The inspection of White Windows took place on 22 and 28 January 2019 and was unannounced. At the last inspection in October 2017, the service was rated as requires improvement and identified two breaches of regulation which related to safe care and treatment (medicines management and risk assessment) and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do to achieve compliance in these areas. The provider did this in a timely manner. However, during this inspection we found the service was still in breach of these regulations and we found further breaches of the Health and Social Care Act 2008 associated regulations. These were in relation to meeting people’s health needs and person-centred care, staffing, consent, person centred care and privacy and dignity.

White Windows is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. White Windows has four floors with living accommodation on two floors which are accessible by a lift. The home is registered to provide accommodation for up to 25 people and there were 23 people living in the home during our inspection.

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.

Nursing staff were knowledgeable about safeguarding people but not all care staff we spoke with understood what might constitute abuse and what they should do if they thought someone was being abused.

Medicines were not managed safely. Some medicines and essential items were not available and some people did not receive their medicines in line with their needs.

Risks to people’s health and wellbeing were not well managed. Risk assessments were in care files but many of these were generic. More personalised risk assessments were not always up to date. People at risk of pressure damage were being nursed on mattresses for which staff did not know the correct setting. Accidents and incidents that happened in the home were not analysed to look at ways in which the risk of similar events could be minimised.

There were not enough staff available to meet people’s needs safely. Staff received the training they needed but did not always feel the systems for supervision were effective.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. Mental capacity assessments had not taken place and conditions on Deprivation of Liberty Safeguards (DoLS) were not being met. We did not see any evidence of people’s independence being supported.

People enjoyed the food at the home but we found people were restricted in being able to make drinks and snacks independently.

People’s healthcare needs were not always met effectively and people had been put at risk due to this.

Practices within the home did not always support people’s privacy and dignity needs. One person described the service as “institutional.” Some staff demonstrated a caring approach.

Care was not consistently planned or delivered with a person-centred approach. People were not supported to follow their lifestyle choices and access to appropriate activities was minimal.

The provider had not complied with the Accessible Information Standard (AIS), which sets out a specific approach to meeting the information and communication support needs of people with disabilities, impairment or sensory losses.

Systems for auditing the safety and quality of the service were not effective and did not include the views of people who used the servic

The inspection of White Windows took place on 8 November 2017 and was unannounced. At the last inspection in August 2016 the service was rated as requires improvement and identified a breach of regulation which related to staffing. Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve the premises and governance. During this inspection we found improvements had been made to the premises, but there were further breaches of the Health and Social Care Act 2008 associated regulations.

White Windows is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. White Windows has four floors with living accommodation on two floors which are accessible by a lift. The premises had undergone some refurbishment and redecoration since our last inspection. The home is registered to provide accommodation for up to 25 people and there were 22 people living in the home on the day we inspected.

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.

Staff knew how to keep people safe and what to do if they felt somebody was at risk. Appropriate referrals had been made as required under local safeguarding procedures and reasons for referral had been analysed at both home and provider level to make sure any learning from such events was implemented to mitigate the risk of re-occurrence.

We found inconsistencies in risk management. We saw some risk assessments had been well completed and the risk managed well. However the risk management plan for one person’s skin integrity had not been followed.

Systems were in place to make sure the environment was safely maintained and infection control practices were robust.

There was an individualised approach to administration of medicines with medicines stored safely in people’s own rooms wherever possible. Records were not robust in relation to application of topical medicines or when medicines had to be crushed.

Staffing levels were appropriate to meet the needs of people. Safe recruitment procedures were followed and staff received the support and training they needed.

People were supported to have maximum choice and control of their lives and we saw examples of how people had been supported to meet their identified goals and aspirations.

Where appropriate, the registered manager had made application for Deprivation of Liberty Safeguards (DoLS) authorisations. However where conditions had been applied to the authorisations these had not always been met.

People told us the food was good and they had plenty of choice. We observed mealtimes to be a good experience for people.

We found people accessed health and social care services as needed and the service was in the process of implementing new technology to support this.

