18 March 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Widnes Hall is a care home. 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.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
The inspection was unannounced.
What we did before the inspection
We reviewed all the information we held about the service since it registered with the Commission. We also obtained information about the service from the local authority and local safeguarding teams. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection visit
We spoke with 5 people and 10 family members about their experience of the care provided. We spoke with the registered manager, 8 care staff, a housekeeper, cook and the district manager.
We reviewed a range of records. This included 5 people’s care records and a selection of people’s medication records. We looked at recruitment records for 3 staff members employed. A variety of other records relating to the management of the service, including audits and checks were reviewed.
18 March 2023
About the service
Widnes Hall provides accommodation and personal care for up to 69 people; some of whom live with dementia in an adapted building over two floors. At the time of our inspection 65 people were living at the service.
People’s experience of using this service and what we found
Risks to the health, safety and welfare of people were not always assessed, monitored and managed to ensure their safety. This included risks associated with some people’s care, the safety and cleanliness of the environment and infection prevention and control.
The providers quality assurance systems and processes were not always used effectively to identify and mitigate risk. There was a lack of robust checks carried out across the environment in the absence of the registered manager. There was a lack of management oversight to make sure some people’s records were completed accurately.
Consent to care was not always obtained in line with the Mental Capacity Act 2005 (MCA). Consent forms for care were signed on behalf of people by others without the appropriate legal authority and some mental capacity documentation for some people contained conflicting information about people’s ability to consent.
People told us they felt safe and family members were confident their relative was kept safe. Staff understood their responsibilities for keeping people safe from abuse. They knew the different signs of abuse and the procedures for reporting any concerns about people’s safety and treatment. New staff were recruited safely, and people received care and support from the right amount of suitably skilled and experienced staff.
People’s needs and choices were assessed. Staff received the training and support they needed for their role. People received the support they needed to eat and drink and to maintain a healthy diet. People were supported with their healthcare needs including support to access other services. Staff monitored people’s health and wellbeing and made prompt referrals where this was required for people. The premises were adapted and designed to meet people needs, however some improvements were needed to décor and fixtures.
People’s privacy, dignity and independence were respected. Staff knew people well and spent quality time with them. Staff showed people kindness. People and family members were complimentary about how staff treated them. People or those acting on their behalf were given opportunities to express their views and make decisions about the care provided.
People were involved in planning and reviewing their care along with others including family members. People and family members told us staff provided the right care and support. Staff organised and encouraged people to take part in a variety of meaningful activities and they supported people in relationships which were important to them. People and family members were provided with information about how to complain and they felt confident speaking up should they need to.
There was a positive culture at the service. People, family members and staff felt included and able to speak up freely. People received all round care through good partnership working with others including family members and other health and social care professionals.
Rating at last inspection and update
The last rating for the service under the previous provider was good published on 25 March 2020.
Why we inspected
This was a planned inspection.
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.
We have identified breaches in relation to people's safety, consent and the governance and leadership of the service.
Please see the action we have told the provider to take at the end of this report.
The provider has taken action to mitigate the risks.
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.