The inspection took place on 30 May 2017 and was unannounced.

Windsor House is a care home that has been converted from a large detached house in Standish, Wigan. The service provides care for up to 16 people. There are five double and six single bedrooms. Toilets and bathrooms are in close proximity to the bedrooms and communal areas. There is a large garden at the rear of the home. There were 12 people living at the home on the day of the inspection.

At the time of the inspection there was an acting manager who was in the process of registering with the Care Quality Commission. 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.

Staffing levels were sufficient staff to meet the needs of the people who used the service. There was a robust recruitment system which helped ensure that people were suitable to work with vulnerable people.

Safeguarding issues were dealt with appropriately and staff at the service, staff had undertaken training and demonstrated a knowledge and understanding of safeguarding issues.

Health and safety records at the service were complete and up to date. Accidents and incidents were recorded appropriately and there were safe medicines systems in place.

There was a thorough induction programme and a good programme of training was on-going for all staff. Staff supervisions and appraisals took place regularly.

There was a choice of nutritious food and nutrition and hydration was monitored when required.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We observed in communal areas throughout the day and saw that interactions between staff and people who used the service were friendly and respectful.

We saw records of residents meetings which took place on a regular basis and people were involved in their care planning and reviews.

The service tried to ensure that people could remain at the home if they wished to when nearing the end of their lives.

The care files included a range of health and personal information. People’s preferences, likes and dislikes were clearly documented and people told us these were respected.

There were few activities happening at the service, but a new activities coordinator was being sought to address this. Funding had been obtained for new items to help people with social activities and interests.

There was a complaints procedure which people and their relatives were aware of. However there were few formal complaints made. We saw a number of compliments which had been received by the service.

There was an ‘open door’ policy at the home and people told us the management were very approachable.

We saw minutes of staff meetings, which were held on a regular basis. The provider regularly visited the service to check on care provision.

A number of quality audits and checks were carried out by head office to help drive improvement. Regular satisfaction surveys were sent out to relatives, staff and people who used the service.

We carried out our last unannounced comprehensive inspection of this service on 24 July 2014. During that inspection we found one breach of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to cleanliness and infection control. After that inspection, the provider wrote to us to tell us what action they had taken to meet legal requirements in relation to the breach of regulation.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Windsor House Care Home on our website at www.cqc.org.uk.

This inspection was undertaken on 22 June 2015 and was unannounced. We found the provider had made improvements and was now meeting the requirements in relation to the breach we had found.

Windsor House is a care home that has been converted from a large detached house in Standish, Wigan. The service provides care for up to 16 people. There are five double and six single bedrooms. Toilets and bathrooms are in close proximity to the bedrooms and communal areas. There is a large garden at the rear of the home.

At our last inspection we found that the registered person had not protected people from the risks associated with the cleanliness and infection control. During that inspection we found vulnerable people were exposed to the risk, because the service did not have appropriate arrangements in place to ensure the environment of the home was clean on a consistent basis. We found that areas such as the staircase leading to the second floor of the home and several toiler/bathroom areas to be unclean. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which related to cleanliness and infection control.

During this inspection we found the provider was now meeting the requirements of the regulation. We looked around the home to check it was clean and tidy. We also checked bathrooms and bedrooms to ensure they were equipped with appropriate paper towels, hand sanitizers and hand washing guidance.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

Windsor House is a care home in the Standish area of Wigan, Greater Manchester. The home is registered with the Care Quality Commission (CQC) to provide personal care for up to 16 people. The home is located in a residential area and accommodation is provided over two floors. There were 12 people living at Windsor House on the day of our inspection.

We last visited the home on 13 August 2013 and found the home was meeting the requirements of the regulations, in all the areas we looked at.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We founda breachof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 with regards to infection control. You can see what action we told the provider to take at the back of the full version of the report.

People told us they were happy living in the home and felt safe in the presence of staff. Whilst undertaking a tour of the building, we encountered several instances of uncleanliness and poor practice with regards to infection control within the home. This could affect people’s safety.

