About the service:

• Windmill Lodge Care Centre 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.

• Windmill Lodge Care Centre accommodates up to 93 people in one adapted building across four separate wings, each of which has separate adapted facilities.

People’s experience of using this service:

• Staffing levels were not always safe to ensure that people’s needs were met in a timely manner.

• Risks were not always sufficiently assessed and recorded so that staff were clear on how to support people safely.

• Improvements were needed to ensure that medicines were managed in line with best practice guidance.

• People were not always suitably supported with eating, however they told us they liked the food on offer to them.

• The provider had identified gaps in staff training, supervision and appraisal.

• Quality assurance systems were not always conducted effectively in order to identify and drive improvements.

• We received mixed views from people and relatives as to the care received, some people felt staff always displayed compassion whereas others found some staff to be abrupt.

• The provider had identified that the environment and activities needed improvement so that it was better suited to the needs of the people living at the home.

Rating at last inspection:

• At our last inspection we rated the service ‘requires improvement’ with breaches in relation to the need for consent, and good governance. (Report published 24 April 2018)

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

• At this inspection we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and staffing. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This inspection took place on 06 March 2018 and was unannounced.

Windmill Lodge Care Centre 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.

Windmill Lodge Care Centre accommodates up to 93 people in a purpose built home. The home was set across four floors across three separate units, each of which had separate adapted facilities. One of the floors specialised in providing residential care to people living with dementia, whilst the other three floors provided nursing care. The home had been offering care to people living with dementia for six weeks, with the ground floor a mix of residential and those with dementia. At the time of our inspection 88 people were using the service.

A registered manager was in place at the time of our inspection. 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 did not ensure that accurate, complete and contemporaneous records were kept in relation to each person using the service. Quality assurance systems did not identify issues that we found at our inspection.

The home did not always follow the principles of the Mental Capacity Act 2005 (MCA). Some people using bedrails were unlawfully deprived of their liberty as Deprivation of Liberty Safeguards (DoLS) applications had not always been made to the local authority.

These failings represent two breaches of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s risk assessments did not always contain guidance for staff on how best to mitigate risk. Care plans did not always reflect people’s like and dislikes and personal preferences in relation to their care.

We have made a recommendation to the home to audit people’s risk assessments to ensure that there is up to date information to mitigate risks and to review care plans to ensure that people’s preferences are reflected.

People and their relatives were positive about the care that they received from staff and the management team. Staff respected people’s privacy and dignity and considered people’s preferences when supporting them. End of life care planning was in place the service had maintained the Beacon level as part of the Gold Standards Framework for the past nine years.

People and their relatives were supported to express their views through regular residents and relatives meetings. A complaints policy was accessible to all and people felt comfortable approaching management and staff with any issues that they may have.

Staff were clear on how to recognise abuse and the provider had appropriate systems in place to monitor and investigate any incidents as they occurred. Health and safety checks for the premises were maintained and infection control was routinely monitored. There were enough staff to meet the needs of people at the home and people’s medicines were managed safely.

Staff received appropriate training in order to fulfil their roles and received regular support from management through supervision and appraisals. People were supported to maintain a nutritious balanced diet and received support from other healthcare professionals where required.

This inspection took place on 27th January and 4th February 2016 and was unannounced.

Windmill Lodge Care Centre provides nursing and personal care to 93 people. At the time of our inspection, 88 people were using the service. The home is on four floors. The ground floor provided residential support for people. The other three floors provided nursing care for people.

The service was last inspected on 19 September 2013. The regulations inspected were met by the service.

At this inspection we found that staff had knowledge and skills to ensure people’s safety. Staff were aware about potential signs of abuse and they managed risks as required. People were involved in identifying and planning their support around the risks. Risk management plans were specific to people’s individual needs and were regularly reviewed. This ensured that people received the care they needed. Sufficient numbers of staff were available to ensure people’s safety. However, people told us that sometimes the care was delayed because there were not enough staff. Staff shortages had an impact on people’s routines, but the majority of people we spoke with did not mind this. People had support to take their medicines safely and as prescribed. The medicines were stored and reviewed regularly as required.

Staff received regular training courses that were relevant to their role. This ensured effective care provision for people. Staff attended induction to ensure they had knowledge to support people with their needs. Regular supervisions and appraisals were carried to discuss staff’s performance and training needs which meant that staff were supported to develop in their role. The service followed effective staff recruitment processes to ensure that staff had the required level of knowledge to provide good care for people. Staff supported people to make decisions and where required a mental capacity assessment was carried out, followed by a best interest meeting to ensure that decisions made on people’s behalf were in their best interests. People had a choice of what and when to eat. Staff worked together with health professionals, including speech and language therapists and dieticians to ensure continuous care for people. People had support to attend their health appointments as required.

People felt they were treated with respect. Staff ensured that people’s privacy was maintained. People told us they were provided with support to fulfil their spiritual needs and follow religious beliefs. The service provided choice of activities for people. Staff supported people to go out in the community when they wished to. This meant that people were encouraged to socialise as appropriate. The service supported people to maintain relationships with their friends and families. People had their preferred communication methods identified and staff helped them to make decision for themselves. People received support to make decisions and plan their care as appropriate.

