The inspection took place on 9 & 10 May 2018 and was unannounced.

This service has been in Special Measures since June 2017 and at least one domain has been rated Inadequate since then. The service had been rated as Requires Improvement since November 2014. 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. However the Well-led domain is rated as Requires Improvement as further time is needed to demonstrate the improvements can be sustained.

At our last inspection we found breaches of legal requirements. This was because the service was unsafe. Medicines were not managed safely, risks to people were not managed safely, there were not always enough staff to meet people's needs, records were not complete in respect of skin care, and staff were not sufficiently trained and knowledgeable. People did not always have decisions taken in their best interests recorded as required by the Mental Capacity Act (2005) and the quality assurance systems in place had not been operated effectively.

Following our last inspection we imposed a condition on the provider's registration. This was because people were at risk of receiving unsafe and inadequate care. Each month the provider had to provide a report of actions taken or planned and any improvements to the Commission. These reports have been submitted as required.

At this inspection we found the required improvements had been made and there were no breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Winscombe Hall accommodates 39 people across two separate units, with some shared facilities. One of the units specialises in providing care to people living with dementia. At the time of our inspection the main building was closed for refurbishment and the unit for people living with dementia had 19 people living there.

There was a registered manager in post. 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.

People and their relatives were happy with the service they received. People felt safe and cared for by staff they trusted. Relatives told us their relatives were safe and well-cared for. They were positive about the staff and management team.

Staff understood how to protect people from abuse. Staff were confident they would identify and report any concerns. The provider assessed risks to people using the service and had comprehensive, detailed plans in place to keep people safe.

There were enough staff, safely recruited, to meet people’s needs. Staff had received training and were supervised effectively to help support them and monitor the effectiveness of the care they delivered. Staff were positive about working at the service, they were happy at work and told us they felt well supported by colleagues and the management team.

People received good nursing care which followed best practice guidance. Medicines were managed and administered safely. There were comprehensive, person-centred plans in place to support people both physically and emotionally. Nursing and care staff maintained effective records of care needed and given. People’s care was regularly reviewed and changes put in place if needed.

People at the service were treated with warmth, kindness and compassion. Staff knew people well and spoke of them respectfully. Relatives were involved in people’s care and were made welcome at the service.

At our previous ins

This inspection took place on 06 and 07 June 2017 and the first day was unannounced.

We inspected Winscombe Hall in November 2014. At that inspection we found the provider to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because the provider was not supporting staff with appropriate training and supervision. Records did not show how specific decisions were made in people’s best interests. Records did not contain accurate information. Areas identified for improvement were not being followed up.

We carried out an unannounced comprehensive inspection of this service on 21 and 22 January 2016. Breaches of legal requirements was found where restrictions were in place because the provider had not ensured effective processes were in place to make best interest decisions in accordance with the Mental Capacity Act 2005. Medicines were not always administered safely and the service was failing to monitor and mitigate the risks relating to the health, safety and welfare of people. Sufficient numbers of staff had not been deployed to respond to people's needs and accurate, complete and contemporaneous records were not kept in respect of each service user.

After the comprehensive inspection, we used our enforcement powers and served Warning Notices on the provider on 4 March 2016. These were formal notices which confirmed the provider had to meet the legal requirements by 14 July 2016.

We undertook a focused inspection on 24 October 2016 to check they met these legal requirements. At the inspection in October 2016 we found action had been taken to improve the areas of the service looked at but some areas required further improvement. These included the need for further information relating to risks around the use of bed rails and further improvements were necessary to ensure people's rights were fully protected where they lacked capacity to make decisions for themselves. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Winscombe Hall on our website at www.cqc.org.uk

Winscombe Hall is a care home which provides accommodation for up to 39 people, some of whom are living with dementia. At the time of the inspection there were 34 people living at the home. The home comprises of two areas; Stable Cottage provides care to people living with dementia and The Halls which provides nursing care. The home is situated on the outskirts of the village of Winscombe.

There is a registered manager in post. 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. There were also two managers; one responsible for clinical management, the other responsible for business management.

Where people were given their medicines covertly, they were not always given in line with pharmacy guidance. Medicines were not always stored safely.

People had not been referred to the falls team after suffering multiple falls. Records of treatment provided for people who had pressure ulcers did not give information whether the wounds were healing or deteriorating. Air mattresses were not set to the correct setting to be beneficial for people with pressure areas. Safeguarding referrals to the local authority were not always made.

