This inspection took place on 16 January 2019 and was unannounced.

Windsor House is a residential care home for up to fourteen adults with a learning disability. At the time of the inspection there were eleven people living at the service.

Windsor House is a ‘care home’. People in care homes receive accommodation and 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.

The accommodation was spread over two floors of a converted house in a residential area. There was a large kitchen, a lounge and a dining room. People living at the service had a range of learning disabilities. Some people also required support with behaviours that challenged and physical disabilities.

At the last inspection the service was rated overall as requires improvement. In that we found that activities for profoundly disabled people required further development. And there had not been enough time for the new manager to embed improvements at the service. However, there were no breaches of the regulations. At this inspection we found that the service had improved, and the service is now rated Good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. 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.

Risks to people had been assessed. There was clear and detailed guidance for staff to enable them to minimise risks. People’s needs were appropriately assessed before they moved to the service. These assessments were used to plan people’s support. Medicines continued to be managed safely and people received their medicines on time and when they needed them.

There were systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Staff had regular discussions with people about their safety to protect them from the risk of abuse.

Staff knew how to keep people safe from the risks of infection and took the appropriate actions to do so. The service was clean and free from odour. The environment had been adapted to meet people’s individual needs and was personalised to reflect the people that lived there.

There were sufficient numbers of staff to meet people’s needs and support people effectively. Staff had the training, skills and knowledge they needed to support people with learning disabilities. Spot checks were carried out to monitor staff performance and staff had regular supervision meetings and annual appraisals. New staff had been recruited safely and pre-employment checks were carried out.

Peoples support was personalised to them and met their needs. There was information on people’s goals, preferences and their plans for the end of their life. Support plans were reviewed regularly and updated when their needs changed. People’s support records were complete and up to date and the registered manager regularly audited the service to identify where improvements were needed.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and were involved in decisions about their support.

People continued to be supported to maintain their health and wellbeing. Where people needed access to healthcare services, this was in place. When people needed to go t

This inspection took place on 11 December 2017 and was unannounced.

Windsor House is a care home registered to provide accommodation and personal care for up to 14 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People living at the service had a range of learning disabilities and required support with behaviours that challenged.

Downstairs there were two lounges, a kitchen and dining room. There were 14 bedrooms and some bathrooms spread across the remaining two floors. At the time of the inspection there were 10 people living at the service.

The service had a registered manager in post. A registered manager is a person who is 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.

We last inspected Windsor House in May 2017, we found significant shortfalls and the service was rated inadequate and placed into special measures. There was no registered manager in post. There were not enough staff to keep people safe. Conditions on people’s Deprivation of Liberty Safeguards authorisations (DoLS) had not been met and appropriate action had not been taken when safeguarding alerts had been raised. Risks relating to people’s care and support were not always adequately assessed or mitigated. People’s needs had not always been assessed before they moved into the service. Complaints had not been adequately investigated or responded to. The quality assurance audits were not effective to ensure that all shortfalls in the service were identified and acted on. The provider had failed to notify CQC in a timely manner of important events that had happened in the service.

We took enforcement action and issued a warning notice relating to ‘Good Governance.’ We required the provider to make improvements. This service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. We received an action plan from the provider, and they told us they would be compliant with all regulations by 31 August 2017.At this inspection we found that improvements had been made in many areas. A new registered manager had been employed and there were no breaches of the regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At our previous inspection we found that the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At this inspection we found that many improvements been made, however, there was still further work to ensure that people were encouraged to be as independent as possible and formalise goals for people to work towards. People with profound learning disabilities required more specialist support from staff regarding their sensory needs. We made a recommendation regarding this.

Since our last inspection the new registered manager and new deputy manager had made many improvements. There was now enough staff to kee

This inspection was carried out on the 23 May 2017 and was unannounced.

Windsor House is registered to provide accommodation and personal care for up to 14 people. People living at the service had a range of learning disabilities and required support with behaviours which challenged.

Downstairs there were two lounges, a kitchen and dining room. There were 14 bedrooms and some bathrooms spread across the remaining two floors. At the time of the inspection there were 11 people living at the service.

There was no registered manager working at the service. 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 and associated Regulations about how the service is run. We were supported during the inspection by the quality lead person for the organisation, who had recently started overseeing the service and two service support managers. These were registered managers from other services run by the provider, who were providing support as needed.

We last inspected the service in June 2016. We found significant shortfalls in the service. We found that there were not enough staff on duty to meet people’s needs and enable them to access activities in the community. Some people had Deprivation of Liberty Safeguards (DoLS) in place because their liberty was restricted. The conditions of the DoLS had not always been met. Full assessments had not always been carried out before people moved to the service. Risks relating to one person’s health and wellbeing had not been assessed to protect them from harm. Notifications of significant events within the service had not been sent to the Care Quality Commission (CQC), in line with current guidance.

We asked the provider to provide an action plan to explain how they were going to make improvements to the service. At this inspection we found that no improvements had been made to the service. Four breaches of regulations identified at the last inspection continued and there were three additional breaches of regulations.

