Winsor Care Services

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last inspection we found that there were not risk assessments in place for people with known diagnoses and needs with associated risks. We also found that there were safeguarding concerns relating to the same risks. At this assessment we found that there were more risk assessments in place, but not in all instances. We found that action had been taken to mitigate the resulting risk by staff having access to tasks to complete at each care visit which related to the appropriate risk management. We found that through lack of consistent assessment there was a continued breach of Regulation 12. We found that safeguarding concerns had reduced and there was a good record of how incidents and accidents had been recorded, responded to and lessons had been learnt. We saw that staff were vigilant about raising their concerns relating to risks and people told us they felt safe when being supported by the staff. We found that the provider was no longer in breach of Regulation 13.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff delivered appropriate care to them and that staff had adapted the support they provided to manage risks. One person told us, “They know if I drop something that I cannot pick it back up in case I fall over so when they come in, they pick anything up before anything else”. Relatives also felt staff had learnt how to mitigate known risks. One relative told us, “My wife is bed bound and is at risk of pressure sores and they always notice if anything appears”. Another relative told us “The carer is aware that there is a possibility of seizures and the times that they will occur, and potential coughing fits and they are all managed perfectly well.”

Staff told us that they felt confident that they could recognise new risks, and they reported any concerns to the office. Staff told us they would be made aware of any changes to someone’s care from the task list and notifications on their handheld device, as well as communicating with one another. One staff member told us, "I receive feedback via the app that we use and if it is something important the manager will call me." The Registered Manager told us that staff were encouraged to report concerns and they were reassured that it was the right thing to do. Staff were congratulated for identifying learning opportunities for how care could be adapted. The consultant for the provider told us, “If you see something happen, you have got to be open and honest. There is no blame to be given. It is about the safety of the service user.”

We saw that there was a policy relating to raising concerns and speaking up which encouraged staff to feel able to discuss concerns without fear of reprisal. Incident and accident records showed details of investigation and actions which had been taken to mitigate future risks for people. Staff supervision records showed that staff were provided with updates, reminders and reassurance to report incidents in order to apply learning.

Relatives told us that the local authority had carried out assessments, the information from which had been shared with Winsor Care Services when they had sourced the provider. One relative told us “A social worker came round to the house to complete it and they appointed Winsor Care for us, telling them all about her”. They felt carers were up to date with updated handed over from health professionals. One relative told us, “They have a vast knowledge of seizures and pressure sores. They are also very aware of joints needing to be moved as well. They also have good knowledge about helping with feeding as sometimes we need to change food from pureed to mashed and vice versa.”

The registered manager told us that people can be discharged from hospital at very short notice without time for an assessment to be completed. They told us, "We get a notification [of discharge] from the hospital. They tell us what time to come." The registered manager added that they persist with the hospital to be provided with an up to date discharge summary of the persons needs and this information is passed to carers on their handheld devices. Staff were clear on processes in place to manage, monitor and assure safety. One member of staff told us, "If I see that a client has marks on their chest, I would record it and contact the office, they will then contact the GP or nurse for them to call out to the clients house."

Professionals involved with the service felt confident safe systems were in place to share relevant information to keep people safe. One professional told us the provider had been, "Communicating any issues or changes in need such as medication not delivered, client not well, reduced mobility and onward referrals."

People had grab sheets to support information sharing with the hospital should they be admitted in an emergency. The information held in those included the highest risk information but the provider was in the process of updating them all with more cohesive and consistent information. We saw communication with the local authority relating to adaptations to care to keep people safe. We saw a record of incidents and accidents which had been investigated and resulting actions made to the care provided.

People told us they felt supported safely with medicines "Yes, they help me set them up for the week in the boxes that I have”. Risks are anticipated and proactive care was delivered. One relative told us “I work as a team with his carer, and we manage anything that may come up like one time he had a tiny pressure sore and we worked together to keep repositioning my partner so it did not develop further”

The leadership team encouraged openness and transparency when reporting concerns which included safeguarding matters. The registered manager told us and demonstrated on-site that safeguarding enquires had been thoroughly investigated and closed since the last inspection. Safeguarding concerns for skin integrity in particular had been a concern previously but had not been raised since the last inspection. The registered manager told us that if staff identify concerns on a visit, they must take appropriate action before they leave the visit. They told us, “We say ‘well done’ to someone who has reported a near miss.” Staff had a good understanding of safeguarding. One staff member told us, "I would contact the office or if it were an emergency, I would ring 111 or 999." Another staff member told us, "My company taught me what [safeguarding] is, protecting people from harm and abuse and keeping them safe…if I identify an issue, I call my line manager and give them the details".

We saw that safeguarding concerns had been raised by the provider in relation to concerns carers had identified relating to other services. We saw that the topic of safeguarding was covered in staff supervision and induction. Training had been provided to all staff about safeguarding. We also saw a safeguarding policy in place which all staff had been provided with.

We asked people if they felt safe whilst being supported. People told us they felt safe, saying “I feel completely safe with [staff member], he is brilliant” and “Yes, one hundred percent, they are very nice people”. When asked if people felt safe, their relatives told us “Absolutely safe, there are no worries there” and “I am 100% certain that he is, I have seen him in hospital when he has not felt safe, and he lets us know”.

Where we found areas of risk without risk assessments, the registered manager confirmed staff had diagnosis specific training and carers had tasks on their devices which indicated how risk should be managed. The consultant for the provider told us, “This will be added to [persons] risk assessment and support plans”. The registered manager and consultant acknowledged the further improvement required. As well as reading what assessments there were, staff applied their knowledge of medical conditions when supporting with risk. One staff member told us, “I read any assessments that have been completed if they are a new client. I also ask them how they want things to be done. I also look to see what medical conditions they have to know how to support them.”

We saw that there were more risk assessments in place where people had known risks associated with their care such as skin integrity, falls, as well as risks relating to specific diagnoses such as diabetes. However, this had not been rolled out to all people receiving a service. Although the provider was in the process of updating all electronic records for people, they had prioritised all risk tasks on staff members handheld devices to mitigate risk. If professionals or carers needed to access full detail of how risks regarding a specific condition should be managed, this was not always be available. This could impact the continuity of care being delivered and increase risks to peoples safety. The registered manager assured us this was on the action plan to be achieved.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.