Windsor House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Windsor House accommodates up to 17 older people.

There were 17 older people, some living with dementia, living in the service when we inspected on 4 June 2018. This was an unannounced comprehensive inspection.

At our last inspection of 20 October 2015, this service was rated good overall. The service had maintained the rating of good overall. However, well-led was rated requires improvement at this inspection. This was because, despite the systems in place to monitor and improve the service provided to people. the provider had failed to provide appropriate equipment for a person. The provider’s quality checks had failed to identify the issue. However, following our inspection this had been addressed by the provider, after we had identified the issue.

The service continued to provide people with a safe service. Staff were trained and understood how to safeguard people from abuse. Risks to people were assessed and staff were provided with guidance about how to minimise risks. Staff were available when people needed assistance. There were safe recruitment systems. Medicines were managed safely. There were infection control systems in place to reduce the risk of cross contamination. Where incidents had occurred, the service learned from them and used them to drive improvement.

Staff were trained and supported to meet people’s needs effectively. However, there were some gaps in staff training, but this was booked for the month of our inspection. People had access to health professionals when needed. People’s nutritional needs were assessed and met. Staff worked with other professionals involved in people’s care to provide people with an effective and consistent service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, the records relating to people’s capacity to consent would benefit from more detail, the registered manager said this would be addressed. The environment was appropriate for people using the service.

People were treated with care and compassion by the staff. People’s privacy and independence was promoted and respected. People were listened to and their views about how they wished to be cared for were respected.

People’s care was assessed, planned for and met. Care records guided staff in how people’s preferences and needs were met. People had access to social activities to reduce the risks of isolation and boredom. People’s choices were documented about how they wanted to be cared for at the end of their life. There was a complaints procedure in place and people’s complaints were addressed and used to improve the service.

Windsor House provides accommodation and personal care for up to 17 older people, some living with dementia.

There were 14 people living in the service when we inspected on 20 October 2015. This was an unannounced 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.

There were procedures and processes in place to ensure the safety of the people who used the service.

Staff were trained and supported to meet the needs of the people who used the service. Staff were available when people needed assistance, care and support. The recruitment of staff was done to make sure that they were able to work in the service.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

People, or their representatives, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. The service was up to date with changes to the law regarding the Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People’s nutritional needs were being assessed and met. Where concerns were identified about, for example a person’s food intake, appropriate referrals had been made for specialist advice and support.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There was an open and empowering culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.

We spoke with eight of the 16 people who used the service at the time of our inspection. We also spoke with one person's relative, the registered manager and two staff members. We looked at three people's care records. Other records viewed included staff training records, health and safety checks, meeting minutes and satisfaction questionnaires completed by the people who used the service. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member looked at our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, relevant staff had been trained to understand when an application should be made, and how to submit one. We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The service was safe. We saw records which showed that the health and safety in the service was regularly checked.

We saw the staff rota and discussions with the registered manager and staff showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them. One person told us that when they used the call bell, "They (staff) come more or less straight away."

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "I would not want to move from here, I have made this my home."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

The service was clean and hygienic. This meant there were systems in place to ensure that people were protected from the risks associated with cross infection.

Is the service caring?

The staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect and kindness. One person said, "They (staff) are all very nice."

People using the service, their relatives and other professionals involved with Windsor House completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

We spoke with seven of the 13 people who used the service. People told us that they were happy living in the service. One person said, “I can't complain, we do quite well here.” Another person said, “I am very happy, I am well looked after.” Another said, “It is very good, we get well fed, it is always clean, I don't have to worry.”

We also spoke with a person's relative who told us that they were happy with the service their relative was provided with.

People told us that the staff treated them with respect and kindness. One person said, “They (staff) are all very good.” Another person said, “They (staff) are all kind.” This was confirmed in our observations during our inspection. We saw that staff interacted with people in a caring, respectful and professional manner.

We found that people's complaints were listened to and acted upon.

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Four staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service.

People who used the service were provided with a safe environment to live in.

We spoke with six of the nine people living in the service. They told us that their needs were met and they were consulted about the care that they were provided with. One person said "I can't grumble one bit." Another person said that they felt "No pressure" living in the service.

People said that the staff were attentive to their needs and supported them when they needed it. One person said "If I need anything I only have to ring the bell and they (staff) come."

People also told us that the staff listened and acted on what they said and that they made choices in their daily living. They also said that the staff treated them with respect. One person said that the staff had "Very good attitudes." Another person said “All the staff are wonderful.”