The service supported people with their changing needs to ensure they received the care required. Staff were aware about people’s individual needs and preferences. Care records had information about people’s care needs and how they wanted to be supported. People and their relatives were encouraged to give feedback about the services provided. People told us they knew how to complain and were confident that actions would be taken to manage a complaint they had as required.

Staff were involved in developing the service which ensured their participation in people’s care planning. The registered manager provided guidance to the staff team. This meant that staff were supported to carry out their roles effectively. Staff were encouraged to undertake additional duties and the gained knowledge was shared with the team to ensure good practice. The service used effective quality assurance systems to monitor the care and support provided for people. People’s personal information was stored securely and staff

Windmill Lodge Care Centre provides nursing and personal care to 93 older people, 87 of whom were present when we visited. There are four floors in total. The ground floor offers residential care, and the other three floors provide nursing care. All areas of the home are wheelchair accessible. The home has a registered manager; the same person has been in post since the home opened ten years ago.

We spoke with forty people living in the home. The people using the service told us they felt safe and relatives we spoke with were confident that their loved ones were safe and comfortable in this home. An external healthcare professional involved in the service told us they had no concerns about the welfare of people living in the home and had confidence in the ability of staff there to look after people in their care and keep them safe.

There were policies and procedures in place for minimising and managing risk and these were effective. Staff understood the importance of risk assessments and followed guidance to protect people. Restrictions were minimised so that people felt safe but also had the most freedom possible regardless of their needs.

The home ensured people had enough suitably skilled and qualified staff available to meet their needs. Staff received training and development to make sure they were equipped for their role. People in the home were shown compassion and kindness.

Care, treatment and support plans were kept under review and reflected people’s needs, choices and preferences. Staff were aware of changes to people’s care and support needs and were responsive to them. People received care and support from staff that knew their history, and responded to their likes, preferences, needs, hopes and goals. Staff understood equality and diversity; this was reflected well in practice; staff responded appropriately to each person’s diverse cultural and spiritual needs and met their care and support needs promptly. Appropriate referrals were made to other health and social care services as necessary. Specialist or adaptive equipment was made available as and when needed. The service made good provision for caring for and treating people approaching the end of their lives.

The service offered people opportunities to participate in activities within the service or in the community. Staff made sure that people were able to keep relationships that mattered to them such as family, community and other social links, those without relatives were offered advocacy or a volunteer befriending service

The staff team demonstrated shared values, such as compassion, dignity, equality and respect and put them into practice. Staff were effectively supervised and supported; the feedback to staff was constructive and motivating. The management team worked alongside organisations such as the Gold Standard Framework to promote and guide best practice in caring for people approaching the end of their life.

During our inspection we viewed all of the communal areas and met the people living on each of the four floors. The majority of people spoken with were complimentary about the quality of life they experienced.

A person that lived at the home for some years said, "I still enjoy living at Windmill Lodge Care Centre, I feel they do things well, life gets better for me, there are lots of interesting things going on here to keep one entertained.".

Another person who used the service told us "I cannot speak highly enough of staff, they always seem to be available when I need them, they are excellent".

We found care and treatment was planned and delivered in a consistent way that helped to promote people’s safety and welfare. The care needs of people using the service were kept under review. When staff identified concerns about a person's health they took prompt action by involving external health professionals. Staff followed up on the recommendations made by health professionals. This helped to ensure the health and wellbeing of individuals was promoted.

Staff were supported in their roles and had their work appraised. Training and development programmes were tailored according to staff professional development needs.

One relative told us "staff keep me up to date with my mother's progress", and “we are pleased with the care provided”.

We met with a large number of people living at Windmill Lodge Care Centre, some were unable to respond verbally due to cognitive impairment. They were calm and displayed positive signs of wellbeing, they indicated by smiling and gesturing they were happy and well cared for.

Where people were unable to contribute to care plan development staff worked closely with relatives to plan and arrange person centred care. Two relatives spoken with said that people received the care and support they needed.

People living at the home described the environment as warm and inclusive. They said they experienced stability and consistency as they had familiar staff that understood their needs and preferences.

A person living at the home for some years said “I like living here at Windmill Lodge, staff are interested in me and the others that need care and support, staff have the caring qualities and an empathy with people which I appreciate”.

A person living at the home told us they very happy with their care. They said "my food is important, the cook endeavours to provide African food I like such as Jollof rice and Palm oil soup a couple times a week".

Another person said they enjoyed doing interesting activities and that they were able to do this, they visited places like the London Eye and London zoo.

Another person spoken with required frequent repositioning in bed, they said "Staff are lovely and they regularly change my position so that I am made comfortable".

People who use the service told us that they were happy living in the home. They find that they get the care and support they require and that care is personalised.

A couple living at the home praised the home for the facilities offered, these arrangements have enabled them stay together.

We heard from people about the benefits of living in the home. One person said, "we have kind caring staff present to help with things we cannot do independently", Another person said,"This is a happy place, with lots going on that we can enjoy at our age". Photographs were on display of many of the happy events people have enjoyed in the past twelve months.

People said that that staff were kind and caring. One person said, "Staff couldn't do enough for you, they are so kind". We saw that the staff were helpful and vigilant during our visit. They encouraged and supported people with walking and exercising indoors and in the garden.

They took the time to speak to people as they assisted them with tasks. They offered people choices and showed them respect.

People living in the home, and relatives told us that they had confidence in the service. They felt the home was well run, and that management approach was open and honest.