CQC rates Royal Borough of Windsor & Maidenhead Council’s adult social care provision as requires improvement

The Care Quality Commission (CQC), has rated Royal Borough of Windsor & Maidenhead as requires improvement, in how well they are meeting their responsibilities to ensure people have access to adult social care and support.  

CQC has a new responsibility to assess how local authorities meet their duties under Part 1 of the Care Act (2014). 

CQC looked at nine areas spread across four themes to assess how well the authority is meeting their responsibilities in order to create their requires improvement rating. CQC has given each of these nine areas a score out of four with one being the evidence shows significant shortfalls, and four showing an exceptional standard.  

1. assessing people’s needs – 3 
2. supporting people to lead healthier lives – 3 
3. equity in experience and outcomes – 2
4. care provision, integration and continuity of care – 2 
5. partnership and communities – 2
6. safe pathways, systems and transitions – 3 
7. safeguarding – 2
8. governance, management and sustainability – 2 
9. learning, improvement and innovation – 2

James Bullion, CQC’s chief inspector of adult social care and integrated care, said: 

At this assessment we found an authority who had a new Chief Executive, Director of Adult Social Services (DASS) as well as new portfolio leads and committee chairs following local elections. It was encouraging to see the positive, professional relationships with healthy challenge that had already been established. It was also undergoing a huge transformation, bringing their Care Act functions in house with the introduction of new teams employed by them. The authority can lean on these relationships to make improvements in their adult social care offer to the people of Windsor and Maidenhead. 

We found people were waiting too long for a full assessment of their occupational therapy needs. Some people waited up to six months, and at the time of the assessment there were almost 200 people waiting for a full occupational therapy assessment. However, it was positive to see the local authority using occupational therapy assistants and trusted assessors to install some urgent equipment like grab rails or bathing equipment to reduce the biggest risks while people waited. 

Staff also weren’t always able to deliver timely annual reviews of people’s care and support needs. The local authority took a risk-based approach to reviews which meant they were able to respond to increases in risk or changes in need, but leaders acknowledged planned reviews weren’t always prioritised.  

There was a strong private care sector in the borough as a high number of people paid for their own care. This made it difficult for the local authority to monitor whether people were placed in services that met their care needs. If a person’s savings fell below the threshold, the authority had to step in to support and cover the costs which were often above budget. This put extra pressure on them to make the market more sustainable and ensure people were receiving safe, effective care. The local authority was also carrying out work to improve the uptake of direct payments.

Staff were proud to work at Royal Borough of Windsor & Maidenhead and were passionate about serving local people, with new initiatives already starting to produce results. Such as recent work to reduce the time it took people to be discharged from hospital to home. National data showed the equipment and support people received during the process were helping them to stay healthy at home and prevent readmission to hospital.  

Royal Borough of Windsor & Maidenhead has a great foundation in place on which to build their future plans and make improvements with local people at the heart of it.  We look forward to returning to see how they’ve done this and how their current plans mature.

The assessment team found:

1. Feedback about unpaid adult carer provision was mixed. There was good provision available and waiting times for assessments were low. But people told CQC information was difficult to find which also impacted the authority’s ability to proactively identify carers. 
2. Young carers were also not always identified proactively, and it was sometimes difficult for them to access assessments. The local authority recognised a need to do more in this area, particularly around identifying young carers so support could be offered. 
3. The authority’s access to data, to help them make informed decisions was currently limited as early work had yet to come to fruition
4. The local authority lacked ability to demonstrate how well it met its public sector equality duty. This was because it knew it lacked accurate data on how people used their services.
5. The local authority had really strong relationships with voluntary groups with dedicated employed staff responsible for those relationships. While there was good on the ground working, community groups said it could be difficult to work more strategically with them to secure more long term lasting results. 
6. Direct payment uptake within the Borough was low and the local authority recognised a need to improve this. There were 12.08% of people in receipt of services using direct payments which is significantly lower than the national average for England of 26.22%. Although additional information supplied by the authority suggest this has improved in 2024.
7. Leaders had identified delays to reviews as a risk and had commissioned an external company to support them with these reviews. Whilst this would address the issue in the short term, more needs to be done to implement a process making sure reviews were consistently timely in future. 
8. Their website had guidance for people on how to complain, but it did not detail people’s rights to appeal eligibility decisions after a Care Act assessment. Appeals against charging decisions were often submitted as complaints; this meant they did not have accurate data about the number of appeals made following financial assessments. 
9. Access to advocacy was sometimes limited. Safeguarding Adults Collection data showed 58.33% of people who lacked mental capacity were supported by advocates, family, or friends. This was significantly lower than the national average in England of 83.12% and shows that people who lacked mental capacity to make particular decisions faced a risk of not having their voices heard in decision-making that affected their lives.

However, the assessment team also found:

1. Leaders had a good understanding of where they needed to improve and where CQC identified shortfalls, there were already plans underway to address them.
2. There had been recent changes to public health, with examples of data being used to understand the health needs of the population, keep people healthy and anticipate future need. 
3. Staff and leaders had a good understanding of diverse communities across the borough, and they knew who their seldom heard groups were. Whilst some work was achieving good outcomes, planned actions such as updating the strategy for autistic people, or improving service commissioning for people with a learning disability, weren’t yet mature enough to see results.
4. Data showed the local authority performed particularly well in how safe people felt, with 80.77% of people who used services stating they felt safe (ASCS) which was significantly above the national average of 69.69%. 
5. There was positive feedback from health partners and care service providers about sharing of information, prompt sharing of concerns, and local authority responsiveness to issues raised about care quality. 
6. Staff and leaders had a good understanding of which cases were awaiting care reviews and which were prioritised where there was increased risk or changing need.
7. In the Adult Social Care Survey (ASCS) 87.5% of people said they felt they had control over their daily lives, which is significantly higher than the national average in England of 77.21%. CQC heard examples of people being supported to achieve outcomes in different areas of their lives, such as maintaining important family relationships, being more active in their community, or gaining employment.
8. A jointly funded social prescribing team hosted health and wellbeing events held in local libraries and community centres, aimed at helping people stay independently healthy such as a recent session providing support and advice to men about mental health and wellbeing. as well as support in areas such as loneliness or drug and alcohol misuse. Local authority data showed the social prescribing service had over 2,000 referrals in the first three quarters of 2023/2024 with 98% of new referrals contacted and a person-centred plan started within seven days. 
9. Staff often worked with people at an early stage during assessments, before they developed eligible needs, to delay or avoid the need for more intrusive or restrictive interventions in the future.

The assessment will be published on CQC’s website on week commencing 4 November.