About the service:

Winchcombe Place is a care home with nursing which provides personal care and support for up to 80 people.

The registered manager of the home had left the service in December 2018, however was still registered with the Care Quality Commission (CQC). We were assisted by the management team during the inspection. The registered manager and registered provider are ‘Registered Persons’. Registered Persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s experience of using this service:

¿People did not receive a service that provided them with safe, effective and high-quality care.

¿Risks to people's safety and well-being were not managed effectively and this placed people at risk of harm.

¿Infection control was not always managed in an effective way.

¿Incidents and accidents were not managed safely to prevent a reoccurrence.

¿People's needs and preferences were not always assessed or person-centred plans developed to guide staff on how to meet people's needs.

¿Staff did not always complete training in meeting people's needs and this meant people were at risk of inappropriate care and treatment.

¿People were not always treated respectfully or in a way that promoted their privacy and dignity.

¿Staff were not always deployed effectively.

¿The service was not well-led and the governance system were not always effective and did not always identify the risks to the health, safety and well-being of people or actions for continuous improvements.

¿Complaints had not always been managed appropriately.

¿Appropriate referrals were no made to the local authority in a timely way.

¿We were not always notified, as required by law, of notifiable safety incidents.

¿Medicines management was not always safe.

¿People told us staff were caring, although feedback received was that meaningful engagement was limited.

There is more information about this in the full report.

Rating at last inspection:

Good (Published on 4 August 2017).

Why we inspected:

This was a responsive inspection due to information we received of risk and concern regarding the safety and welfare of people living in the home.

Enforcement:

We have told the provider to take immediate action to address some of the concerns we found. 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:

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures

Winchcombe Place is a care home with nursing which provides personal care and support for up to 80 people with needs arising from old age. The service is provided in three ‘units’ over three floors. The ground floor caters for up to 30 people with personal care needs. The first floor accommodates up to 30 people living with dementia. The top floor accommodates up to 20 people, 15 with nursing needs and a further five people who have high dependency needs, possibly including the early stages of dementia.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

The service continued to work to keep people as safe as possible, by the way care was delivered; in terms of health and safety; premises maintenance and the provision of competent staff. The service had a robust recruitment process to ensure as far as possible, suitable staff were employed. Ongoing work was being undertaken to maintain and maximise premises safety. There was a need for additional staffing on the second floor at key times of day and in key areas.

People’s rights and freedom were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff received effective induction, training and ongoing support to help them deliver a good service and encourage their development.

In some areas such as the provision of activities, the service exceeded fundamental standards. A wide range of creative opportunities were provided and new initiatives were being introduced by a motivated team of lifestyle coordinators.

Healthcare needs were well met and health issues were monitored. However, we found room for some further development in terms of recording with regard to fluid intake and turning records for some people. Some additional specialist equipment was needed. For example, additional 'crash mats' were required to replace the pressure mattresses currently being used, in some rooms, to reduce the risk of injury from falls.

The service had experienced several changes in key management posts and an unsettled period. The new manager had applied to become registered manager of the service. He was supported by the newly appointed deputy manager, the recently appointed customer relations manager and other key senior staff. Feedback from staff was positive and staff felt Winchcombe Place was a good place to work.

A range of monitoring and audit systems helped ensure that an effective overview of the service was maintained by the management team. Issues had been identified and addressed, or were in the process of being addressed. The management team had already identified further areas they wished to develop.

This inspection took place on the 16 and 17 April 2015 and was unannounced. Winchcombe Place is a purpose built care home for older people and for people who live with dementia. It is situated near the centre of Newbury and opened in April 2014. The building, grounds and furnishings have been completed to a high standard. Accommodation is divided over three floors and arranged to create a comfortable and welcoming environment. Shared areas include library, salon, cinema, coffee shop, arts and crafts room, large lounges and smaller themed lounges.

The service does not have a registered manager, but was actively recruiting to the position. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

An area manger within the organisation is managing the service in the short-term until a permanent manager is recruited. The service is registered to provide nursing and personal care for up to 80 people. However, as a new service the provider had placed a voluntary embargo on admissions until they had built up a permanent staff team to meet people’s needs. At the time of our inspection 37 people lived in Winchcombe Place.. The manager told us that they were now in a position to lift the embargo as more permanent, experienced and trained staff were employed.

People’s care plans detailed how the person wanted their needs to be met. These were being further developed to promote individualised person centred care. Risk assessments identified risks associated with personal and specific health related issues. They helped to promote people’s independence whilst minimising the risk identified.

We spoke with people and their families. They spoke enthusiastically about the services provided, making reference to residents and relatives meetings and the openness and friendliness of staff. They told us that this makes people feel relaxed and comfortable. Comments included: "we came to visit the home twice and spoke with staff before mum moved in and on our second visit we picked her room; it's wonderful". "They run courses for relatives and staff on living with dementia and always call me, even with a little concern for example, if she's not eating enough”. People told us they felt safe and secure and would approach staff if they were worried about their safety or about the services provided. They said they felt they would be listened to.

The recruitment and selection process helped to ensure people were supported by staff of good character. There was a sufficient amount of qualified and trained staff to meet people’s needs safely. Staff knew how to report any concerns they had about the care and welfare of people to protect them from abuse.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm.

Staff were supported to receive the training and development they needed to care for and support people’s individual needs. People received good quality care. We found that the provider had an effective system to regularly assess and monitor the quality of service that people received. There were various formal methods used for assessing and improving the quality of care.