CQC report explained · a nursing home
What the CQC found at Winchester House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff on the inspection day, appropriate risk assessments, improved safeguarding arrangements and safe medicines systems. Infection prevention and control arrangements were also found to be suitable.
- Effective?
- Requires improvement
- This question was not covered by this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Requires improvement
- This question was not covered by this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Requires improvement
- People's needs were not always met. Activities and engagement were limited for some people, particularly people cared for in bed, and care plans were difficult to read and follow.
- Well-led?
- Good
- Inspectors found improved quality checks, clearer staff structures and an open approach from management. However, they were not assured that feedback from people and relatives was being gathered and shared consistently.
What inspectors found, August 2021
Rated Good overall; inspectors found safe, well-managed care, but the home was not always responsive to people's activities and communication needs.
Inspectors visited without notice on 15 and 26 July 2021. They spoke with eight people, two relatives, 13 staff and two visiting professionals. They reviewed care records, medicines records and management records.
The home was rated Good for Safe and Well-led. Inspectors found enough staff on the inspection day, safer medicines systems, suitable risk assessments, improved safeguarding work and better checks on service quality.
Responsive was rated Requires Improvement. Activities did not meet everyone's needs, especially for people cared for in bed. Care plans were detailed but often difficult to read and follow. The overall rating improved from Requires Improvement at the previous inspection, and the home was no longer in breach of regulations.
Staffing
Inspectors found enough staff to meet people's needs on the inspection day, with different staff skills available across the units.
“Enough staff were deployed to meet people's needs.” from the report
Medicines
Medicines were administered by trained staff. Records were complete and accurate, and medicines were stored safely.
“Medicines administration records were reviewed, and these were complete and accurate.” from the report
Safeguarding
Safeguarding incidents were investigated and recorded, and the report says the number of alerts had reduced significantly since the previous inspection.
“At the last inspection there were high levels of safeguarding alerts including people who lived together in the service abusing each other.” from the report
Quality checks
The home had increased its checks, including night visits, daily walkarounds and regular regional audits. These checks identified actions for improvement.
“The registered manager had completed a range of quality assurance checks regularly.” from the report
Complaints handling
Complaints were acknowledged promptly and investigated in detail. One relative said an informal complaint had been resolved quickly and satisfactorily.
“Investigations into complaints were detailed and thorough. Investigations included recorded statements from staff and data analysis” from the report
Limited activities
needs fixingSome people felt bored and stayed in their rooms for long periods. Inspectors found little stimulation on one nursing unit for people cared for in bed.
“On one unit most people were cared for in bed and there did not appear to be any stimulation for these people” from the report
Hard-to-follow care plans
needs fixingCare plans contained a lot of handwritten information and were not always easy to read or follow. This could make it harder for new or agency staff to find current instructions.
“They contained a large amount of information, were handwritten and did not contain a summary of the person's needs.” from the report
Communication with relatives
minorThe report was not assured that feedback systems were working consistently. One relative also said they did not know what their relative did each day unless they phoned or visited.
“I would like to know what my [relative] gets up to daily and how they are occupied.” from the report
- 01How will you provide regular activities and stimulation for my relative if they spend much of the day in bed?
- 02How do you make sure new or agency staff can quickly find the most up-to-date information in my relative's care plan?
- 03What is your current plan to improve the readability of handwritten care records?
- 04How will you keep relatives informed about what their family member does each day, including if they do not use social media?
- 05What were the previous ratings for Effective and Caring, which were not assessed during this inspection?
This was a focused inspection of Safe, Responsive and Well-led; the Effective and Caring ratings were not assessed and previous ratings for those questions were carried forward. This explanation was written from the published report of 20 August 2021 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, January 2020
Requires Improvement; inspectors found risks from staffing, care planning and poor follow-through on known problems.
This was an unannounced inspection on 12 and 14 November 2019. Inspectors spoke with people, visitors, staff and health professionals. They reviewed care records, medicines records, staff files, training records, audits and other management records.
The home was not always safe. Staffing numbers were based on inaccurate assessments and were sometimes too low. Risk controls were not personalised or updated after incidents. People did not always feel safe from other people living in the home, and medicines information was incomplete.
Care plans did not record people's preferences, communication needs or end of life wishes in enough detail. People were not always offered choices or the support they needed at mealtimes. Activities had improved for some people, but others were still bored.
The overall rating and all five key question ratings were Requires Improvement. The previous rating was Good, published in April 2017. The report says the provider must send an action plan, and CQC will monitor progress and return for another inspection.
Medicines usually given correctly
Inspectors found that people received their medicines as prescribed. Medicines were stored safely, and there was clear guidance for as-needed medicines.
“People were supported to take their medicines as prescribed.” from the report
Infection control systems
Cleaning schedules were being followed. Staff had suitable protective equipment and used it appropriately during the inspection.
“There were systems in place to ensure the effective prevention and control of infection.” from the report
Access to healthcare
People were supported to see doctors and other health professionals. Healthcare professionals were visiting the home during the inspection.
“People and relatives told us they were able to access healthcare services when they needed.” from the report
Some activity improvements
Some people reported that activities had recently improved. The home offered activities, outings and links with local schools and a playgroup.
“Other people told us there had been improvements to the activities provided.” from the report
Not enough staff
seriousPeople, relatives and staff reported that staffing was too low. Inspectors saw people waiting for help to move and found rotas that did not meet the home's own dependency assessments.
“There were not enough staff available to meet people's needs.” from the report
Risk controls were not effective
seriousRisk assessments were often generic and were not updated when people's needs or risks changed. Incidents between people living in the home continued, and measures did not prevent them effectively.
“Risks faced by people had been identified, but measures in place to mitigate them were not effective in reducing risks of harm.” from the report
Care plans lacked personal detail
seriousCare plans did not consistently record people's preferences, communication needs, health conditions or end of life wishes. This made it unclear how staff should provide personalised support.
“Care plans lacked personalised detail and records of care lacked detail about the nature of support provided to people.” from the report
Known problems were not fixed
seriousThe provider's audits had identified care-record and other quality problems, but actions had not been completed or had not improved the service. Inspectors found the same issues remained months later.
“The audit reports showed that issues with the quality of care within the service were well known to the provider and had been known for a significant period.” from the report
Informal concerns not always resolved
needs fixingPeople and relatives knew how to complain, but concerns raised informally were not always recorded or fully addressed. These included delayed care and missing or damaged laundry.
“However, people told us concerns they raised informally, including missing and damaged laundry, details of bedding preferences, and people not always receiving care in timely manner were not always fully addressed” from the report
- 01How will you make sure there are enough staff on each community, including at mealtimes and when people need help to move?
- 02How are risk assessments updated after falls, incidents between people or changes in someone's needs?
- 03How will you record my relative's preferences, communication needs, health conditions and end of life wishes in their care plan?
- 04What support and food choices will my relative receive at each mealtime?
- 05What action has been completed since this inspection, and how can I see evidence that the changes have improved care?
This was an unannounced planned inspection that looked at the premises and care provided and assessed all five key questions. This explanation was written from the published report of 7 January 2020 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.
Every inspection of Winchester House
4 rated inspections over 5 years: the service has improved, from Requires improvement to Good.
- August 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Good
- January 2020Requires improvementdown from GoodSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 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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