There had not been a registered manager in post since the beginning of 2017. There had been no structured leadership and oversight of the service since then. Shortfalls found at this inspection had not been identified; however, some action was taken during the inspection. There was an action plan in place to address the breaches of regulations found at the last inspection. There were 25 actions but only eight had been completed. Audits and checks had not been completed since March 2017. Quality assurance surveys had not been sent to staff, people, relatives and other stakeholders, such as GP’s, since 2015.

Full assessments had not been carried out before people moved into the service. Risks relating to one person’s mobility had not been assessed and there was no guidance for staff about how to safely support the person with their mobility. During the inspection it was identified by inspectors that staff had been supporting the person in an unsafe way since they moved to the service in November 2016. The service support managers reported this as a safeguarding issue and contacted the local safeguarding team immediately.

Some accidents and incidents had been recorded and these were analysed to identify patterns or trends. This analysis was used to update people’s risk assessments or report incidents to other authorities. However, one incident had not been identified, recorded and analysed, the incident highlighted poor practice by staff and placed people at risk.

People said that they felt safe; however, there was not enough staff to meet people’s needs. People were limited with the activities they could do, both in the service and the community. Some people had a DoLS authorisation in place, with a condition that they go out into the community weekly. This co

This inspection was carried out on the 14 June 2016 and was unannounced.

Windsor House is registered to provide accommodation and personal care for up to 14 people. People living at the service had a range of learning disabilities. Some people had physical disabilities and occasionally required support with behaviours which challenged.

Downstairs there was two lounges, a kitchen and dining room. There were fourteen bedrooms and several bathrooms spread across the remaining two floors. At the time of the inspection there were 14 people living at the service.

The service had a registered manager in post. A registered manager is a person who is 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.

People said they felt safe, however there was not enough staff to meet people’s needs. Three new people had moved in recently and staffing levels had not been increased. People sometimes had to wait for support. The registered manager was recruiting for new staff but said, “Right now we are not able to give people the opportunities to do things that they want to do.” Detailed, relevant references had not always been gained before staff started work.

People were not always able to access the activities they wanted outside of the service. The registered manager and staff told us there was not a formalised activity timetable in place due to a lack of staff.

Some people had Deprivation of Liberty Safeguards (DoLS) authorisations in place because they were being restricted. The conditions on these DoLS were not always met. One person had a DoLS granted on the condition they regularly accessed activities outside of the service. They had not done so for the past four weeks. The registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA) and best interest meetings had been held regarding people’s care and support.

Full assessments were not always carried out before people moved into the service. Risks relating to one person’s health and wellbeing had not been assessed to protect them from harm. Staff were not clear about how to support a person who had recently moved in as a result.

The dishwasher and washing machine had been out of use for some time. Staff had to do the washing up by hand. The registered manager had to take dirty and soiled laundry to another service to wash them. This was disrupting the normal running of the service and the registered manager had not notified the Care Quality Commission (CQC), in line with current legislation.

People were involved in planning and preparing their meals. A visual menu was in place but not used as the pictures were missing. Some people had Speech and Language Therapy (SaLT) guidelines in place. Staff followed these so people could eat and drink safely.

The registered manager and area manager carried out regular audits. However, staffing levels had not increased as needed to meet people’s needs and gaps in people’s care plans had not been identified. People and health care professionals had been asked their opinions on the service recently, but relatives had not.

The registered manager carried out regular health and safety checks to the premises and equipment. Regular fire drills occurred to ensure people and staff knew what to do in an emergency.

There was a safeguarding policy in place and staff knew how to recognise and respond to different types of abuse. The registered manager was clear on their responsibilities with regards to safeguarding and was in regular contact with the local safeguarding co-ordinator. Medicines were stored appropriately. People received their medicines when they needed it and were encouraged to be as independent as possible when taking it.

Staff received the training and supervision ne

There were twelve people using the service. We met and spent time with most of them. Some people were unable to express their views verbally so we sat with people and observed interactions between them and others, including staff.

People were not fully supported in promoting their independence and community involvement. Opportunities to take part in activities when at home or outside the home were limited.

Choice and decision making was not well supported which meant that people with communication needs had limited opportunities to lever change and make choices. Records were not up to date and lacked review so may not have been accurate

Cultural and religious needs were not fully supported. Staff were not aware of the details of people’s religious beliefs so were unable to give the right support.

Health needs were recorded but staff were not aware of what these health needs were and so how to give the right support. This placed people at risk of inappropriate care and treatment.

There were not enough, trained competent staff to meet people’s needs. There was a new manager in post. She had recognised the shortfalls that we found and had produced an action plan to improve the service.

There were eleven people using the service and we met and spoke with most of them. People said or indicated that they were happy with the service.

There were enough skilled and experienced staff to meet people’s needs as the staffing levels had been increased. Staff were supported and supervised and supported people in a discreet respectful manner.

Care records were in the process of being reviewed and updated. Staff records were available and organised as well as being accurate and up to date. This meant that people were protected from the risks of unsafe or inappropriate care and treatment.

People were now being encouraged to be involved in the running of the service including taking part in the cooking. People maintained good health as the service worked closely with health and social care professionals. People now had the support they needed to meet their spiritual needs.