This inspection was carried out on 11 and 12 April 2017. The first day of the inspection was unannounced.

Winchester House is a care home for older people. The home is set out in five separate units and comprises the Peter Mews unit which provides care for people with a physical disability; the Marconi suite for people with residential dementia care needs; the LaFarge suite for older people with nursing care needs; and Shorts Terrace and Cathedral Square suites which provide dementia and nursing care. At the time of our inspection 118 people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility, a number of people were cared for in bed.

The service had a registered manager. 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.

At our previous inspection on 26 and 28 January 2016, we found breaches of Regulation 10, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the home was not clean in all areas. Medicines administered were not adequately recorded to ensure that people received their medicines in a safe manner. People were not always treated with dignity and respect. Decoration of the home did not follow good practice guidelines for supporting people who live with dementia. Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. We asked the provider to take action to meet the regulations.

We received an action plan on 06 May 2016 which stated that the provider would be meeting regulations 10 and 12 by 10 May 2016 and regulations 15 and 17 by 30 May 2016.

At this inspection people told us they received safe, effective, caring and responsive care from staff.

Medicines were well managed. Medicines were stored and administered appropriately. Some medicines were prescribed on a ‘when required’ basis. There was guidance in place for each person’s when required medicine. However, details of the dose of medicines and frequency did not always match with what was printed on medicines administration records. We made a recommendation about this.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.

The provider followed safe recruitment practice. Essential documentation was in place for all staff employed. Gaps in employment history had been explored to check staff suitability for their role. There were suitable numbers of staff deployed on shift to meet people’s assessed needs.

The premises were well maintained, clean and tidy. The home smelled fresh. Areas of the home had been decorated to help people orientate in their environment. More improvements were planned.

Staff had undertaken training relevant to their roles. Staff were supported to gain qualifications and were supported in their roles. They had received regular supervision meetings.

Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.

Staff had a good understanding of the Mental Capacity Act 2005 and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the registered manager.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. Feedback from healthcare professionals was positive.

People were supported to maintain their relationships with people who mattered to t

The inspection was carried out over a period of nine hours by two inspectors who were supported by a clinical nurse specialist. There were 121 people who lived at the home on the day of inspection. They had a range of needs including difficulties with mobility and communication. Some of the people who lived in the home had dementia. This meant they were not always able to tell us about their experiences. Some of the people in the home had complex needs such as having special medical devices to aid breathing and being fed through a tube into their stomach (PEG) which required staff to have particular skills and knowledge in the care of these conditions.

The report is based on our observations during the inspection, talking with two people who used the service, four relatives, one visitor, five staff who were working in the home, and reviewing records. We also talked with the manager, deputy manager and the HR administrator.

Winchester House includes five different units catering for people with specific needs such as dementia and nursing care.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff told us that they understood their responsibilities for reporting adult protection concerns and we saw that appropriate training and guidance was in place to ensure that people were protected from harm. We saw that a whistleblowing policy was in place, for staff to be able to report concerns about the service, and information about this was on display.

The CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the manager about the applications they had made to the court of protection under the Deprivation of Liberty Safeguards. They demonstrated a sound understanding of the circumstances that would mean an application needed to be made. This meant that appropriate applications were made when necessary.

Is the service effective?

We saw that people’s needs were assessed and care was delivered to meet their documented care needs. Staff we spoke with understood people’s care needs and demonstrated that they knew how to meet people’s needs and what to do if they noticed any changes or concerns. We found that the home worked proactively to meet the needs of a range of people.

Is the service caring?

People were supported by staff who were kind and attentive. We saw positive interactions between staff and the people they supported. People were supported to eat and drink at their own pace. People with mobility difficulties were supported to move at their own pace when staff helped them to move around the home. We saw comments from one person in a survey that stated “The staff all know me and are very kind and understanding”.

Is the service responsive?

We found that the managers of the home acted to address concerns as soon as they were noted. When referrals to other professionals were required these were made in a timely manner. People had access to activities they enjoyed and they were able to make suggestions concerning what they would like to do at residents’ meetings. People were given forums for making their views known and suggestions were acted on when possible.

Is the service well-led?

