standard.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We saw that all medicines had been stored securely and had only been administered by registered nurses.

Is the service effective?

We found the service to be effective because people's care treatment and support achieved good outcomes. We also found that people's rights and choices were respected by staff.

We saw staff recorded information about each person on a daily basis. Information included how people had spent their day and how they had responded to activities of daily living. This meant the effectiveness of people’s care plans could be fully reviewed.

We saw that people's prescribed medicines had been regularly reviewed by their GP or specialist health care professional. This meant that people received medicines which were appropriate to their needs.

Is the service caring?

Staff interacted with people in a gentle and kind manner. The people we spoke with were very complimentary about the care they received and the staff who supported them. Comments included “I am so satisfied with everything. Honestly, things couldn’t be any better” and “I have nothing to grumble about. All the staff are very nice and kind.” The visitors we spoke with told us “The care and attention couldn’t be better. I visit most days and all I see is kindness” and “Everyone is so friendly and welcoming. I have no complaints at all.”

The staff we spoke with had a very good understanding about the needs and preferences of the people they supported. They understood and responded to people’s needs and requests where individuals were unable to make their wishes known verbally. This demonstrated that staff knew people well.

Is the service responsive?

The service was responsive to people's needs. We observed people were supported in accordance with their needs. For example we saw people were provided with soft diets and nutritional supplements where required.

People told us they did not have to wait long when they used their call bell to summon assistance. Throughout our visit we saw staff responded to call bells in a timely manner. The maximum time someone waited was five minutes.

The staff we spoke with were very knowledgeable about the needs and preferences of the people they supported. They knew about the things which were important to people. For example what drinks people preferred and how strong they like their coffee and how and where people preferred to spend their day.

We observed staff offering people choices throughout our visit and saw they responded promptly to any requests. The people we spoke with made the following comments “the staff know me very well. They know I prefer to stay in my room. They respect that and they pop in regularly to see I am alright” and “the staff know that I am frightened to go in the hoist so I don’t like to have a bath. I prefer a bed bath and that’s what I get. They are so lovely.”

Information about people’s health needs and contact with health and social care professionals had been recorded. One person told us “they are very good here. If you need the doctor, they get the doctor. No questions. Another person said “I have no doubt at all that they would call the doctor if I wasn’t well.”

Is the service well led?

The service was well led because there were systems in place which monitored the quality of the service provided. A manager was in post who had recently been registered by us. The manager was supported by a deputy manager and an administrator. We saw that registered nurses and senior staff were always available to support less experienced staff.

We asked staff what it was like working at the home. Some of the staff we spoke with had worked at the home for many years and some under a year. They made the following comments “I am very happy here. There is really good team work and I feel we are able to give people really good care” and “I love it here. I wouldn’t want to work anywhere else. It’s a great team and the support is really good.” We asked people who lived at the home and visitors for their views. They made the following comments “the staff are wonderful. They couldn’t be more caring if they tried” and “there always seem to be plenty of staff about.”

People who lived in the home and their representatives were provided with opportunities to express a view about the quality of the service provided. Information about meeting dates for people’s representatives had been clearly displayed in the reception area of the home.

We found procedures were in place to minimise any risks to the people who lived at the home. Regular internal audits had been carried out which monitored the on-going health and safety of people. Internal audits included checks on the home's fire systems, environment, care planning and the management of people's medicines.

We saw that staff had the opportunity to attend regular staff meetings. We looked at the minutes from a recent meeting. These showed that a range of topics had been discussed which included policies and procedures, staffing and information about the people they supported.

This inspection was carried out to check compliance because of areas for improvement were found at the last inspection visit in September 2012. These were in regard to the following outcomes; Cleanliness and Infection Control and the Requirements Relating to Workers.

We met and spoke with seven people who used the service; seven visitors and six staff. Following the visit to the home we also obtained feedback from three health and social care practitioners and a GP practice who were regularly in contact with the service. We looked at three care records, two staff recruitment records and records for the management and administration of the service.

The people we spoke with told us they had the care and support they needed. One person told us “I have no worries; I get the help I need.” We were told by visitors about their experiences of the care and support provided to their relatives by staff in the home. They used words such as “wonderful,” “caring” and “supportive.” They also told us they had the confidence to leave their relative at the home and feel sure that all their needs would be met.

People told us they found the staff approachable, friendly and supportive. When we spoke with relatives visiting the home they told us how much they had appreciated and valued the support and care they had had from staff. We were told,” Could not have asked for better. The care given to X was above expectations. Above and beyond.”

