The inspection was carried out on 10, 11 January 2018. The first day of the inspection was unannounced and the second day was announced.

Windsor Rest Care Home provides accommodation with personal care for up to 13 older people. Staff provided personal care for older people who were frail or were diagnosed with dementia or mental health. The property was originally two separate houses and spanned two floors. A lift was available for people to travel between floors. There were 12 people living in the service when we inspected.

Windsor Rest Home was rated as good at the last inspection at this inspection we found the service remained Good

The registered manager was also an owner of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the last Care Quality Commission (CQC) inspection on 27 July 15 the service was rated as Good. At this inspection we found the service had remained good

People were assessed as individuals and staff had a very good understanding of how people’s care should be provided to maintain their safety, health and wellbeing. Risks were assessed within the home, both for individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk and report any new risks that they identified.

The registered manager had plans in place for PEEP (personal emergency evacuation plans) for each person living at the home. These were individual plans which gave information about how many staff would be needed to evacuate the person and what equipment should be used.

Incidents and accidents were recorded and checked by the registered manager to prevent these happening again and improve the home offered.

People were kept safe by staff who understood their responsibilities to protect people living with dementia and mental health illness. Staff had received safeguarding training and knew how protecting people from abuse. The staff team had access to and understood the safeguarding policies of the local authority which they must follow. Staff understood what whistleblowing meant and all said they would report another member of staff if they believed they were abusing people in any way.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to a range of health care professionals such as dentists, chiropodists and when required arrangements were made for people to attend outpatients appointments at the hospital. People also had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Staff had been trained to assist people to manage daily health challenges they faced from conditions such as diabetes and dementia.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough nutritious food to eat and sufficient drinks to maintain their hydration.

The home was welcoming and friendly, with people engaging easily with the people they lived with and staff. Staff provided friendly compassionate care and support. People were encouraged to do what they can for themselves to maintain their independence. Staff enabled people to participate in community life, both within the home and in the wider community.

The deputy manager was the appointed person for infection control. The home looked clean and there were no unpleasant odours. Staff wore appropriate PPE (personal proactive equipment) for example gloves and aprons when providing personal care. These were removed and disposed of correctly between each person they cared for.

Windsor Rest Home is a residential care home which is registered to provide accommodation for 13 older people, some of whom were living with mild dementia. The registered provider is Cantonfield Limited. The home provides accommodation over two floors and there is a lift available to access the first floor. There were a total of 18 care staff, two domestic staff and the registered manager who provided support for people. On the day of our visit 12 people lived at the home and the home was full as a double room was being used by a single person..

The last inspection was carried out in July 2014. The registered provider was found to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 relating to; Cleanliness and infection control (Regulation 12), staffing (Regulation 22) and assessing and monitoring the quality of service provision (Regulation 10). The provider sent us an action plan stating they would be compliant with these regulations by October 2014. At this visit carried out on 21 July 2015 we found that improvements had been made.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

People felt safe with the home’s staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Care records contained risk assessments to protect people from any identified risks and help keep them safe. These gave information for staff on the identified risk and gave guidance on reduction measures. There were risk assessments in place to help keep people safe in the event of an unforeseen emergency such as fire or flood.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained at a level to meet people’s needs safely. People told us there were enough staff on duty and staff also confirmed this.

People told us the food at the home was good. They were involved in planning meals and staff provided support to help ensure meals were balanced and encouraged healthy choices.

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to DoLS, we found the registered manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. There were no restrictions imposed on people and they were able to make individual decisions for themselves. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

Each person had a plan of care which provided the information staff needed to provide effective support to people. Staff received training to help them meet people’s needs. Staff received an induction and there was regular supervision including monitoring of staff performance. Staff were supported to develop their skills by means of additional training such as the National Vocational Qualification (NVQ) or care diplomas. These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard. All staff completed an induction before working unsupervised. People said they were well supported and relatives said staff were knowledgeable about their family member’s care needs.

People’s privacy and dignity were respected. Staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

The registered manager operated an open door policy and welcomed feedback on any aspect of the service. There was a stable staff team who said that communication in the home was good and they always felt able to make suggestions. They confirmed management were open and approachable.

A visiting professional told us that the registered manager and staff were very approachable and had good communication skills; they said the home was open and transparent and worked well with them to meet people’s needs.

There was a policy and procedure for quality assurance. The registered manager completed weekly, monthly and quarterly checks and audits to monitor the quality of the service provided to ensure the delivery of high quality care.

