White Windows

White Windows is a residential care home providing personal care to 25 people at the time of the inspection. The service can support up to 25 people. White Windows supports people with physical and learning disabilities in one adapted building. White Windows is also registered to provide personal care to people in their own houses and flats but were not providing this service at the time of the inspection.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service could not show how they met some principles of right support, right care, right culture.

Right support

Risk assessments were not always followed to make sure people were safe. Medicines were not always managed safely and people’s abilities in managing their own medicines had not been routinely assessed. Environmental risks were not always identified and addressed through audit systems. Staff were recruited safely but there were not always enough staff to meet people’s needs and maintain a clean and safe environment for people. People were supported in the least restrictive way possible but where people had Deprivation of Liberty Safeguards (DoLS) in place, there was no evidence of conditions with the DoLS being met. We also found care records were unclear in relation to people’s capacity and there were inconsistencies in the ‘best interest decision’ process.

Right Care

People were not fully supported to meet their social and recreational needs and there were times when their dignity needs were not fully met. People were not always protected from risk because some risk assessments were not being followed by staff. People told us they were happy with the staff who supported them. We observed some kind and caring interactions between staff and people. Staff knew people well but there were missed opportunities to fully involve people in their care and to promote people’s independence. People’s families felt involved in the care and support of their relatives.

Right Culture:

The provider’s audit systems did not always identify and drive improvements in the quality of care and the safety of the environment. Although regular meetings were held, there were limited opportunities for people’s views to be heard. At the time of the inspection, views of people’s relatives about the service, were being sought but the outcome of this was not yet available.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 October 2022), and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for White Windows on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, medicine management, staffing, need for consent and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

White Windows is a residential care home providing accommodation and personal care to up to 25 people. The service provides support to people with a range of physical and neurological conditions. At the time of our inspection there were 22 people using the service. White Windows is also registered to provide personal care to people in their own homes.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating.

At the time of inspection White Windows was not providing any personal care to people in their own homes.

People’s experience of using this service and what we found

The provider's systems and processes were not always effective in assessing, monitoring and mitigating risks to the health, safety and welfare of people using the service. The provider had quality monitoring processes in place, but these were not consistently applied to enable them to identify and address the issues we found during the inspection. This placed people at risk of harm.

Care plans were not always consistently reviewed and updated as people's needs changed. People were supported by staff who knew them well and were able to identify people's likes and dislikes. How people and their relatives were involved in the development of care plans and risk assessments was not always clear. Therefore, we were not assured care plans and risk assessments were always person centred.

Systems in place to manage medicines were not always effective, records to show topical preparations such as creams were being applied were not always completed; therefore, we were not assured people’s skin was cared for properly. This placed people at risk of harm.

New staff received an induction programme and most staff had completed a range of training which gave them the skills and knowledge to care for people. Staff told us they felt supported by the acting service manager.

Governance systems were not always in place to ensure all aspects of the service were reviewed and checked regularly. This placed people at risk of harm. The provider had systems to monitor accidents and incidents and used these to identify lessons learnt to the improve the service.

People and their relatives told us they were provided with safe care. People were not always treated with dignity and respect. Staff cared about and had positive relationships with people.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People were not supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service under the previous provider was requires improvement published 17 September 2019.

Why we inspected

This was a planned inspection based on the date of registration.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of risks and medication, and the provider’s systems of governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.