Staff we spoke with told us that the managers of the home were approachable and they were able to seek advice and guidance whenever it was required. We looked at the way the quality of the service was assessed and monitored. We found that a number of audits, visits and checks were made by the managers within the home and they also received support from a regional manager and clinical specialist. This meant that management was overseen to ensure the service was well-led and met the needs of the people who lived at the home.

There were five units in the home, two of which cared for people with dementia which meant that we were not able to ask them about their experiences. We spoke with people who lived on the other units and observed the care provided on the dementia units. We spoke with the regional manager, the registered manager, deputy manager, two Registered Nurses, an activities coordinator, four carers, five people who used the service and three relatives.

People we spoke with told us that staff were "Kind and caring".

People who used the service, or their relative, had been asked for their consent, and their views and wishes had been considered and acted upon when care was delivered.

We saw that people who used the service received consistency of care and support that met their needs; as staff were knowledgeable about individuals care plans and supporting risk assessments.

People who used the service were protected from the risk of abuse, because reasonable steps had been taken to identify the possibility of abuse and prevent abuse from happening.

There were appropriate arrangements in place to manage medicines safely and effectively.

We saw that there was sufficient, well-maintained equipment to meet people's needs.

Staff received training and support appropriate to their role.

There was an effective system to regularly assess and monitor the quality of service that people received.

We saw that accurate and appropriate records were maintained.

The inspection was carried out to follow up an area of concern which was identified at our previous inspection in September 2012. At that visit we found that the home had insufficient numbers of staff on two of the units, Shorts Terrace, and Cathedral Square. This was particularly noticeable during the morning and at lunchtime, when we saw that staff were rushed and there were not enough staff to observe people who were wandering. We noticed that people were late being given their lunch because there were not enough staff available to assist those who needed help with their meals.

At this visit we discussed staffing levels with the manager, and went to view both units during lunch time. We found that staffing levels had been increased, and the units were operating calmly and efficiently.

The inspection was carried out by one Inspector and lasted for nine hours. The registered manager was on leave, and so we (i.e. CQC) gave feedback to the regional manager and two deputy managers who were present during the day.

We visited all five units of the home, and spent time in each unit talking with people living in the home, relatives and visitors, and staff members. We viewed care plans and inspected medication in each unit. In one of the units (Shorts Terrace) we carried out a Short Observational Framework Inspection (SOFI) for forty minutes.

During the day we had meaningful conversations with 12 people living in the home, and also spent time chatting with other people who had dementia. We talked with nine relatives and visitors, and with 16 staff as well as the management. These included staff from different job roles, including nurses, care staff, domestic staff, laundry staff, the head chef and activities staff.

People living in the home and most visitors spoke positively about the standards of care. However, some people felt that concerns they had raised had not been fully addressed; and some relatives and staff did not think there were “enough staff” for some of the units.

Comments from people living in the home included:

"It is all very good. Everyone is always friendly.”

“I’ve got a lovely home here.”

We visited the service in January 2012 to review improvements made since out last visit in September 2011. At our last visit we made two improvement and two compliance actions. We also found four areas where we judged the service to be non compliant. At this visit we looked at the two compliance actions and the four outcome areas we judged to be non compliant to review progress. At this visit we did not review the improvement actions.

Some of the people who lived in the home were not able to tell us their views as they had dementia or limited verbal communication. We observed the care and support provided to people who lived in the Shorts Terrace and Cathedral Square suites and spoke to relatives who were visiting the home.

Relatives said that they felt their loved one was well cared for and that they were informed of any changes needed.

There was a mixed response with regards to the staffing levels on the Shorts Terrace and Cathedral Square suites. One relative said that staffing levels did not allow for care staff to spend much time sitting with people, chatting, or just spending time with them. Another relative told us that there was always a member of staff around if they needed to speak to someone.

At our last visit we observed that although staff were kind and caring, they did not always interact with people or tell them what they were going to do. At this visit we observed that staff interaction had improved. We saw that staff asked people if they had enough to eat when they finished their lunch, they talked to people when they were taking them either to a different communal area or to their rooms. When someone who used the service spoke to a member of staff they responded in a patient and caring manner.

Our observations showed us that staff spent time with people when they were in the communal areas and tried to make sure that people benefitted from staff interactions. We saw, however, that there were people who remained in their rooms and they did not always have the opportunity to have staff spend time with them.

