Wentworth Grange

Wentworth Grange is registered to provide accommodation, nursing and personal care to a maximum of 51 older people, including people who live with dementia. The service was made up of 2 distinct units, with shared outdoor grounds. At the time of the inspection there were 46 people living at the home.

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

There were a lack of coherent systems and processes for identifying patterns and trends. Audits had been completed, but not rigorously or systematically. Opportunities for practice improvement had therefore been missed.

Some aspects of medicines administration were not always in line with current good practice. Some records needed improvement.

The provider had not always conducted internal investigations sufficiently, or with demonstrable lessons learned to ensure that future recurrences would be avoided.

The culture was not always open, with delays in sharing information with relevant agencies and a lack of clear lessons learned after incidents. We have made a recommendation about this.

There were some aspects of good medicines management and sound knowledge of people’s needs demonstrated by staff. Staff were trained, supervised and had their competence regularly assessed.

Care planning was person-centred and detailed. Staff demonstrated a good understanding of the risks people faced and how to reduce them.

People were supported to have maximum choice and control of their lives and to live in the least restrictive way possible and in their best interests; policies and systems in the service supported this practice. The provider had not always made the relevant notifications to CQC in a timely fashion. We have made a recommendation about this.

People felt safe and supported. Staff regularly checked on people’s wellbeing. Relatives told us they had confidence in the ability of staff to look after their loved ones in a safe way.

The environment was clean and well maintained. Areas of the home had been recently refurbished to a high standard.

Staff were recruited safely. Staff received supervisions and felt able to raise concerns where they had them.

The provider had relevant policies and procedures in place to help reduce the risk of abuse. Staff reacted promptly to individual incidents and concerns, but there was a lack of meaningful oversight and lessons learned. Some policies needed review, or there was a lack of review of some policies. The provider had not always stayed abreast of good practice. We have made a recommendation about this.

The provider worked with external health and social care professionals to ensure people received the right care. The provider did not always share information in a timely way.

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 was good (published 6 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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 and Recommendations

We have identified a breach of regulations in relation to good governance. We have made recommendations regarding the provider’s understanding of notifications to CQC, the provider’s awareness of best practice and the provider’s openness.

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.

We found the following examples of good practice.

Current government guidance was being followed in relation to supporting visiting inside the home. Outdoor visiting opportunities were still provided as were video calls.

Robust systems were in place to ensure staff and people living at the home participated in regular testing for COVID-19.

Systems were in place to ensure government guidance was followed in relation to visiting healthcare professionals.

Staff understood infection prevention control measures and were committed to minimising the risks of COVID-19.

There was a good supply of PPE and staff understood when it should be worn and how to put it on and take it off safely.

The provider had a range of policies in relation to infection prevention and control.

Further information is in the detailed findings below.

Wentworth Grange accommodates 51 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager actively sought people’s and relative’s views. Feedback forms were available for people to share their views about the home and people could also attend meetings.

People and staff told us the home was a safe place to live. Staff showed a good understanding of the provider’s safeguarding and whistle blowing procedure including how to raise concerns. Staff did not raise any concerns about safety with us. One previous safeguarding concern had been dealt with and investigated appropriately.

Sufficient staff were on duty to meet people’s needs. People told us staff responded quickly when they needed assistance. Throughout our inspection we observed there was a visible staff presence at all times.

The provider had effective recruitment checks to ensure only suitable staff worked at the home.

Medicines were managed safety. Only trained staff were able to administer medicines. There were accurate records for the receipt, administration and disposal of medicines and medicines were stored safely.

Where a potential risk had been identified, a risk assessment had been completed. These had been reviewed regularly to ensure they were up to date.

Regular health and safety checks were carried out to help maintain people’s safety. The provider had up to date procedures to deal with unforeseen emergency situations.

People told us the home was clean and hygienic, we also observed this to be the case.

Incidents and accidents were logged and investigated. Where required action had been taken to keep people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Meeting nutritional needs was an area of strength at the home. The registered manager was motivated to make people’s mealtimes special with great attention to detail and quality ingredients used. Chefs were skilled at preparing and presenting special diets so that people requiring these had a good experience.

People were supported to access a range of healthcare services in line with their needs such as professionals including speech and language therapy, chiropody, opticians and mental health professionals including the behaviour support service.

The provider had adapted the environment to meet the needs of people living with dementia. This included low sheen plain flooring, good levels of lighting and contrasting toilets with flooring. The registered manager was motivated to make the home "special" whilst still meeting the needs of people living with dementia.

People's care plans were up to date, individualised and reviewed regularly. Although care plans were detailed and personalised, some of the very specific information staff were aware of was not always included in the plans. We discussed this with the registered manager who agreed to ensure care plans were developed further. Where required care records included risk assessments and risk management plans.

There were opportunities for people to take part in activities such as hair and nails, board games, baking, chair exercises, arts and crafts, flower arranging, Sunday lunch, outings and special events. We have made a recommendation about reviewing the suitability of the activity programme for people living with dementia.