People were not protected from risks in the general environment. Some areas of the home were dirty and could pose a fire risk.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staff did not always have the training they needed to provide appropriate support for people.

The staff understood their role in relation to the Mental Capacity Act 2005 (M

This inspection was unannounced and took place on 24 October 2016.

Winscombe Hall is a care home which provides accommodation for up to 39 people, some of whom are living with dementia. At the time of the inspection there were 32 people living at the home. The home comprises of two areas; Stable Cottage provides care to people living with dementia and The Halls which provides nursing care. The home is situated on the outskirts of the village of Winscombe

There was not a registered manager in post. 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. The provider was in the process of applying to be Registered Manager and there was also a compliance manager and business manager who had been put in place since the last inspection.

We carried out an unannounced comprehensive inspection of this service on 21 and 22 January 2016. Breaches of legal requirements was found as where restrictions were in place the provider had not ensured effective processes were in place to make best interest decisions in accordance with the Mental Capacity Act 2005. Medicines were not always administered safely and the service was failing to monitor and mitigate the risks relating to the health, safety and welfare of people. Sufficient numbers of staff had not been deployed to respond to people’s needs and accurate, complete and contemporaneous records were not kept in respect of each service user.

After the comprehensive inspection, we used our enforcement powers and served Warning ¿Notices on the provider on 4 March 2016. These were formal notices which confirmed the provider ¿had to meet the legal requirements by 14 July 2016.¿

We undertook this focused inspection to check they now met these legal requirements. This report ¿only covers our findings in relation to these requirements. You can read the report from our last ¿comprehensive inspection, by selecting the 'all reports' link for Winscombe Hall on our website ¿at www.cqc.org.uk

We found action had been taken to improve the areas of the service looked at but some areas required further improvement.

Improvements had been made to staffing levels to ensure there were enough staff available to respond to people’s needs. The provider has employed more people and views about the increase in staffing were positive.

Risks to people had been identified and measures were put in place to reduce risks. Where risk assessments were in place they contained accurate information to support people safely. Some further information relating to risks around the use of bed rails was needed in some people’s rooms.

Medicines were administered safely and were looked after in line with national guidelines. There was a system in place to check the expiry date of creams and ointments.

Whilst some improvements had been made to ensure the principles of the Mental Capacity Act 2005 were being followed we found that further improvements were necessary to ensure people’s rights were fully protected where they lacked capacity to make decisions for themselves.

Improvements had been made which ensured records were up to date and accurate. We found some weights to be missing from records but the weights had been recorded in a book rather than the person’s care plan so all the information wasn’t kept together.

This inspection took place on 4 November 2014 and was unannounced. The previous inspection of Winscombe Hall was on 5 December 2013. There were no breaches of the legal requirements at that time.

Winscombe Hall is a care home with nursing for up to 39 older people. The home comprises two areas known as Stable Cottage, which provides care to people with dementia, and The Halls which provides nursing care.

There was a registered manager in post. 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.

People told us they felt safe. Procedures were in place to ensure people were safe, for example when receiving care and when using the home’s facilities. However, there were concerns about the availability of staff and the level of support people received. There was a risk that staffing numbers did not reflect the level of support people needed. A relative commented “We would like to see more of a staff presence, trying to find someone is difficult.”

The provider had made arrangements for staff development. However, not all staff had received the level of training and supervision that was expected. Staff told us about further training they would like in areas such as dementia and end of life care.

People had a choice of meals and food was prepared in different ways to meet people’s individual needs. A GP visited the home regularly and people’s medicines were being safely managed.

People felt valued by staff and they appreciated their friendly approach. Staff were described as “very kind” and people said the staff spoke nicely to them. A number of relatives visited regularly and felt that staff kept them well informed of significant events.

People had individual care plans which helped staff to provide support in a consistent way which met people’s needs. However, there were shortfalls in how people’s care was being monitored and kept under review.

People spoke positively about the registered manager, describing her, for example, as being “all for the residents.” Relatives had the opportunity to give their feedback about the home and the registered manager had plans to improve communication with people overall.

The home was working towards achieving a recognised standard in relation to dementia care. The provider had systems in place for checking and monitoring the quality of the service. However these were not wholly effective in identifying areas for improvement and ensuring these were followed up.

We found four breaches of regulations during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

We visited the home on the 4 January 2013 and found that the service was not meeting the 'Essential Standards of Quality and Safety' in one of the outcomes. Concerns were evident in outcome 4, in relation to the safe 'moving and handling' of people that use the service that impacted on their safety and welfare.

