30 May 2023
During an inspection looking at part of 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.