Walfinch Windsor & Maidenhead

Staff recruitment procedures were not robustly followed and placed people at risk of being supported by unsuitable staff. People's relative told us their family members received agreed levels of staff support on time. Infection prevention procedures were in place. Relatives told us staff wore appropriate personal protective equipment to reduce the risk of COVID-19 transmission.

Initial assessments were not holistic and did not capture relevant information about people's needs or preferences. Staff did not always complete training to meet people's needs prior to providing unsupervised care and support. Staff told us management supported them through their induction and felt prepared for their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Documentation did not consistently follow the principles of the mental capacity act code of practice.

Relatives felt their family members received caring and kind support from staff, with comments such as, "[Care workers] seem caring, they treat [my family member] with dignity" and "I can't sing their praises highly enough, it's good team work. They care for [family member] with kindness and respect, they understand [family member] has dementia".

Care plans did not contain all relevant information about people needs, likes and dislikes. One relative said, "I don't think they know [family member's] likes and dislikes, if there was a bit more conversation, they might have understood their needs a bit more". Some care plans contained detailed information about people's background and hobbies.

The service understood the requirements of the accessible information standard to identify and take relevant action to meet people's communication needs. Care plans included information about how staff should adapt their communication. However, the full range of communication tools was not considered for one person with complex needs. We have made a recommendation in relation to the accessible information standard.

The service had not identified whether people had do not attempt resuscitate notices in place, which was important to ensure staff had the right information and to enable them to check such notices were appropriate and lawful.

The service had not always established robust systems to monitor the quality and safety of the service. Policies and procedure were not consistently up-to-date with relevant national guidance or professional standards. The deployment of the registered manager meant there had not been effective oversight of procedures and staff practice. The service had identified this previously and recruited a new manager who commenced 4 May 2021. The manager demonstrated a person-centred value base and knowledge of the regulations. They were responsive throughout our inspection and had already taken some action to mitigate risk prior to our inspection.

Staff and people's relatives were consistently complimentary about the support and responsiveness of the nominated individual, who delivered a significant amount of care directly.