This inspection was carried out to check compliance because areas for improvement were found at the last inspection visit in February 2012. The improvement actions were made in regard to the outcome areas; care and welfare of people using the service, the quality of the record keeping and the management of the service. We found that these areas had been addressed. We found from this inspection visit that we had concerns about how the service managed the control of infection in the home and how checks were made about suitability of staff when they were employed.

We visited the home where we reviewed records and spoke with five people who used the service, one relative and seven staff including the deputy manager.

We saw that people had been assisted with their personal care, dressed in appropriate clothing with their hair and nails attended to. We were told by people that they thought that they had the help and support they needed including medical help when it was required.

We asked people about the support they were provided with for activities and maintaining their interests. We were told by two people that there was not always much to do and that they did not enjoy using the lounge area downstairs as there were not many people who could participate in a conversation. People told us that they thought the staff were, “nice.” and that they were “approachable and friendly”. They also said that there were usually enough staff on duty to meet their needs.

This inspection was to follow up on concerns found at an inspection carried out in October 2011.

We had also inspected in November 2011 to check on compliance with enforcement action we had taken on one area of concern. We had found compliance on that enforcement action.

The home had been under safeguarding scrutiny because of concerns about care practices. Admissions had been stopped by the local authority and a voluntary agreement to not admit people to the home until improvement were achieved was agreed with the Care Quality Commission.

During this inspection we found that the majority of people we spoke with told us that staff were kind and caring. One person said “they are lovely they do so much for me and are very kind”. Another person said “I can’t fault them they are busy but always take their time when they care for me”.

A person said “most of the staff are good but there is the odd one who is miserable” When asked if they told anyone about it they said “oh no I don’t tell tales”. Another person said “on the whole they are a nice bunch but some aren’t so good”. When asked what they meant they said “I don’t want to say as I don’t want to get anyone in trouble”.

We observed how staff interacted with people and found that they were polite and respectful. However, only two staff appeared to be cheerful in their work which created a less than happy atmosphere. We noted that staff appeared less rushed than at the last inspection.

We observed that people were clean and dressed well. Females had jewellery and make up to match outfits. One person said “I love looking nice and staff always take their time to make sure I do”. This showed that staff considered people’s dignity.

Two people told us that they loved to spend time in the garden when the weather was nice. We observed at lunchtime that they sat in the conservatory area which overlooked the garden.

At the last inspection we found that a lot of people stayed in their rooms. Although for some this was through choice many were unable to express their views. During this inspection we found that more people were in the lounge and were engaged in conversations with staff. Activities were planned for the afternoon.

We saw garden decorations that people had planted and an activities time table for the whole week. One person had told us about a “wonderful violinist” the day before.

People spoken with were happy with the care they received. One person who had needs that required a lot of attention said “I can’t fault the staff, I demand a lot of attention and most of the time I get it”. They added “Some staff do not always listen to what I need and I end up having to ring the bell again because I haven’t been positioned properly because they didn’t listen to me properly in the first place”.

Another person said “staff know what I need and take care of me very well”.

People spoken with were happy with the food they received in the home. One person said “you always get a choice of two meals but if you don’t like them you can ask for something else”. We observed one person had egg and chips which was not on the menu but that was what they wanted. Another person told us “We were asked what our likes and dislikes were but I haven’t seen many changes, but there is usually something I like”.

We saw that people had plenty of drinks offered and on the whole jugs of drinks were near to those who stayed in their rooms. However one person said “I’ve been told that I must drink plenty but the jug is often out of my reach”. We fed this back to the manager who said she would take action to ensure this was resolved.

We observed at lunchtime the dining room was quiet and calm compared to the last inspection. This was mainly because there were only 21 people that lived at the home and not all of those came to the dining room for lunch.

Food looked appetising and where appropriate we saw condiments were available for people. Staff sat with people who required assistance and were patient and kind.

At the last inspection on 20 and 25 October 2011 we had major concerns about the poor fluid intake of one person and the lack of consistent assessment and care planning for this person. We had concerns about the ineffective monitoring of this person’s fluid intake and the lack of appropriate action taken to improve the outcome for this individual.

We took enforcement action against the provider about this issue and gave the home a short period of time to improve.

This inspection was to check that improvements had been made.

We were unable to speak with the person the issues related to. We observed that this person was in bed and found that their fluid intake had increased. We found that the planning and monitoring of this person’s care had improved and was effective.