The home had a complaints procedure. There had been no complaints made about the home. However, people knew how to complain if needed.

The registered manager articulated a clear vision for the home and planned future developments. These were focused around providing the best experience for people using the service.

The provider had a dedicated audits manager to oversee quality assurance within the home. There was a structured approach to quality assurance with a range of audits carried out to check people received good care.

Staff were well supported to carry out their role and received the training they needed. Records confirmed training, supervisions and appraisals were up to date when we inspected the home. Essential training included infection control, fire safety, moving and handling and medicines management. Additional training available included more advanced training in dementia care and the recognition of delirium.

Wentworth Grange provides accommodation and support for up to 51 older people with personal or nursing care needs. The accommodation consists of a main house, with accommodation spread over two floors, and an annex building known as Hampton House, within the grounds of the main building. Hampton House is a single storey conversion which predominantly supports people living with dementia or cognitive impairment. At the time of the inspection there were 39 people living in both areas of the home.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since October 2010. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At a previous inspection we had found some issues with the safety of the premises, in that window restrictors in the Hampton House area did not meet current guidance and a garden area was not secured. At this inspection we found window restrictors had been fitted to vulnerable areas. On the first day of the inspection we noted the garden gate, previously unsecured, could still be potentially opened and the area exited unobserved. By the second day of the inspection this matter had been fully addressed.

We had also previously noted not all potential safeguarding issues had been referred to the local safeguarding adults team. At this inspection we found safeguarding issues and notifications had been logged, although the standard of the records meant it was sometimes difficult to track progress of matters. People told us they were safe living at the home. Staff had a good understanding of safeguarding issues and had received training in relation to protecting vulnerable adults. There was regular maintenance of the premises and fire risk and other safety checks were carried out on a regular basis. Accidents and incidents were monitored and reviewed to identify any issues or concerns.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). People and staff told us they felt there were sufficient staff to provide care and support.

At the previous inspection we had found some issues with the management of medicines at the home, including the effective administration of topical medicines. At this inspection we found new processes had been introduced to ensure all topical medicines were in date and stored appropriately. There were some minor gaps in MARs and some “as required” medicine care plans required additional detail. We have made a recommendation regarding this.

Staff told us they had access to a range of training and updating. The home had a dedicated training manager who oversaw the provision of internal and external training courses. Staff told us, and records confirmed they received annual appraisals and bimonthly supervision.

People told us, and our observations confirmed that the home was maintained in a clean and tidy manner.

People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists, district nurses and other specialist health staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw applications for DoLS had been made appropriately and, where granted, the expiry dates were monitored. People were asked their consent on a day to day basis. Some relatives of people living at the home had been legally granted Lasting Power of Attorney (LPA). However, on the first day of the inspection we found formal consent had not always been sought from these relatives, or relatives without this legal approval had signed consent forms. The provider was addressing these issues by the second day of the inspection.

People were happy with the quality and range of meals and drinks provided at the home. The home had employed an executive chef to improve the range and standard of meals at the home. Specialist diets were catered for and we observed people were supported effectively with meals and drinks.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. People and relatives said they were always treated with respect and dignity.

The home was in the process of moving to a new electronic care records system and not all current records had been fully transferred or updated. We found the majority of care plans were comprehensive, person centred and related appropriately to the individual needs of the person. Some areas relied on standard phrases. Care plans were reviewed regularly. A range of activities were offered for people to participate in. The registered manager maintained a record of complaints or concerns, although it was not always possible to fully track responses to complaints.

At the previous inspection we had found records were not always readily available and that audits were predominantly tick box in nature. At this inspection we noted the provider employed an audit manager who carried out checks and audits related to people’s care and the environment of the home. A new senior management meeting had been instigated to oversee the running of the service and staff said this had improved matters at the home. A range of other meetings also took place to monitor care and the running of the home. Specific checks by the registered manager, and questionnaires offered to people living at the home, remained limited and tick box in style. Records requested as part of the inspection were readily available.

Staff felt supported by management, who they said were approachable and responsive. We noted the provider had failed to display their current inspection rating on the home’s website and on the first day of the inspection the rating certificate was not displayed conspicuously in a public area.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the requirement to display performance rating. You can see what action we told the provider to take at the back of the full version of the report.

We were unable to speak to all of the people who used the service because of the nature of their condition. We spoke with staff and observed their practices to determine how care and support was delivered.

We found that people were provided with a choice of adequate nutrition and hydration.

The home was clean and we saw there were effective systems in place to reduce the risk and spread of infection.

We found staff recruitment procedures were in place and records showed that these were followed when new staff were appointed. We saw appropriate checks were undertaken before staff began work. One member of staff told us, 'There is a high level of support and training for all the staff and it is easy to talk to the management here.'

We saw that people's personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

People said they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said, "When the weather is better we get out and about" and "I can go and see my family."

People's safety was ensured and they were protected from harm by the provider's arrangements for safeguarding people from abuse, staff training and maintenance of the premises. People felt safe, comfortable and able to raise concerns.