We visited the home on 13 July 2011. At that visit we made compliance actions and requested that the registered provider send us a report on how they would address the shortfalls. This was received within the requested timescales. This visit was carried out on 7 September 2011 to monitor progress.

Some of the people who lived in the home were not able to tell us their views as they had dementia or limited verbal communication. We used a formal way to observe these people. This is called the 'Short Observational Framework for Inspection' (SOFI). This involved observing up to five people for up to one and half hours. We did this in two areas of the home, Shorts Terrace and Cathedral Square units, and recorded their experiences at regular intervals. This included their state of well being, how they interacted with care staff and how they occupied themselves. The findings of our observations are included in this report.

We spoke to people who lived in the Marconi, Peters Mews and Lafarge units of the home. People told us that they liked living at Winchester House and were happy living in the home.

People said that they thought the staff were kind and caring. One person told us that they felt well looked after and other people said that they got all the help they needed.

Some people told us that they grew vegetables in the greenhouse and that they enjoyed doing this. One person told us that they helped to call the bingo.

People told us that they liked the food and were given a choice of meals.

We spoke to relatives and they told us that they felt people were well cared for in the home. One relative told us that there had been some problems, but these had been "Sorted out".

Two relatives told us that there had been problems with the laundry and this meant that their families became quite anxious about sending their clothes to the laundry

One relative told us that his father lived in the Shorts Terrace unit and that he felt his father did not have enough to do in the way of activities.

We observed people who lived in the Shorts Terrace and Cathedral Square units and saw that interaction from staff varied. We observed that staff did not always relate to people and tell them how they were going to support them. Some staff did not speak to people at all even when they were sat next to them. We saw other members of staff who would go out of their way to talk to people.

We spoke to nine people who used the service and four relatives who were visiting the home. We did not ask people on the dementia care nursing units about their support as they had complex needs and were unable to tell us about the care they received.

People who used the service told us that they felt well supported and that staff were kind and caring. People we spoke to did not have any complaints about the service and all told us that they would speak to a member of staff if they felt they needed to complain.

In particular people who used the service and lived in the Marconi and LaFarge units told us “I couldn’t grumble about how we are looked after, staff help us all the time” and “we often go out on trips, we don’t want for anything” and “the meals are lovely”. People also said "if I need anything I only have to ask" and "the girls are brilliant and always support me with my care needs". "They are polite and always knock on the door".

Relatives told us that overall they were happy with the care provided at the home and they were always made welcome. One relative told us how the home had helped to arrange a birthday party and that they had been given a room and been able to invite thirty friends and family to celebrate this person's birthday.

Another relative said "generally I am happy with the care provided but feel that staff are very busy and don't always have time to spend with people".

The inspection was carried out on 26 and 28 January 2016. Our inspection was unannounced.

Winchester House is a care home for older people. The home is set out in five separate units and comprises the Peter Mews unit which provides care for people with a physical disability; the Marconi suite for people with residential dementia care needs; the LaFarge suite for older people with nursing care needs; and Shorts Terrace and Cathedral Square suites which provide dementia and nursing care. At the time of our inspection 119 people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility, a number of people were cared for in bed.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People and their relatives were complimentary about the care and support provided by the service.

Medicines administered were not adequately recorded to ensure that people received their medicines in a safe manner.

The home was not clean in all areas. Some rooms had a strong and overpowering smell of stale urine and some mattresses were stained.

Meals and mealtimes did not promote people’s wellbeing. People were not always treated with dignity and respect at meal times. Records relating to food and fluid were not concise. We made a recommendation about this.

Decoration of the home did not follow good practice guidelines for supporting people who live with dementia.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits undertaken had not picked up the concerns about cleaning, infection control, topical medicines and the decoration of the home.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as falls, mobility and skin integrity.

There were enough staff on duty to meet people’s needs. Staff had undertaken training relevant to their roles and said that they received good levels of hands on support from the management team.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA), that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved.

People were supported and helped to maintain their health and to access health services when they needed them.

Relatives told us that they were able to visit their family members at any reasonable time, they were always made to feel welcome and there was always a nice atmosphere within the home.

People’s view and experiences were sought during meetings. Relatives were also encouraged to feedback during meetings.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People and their relatives knew who to talk to if they were unhappy about the service.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the senior managers within the organisation. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.