We carried out this two day inspection to follow up on improvements needed following the last inspection in December 2010 and in response to information we had received.

We spoke with people in the home, spoke with staff and managers, observed care practices and read documentation relating to people’s care. At the time of the inspection there were 29 people in the home.

People we spoke with told us they liked living in the home and they had everything they needed. When asked if staff discussed their care and care plans with them the people said they did not think so. Some said, if they had any concerns about their care they would tell the carers or nurses.

One person we spoke with said the staff were very good. They said “they are always very caring and patient. They told us that today they were in pain but said they had asked the nurse for pain killers. The person received the pain killer within five minutes.

People told us staff were kind and caring but also very busy. One person said “I feel I can’t ask for little things to be done, they have so much to do”. Another person who was in a wheelchair in their bedroom was asked if they would prefer to be in the lounge in the mornings. They said “I don’t mind either way, I think it is easier for staff if I stay in my room until they are ready to take me down, they are so busy”.

We asked people if they were involved in their care plan, all said no. We asked if they were ever asked their opinion of the home, they said no. We asked people if they were ever asked for suggestions for menus they said no but people told us they were happy with the food. We asked people if they attended meetings where they could raise issues about the home or come up with suggestions, such as activities, they said no. We asked people if they felt able to complain or raise concerns, most people said they did not have anything to complain about but said they could speak to the carers if they were worried about anything. Some people felt the staff were too busy to worry them with anything.

Many of the people living in the home had a degree of dementia so found it more difficult to communicate verbally. We observed staff delivering care and observed how they supported people. On the whole we found staff spoke with people in a kind and respectful manner. However, when we asked a member of staff to help a person who was uncomfortable because their foot had become caught behind the foot rest of their wheelchair, they were not respectful. The member of staff said to the person “you will have to learn to do this yourself”. We also heard a member of staff, in the lounge, say to another member of staff “whose transferring these because they all need transferring”. The staff member was referring to the fact that people needed to be hoisted into wheelchairs and transferred into the dining room.

People spoken with said that most of the time the food they received was good and there was plenty of it. They said that staff asked them each morning what they wanted for lunch and supper. They said there were always two choices. People said they had not been asked by the chef or staff if they would like changes to the menu, or if they were happy with the food. One person on the top floor of the home preferred to spend their time in their bedroom. This person said that food and drinks were often cold by the time they got them but did not feel able or comfortable to complain.

We observed that bedrooms had jugs of water and some people had their own squashes to add to it. However we observed one person received a cup of tea and some biscuits in a specialist cup when they were in their bedroom. When this person was moved to the lounge some time later, the staff had brought the tea and biscuits with them. At lunchtime when the person was taken into the dining room the tea had not been drunk. We did not see staff attempt to support the person to drink this tea while it was warm or even when it was cold.

In the morning we observed that people who were less able and had a degree of dementia were in wheelchairs in their bedrooms. They were either asleep or staring into space. There was no TV on or music playing. All had call bells attached to their clothes but it appeared that the majority were unable to use them. We saw the care plan for one of these people which stated that they were unable to summon help using the call bell. There was no action recorded on how this person could be monitored safely.

We observed that a person who was in bed and unwell had a fluid / food and movement chart was not receiving adequate amount of fluid. We spoke with a registered nurse about this person and also observed the nurse trying to encourage this person to drink. The person refused even small sips of drinks. The nurse said it was very difficult to encourage them to drink. We asked if they had discussed this with the person’s GP and considered other ways to ensure they received adequate fluids and to prevent the risk of dehydration, we were told they had not considered other methods. The care plan or fluid charts did not describe the optimum level of fluid for this person; there was no information on what should be done if the person consistently refused drinks or food. We have taken enforcement action against the provider for this issue to protect the safety and welfare of people who use this service.

Some people who live at The Winsor Nursing Home were unable to tell us about the care they received however everyone we saw looked clean and comfortable.

People told us that they were well cared for and that staff were kind to them.

One person told us about the ways in which the home supported their choices about how their days were spent.

We were told that there was “plenty of food” and that individual preferences were addressed.

People said that there was “usually something going on” in the afternoon. We saw that people enjoyed the musical event organised on the day we visited the home.

The care that people received had been agreed with them and was adapted to their own preferences.

Overall people who were able to express an opinion were satisfied with the home. The home accommodates people who are not able to express an opinion and is developing the ways in which these people are supported and cared for to comply with best practise.

What we found about the standards we reviewed and how well The Winsor meeting them