Staff were considerate, caring and friendly in their approach. People told us staff were respectful of their privacy and dignity needs.

Care records were person-centred and were under review to make sure they reflected a fully person centred approach.

People had access to a range of social and recreational activities within the home and the local community. People told us about clubs and activities they attended and how they were supported to make lifestyle choices. Transport was available to support people in accessing activities of their choice.

People were involved in the running of the service through a residents committee, a ‘have your say’ survey and through various meetings. People were also involved in staff recruitment.

The registered

This was an unannounced inspection which we carried out on 9 August 2016.

We last inspected White Windows in November 2013. At that inspection we found the service was meeting all of the legal requirements in force at the time.

White Windows Care Home with Nursing and Physical Disabilities is a care home that provides accommodation and personal care for up to 25 people. Nursing care is provided.

A registered manager was in place. 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.

Staff said the management team were supportive and approachable. The new registered manager monitored the quality of the service provided and was introducing improvements to ensure that people received safe care that met their needs. People and their relatives had the opportunity to give their views about the service. A complaints procedure was available.

Not all areas of the home were well maintained for the comfort of people who used the service. We have made a recommendation about the maintenance of the environment.

People said they were safe and staff were kind and approachable. People were protected as staff knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. Staff had not all received updated training to ensure they had a good understanding and knowledge of safe working practices and people’s care and support needs.

White Windows was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had some understanding of the Mental Capacity Act (MCA) 2005 and Best Interest Decision Making when people were unable to make decisions themselves.

People had food and drink to meet their needs. People had access to health care professionals to make sure they received appropriate care and treatment. Risk assessments were in place and they identified current risks to the person. People received their medicines in a safe way.

Systems were being put in place to ensure people received individual care that met their needs in the way they wanted. Staff knew the people they were supporting well and care was provided with patience and kindness. People's privacy and dignity were respected.

People had some opportunities for activities and outings but people we spoke with and relatives said more activities and stimulation needed to be provided for people. We have made a recommendation about increasing the activities provision.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with six people who use the service, one relative and three members of staff. These were some of the things they told us:

“I am very happy here. I like the staff and they are all very caring and helpful. I listen and watch what is going on and staff are very nice with people.”

“I am involved in planning my care and support and I am confident with my named nurse, they sort things out for me.”

“It is very pleasant here and I have a nice room. The staff are very nice and I get the help I need.”

“The food is good.”

“We are looking forward to the refurbishment that is going to happen in the New Year.”

“I am always made to feel welcome when I visit and I often have a meal with my relative. The house is always clean and tidy and the staff are all very pleasant.”

“I love my job and I love working here.”

We found that people were treated with respect and were involved in planning their care and support.

Care plans were detailed and provided staff with the direction they needed to support each individual.

People told us that their care and support needs were being met, but sometimes they felt staff were ‘rushing’ because there weren’t enough of them on duty.

The provider had appropriate systems in place for gathering and evaluating information about the quality of care the service provided. Records were up to date and stored safely.

We spoke with 10 people who lived at the home, one relative and four members of staff. These are some of the things they told us:

“I like it here the staff are good. I have a nice bedroom that is kept clean. There is a member of staff who is my key worker and if I want any shopping they will do it for me.”

“I have an individual support plan that I can look at and have recently attended a review meeting with staff and my social worker. “

“I like the staff and get the care and support I need.”

“It’s a very nice place, I feel really looked after and my bedroom is perfect.”

“They organise trips out, which are good, recently I went Christmas shopping.”

”I love it here the staff are very good. I am a very picky eater and if I don’t like what is on offer they make me something else.”

“We have meetings and talk about what is going on. We had one recently and talked about entertainment we would like for Christmas.”

“I am made to feel welcome when I visit and my relative seems happy here.”

”Staff that we spoke with all said they like working with the people living at White Windows and enjoy their job.”

People we spoke to during the review were positive about the staff at the home and how kind and caring they are. People also told us that their rooms and the home is kept clean.

People also told us that any concerns they have are dealt with by staff, that there are various trips and outings organised on a regular basis, and relatives told us that they are always made to feel welcome at the home.