Windmill Manor is a care home for up to 60 people who require nursing care or are living with dementia. At the time of our inspection 50 people were living in the home.

This was an unannounced inspection that took place on 19 April 2017.

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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

We carried out an inspection to Windmill Manor in July 2016 where we identified some breaches of

regulation in relation to staffing and good governance as well as a breach of the registrations regulations in respect of notifications. As these breaches of regulation were continued breaches we took enforcement action against the registered provider in order that they took immediate action. We also made recommendations to the registered provider in respect of activities and person-centred care. We carried out this inspection to see if the registered provider had taken appropriate action to address our concerns. We found at this inspection action had been taken and therefore we found the registered provider had met the warning notices and breaches of regulations. Although improvements had been made to activities and person-centred care we fed back to the registered manager during our inspection that continued work was needed in both areas to sustain these improvements.

In the event of an emergency where the home would have to close there was a contingency plan in place and there was evacuation information for each person. Staff were able to evidence to us they knew the procedures to follow should they have any concerns about abuse or someone being harmed.

There were a sufficient number of staff to care for people. Safe recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home.

Staff had completed decision specific assessments in relation to the Mental Capacity Act 2005 and applications where people’s liberty was being restricted had been made. Staff were heard to obtain people’s consent before they supported them.

There was a pleasant atmosphere in the home where people and staff interacted in an easy-going manner. People and relatives were happy with the care provided and they were made to feel welcome when they visited. Staff supported people to take part in various activities and work was on-going in relation to developing meaningful, individualised activities for people.

Care was provided to people by staff who were trained and received relevant support from their manager. This included regular supervisions and appraisals. Staff told us they felt more supported by the registered manager since our last inspection. People knew how to make a complaint if they felt the need to. They told us any concerns they raised were dealt with immediately by the registered manager.

Care plans contained information to guide staff on how someone wished to be cared for. Information included detail around people’s mobility, food and personal care needs. However, there were some areas where additional information may have been useful for staff. Where people had risks identified guidance was in place for staff to help reduce these risks. Staff followed correct and appropriate procedures in administering medicines and medicines were stored safely.

Quality assurance checks were carried out by staff to help ensure the environment was a safe place for people to live and they received a good quality of care. Staff were involved in the running of the home as regular staff meetings were held. Relatives were asked for their views about all aspects of the care that was being provided to their family members.

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Windmill Manor provides nursing, personal care and support for a maximum of 60 older people, some of whom may be living with dementia. Accommodation is set over two floors and the majority of people who have more advanced dementia live on the top floor of the home. On the day of our inspection 53 people were living in the home.

This was an unannounced inspection that took place on 18 July 2016.

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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

We had carried out an inspection to Windmill Manor on 20 May 2015 where we identified a number of concerns. These related to a lack of qualified staff, staffing failing to follow the requirements of the Mental Capacity Act 2005, people not receiving respectful care from staff and a lack of good governance within the home. Following that inspection the provider sent us an action plan which detailed how they were going to address these concerns. We have carried out this inspection to check whether or not the provider had completed the actions in line with their action plan.

There were an insufficient number of staff to care for people and the premises were not always well-maintained because of a lack of housekeeping staff. Staff morale was low mainly due to the lack of staff. People may not always receive responsive care as care records for people were not always accurate.

People did not always have to access to meaningful, relevant activities particularly those people living with dementia.

Although quality assurance checks were carried out by staff these did not always identify shortfalls in the recording of information in people’s care plans. The registered manager was not always aware of their responsibilities in relation to CQC.

Care was provided to people by staff who were trained and received regular supervisions and appraisals from their line manager.

There was a good atmosphere in the home where people and staff interacted in an easy-going manner. People were cared for by staff who were kind, caring and supportive. People and relatives were happy with the care provided and they were made to feel welcome when they visited.

Staff followed correct and appropriate procedures in administering medicines and medicines were stored safely and appropriately.

Care plans were written in a person-centred way and where people had risks identified guidance was in place for staff to help reduce these risks. People’s care would continue in the event of an emergency and staff helped safeguard people from abuse as their understood their roles in this regard. Safe recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home.

Staff completed assessments in relation to the Mental Capacity Act 2005 and where people had restrictions in place to keep them safe, the registered manager had submitted the appropriate DoLS applications.