The manager had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS are laws protecting people who are unable to make decisions for themselves. There were no DoLS currently in place at the home, however the manager knew the correct procedures to follow to ensure people’s rights were protected. Staff had received training in the MCA and DoLS which was recorded on the training matrix.

On the day of our inspection the staffing team consisted of the registered manager, a senior carer, a care assistant, the chef and a domestic member of staff. This was to provide care and support to 12 people. The manager told us staffing levels would be increased when the home reached full occupancy or increased further.

Staff felt supported and understood the ethos and values of the home. They felt they could raise any issues and they would be dealt with. One staff member said, “We all work together as a team to give the best quality care possible. If we think we can improve it in any way we just say and they listen.”

There were systems in place to monitor and review accidents, incidents and complaints. The manager told us they monitored staff training using a training matrix, which identified when updates were required for staff.

We saw the home followed safe recruitment practices which meant people were kept safe as suitable staff were employed, and appropriate checks undertaken.

People’s care records showed their needs had been assessed and were regularly reviewed. They showed the support people needed and how they wished to be helped in their daily lives.

People we spoke with and their relatives said they felt able to raise any concerns or complaints with staff and were confident they would be acted upon.

Leadership in the home was good. The manager worked alongside staff overseeing the care given and provided support and guidance where needed.

We spoke with four people who lived at Windsor House Care Home and one visitor. All of the people we spoke with told us they were happy living there and they did not express any concerns about their care or treatment. We were told "I get on well with the staff"; “The staff are very attentive” and "There is nothing I find unsatisfactory.”

We found that people were cared for in a calm and dignified manner. We saw people’s nutritional needs were met and there were no concerns about the safety of people living at the home. People's medicines were also managed safely.

We spoke with staff and saw that they were aware of the best way to meet people’s needs. We saw evidence that confirmed the provider had suitable recruitment arrangements in place.

At our last inspection we found that the standards relating to infection control and record were not being met. The provider had made improvements and we found that these standards were now being met.

We found that there was an effective process in place for monitoring the quality of care provided at Windsor House. The people we spoke with told us they were not aware of any changes required at the home.

During our inspection we spoke with four people and two relatives who were visiting Windsor House. People told us they were well cared and they felt involved in their care and that they were not forced to do anything that they did not want to do. One visitor told us “the staff keep us informed about what is going on with my relative.”

We heard positive comments about the staff and the care given. We were told "the staff are champion“; “I get on well with the staff. I am OK living here” and "I cannot find any faults with the home at all." We found that people received the care was needed but that action was required regarding the maintenance of the home. The home did not have a sufficient number of foot-operated pedal bins for disposing of clinical waste.

Staff told us they received appropriate training and that they were well supported in their roles.

We found that there was a complaints procedure in place and this was followed when a complaint was received. People told us that would be happy to approach the manager with any concerns that they had about their care or the care of their relatives.

We found that some people were at risk because their care records did not accurately reflect their current circumstances.

People told us that they were happy living at Windsor House. Three out of the four people that we asked said that they like the new privacy curtains. One person told us "They close the privacy curtains at night. I like it."

One person told us "I don't like the privacy curtain as I like to see what is going on."

Staff told us that they thought that the privacy curtains were a good idea.

People who lived at Windsor House were content with the service they received. People told us the staff were friendly and made sure that their health needs were met.

Comments included:

" I went to the doctor with staff, they look after you."

And,

"Staff listen I can talk to any of them they’re all very nice.”

People said they got on well with each other, saying,

"It’s a bit of company here, I like it very much.”

And,

"As far as I’m concerned it’s very nice. And if you say anything they do something about it."

People at Windsor House said they felt safe and listened to.

We were told:

"Over all everybody is friendly and kind, people are well looked after."

And,

"I've never had a complaint but would talk to any of the staff. They’d write it down and it would be sorted.”