Wellington Grange is a care home that provides nursing care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Wellington Grange provides accommodation and support for up to 72 people. Accommodation is arranged over three floors with those who require nursing care on the second floor. There are three passenger lifts linking each floor and the home has an attractive accessible garden. The inspection was conducted over three days, 19 and 20 September 2017 and later on 12 December 2017. A third date was arranged with the provider as due to unforeseen circumstances, the inspector was not able to complete the report. A third day of inspection was needed to ensure completeness of information for this inspection report. Information gathered on 12 December provided the basis for this report but some information from the previous days was also considered. On 12 December 2017 there were 57 people living at the home.
The home had a registered manager who was present throughout the inspection on 12 December 2017. A registered manager is a person who has registered with the Care Quality Commission (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.
The home was registered with CQC in March 2016 and this was the first inspection of the home.
Staffing levels in the home had been increased in recent months. However, staff were not always being deployed effectively in some areas of the home. People told us that they sometimes had to wait longer than they should expect to have their needs met. People’s comments included, “There’s a lack of carers,” and “Usually they are quick but sometimes it’s a long, long wait in the night.” We identified the deployment of staff as an area of practice that needed to improve.
People told us they felt safe living at Wellington Grange, one person said, “I am definitely safe here because of the staff.” Risks to people were assessed and managed and staff demonstrated a firm understanding of their responsibilities with regard to safeguarding people. Incidents and accidents were monitored and actions were taken to reduce the risk of a reoccurrence. People were receiving their prescribed medicines safely and were supported to manage their own medicines where appropriate. There were robust arrangements in place to ensure that the environment was well maintained and risks of infection were effectively managed.
People’s needs had been assessed using a number of validated tools. Care plans were regularly reviewed and updated to reflect the care provided. People told us they had confidence in the skills and knowledge of the staff. One person said, “The staff are very well trained and know exactly what to do.” Another person said, “The quality of the staff here is excellent.” The provider had robust recruitment procedures and staff told us that new staff received a comprehensive induction when they joined the team. Staff received the training and support they needed to be effective in their roles. One staff member said, “I have done a lot of training and it has all been helpful.” Records showed that staff had received training in subjects that were relevant to the people they were caring for.
People and their relatives spoke highly of the food available at the home. There were a number of different dining areas and people said that they were offered plenty of choice. One person told us, “The kitchen does well, the food is good.” We observed that people had a pleasant meal time experience and staff were supporting people to make sure they had enough to eat and drink. Specific risks and nutritional needs were identified and monitored to ensure that people maintained a healthy weight. People could help themselves to drinks and staff were proactive in offering drinks to people throughout the day.
People told us that staff always asked them before assisting them. Staff had received training about the Mental Capacity Act 2005 (MCA) and demonstrated a clear understanding of their responsibilities. Staff had considered whether people had capacity to consent to their care and treatment in line with the legislation and guidance. People told us they were supported to access the health care services they needed. One person said, “I had to go to the doctor and they (Staff) came with me.” Other people told us that health care professionals visited them at the home.
People and their relatives told us that they had developed positive relationships with the staff. One person said, “All the staff are so kind and attentive, there’s nothing I would change.” A relative told us, “They have always included me from day one, I have been kept well informed all the way through.” Staff knew people well and supported them to be involved in planning their care. Staff were kind and gentle in their approach to people. One person told us, “They are lovely girls, always kind and helpful.” Staff had a good understanding of the need to maintain people’s confidentiality. People told us staff treated them with respect and maintained their dignity. People were supported to remain as independent as possible.
People were receiving care that was personalised according to their needs and preferences. Care plans included details of what was significant for people, including cultural or religious needs or preferences, people, events and routines that were important to them. People and their relatives were supported to make plans for the end of their life and the registered manager told us that they were developing an end of life strategy to guide staff in this area of practice. A relative told us about their experience when their relation was at the end of their life, describing the care provided as “exceptional.”
A wide range of organised activities and events were available at the home. People’s interests and hobbies were considered when planning activities and staff spent time with people in their rooms to ensure they were not isolated. Staff supported people to access events and facilities in the local community on a regular basis. One person said, “I love going out for a pub lunch. It’s a normal thing isn’t it and stops you feeling institutionalised.” Staff had developed links within the local community and people benefitted through access to services, people and events. People’s aspirations were considered and staff used links with local organisations to meet their wishes.
People told us they knew how to raise any complaints or concerns and would feel comfortable to do so. The registered manager took action to address people’s concerns and used learning from complaints to make improvements at the service.
Systems and processes were in place to provide clinical governance and to monitor the standards of care provided. People’s views were sought in a variety of ways including through regular meetings, informal discussions and with a quality assurance survey. Monitoring of complaints and incidents and accidents also contributed to learning that was used to drive improvements. There was a clear management structure and staff understood their roles and responsibilities. Staff reported feeling well supported and described effective team work. Staff and people spoke highly of the registered manager.