This inspection took place on 22 March 2017 and was unannounced. Winslow House is located in the small town of Nailsworth near Stroud and is registered to accommodate up to 35 older people. There were 33 people in residence when we visited and two people were in hospital. There were no vacancies. The property is a grade two listed Victorian house which has been extended and adapted to suit the needs of people with physical and sensory disabilities. The home is accessible to those people with mobility impairments however some rooms require one or two steps to be negotiated. All private bedrooms have en-suite facilities.

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 were safe. Staff received safeguarding adults training and knew what to do if bad practice was witnessed, alleged or suspected. The registered manager was aware of the need to report events promptly to the local authority and CQC. There were safe recruitment procedures in place to ensure unsuitable staff were not employed. The appropriate steps were in place to protect people from being harmed.

Any risks to people’s health and welfare were assessed and then measures put in place to either reduce or eliminate the risk. These plans were then regularly reviewed. The premises were well maintained and all maintenance checks were completed. The management of medicines was safe and people received their medicines as prescribed.

The registered manager monitored the staffing levels and based the staffing numbers on the care and support needs of each person in residence. The different shifts the care staff did ensured that the busiest times of the day were covered and people’s needs could be met. People were not put at risk because staffing levels were low.

There was a programme of mandatory training all staff had to complete, enabling them to carry out their job roles. New staff had an induction training programme to complete and there was a programme of refresher training for the rest of the staff. Care staff were encouraged to complete nationally recognised qualifications in health and social care. The staff team were well supported to do their jobs.

People were encouraged to make their own choices and decisions and to remain as independent as possible. Staff asked people to consent before they provided care and support. When people lacked the capacity to make decisions, best interest decisions were made involving healthcare professionals. We found the service to be aware of the principles of the Deprivation of Liberty Safeguards. They had acted accordingly when there was a need.

People were provided with sufficient food and drink and any specific dietary requirements were catered for. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to.

Staff had a kind and caring attitude towards the people they were looking after and would recommend the home to family members. Their interactions with people were friendly and meaningful. People were able to participate in a range of different activities and external entertainers visited the home.

People were involved in making decisions about how they were looked after and agreed the way that care and support was delivered. Their care needs were regularly reviewed and the staff listened to what they had to say. People were encouraged to have a say about their daily life and how Winslow House was run.

‘Resident’ and relatives meetings and staff meetings enabled everyone to express their views and make suggestions about how things could be done differently. The provider had a regular programme of aud

This inspection took place on 15 October 2015. Winslow House is located in the small town of Nailsworth near Stroud and is registered to accommodate up to 35 older people. However, one shared room is used by a single person. There were 34 people in residence when we visited. The property is a Victorian house which has been adapted to suit the needs of people with physical and sensory disabilities. The home is accessible to those people with mobility impairments however some rooms require one or two steps to be negotiated. All private bedrooms have en-suite facilities.

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.

The provider had a regular programme of audits to complete. Some of the checks were completed on a daily basis, others on a weekly or monthly basis. However the information collected from some of the audits was not always analysed to see where improvements could be made. They were missing the opportunity to make improvements to ensure the quality and safety of the service was maintained.

All staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if bad practice was witnessed, alleged or suspected and would take the appropriate actions. The registered manager was aware of the need to report events promptly to the local authority and CQC. The appropriate steps were in place to protect people from being harmed.

A range of risk assessments were completed for each person and appropriate management plans were in place. The premises were well maintained and all maintenance checks were completed.

The registered manager monitored the staffing levels and based the staffing numbers on the care and support needs of each person in residence. The different shifts the care staff did ensured that the busiest times of the day were covered and people’s needs could be met. People were not put at risk because staffing levels were low.

All staff completed a programme of essential training to enable them to carry out their roles and responsibilities. New staff completed an induction training programme and there was a programme of refresher training for the rest of the staff. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

Care records were accurate and detailed and provided sufficient information to instruct care staff how each person wanted their care and support to be provided. The healthcare needs of people were met appropriately.

People were supported to make their own choices and decisions. Staff were aware of the need to ensure people consented to their care and support. When people lacked the capacity to make decisions, best interest decisions were made involving healthcare professionals. We found the service to be aware of the Deprivation of Liberty Safeguards and able to act accordingly when there was a need.

People were provided with sufficient food and drink. Their specific dietary requirements were catered for and there were measures in place to reduce or eliminate the risk of malnutrition or dehydration. Some people thought that improvements should be made and they had voiced their opinions in feedback to the registered manager and provider. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to.

The staff team had good friendly relationships with the people they were looking after. People were able to participate in a range of different activities and external entertainers visited the home. People were encouraged to be as independent as they were able and used the local community facilities.

There were safe recruitment procedures in place to ensure unsuitable staff were not employed. Regular staff meetings were held in order to keep them up to date with any changes and developments in the service. There were also ‘resident meetings’ and people were encouraged to express their views about things they wanted to happen. This feedback however was not included in reviews of the service to ensure that people’s views were heard and acted on.

We found one breach 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.

We spoke with 11 people who lived in the home, six members of the staff team and the provider. We also spoke with one visitor. We received positive comments about life at Winslow House and the way people were looked after. They told us “I have a comfortable life”, “My relative is well cared for”, “The food is very good, it is the sort of food I like” and “I am not always hungry but they encourage me to eat”.

People received the care and support they needed because assessment and care planning took account of each person's needs, choices and preferences. There was a rolling six week menu plan, which was adjusted in line with the different seasons.

People were cared for in a clean, hygienic environment. We found high standards of cleanliness. They were protected from the risk of infection because appropriate guidance was followed.

There were effective recruitment processes in place and appropriate checks were undertaken before staff began their employment. Written references and Criminal Records Bureau (CRB) (now Disclosure and Barring Service (DBS)) checks had been completed.

There were enough staff on duty to meet people's needs and staffing levels were reviewed monthly by the general manager and adjusted accordingly. The home was fully occupied when we visited.

People said they felt they would be able to raise any concerns or complaints they may have with the managers or any of the staff, and were confident that they would be listened to.

People who lived in the Winslow House told us that they were asked for their agreement before any care was delivered. They commented, “I have lived here a long time and I am quite content with the way I am looked after”, “we have a good time here” and “I get all the help I need. I am fairly independent but if I need help the staff will always help me out”. People told us that they felt safe and well looked after.

People told us the meals were good, they were offered choice and they had plenty to eat and drink.

We found that the systems in place for the management of medicines were satisfactory.

People were complimentary about the staff, some of whom had worked at the home for many years. “Everyone is very good at their jobs” and “we could not ask for better staff”.

We spoke to a number of people who lived at the home and two relatives. They all spoke positively about the staff. One person said “they are all so helpful and friendly”. They told us they were well cared for and if they used their call bells to summon assistance, staff responded quickly. They told us they liked their bedrooms, which were spacious and light and they enjoyed the “pleasant surroundings" and “homely atmosphere”. People told us they enjoyed the food at Winslow House and appreciated the assistance they were given at meal times.