In July 2011 all people living in the service were found alternative accommodation because serious risks to their health and safety were identified. We imposed a condition to stop the provider from accommodating and providing care for people at this location. The provider submitted evidence to show that following refurbishment and organisational changes the service was safe and appropriate to accommodate people. They stated that they had the systems in place to ensure ongoing compliance against the regulations. The service reopened in April 2012.

We visited on 17 May 2012 and spoke with five people who used the service. They told us that their views and choices were listened to and acted upon. People also said that they felt that their needs were met. They were all positive about the food available and the choices they had. One person told us “(They) come around nine o’clock for orders, get a choice (I am) well attended to.” We also saw that people were being asked about the food on offer and their preferences recorded for future menu planning.

During our visit we observed that staff encouraged people living in the service to be independent. One person told us they liked to go outside and staff helped them to do this. Another told us they liked the atmosphere in the service and enjoyed talking with staff and visitors.

All the people we spoke with were positive about the staff working in the home. One person said “(They) are always there to help if you need them.”

Two relatives confirmed they were able to look around the service before it reopened. They told us they were able to discuss any issues with the registered manager.

We visited the service on the 1 May 2012 following concerns raised that the service may have re-opened before they had all the required equipment in place. The focus of the visit was to look at the issues that had been raised.

We met five of the six people who had moved into the service since it reopened on the 12 April 2012 following a refurbishment. People were positive about the care and support they received. One person told us “It’s all so lovely here.”

Two people had lived in the service before the refurbishment. They told us they were pleased with the changes. One person told us it was “Lovely to be back.”

People told us that they found the staff helpful and they felt supported with their individual needs. One person told us they thought all the staff to be “Very nice.”

People we visited in their bedrooms confirmed that they were warm enough and staff had left a call bell at hand in case they needed it. Two people confirmed that they had no problems with their hot water supply.

One person told us they were unsure if they would be able to have a shower, as they didn’t know if they would have “Anything to sit on.” Another person said staff gave them the help they needed to get in out of their bed. When they went downstairs they told us staff assisted them in using the lift.

People told us the change in the use of communal rooms has given them a larger lounge with more space. People were unable to freely access some areas of the home because it was unsafe to do so. Three people had moved out of their bedrooms on the second floor, and alternate sleeping arrangements had been made for them. One person had moved into another bedroom within the home and two people were sleeping overnight in a nearby care home.

People living in the home told us they liked the staff although one person said, “Some staff speak to you others don’t”. One person told us the, “…girls are lovely, they look after me well” and “I do most things for myself, but need a small amount of assistance so that I can have a bath”. They also said staff help them to go to church on a Sunday, and have regular visits from family

Another person told us they were very happy with the care they receive, but were unhappy about the behaviour of another person living at the home. We reported this to the consultant in day to day control. We observed one person being escorted out to the local shops.

One person told us they had breakfast in the main dining room but could have it in bed if they wanted. Another told us that that their lunch was ‘”ok” but they didn’t want to finish it. Another told us they were not happy about the quality of the meat pies or fish served.

One person living in the home told us it was “Too soon to tell” when asked if they thought the new cleaner was making a difference.

People with whom we spoke told us they were happy with the standard of care they received. One person told us the home employed “nice staff” who always responded when they rang their call bell. People told us they benefited from being looked after by the same group of staff whom they have got to know and like. We observed when we visited the home that people living with dementia are not experiencing a consistent level of safe and appropriate care or benefiting from an effectively run service. This was due to a lack of training and awareness of how to support people living with dementia related needs.

We were told that the manager was “nice”, with several people also commenting that she is a “good cook”.

One person told us that they are able to choose how they spend their day, either enjoying the company of others or preferring time on their own watching television. Other people said that there was not enough going on to occupy their time. One person told us they “just get up, wash and breakfast”. Another person commented that it was “a case of looking at papers, books and television".

We asked people using the service if staff kept their bedrooms clean. One person told us “staff come in every morning and make my bed”. Another said they have “no grumbles”. People told us the maintenance of the home could be better and the towels provided were a “bit thin". People told us that work carried out on the heating system had made the radiators more efficient but some areas of the home still get cold during the winter. We found people were not always being provided with a clean and hygienic environment to live in.

When we asked about the quality of food, people said it varied according to who was the cook on duty at the time. One person told us “food is not what it used to be”. Another person said "I don't want for anything - if I want a drink, I get it straight away".