White Windows is a residential care home providing personal care to up to 25 people, with physical and learning disabilities. It is also registered to provide personal care to people in their own houses but were not providing this service at the time of the inspection. This assessment commenced on 18 April 2024 and was completed on 30 July 2024. The assessment included 4 visits to the service on 18, 23 and 26 April 2024. The final site visit took place on 21 June 2024 and we looked at all quality statements. At the last inspection the provider was rated inadequate, at this inspection the provider had improved and the rating is now good. Staff now assessed, managed and mitigated risks, including in the environment, to make sure people were safe. People were supported in the least restrictive way possible and care records reflected people’s capacity to make decisions about their care and support. Improvements were still required with the management of some medicines. People were well supported by kind and caring staff, who knew them and their needs well. Staff and leaders ensured people were at the centre of decision making, including how they spent their time and the activities they participated in. The service worked in partnership with other health and social care services, to ensure people lived healthy lives and achieved good outcomes. People were now supported to have choice and control over their daily lives and were involved in planning aspects of their care. The provider had made improvements, which had been recognised by people and partner agencies, to the quality and safety of the service. People’s feedback was sought in different ways and used to inform how the service was run. This service has been in Special Measures since 22 August 2023. The provider demonstrated improvements that have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, the service is no longer in Special Measures.
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White Windows, a 25-bed residential care home for people with physical and learning disabilities, was rated Inadequate overall and placed in special measures following this June 2023 inspection, with enforcement warning notices issued for breaches of Regulations 12 and 17. Widespread and repeated failures were found across medicines management, risk assessment, infection control, staffing levels, consent and capacity recording, governance, and person-centred care, all of which had persisted from the previous inspection.
Concerns (15)
criticalMedication management: “The medicines fridge, which contained insulin was unlocked on both days of the inspection with the key in the door.”
criticalMedication management: “Medicine records were not always accurate. One person's medicine, signed as administered, was still in the person's bedroom not taken.”
criticalCare planning: “One person's risk assessment and care plan said they were at risk of choking, needed their food cutting up...We saw this person's food was not fully cut up and they ate alone.”
criticalSafeguarding: “One person had raised an issue of possible financial abuse. This had been referred to safeguarding but the person was still experiencing the same issue.”
criticalStaffing levels: “Two people told us there were not enough staff to respond to their call bells in a timely way. Both said they had been incontinent because of the wait.”
criticalInfection control: “A catheter bag containing urine had been left in one person's bedroom and the bed rails in this room were heavily soiled.”
criticalConsent / capacity: “There was conflicting information in people's care files relating to capacity...a mental capacity assessment said the person lacked capacity...another form said the person had capacity, but was signed by a relative.”
criticalGovernance: “Effective systems were not in place to monitor the quality and safety of the service. Learning had not always been taken from the results of audit.”
moderatePerson-centred care: “Activity records for another person with a learning disability showed the only activity they had engaged in for a period of 18 days was watching television.”
moderateRecord keeping: “There was no recording of the application site for over 6 weeks. Record of application site is needed to prevent skin irritation.”
moderateIncident learning: “The manager was working with the local authority to develop their skills in analysing accidents and incidents looking for patterns and trends.”
moderateEnd-of-life care: “One person's documentation said, 'I don't not have a DNCPR'...Information in relation to 'Do not attempt resuscitation' orders was also not always made clear on people's hospital passports.”
moderateLeadership: “The manager said they did not complete a daily walkaround to make sure the service was clean and safe...The manager had not undertaken any training in relation to managing a service.”
minorStaff training: “One staff member said they didn't know who to go to if they hadn't understood something and would prefer face to face training so they could ask questions.”
minorCommunication with families: “The manager had not provided the nominated individual with a clear overview of the feedback we provided to them on the first day of our inspection.”
Strengths
· People living at the home told us they felt safe and most said staff were kind and caring.
· Staff knew people well and relatives reported positively about staff attitude and treatment of their family members.
· Employed staff were recruited safely.
· Controlled drugs were stored and managed safely and medicines stocks tallied with records.
· The provider was using PPE effectively and safely and the infection prevention and control policy was up to date.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongRequires improvement
effective: The Mental Capacity Act and Deprivation of Liberty SafeguardsRequires improvement
effective: Supporting people to live healthier lives and access healthcare servicesRequires improvement
effective: Assessing people's needs and choicesRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversity; privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
responsive: Planning personalised care; supporting people to maintain relationships and take part in activitiesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff understanding quality performance, risks and regulatory requirements; continuous learningInadequate
well-led: Promoting a positive, person-centred, open and inclusive cultureInadequate
well-led: Working in partnership with othersRequires improvement
White Windows received a Requires Improvement rating across all five key questions at its first inspection under Valorum Care Limited, with regulatory breaches identified under Regulation 12 (safe care and treatment) and Regulation 17 (good governance) relating to ineffective risk assessment, unsafe medicines management, and insufficient audit systems. Widespread concerns included inconsistent care plans, dignity breaches, unaddressed safeguarding risks, and inadequate DoLS oversight, though staff relationships with people and the acting manager's openness to improvement were noted as positives.
Concerns (13)
criticalMedication management: “Records to show topical preparations such as creams were being applied were not always completed; therefore, we were not assured people were receiving these medicines as prescribed.”
criticalCare planning: “Care plans were not always consistently reviewed and updated as people's needs changed...we were not assured care plans and risk assessments were always person centred.”
criticalGovernance: “Governance systems where not always effective in ensuring oversight of the safety of the service...breach of regulation 17 (Good governance).”
criticalSafeguarding: “The referral form said anybody around the person were at risk of violence and aggression...We did not see evidence of any safeguarding referrals having been made.”
criticalConsent / capacity: “One person's care records included a DoLS application dated August 2021. There was no evidence of the application having been followed up.”
moderateRecord keeping: “Fluid charts for a person with a medical condition said they needed 1500 and 2000mls of fluid per day. Fluid charts for four consecutive days showed an intake of between 700 and 750mls.”
moderateSupervision / appraisal: “Some staff told us that this was approximately only once over the last year. This meant staff and their supervisors had limited opportunity to discuss their work.”
moderateStaffing levels: “People and their relatives told us there were a number of occasions when there were insufficient care staff. One person told us staff shortages meant call bells were not being answered quickly.”
moderatePerson-centred care: “One person told us they had been forced to be incontinent as staff did not come quickly enough to support them to the toilet. The person was very distressed by this.”
moderateInfection control: “We noted dirty bedding and furniture in some people's bedrooms. Bumpers covering bed safety rails in some rooms were torn. This made effective cleaning difficult.”
moderateStaff competency: “Care staff competency assessments to administer medication had not been completed in line with the provider's own policy.”
minorIncident learning: “We saw at a handover meeting that some staff were not clear about how to report and record incidents.”
minorEnd-of-life care: “The care records we reviewed did not have care plans in place to consider people's individual wishes, values and beliefs at the end of their lives.”
Strengths
· Staff knew people well and were able to identify people's likes and dislikes, forming caring relationships.
· The provider had systems to monitor accidents and incidents and used these to identify lessons learnt.
· Staff received mandatory and specialist training with good compliance rates monitored by the provider.
· The acting service manager was approachable, supportive, and enthusiastic about addressing improvements.
· Processes were in place to ensure referrals to outside organisations such as occupational therapists and dieticians.
Quality-Statement breakdown (25)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Requires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Adapting service, design, decoration to meet people's needsRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Supporting people to develop and maintain relationships to avoid social isolationRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Continuous learning and improving care; Managers and staff being clear about their rolesRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Working in partnership with othersRequires improvement