People were provided with a choice of meals each day and those who had dietary requirements received appropriate foods. Staff maintained people’s health and ensured good access to healthcare professionals when needed. For example, the doctor, dietician or district nurse.

People and staff were involved in the running of the home and complaint procedures were available to people should they feel the need to complain.

During the inspection we found one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two new breaches. We have also made some recommendations to the provider. You can see what action we told the provider to take at the back of the full version of the rep

Windmill Manor is a purpose built care home that provides nursing and personal care for up to 60 people. Many of the people living at Windmill Manor are living with dementia. The home is set across two floors; with the ground floor mainly for people who require nursing care and the first floor for those who are living with dementia.

At the time of our inspection 55 people were living at Windmill Manor.

This inspection took place on 20 May 2015 and was unannounced.

The home is run by a registered manager, who was present on the day of the 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 and associated Regulations about how the service is run.

We found the home did not have a sufficient number of trained staff to meet the nursing needs of the people who lived there.

Where restrictions on people were in place to deprive them of their liberty, staff had not always followed legal requirements to make sure this was done in the person’s best interest. The registered manager had submitted Deprivation of Liberty Safeguards (DoLS) applications to comply with their responsibilities; however these had not been made appropriately.

Complaint procedures were available for people. The registered manager had received two complaints and were responding to them. However, we heard from people they felt their complaints had not been taken seriously.

People were involved in their care and support however we did not see staff encourage them to do things for themselves. We found staff did not always make people feel as though they mattered or treat them with consideration.

Staff told us and we saw, ways in which staff supported and enabled people to maintain their independence and take part in various activities. However we saw people sitting for long periods of time without social interaction from staff. Appropriate activities for people living with dementia were not always provided.

Care was provided to people by staff who were competent to carry out their role. Staff told us they received supervision, but did not have appraisals.

Staff felt supported by management however we found improvement was need to ensure senior staff were aware of the needs of all people living in the home.

Checks had been carried out to make sure people were safe living in the home and any risks they may take were minimised.

Medicines were managed appropriately and people received their medicines in a safe way.

The provider had ensured they followed appropriate recruitment processes to help them employ suitable staff to work in the home.

Staff understood their responsibilities in relation to safeguarding. We were assured they knew how to report any concerns they may have.

A choice of meals was provided to people and people were involved in making decisions about what they ate.

Staff referred people to external healthcare professionals when appropriate and the local GP was actively involved in the home.

Care plans contained information to guide staff on how someone wished to be cared for. When people's needs changed, staff responded to these appropriately and provided effective, responsive care.

People and relatives were involved in making decisions about the home and they were asked for their feedback.

Quality assurance checks were carried out by staff and the provider to help ensure the environment was a safe place for people to live.

During the inspection we found some breaches of the Health and Social Care Act 2008 (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 who used the service told us that they enjoyed living in the home. One person told us that the home was so comfortable it was like being on holidays.

People told us that they were encouraged to express their views regarding their care and treatment and that they were included in discussions when their care was reviewed.

People who used the service told us that the staff were kind and caring and that they were treated with dignity and respect.

People who used the service told us that the food was "fantastic", and that there was a wide choice available at every meal.

Relatives visiting the home told us that they always found the care was excellent and that staff were kind and considerate. They also said that they were kept informed and included in their relative's care.

People who used the service told us that there was always something to do to keep them occupied. They told us that it was their choice what activities they decided to participate in, and they sometimes chose their own company.

Staff told us that they enjoyed working in the home and that they felt that they had the training and support necessary to enable them to undertake their roles.

People told us that they were consulted about their views regarding the home and relatives told us that they could remember completing a survey.

People had access to the home's complaints procedure.

People told us that they were very happy living in the home.

They told us that staff were professional and respectful.

People said that the home was spotless and “it was like living in five star hotel”.

We were told that people were involved as much as possible to make decisions regarding the care and treatment they receive.

People told us that the standard of catering was excellent and that there was plenty of choice at meal times.

People told us that there was plenty to do and that it was an individual’s choice if they wished to participate in activities or not.

Relatives told us that the home is welcoming and that they are encouraged to participate in home events.