During this inspection, we observed some good improvements had been made and the provider is now compliant with the essential standard.

During our inspection we spoke with three people living in the home, one visiting relative, four members of staff and examined the care records. Not all the people living in the home were able to verbally tell us about the care they received and if they were happy, due to their level of dementia. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

Overall people we spoke with who used the service were happy with the care they received. Comments received included; "the provider has made many changes for the better, I recognise the changes they have made", "it's fantastic now here, never been happier and new staff have slotted in well".

One relative told us their family member had settled in very well and they felt staff updated them about any changes in their relative's care needs.

We visited the home in August 2012 and found that the service was not meeting the 'Essential Standards of Quality and Safety' in outcomes 4, 10, 13 and 14.

During this inspection we observed some good improvements had been made in all outcomes. However, concerns were still evident in outcome 4 in relation to the safe 'moving and handling' of people that use the service that impacted on their safety and welfare.

During our inspection we spoke with people living in the home, staff and examined the care records. Not all people were able to verbally tell us about the care they received and if they were happy. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

We observed some people being supported and examined their care plan documentation at different stages of their assessments. This was to ascertain if an appropriate level of care was being provided, in line with their assessed needs.

Overall people we spoke with who used the service were happy with the care they received. Comments received included; "we get good care, art classes, exercise is great, X is fantastic and gets us moving". Another person told us "staff are lovely”,” I like the exercise classes that the activity co-ordinator organises, I am more flexible and noticed an improvement when I walk around the garden”.

Winscombe Hall is a care home providing accommodation for up to 39 people, some of whom are living with dementia. During our inspection there were 36 people living in the home. The home comprises two areas; Stable Cottage provides care to people living with dementia, and The Halls which provides nursing care. The home is situated on the outskirts of the village of Winscombe.

We inspected Winscombe Hall in November 2014. At that Inspection we found the provider to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The regulations included; supporting staff, consent to care and treatment, records and assessing and monitoring the quality of service provision. These correspond to regulations 18 staffing, 11 need for consent and 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider wrote to us with an action plan of improvements that would be made. They told us they would make the necessary improvements by April 2015. During this inspection we saw some of the improvements identified had been made. However we found some of the actions identified by the provider had not been completed. We found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection took place on 21 and 22 January 2016 and was unannounced.

There was a registered manager in post. 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.

There were not always enough staff available to respond to people’s needs. People were waiting for long periods of time without staff support. Views from the staff were mixed over staffing levels. Staff were busy but told us they felt there were enough staff to keep people safe.

Risks to people were not always identified and measures were not always implemented to reduce the risk. Where risk assessments were in place they did not always contain accurate or enough information for staff to safely support the person.

Medicines were not always administered safely. People were left to take their own medicines with no risk assessment in place. Medicines were not always looked after in line with national guidance. There was no system in place to check the expiry dates of creams and ointments.

We found people’s rights were not fully protected as the manager had not followed correct procedures where people lacked capacity to make decisions for themselves. We observed where decisions were made for people the principles of the Mental Capacity Act 2005 were not always followed.

Staff did not always support people in a way that promoted dignity and respect. People and their relatives told us they were happy with the care they or their relative received at Winscombe Hall. We observed staff were caring in their interactions with people.

Staff had an understanding about the assessed needs of people and how to keep people safe. However; care plans had not always been updated to reflect people’s needs when they had changed or contain enough or clear information on how staff should support people.

The registered manager and provider had systems to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and medicines. We found the audits were not always effective at identifying shortfalls in the service.

Where there were areas of the home requiring maintenance and repair the provider had improvement plans in place to address these.

People and their relatives told us they or their relatives felt safe at Winscombe Hall.There were systems in place to protect people from abuse and most of the staff we spoke with knew how to follow them. One staff member who was not directly employed by the service was not aware of where to report concerns outside of the home or aware of the whistleblowing policy. There was information detailing the whistleblowing policy displayed around the home.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service. Staff received training to understand their role and they completed training to ensure the care and support provided to people was safe. New members of staff received an induction which included shadowing experienced staff before working independently. Staff received supervision and told us they felt supported.

People were complimentary of the food provided. Where people required specialised diets these were prepared appropriately.

Relatives were confident they could raise concerns or complaints with the registered manager and they would be listened to. The provider had systems in place to collate and review feedback from people and their relatives to gauge their satisfaction and make improvements to the service.

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.