Windmill House

Updated 2 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Day 1 consisted of 2 inspectors and 1 Expert by Experience (An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service).

Day 2 consisted of 2 inspectors and 1 specialist medicine inspector.

Service and service type

Windmill House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Windmill House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. We therefore liaised with the regional operations manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed other information held on our system. We used all this information to plan our inspection.

During the inspection

We spoke with thirteen members of staff including the regional operations manager, a manager from another service providing temporary cover in the absence of a registered manager, operations manager, 2 senior care staff and 3 care staff, an agency chef and kitchen assistant, 2 members of the laundry team and 1 member of the housekeeping team, as well as observing care and support provided in communal areas. We reviewed 5 people’s care and support records and 22 people’s medicine management records. We observed part of the medicine round on day 2. We spoke with 6 people and 4 people’s relatives. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We liaised with stakeholders after our inspection visits.

Updated 2 August 2023

About the service

Windmill House is a residential care home providing personal care and support to up to a maximum of 59 people. The service provides support to older people, including those living with dementia. At the time of our inspection there were 47 people using the service and 1 person in hospital.

People’s experience of using this service and what we found

People continued not to be living in a visibly clean and well-maintained care environment and were not being protected from the risk of harm. This included people living with dementia still having access to unsecured risks such as razors and prescribed creams. People were not always supported with their personal care. We identified areas of concern relating to infection, prevention and control practices including a further deterioration in the rating of the service’s food hygiene rating. Improvements to the guidance in place in people's care records, and ensuring this information was individualised and person-centred, was needed. This remained of particular concern in relation to the management and oversight of care for people living with diabetes.

A greater level of governance and oversight by the provider was required in the absence of a registered manager, to improve the standards of care provided, and to ensure actions were taken in response to incidents and accidents. Audits and checks needed to ensure the lived experience of people was being accurately captured, and changes made to care where required to uphold people's privacy, dignity and levels of independence.

Areas of improvement were identified in relation to the management of people’s medicines, particularly where they received medicines covertly (concealed in food or fluids), and to ensure people’s patch changing regimes were more accurate.

We found gaps in staff recruitment processes and support in place for new members of staff to ensure they were competent and had the required level of skills to safely support and meet people’s assessed needs and risks. Improvements in relation to specialist training and competencies around supporting those people living with dementia remained an area needing to be addressed to improve people’s overall quality of life.

People were mainly supported to have maximum choice and control of their lives and staff mainly supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We received mixed feedback from people and their relatives about the standards of care and support provided.

Rating at last inspection and update

The last rating for this service was requires improvement with breaches of the regulations (published 07 December 2022).

Why we inspected

We undertook this focussed inspection to follow up on the warning notices served on 11 November 2023, relating to breaches of regulations 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with the compliance dates for the warning notice of 09 December 2022 and 06 January 2023 respectively.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Windmill House on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, checks of staff competency and suitability to work at the service, safeguarding people from risks of harm and abuse and governance and oversight of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will work with the local authority to monitor progress.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.