CQC report explained · a residential care home
What the CQC found at Winchester House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, November 2018
Rated Good; inspectors found safe, kind and personalised care after the home fixed problems found at its previous inspection.
Inspectors visited without notice on 31 October 2018. They observed care, watched staff interactions, looked around the home and reviewed care plans, medicines records, staff files, complaints, incidents and quality checks. They spoke with people, staff, the registered manager and a healthcare professional.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safer recruitment, good medicines procedures, suitable training and better care records. People were treated with kindness and respect, involved in decisions and supported according to their individual needs.
The previous inspection in February 2018 had found multiple legal breaches and rated the service Requires Improvement overall. Inspectors said the required improvements had been made. They noted a small number of issues still needing attention, including some staff knowledge of mental capacity law and keeping certain resuscitation decisions under review.
Safety and staffing
Inspectors found enough staff to meet people's needs and saw that risks, medicines, recruitment and safety equipment were being managed more reliably.
“There were sufficient staff that had been recruited safely, to keep people safe and meet people's needs promptly.” from the report
Kind relationships
Staff knew people well and built warm relationships. Inspectors saw patience, understanding and respect during the visit.
“Staff treated people with respect and kindness. There was a warm and pleasant atmosphere at the service where people and staff shared jokes and laughter.” from the report
Personalised care
Care plans included people's preferences, routines, life history and different support needs. People and relatives were involved in planning care where possible.
“The care assessments and plans were detailed and comprehensive.” from the report
Mental capacity knowledge
needs fixingInspectors found that a few staff did not have enough knowledge of the Mental Capacity Act and the manager said this would be addressed with them.
“Whilst we acknowledge this a few staff lacked knowledge of legislation and guidance relating to The Mental Capacity Act 2005 (MCA)” from the report
Reviewing resuscitation decisions
needs fixingSome people had decisions not to attempt resuscitation. Inspectors told the manager these records needed regular review if people's needs changed.
“We discussed with the registered manager the need to ensure these are kept under regular review in case a person's needs changed and they required review.” from the report
- 01How have you checked that all staff understand the Mental Capacity Act and can apply it in practice?
- 02How often are decisions not to attempt resuscitation reviewed, and who checks that reviews happen when someone's health changes?
- 03How will you assess whether the current staffing levels are enough for my relative's needs, including appointments outside the home?
- 04What activities would be available for my relative, based on their interests and preferred routine?
- 05How would you support my relative's communication needs if they needed large print, talking books or another accessible format?
This was an unannounced follow-up inspection covering the overall service and all five CQC questions, after concerns found at the February 2018 inspection. This explanation was written from the published report of 30 November 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2018
Rated Requires Improvement, with Safe rated Inadequate; inspectors found kind staff but serious problems with risks, medicines, staffing and management.
Inspectors visited the home without warning on 8 February 2018. They brought the inspection forward after concerns from the local authority about poor care management, records, medicines, staffing, recruitment and oversight. They spoke with people, a relative, staff and the manager, observed care and meals, looked around the home, and checked care, medicines, staffing and quality records.
People generally said they felt safe and were happy with the staff. Inspectors saw staff treating people kindly, respectfully and patiently. People were supported with food, drinks and healthcare, and received compassionate end of life care.
However, inspectors found serious safety and management failures. Risk assessments and care plans were incomplete or out of date. Medicines were not always stored or recorded safely. Staffing levels did not always match people's needs, and some recruitment and training checks were incomplete. The home breached several legal requirements and was rated Requires Improvement overall, with Safe rated Inadequate.
Kind and respectful staff
Inspectors saw staff communicating gently and patiently. People and relatives spoke positively about how staff treated them.
“Staff had developed positive and meaningful relationships with the people they supported and knew them well.” from the report
Food and healthcare support
People were offered choices at meals, regular drinks and help to eat and drink. Staff arranged access to healthcare professionals when needed.
“People were supported to eat and drink sufficient amounts to meet their needs and their dietary requirements were detailed in their care plans.” from the report
Emergency arrangements
People had personal evacuation plans, fire drills took place and equipment such as hoists had been serviced. Staff knew what to do in a fire.
“In the event of an emergency people's care would continue with the least disruption and staff would know what action to take in the event of a fire.” from the report
Risk assessments were incomplete
seriousSome risk assessments lacked clear instructions about moving people, using equipment, preventing skin damage and managing nutrition. They were not always reviewed when people's needs changed.
“Risks to people's health and wellbeing were not always assessed properly, and managed effectively.” from the report
Medicines were not managed safely
seriousInspectors found unsecured medicine keys and medicines, gaps and confusing entries in records, and incomplete recording of controlled medicines and patches.
“Medicines were not managed well and in line with current National Institute of Clinical Excellence [NICE] and Royal Pharmaceutical Society (RPS) guidelines.” from the report
Staffing did not match people's needs
seriousStaff numbers had not been reviewed as people became more dependent. This meant people could wait for help and staff had limited time for care and social interaction.
“The registered provider did not have robust systems to plan and review staffing levels and did not ensure a safe level of staff for the needs of people using the service.” from the report
Care records were unclear
seriousCare plans did not always describe people's needs, health conditions or the support staff should provide. Important information could be difficult to find or out of date.
“The design of people's care plans made it difficult to gain or understand up to date information.” from the report
Activities were limited
needs fixingThere was no dedicated activities coordinator or weekly activity programme. Records often described general pastimes rather than meaningful activities suited to each person.
“People were not consistently provided with regular access to meaningful activities and stimulation, appropriate to their needs, to protect them from social isolation, and promote their wellbeing.” from the report
Weak management checks
seriousAudits and quality checks were not regular or effective enough to find and correct the problems. Feedback from people and relatives was not formally gathered.
“Quality assurance and audit systems were in place however; their findings were not used to improve the safety of the care delivered and outcomes for people.” from the report
- 01What has been done to make sure every person's risk assessment and care plan is complete, current and clear for staff to follow?
- 02How are medicines now stored, checked and recorded, including controlled medicines, patches and medicines awaiting return to the pharmacy?
- 03How do you calculate staffing levels from people's current needs, and what happens when staff are needed for hospital or emergency visits?
- 04Have all staff completed current DBS checks, induction, medicines training and other required training?
- 05What meaningful activities are now available for people with different interests and abilities, including people living with dementia?
This was an unannounced inspection covering all five key questions, the premises and care provided; it was brought forward because of concerns raised by the local authority. This explanation was written from the published report of 27 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Winchester House
3 rated inspections over 3 years: the service has held its Good rating throughout.
- November 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2018Requires improvementdown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- July 2011
Registered with the Care Quality Commission on 15 July 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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35 live-in carers within about an hour of Essex
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,260 a week. 25 can care for a couple. 10 years' experience on average.
“Not only was she professional, polite and efficient but she bought a lovely smile and laughter to my parents home.”
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Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.