About the service: Windermere Rest Home is a small privately-owned care home. The service can provide care and accommodation for up to ten older people. At the time of our visit nine people were being accommodated. People living in Windermere Rest Home may have care needs associated with living with dementia.

People’s experience of using the service:

The service did not have robust infection control and cleaning procedures in place.

There were lapses in the documentation relating to the checking of equipment used to lift people.

Systems for governance and oversight were not sufficiently robust to address the issues highlighted at inspection.

Staff had been recruited safely with the appropriate recruitment checks. People spoke positively about the staff and registered manager. Staff had the appropriate training.

Medication was managed safely.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed choices.

People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis.

The manager responded to complaints received in a timely manner. Support was given to people at the end of their life.

We recommend that the PRN protocols are kept with the medication administration charts for staff to follow and that the advice given in audits is followed.

We recommend the provider considers making the environment more dementia friendly when planning any refurbishment. For example, the use of brighter colours and changing door colours to help people living with dementia navigate themselves around the service.

We recommend the registered manager reviews activities on offer and matches these with the needs of the people living at the service, while considering some people would benefit from one to one activities.

Rating at last inspection: Good (report published 4 October 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Windermere Rest Home is a small privately owned care home. The service can provide care and accommodation for up to ten older people. People living in Windermere Rest Home may have care needs associated with living with dementia. At the time of our visit there were 10 people living in the service. An unannounced inspection was carried out on 14 July 2016 and 15 July 2016. At the previous inspection the Commission highlighted areas in the service needed to improve to ensure safety and wellbeing of people living in the service.

Vast improvements have been made since our last inspection, at this inspection the service has been rated overall as “Good” as the provider had shown sustained improvements over a long period of time.

The service is required to have a registered manager; the service had a registered manager in post. A registered manager is a person who has 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 service had made improvements to ensure staff delivered support that was effective and caring and this was delivered in a way which promoted people's independence and wellbeing, whilst people's safety was ensured.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people's individual needs to be met adequately. Trained staff dispensed medications and monitored people's health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People's rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community mental health nurses and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. People were supported to identify their own interests and pursue them with the assistance of staff. Person centred social activities took place within the service.

This inspection took place on 20 November 2014. Windermere Rest Home can accommodate up to ten older people who require personal care and support and who may have care needs associated with dementia.

The service had 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.

This inspection found that improvements were needed in a number of areas where the provider was not meeting the requirements of Regulations.

Risks relating to people’s individual care needs were not being properly assessed. People’s care was not properly planned and issues relating to their healthcare were not recorded. This left people at risk of receiving inadequate care. People and their families were not actively involved in planning and reviewing their care needs.

People said that they were treated with kindness and respect by staff. However, relatives, professionals and staff told us that insufficient staff were available to fully meet people’s needs.

People’s medicines were not being managed in all aspects. There were not safe systems in place for administering medicines.

Systems in place to assess and monitor the quality of the service were not inadequate and had not identified where there were issues that needed to be addressed.

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

In addition to not meeting the requirements of Regulations we found that improvements were needed in other areas of the service.

Staff did not receive the training and support needed to help them fully understand and meet people’s needs.

People were supported to be able to eat and drink sufficient amounts to meet their needs but there was a lack of variety and choice provided.

People had limited opportunities to participate in activities to suit their individual needs and interests.

People had some opportunities to express their views about their life at Windermere Rest Home but the level of involvement and ability to influence the provision of the service was low.

People who used the service told us they felt safe. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse happening through ensuring staff had a good understanding of the issues and had access to information and training.

Throughout the inspection we observed staff interacting with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally we saw that staff responded to people and had an understanding of people’s individual care and support needs. Care tasks were carried out in ways that respected people’s privacy and dignity.

CQC monitors the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and reports on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. We found that the manager had some knowledge of the MCA 2005 and DoLS legislation. They knew how to make a referral for an authorisation so that people’s rights would be protected. However, there was insufficient information guidance available to assist staff in understanding and assessing people’s needs.

We inspected Windermere Rest Home in June 2013 and found that improvements were needed in a number of areas. This visit in October 2013 was to check that the required improvements needed to comply with regulations had been made.

We spoke with a number of people living in Windermere Rest Home. People were happy with the care and support provided and thought that the staff were kind and responsive.

We found that the service was being maintained to a better standard of cleanliness. The right guidelines and suitable procedures were in place to ensure that people were protected by better levels of infection control being maintained. New flooring had been provided in some rooms and areas of paintwork had been improved to provide surfaces that were more readily cleanable.

People praised the staff at the service and made comments such as, "They're a good lot here," and, "They are all kind." We found that staff were now better supported through induction, supervision and on-going training.

We saw that the quality and safety monitoring of the service had improved and that the provider was recording the monitoring taking place. Work needed to continue to ensure that people using the service had a voice. The provider needed to be more proactive in encouraging people, where they were able, to express their views on their care and the service provided.

People we spoke with told us that they were happy and well cared for at Windermere Rest Home. People told us; "I am happy and comfortable here," and; "I have no complaints."

We found that overall people's individual health and care needs had been assessed and planned for but that improvements, including involving people in this process, would be beneficial.

We saw that people were given choices in their day to day lives and were able to follow their own preferred routines. Activities did not always take into account people's individual needs and backgrounds.

The service was kept generally clean but more robust systems are required to ensure that the risk of the spread of infection is minimised through proper monitoring and staff training.

People's medicines were stored, administered and disposed of safely.

Improvements were needed to ensure that staff were properly trained and supported to care for people consistently.

There were not effective systems in place for monitoring and improving the quality and safety of the service, taking into account the views and suggestions of people living there.

People living in Windermere Rest Home were happy with the care and support they were receiving. They told us that staff treated them well and were pleasant. People said that they enjoyed the food.

People living in Windermere Rest Home have a range of needs including those associated with living with dementia. A number of people were not therefore able to tell us directly about their experiences. However, we observed how they interacted with staff and how they were assisted and saw that they were relaxed and had good rapport with staff. We saw that staff were kind and patient with people.

People living at Windermere Rest Home told us that they were happy living there and felt well supported. One person told us, "I am well looked after, they have really good staff here. Another person told us, "Everyone is so nice. I'm very happy here. You can ask anything and they answer and you don't feel silly for asking." People said that they felt comfortable at safe at Windermere Rest Home.

People who were able to talk with us told us that they generally experience good care and are happy with the service they receive at Windermere Rest Home.

People looked relaxed, interacted well with staff and told us that they felt safe at Windermere Rest Home.

A recent survey undertaken by the home also contained comments such as, “The staff are very friendly,” and “The staff are very caring to X and ourselves.”