Winton House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Winton House can accommodate up to 36 people across two floors, each of which has separate adapted facilities. The service provides care to older adults. People live in their own bedrooms and have access to communal facilities such as bathrooms, lounges, activities areas and garden access. Two of the bedrooms is reserved for respite. Winton House can offer day care facilities for non-residents by arrangement. At the time of our visit there were 33 people using the service.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a registered manager in post.

The service was previously inspected on 31 October and 1 November 2016. The provider was rated ‘Good’ in the key questions ‘Caring’ and ‘Responsive’. However, we found breaches in the regulations relating to staffing, fit and proper persons employed and good governance. We asked the provider to take action to make improvements in the key questions of ‘Safe’, ‘Effective’ and ‘Well-led. This was because staff were not appropriately trained to carry out their job roles; recruitment practices were not robust and quality assurance systems did not identify where quality was being compromised. We asked the provider to send us an action plan to show the what improvements would be made, by 28 March 2016. The provider submitted the action plan by the specified date.

We found the service had made the required improvements to address the concerns found at our previous visit on 31 October and 1 November 2016.

People said staff treated them with kindness and compassion. Comments included, “Extremely good staff, friendly, happy, always smiling and polite” and “They are mostly kind, considerate and available if you need assistance.”

People told us staff made sure those close to them felt like they mattered. Staff knew people’s care needs, preferences, personal histories and backgrounds. People said staff protected their privacy and their dignity was respected. Training records confirmed staff had attended the relevant training. People were supported to be independent. Information about people were kept secure.

People felt safe living at the service. Comments included, “No issues at all. If I had a concern I would speak to a member of staff, all lovely people” and “Yes, I feel quite safe.”

Staff were aware of their responsibilities to safeguard people from abuse. Safe recruitment practices were in place and the service followed national and local safeguarding guidance. There were sufficient staff to care for people. Risks to people’s safety were assessed and medicines were administered safely.

We have made a recommendation in relation to medicine errors.

People received care from staff who were appropriately trained to effectively carry out their job roles. People were supported to have maximum choice and control of their lives. The service acted in accordance with the Mental Capacity Act (2005). People’s nutritional needs were met and they were supported to maintain good health and receive ongoing healthcare support.

The service did not consistently carry out reviews of care. People said they were involved in the planning of their care. Staff demonstrated a good understanding of how to deliver person-centred care. The service was compliant with accessible information standard. People had the opportunity to pa

Winton House is registered to provide accommodation for up to 29 older people who require nursing or personal care. On the day of our visit there were 24 people living in the service.

The registered manager has been registered since February 2014. 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 service was previously inspected in August 2013 where it was found to be compliant with regulations. This is the first inspection of the location under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and rating required by the Care Act 2014.

We have made a recommendation for the service to seek current guidance on national and local safeguarding arrangements.

We found safe recruitment practices and best practice guidance in relation to recruitment were not consistently followed. This meant the service did not have appropriate processes to ensure potential candidates were competent, skilled and experienced to undertake their job roles.

Risks to people’s personal safety had been assessed and plans were in place to minimise identified risks. People said they felt safe living in the service. Comments included, “I have a call bell in my bedroom and one in the bathroom and this makes me feel safe. I know that nobody can get at us” and “I have a walker with an alarm attached to it, which makes me feel safe.”

People received care from staff who were not appropriately trained to effectively carry out their job roles.

The service did not act in accordance with the Mental Capacity Act (2005). The Act protected people who lacked the capacity to make specific decisions and enabled them to take part, as much as possible in decisions that affected them. We found no mental capacity assessments were undertaken where people were unable to make specific decisions and the service obtained consent from people who did not have legal power to give it. We have recommended the service see the MCA for current guidance in relation to this.

We found people were supported to maintain good health and receive on-going healthcare support.

Quality assurances systems in place to monitor and improve the quality and safety of the services provided failed to identify where quality was being compromised. Care records did not always accurately record discussions held with people’s relatives.