People and staff were able to influence the running of the service and make comments and suggestions about any changes. Regular meetings with staff and people took place. These meetings enabled the registered manager and provider to monitor if people’s needs were being met.

We inspected Windsor Rest Home as we had received some concerns about the quality of care and staffing levels at the home. The inspection team was made up of an inspector and a specialist advisor in the care of older people. 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. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service caring?

We observed staff interaction with people who lived at the home and saw this was caring, compassionate and kind. Staff were attentive and spent time with people chatting and playing board games. People told us they were happy living at Windsor Rest Home and that staff were “Wonderful” and “Kind”.

Is the service responsive?

We found that the service was not always responsive. Staff told us they tried their best but sometimes people had to wait to receive the care they needed due to staffing levels within the home. The call bell alarm panel was in the kitchen which could only be heard when staff were in the kitchen or close by. This was confirmed during our observations.

Is the service safe?

We found that the service was not safe in relation to staffing and cleanliness. Staffing levels were not sufficient to enable staff on duty to carry out all tasks expected of them, such as cleaning, cooking and laundry, as well as care for people in a way that ensured their safety and met their needs. There was a risk that the staff member administering medicines could be interrupted when they were one of two staff members on duty.

Some areas of the home, such as the kitchen and bathrooms, were not clean. During our visit we called the Environmental Health Officer to discuss our concerns. They attended the home to check the cleanliness of the kitchen and found a number of concerns.

Clinical waste procedures were unsatisfactory and meant there was a risk of cross contamination within the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. When asked, staff we spoke with were not able to explain about DoLS which meant that people were at risk of being deprived of their liberty unlawfully.

Is the service effective?

Assessments of people’s needs, potential risks to them and corresponding care plans had been regularly reviewed and updated when necessary. People we spoke with confirmed their care needs had been regularly reviewed and also when their needs or wishes had changed. One person said, “They ask me what I want”.

We saw that health professionals were involved in people’s care when required. For example, the chiropodist, optician and GP.

Is the service well led?

We found that the service was not always well led. On the day of the inspection we were told the registered manager was away on holiday but there was no delegated responsibility for running the home. Staff told us they all worked together to get everything done, but no-one had overall accountability or responsibility for the service in the manager’s absence. Staff were unable to show us all of the evidence we asked for on the day. Following the inspection, the registered manager contacted us to inform us that there was delegated responsibility during their absence and how this was achieved. They sent us additional evidence in relation to staffing and monitoring systems and policies. However, we noted that systems for monitoring the quality of the service were not always effective and some day to day practice we observed did not match that which was written in the home’s policies.

On the day of our inspection there were twelve people who lived in the home. We spoke with five people who used the service, the manager and two members of staff.

People told us that they were happy in the home and said staff were kind and friendly. One person said “I feel safe and secure here”.

People told us that staff understood their needs and provided appropriate care and support. One person told us “Staff understand my care needs, absolutely.”

Our inspection of 07 November 2012 found that people’s care was planned using inconsistent formats; that some areas of the home posed an infection control risk and the provider did not have robust quality monitoring procedures. We visited the home to see whether improvements had been made. We found that these areas identified as non-compliant in the previous inspection had been attended to.

The provider had introduced new care plans and revised the daily log. Additionally, the provider had refurbished the laundry room, communal bathroom and toilet facilities. The provider had also introduced a new quality monitoring process. This demonstrates that the provider has taken action to address the issues identified at the last inspection.

You can see our judgements on the front page of this report.

We spoke with five people living in the home and obtained feedback from their relatives. People told us they were treated well and with respect. We were told that staff always treated them with kindness. One person told us “they are lovely girls, I couldn't ask for better."

People said that they had choice in how they spent their days and there were activities available for people. People said they felt safe living at the home and told us they felt confident that any concerns were always quickly addressed.

Feedback from relatives included statements such as, “We feel it’s an excellent home, well run home. The staff are very caring, friendly and helpful.” Another person stated that their relative was treated like one of the family. They said, “I can't praise the owners and staff enough, they are wonderful.”

However the three care plans we looked at did not evidence that peoples’ care needs were being appropriately recorded, regularly reviewed and updated. People’s needs were assessed but for some parts of the care plan there was no written guidance for staff to follow on how needs should be met.

There was a lack of risk assessments to address potential hygiene risks and risks from cross infection. We found that potential risks in the environment to people’s safety had not been identified and addressed in a timely manner. There were not adequate systems in place to assess and monitor the safety of the environment and the care provided.