Windsor Street Care Centre

Updated 16 May 2018

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 is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 and 12 March 2018 and was unannounced. One inspector visited the home on 10 March 2018 and two inspectors and an expert by experience visited the home on 12 March 2018. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. In this case a person who has experience of caring for older relatives who lived the dementia.

Before the inspection visit we reviewed all the information we held about the home since the last inspection in December 2016. This included all statutory notifications and the Provider Information Return (PIR). Statutory notifications must, by law, be sent to us by the provider. These inform us of important and significant events which have happened in the home. We used information the provider sent us in the PIR to help plan the inspection. This is information we require providers to send us at least once annually, to give us some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with seven people who used the service and four relatives about their experience. We spoke with 10 staff about their roles and responsibilities and people’s care and treatment. This included day and night nurses, team leaders, care staff, an activities co-ordinator, the chef and the maintenance person. We also spoke with the registered manager, deputy manager and one of the provider’s operational managers. We sought the views of one visiting health care professional.

We reviewed records relating to the Mental Capacity Act 2005 for nine people. We case tracked six people’s care, which included a review of all care plans, risk assessments and other care records for these people. We inspected four staff recruitment files, the home’s training record and planner for all one to one staff support conversations. We read the minutes of some staff meetings. We reviewed audits, which included those for accidents and incidents, infection control, medicines, health and safety, care planning and catering services. We reviewed all records completed and held by the maintenance person and those relating to complaints received. We visited all five households and attended one staff hand-over meeting.

Updated 16 May 2018

This inspection took place on 10 and 12 March 2018 and it was unannounced. At our previous inspection on 1 and 2 December 2016 we rated the service ‘Requires Improvement’ overall.

Following the last inspection we asked the provider to complete an action plan to show what they would do to ensure people’s care records were maintained accurately. The provider told us the improvements would be made by 30 September 2017. During this inspection we found people’s care records had been maintained and they contained accurate information about people’s care.

Improvements had also been made to staff recruitment, staffing numbers, and staff skills, which had improved how people were kept safe and supported. Changes in the management of the home had improved the overall governance of the service and resulted in positive results for people who lived in the home and the staff who worked there. This action and the improvements completed support the service’s overall rating of ‘Good’ awarded at this inspection.

Windsor Street Care Centre is a purpose built ‘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.

People, relatives and staff referred to the home as ‘Windsor Street’ so this has been done in this report. Windsor Street specialises in the care of those who live with dementia, but also provides nursing care to some people. There were four beds commissioned by the NHS, these were called ‘safe haven’ beds. These were used for people who required a short admission; either after a stay in hospital or to avoid a hospital admission. Referrals for these beds were made by people’s GPs. People’s medical care was temporarily handed over to the GP who attended Windsor Street. Once discharged, people’s medical care was transferred back to their own GP. In total 81 people can be accommodated in one adapted building. At the time of this inspection 63 people were receiving care.

People lived on 5 units referred to as ‘households’. Four households provided care to people who lived with dementia; one of these provided nursing dementia care. A fifth household also provided nursing care. Single bedrooms with private toilet and washing facilities were provided. Each household had a lounge, dining/kitchen area and additional adapted toilets and bathrooms. A passenger lift helped with access to upper floors. There was a secure, large garden and balconies for outside use. Car parking was available. The home had wheelchair access.

The home had a registered manager in post who had managed the home since May 2017. Previous to this they had been the home’s deputy manager and dementia care lead. 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.

Arrangements were in place to keep people safe and to protect them from abuse and discrimination. Improvements had been made to how the home was staffed. Staff had been recruited safely, providing the home with enough staff with the right skills, knowledge, experience and commitment. People lived in a clean home where good infection control measures reduced the risk of infection. The staff had support from the home’s visiting GP, which meant people’s health needs and medicines were reviewed and managed well.

Staff were trained and well supported. Robust assessment of people needs meant these were well identified and understood by the staff. Frequent reviews of people’s needs and their abilities meant staff were quick at identifying changes and deterioration in people. People and where appropriate their representatives, were involved in reviewing the care delivered.

People were supported to have a voice. People who lacked mental capacity had decisions made on their behalf but, in their best interests and lawfully. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies, systems in the home and staff training supported this practice. Staff ensured people had enough food and drink. All risks relating to people's ability to maintain their nutritional wellbeing were identified and addressed.

Staff were caring and compassionate. People were treated with respect, dignity and their rights were upheld. Staff treated people equally, as individuals and differences were respected and celebrated. Care was planned around people’s diverse needs, their likes, preferences and wishes.

The home did particularly well at meeting many different and diverse needs in a personalised way.

People were supported to take part in social activities which meant something to them and which they enjoyed. Activities which promoted a healthier life were also provided, for example, singing for the brain, yoga and physical exercises. People at the end of their life were supported to have a dignified and comfortable death. Relatives were able to visit freely and to remain with a relative who was dying. Relatives were encouraged and provided with support to be part of the Windsor Street ‘family’. They were valued and positive input was seen as integral to people's ability to live well with dementia.

The home benefited from strong leadership. The registered manager was supported by their deputy and senior staff team. Since the registered manager had been managing the home there had been a focus on changing the staff culture. The registered manager had made their expectations clear, as well as their vision for the home and the values they wanted to see followed. All the staff we therefore spoke with put people at the centre of what they did. They were committed to improving people’s wellbeing and quality of life.

The registered manager was approachable and transparent in how they managed situations, incidents and complaints. They expected their staff to work likewise. They met on a regular basis with people, relatives and all grades of staff. Both managers welcomed feedback and used this to help them improve the service.

Managers used the provider’s quality monitoring processes to ensure the home remained compliant with necessary regulations and legislation. Actions necessary to make improvements were carried out and followed up by the provider to ensure these were fully completed. There was a strong desire to further improve the services provided to people and to become a centre of excellence.