During our visit we observed major structural refurbishment was being undertaken. The registered manager explained a lot of their time had been spent overseeing the building works which had commenced some months prior to our visit. They told us the deputy manager was able to ensure the welfare and safety of people and provided additional support to staff.

People were positive about the caring nature of staff. The atmosphere of the service was calm and relaxed despite the on-going building works. Staff had established good working relationships with people and spoke confidently about their care and support needs. People could be as independent as they wanted to be. We heard various comments such as, “They help me to be as independent as I can, like I get myself washed and dressed.”

People and their relatives felt the service was responsive to their needs. One person commented, “They (staff) are very good at responding to needs promptly.” Care plans reflected how people’s needs should be met. There were a wide variety of activities on offer to meet people social needs.

The service sought the views of people and responded appropriately to feedback received.

We found a number of 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 this report

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. We spoke with the manager and deputy manager currently in post during this inspection.

At an inspection on 1 May 2013 we found the provider did not have an effective record keeping system to monitor staff training, supervision and appraisal. This meant they were not assured that people who use the service were supported by staff who were suitably trained or assessed. Records could not be located promptly when required. Managerial staff were not fully aware of how or where information was stored.

At our inspection on 30 August 2013 we found the provider had a system in place to support and monitor staff. This allowed the provider to monitor whether staff completed mandatory training and kept up to date with their learning. One care worker we spoke with told us “The managers make sure you know what you’re doing.”

The manager ensured staff were supported appropriately through group and individual supervision meetings and annual appraisals. Records we requested were found promptly and stored appropriately. Managerial staff were fully aware of the information available, and stored this suitably to maintain confidentiality.

People told us that they were treated very well. One person described Winton House as "the best care home you could get". A visitor we met with said that the staff were "brilliant and very helpful".

We found that there were activities available should the people living in the home want to participate. The views and opinions of people living there were sought, and changes made if required.

We found that people living in the home remained part of the local community and accessed local services and facilities where possible, and that members of the community were invited in to support people living there and thereby enhanced the quality of their days.

The home was clean and well maintained and furniture was arranged that maximised a sense of homeliness whilst remaining safe and arranged in a way that minimised the risk of falls.

We found care planning and documentation was found to be comprehensive but noted that there was some duplication and some forms not completed. During the inspection we observed good engagement between people living in the home and the staff.

We spoke with four residents and one relative in some detail, and briefly with ten other residents during the lunch period. We also spoke with a relative by telephone following the inspection.

People who live at Winton House were complimentary about the staff at this home. Residents told us they were treated respectfully, and said that staff gave them choices, for example about meals, and activities. Staff were described as ‘friendly’, and the home as ‘Very good’ and ‘Perfect’.

Residents said the food is very good at Winton House, and they told us the chefs cater for peoples’ individual needs. People told us they felt safe at this home, and were pleased with the facilities on offer. They also told us the home is kept clean and fresh. None of the people we spoke with had any complaints, but said they would know who to speak to if they did have any concerns.

At the time of our inspection the registered manager was on long term absence. An interim manager had been appointed in March 2013. We met with the interim manager and deputy manager of the home.

We observed staff asked people for consent before they assisted or supported them. Care plans contained a consent form signed by the person receiving care agreeing to their planned treatment and support. One care worker said “We listen to the residents and act accordingly.” One person who uses the service told us “I can’t fault the staff in any way.”

We saw the home was clean. There were cleaning schedules and guidance to ensure people were protected from the risk of spread of infectious illness.

Staff told us their training was mostly up to date, but we did not see a suitable method of recording staff training, or ensuring this was maintained in date.

We did not see evidence of planned or recorded supervisions or appraisals for staff. Staff we spoke with told us they did not have regular supervisions. One care worker told us “The managers listen”, and all staff we spoke with said the interim manager was approachable and supportive.

We noted that most records were maintained, stored and disposed of suitably. Managers ensured only those who should have access to documentation could access this. However, there were no records of staff training or supervisions, or of regular checks made of cleaning schedules.