This inspection took place on the 11 and 15 January 2018.

Winton Care Home is a ‘care home’. People in care homes receive accommodation and nursing or 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.

Winton Care Home accommodates 36 people in one adapted building. Accommodation at the home is provided over three floors over two distinct areas in a period building, the main house and the wing. The wing provided additional support to those living with dementia. There are large gardens and patio area’s which provide a safe and secure private leisure area for people living at the home. At the time of the inspection 28 people were using the service.

There was 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 and associated Regulations about how the service is run.

At our previous inspection on 17 and 19 November 2015, we identified a breach of regulations. Recruitment procedures were not fully completed to protect people from the employment of unsuitable care staff. The provider sent us an action plan detailing the steps they would take to become compliant with the regulations. At this inspection we found action had been taken and recruitment procedures were now safe.

There were arrangements in place for managing medicines. However further work was required on the recording of the administration of ‘when required’ (PRN) medicines.

Individual risks to people were not always managed appropriately. Additional measures to keep people safe were not always documented and staff were unclear where disposable clinical equipment was stored to keep people safe.

People felt safe living at Winton Care Home. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff received regular support and one to one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities. Staff knew what was important to people and encouraged them to be as independent as possible.

A complaints procedure was in place. There were appropriate management arrangements in place. Regular audits of the service were carried out to assess and monitor the quality of the service.

This inspection was unannounced and took place on the 17 and 19 November 2015

Winton Care Home is a nursing home which provides nursing and residential care for up to 36 people who have a range of needs, including those living with diabetes and those receiving end of life care. The care home comprised of three floors over two distinct areas in a period building, the main house and the wing. The wing provided additional support to those living with dementia. At the time of the inspection 32 people were using the service.

Winton Care Home has 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.

Recruitment procedures were not fully completed to protect people from the employment of unsuitable care staff. The provider had not ensured that a full employment history had been obtained from care staff. This is a requirement of the regulations to ensure that appropriate checks are in place for new staff. The provider however obtained suitable references to ensure care staff’s suitability for their role. New care staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely.

People using the service told us they felt safe. Care staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and managed. People were supported by care staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as staff sickness and fire or flood. Fire drills were documented, known by care staff and practiced to ensure people were kept safe. The registered manager and deputy manager were also trained care staff who were able to be deployed to deliver care if required.

People were protected from the unsafe administration of medicines. Nurses responsible for supporting people with their medicines had received additional training to ensure people’s medicines were being administered, stored and disposed of correctly. Nurses skills in medicines management were reviewed on a regular basis by appropriately trained senior care staff to ensure they remained competent to continue.

People, where possible, were supported by care staff to make their own decisions. Care staff were knowledgeable about the requirements of the Mental Capacity Act (MCA 2005). The service worked with people, relatives and social care professionals when required to assess people’s capacity to make specific decisions for themselves. Care staff sought people’s consent before delivering care and support. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

People were supported to eat and drink enough to maintain a balanced diet. People told us they were able to choose their meals and they enjoyed what was provided. Records showed people’s food and drink preferences were documented in their care plans and were understood by care staff. People at risk of malnutrition and dehydration were assessed to ensure their needs were being met. Records for people who required food and fluid chart monitoring were completed fully to identify whether people were eating and drinking sufficient to maintain their health.

People’s health needs were met as the care staff and the registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been submitted to the relevant supervisory body to ensure people were not being unlawfully restricted.

Care staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the care provided. The registered manager and care staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times. People were encouraged and supported by care staff to make choices about their care including how and where they spent their day.

People’s end of life wishes had been discussed and documented accordingly. Guidance was provided to care staff on how to best support people in line with their wants and needs.

People had care plans which were personalised to their needs and wishes. They contained detailed information to assist care staff to provide care in a manner that respected each person’s individual requirements and promoted treating people with dignity. Relatives told us and records showed they were encouraged to be involved at the care planning stage, during regular reviews and when their family members’ health needs changed.

People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and care staff were encouraged to provide feedback on the quality of the service during regular meetings with care staff and the registered manager as well as the completion of customer satisfaction questionnaires.

The provider’s values of care were communicated to people and care staff. Care staff understood these, people told us and we saw these standards were evidenced in the way that care was delivered.

The registered manager and care staff promoted a culture which focused on providing individual person centred care. People were assisted by care staff who were encouraged to raise concerns with them and the registered manager. The provider had a routine and regular quality monitoring process in place to assess the quality of the service being provided.

Care staff told us they felt supported by the registered manager.

We found a 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 the report.