Wolston Grange

Wolston Grange is a residential care home providing accommodation and personal care for up to 39 people who may have a diagnosis of dementia. The service is made up of 3 units, the main house is a two-storey building and provides accommodation for older people with dementia. The Lodge is adjoined to the main house and is a two-storey building which provides accommodation for up to 12 adults with dementia. The Barns is a separate building within the grounds of the main house, which provides accommodation for up to 5 people with dementia.

At the time of our inspection visit there were 34 people receiving care across the service.

People’s experience of the service and what we found:

At our last inspection, we found improvements were required around managing people’s risks and risks to support safe medicines management, quality of record keeping and quality assurance processes. At this inspection, we found enough improvements had been made and people were pleased with the levels of care they received. The provider was no longer in breach of the regulations.

Improvements to the management of the home by the provider and registered manager led to a service which supported good outcomes for people. The provider's quality assurance systems and processes were regular, structured and they now identified where actions were taken. Evidence and action plans showed improvement actions had been taken.

The provider had timescales to make improvements to the fire safety of the home. The provider told us they kept the fire authority updated of their timescales and actions.

We found there was a positive culture, which focused on meeting people’s needs. People spoke positively about the service and staff team. People’s views and feedback was sought on the service they received and acted upon through regular meetings and daily interactions.

People were supported to receive their medicines safely, however some improvements to the recording of certain medicines needed to be made. Following our visit, the registered manager had taken those actions. Staff received training and they had their medicine competency assessed, to ensure they followed correct procedures.

People were supported by staff who knew them well and staff were kind and attentive. People’s safety and care needs were identified, their care was assessed and planned, and their needs were met.

People’s individual preferences and lifestyle choices were respected, whilst their safety needs were balanced through risk interventions. Staff understood how to protect people from abuse and were confident the provider would take action to protect people, should this be required. Staff were also confident to refer to other agencies to keep people protected. People told us they felt safe at Wolston Grange.

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 supported this practice. People’s freedom was not unnecessarily restricted, and people were not physically restrained.

People lived in a safe, clean and maintained environment. Regular checks ensured the environment was safe. Improvements to fire safety through better signage and the updating of fire doors was being managed by the provider.

People were encouraged to personalise their rooms and some people were involved in decorating their own and communal rooms. Staff worked with people, relatives and health and social care professionals to maintain people’s overall health and wellbeing.

The provider had safe recruitment systems to ensure staff were suitable to look after people. There were enough staff on duty to support and meet people’s needs. People were involved in how their care was received and how they lived their day, such as what they wanted to do and where they wanted to go.

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 requires improvement overall (published 12 January 2023). The overall rating for the service has changed from requires improvement to good based on the findings of this inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

When we last inspected Wolston Grange on 15 September 2022, breaches of legal requirements were found. This inspection checked whether they were now meeting the legal requirements. We found improvements had been made and the provider was no longer in breach of regulations.

We undertook a focused inspection to review the key questions of Safe, Effective and Well Led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Environmental risks were not always identified and mitigated against. Medicines management required improvement to ensure people always received their prescribed medicines, and medicines were always stored safely to ensure its effectiveness. Infection control measures required improvement to ensure people were always cared for in a clean environment and were protected from the risk of infection.

The provider’s policies and procedures supported people to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, an application to the local authorising body to place a restriction on one person had not been made accurately.

Systems and procedures to identify areas of improvement, and make changes to the service, required improvement to ensure the premises were always safe, and people always received safe and effective care. Important events and incidents were not always notified to CQC when events occurred.

Staff were trained in safeguarding and understood their responsibilities to report potential safeguarding concerns. There were enough staff to meet people’s needs safely. New staff received an induction into the service and received ongoing training to keep their skills and knowledge up to date. The registered manager worked with health professionals to support safe admissions to the home. Staff understood people’s individual dietary needs and prompted people to eat and drink enough to meet their needs. Partnership working enabled people to maintain their wellbeing.

The latest CQC rating was displayed in the home and on the provider’s website as per regulatory requirements. The provider worked with external health and social care professionals to ensure people had access to services they needed, in response to changes in their health and to improve their health outcomes. People knew how to raise concerns and provide feedback about the service.

Rating at last inspection

The last comprehensive inspection report for Wolston Grange (published October 2019) and we gave a rating of requires improvement. At this inspection we found the service had remained the same and have rated the service as requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. You can see what action we have asked the provider to take at the end of this full report.

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

Why we inspected

This was a planned inspection based on the rating at the last inspection. We undertook this focused inspection to check they had improved and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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 remained requires improvement. This is based on the findings at this 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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to regulation 12 safe care and treatment and regulation 17 Good Governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Wolston Grange is a residential care home providing personal care and accommodation for up to 39 people living with dementia. The service is made up of three units, the main house is a two-storey building and provides accommodation for mainly older people with dementia. The Lodge is joined to the main house and is a two-storey building which provides accommodation for up to 12 adults with dementia. The Barns is a separate building within the grounds of the main house, which provides accommodation for up to five adults with dementia. At the time of our inspection visit there were 24 people receiving care, 12 in the main house, seven in the Lodge and five in the Barns.

People’s experience of using this service

Changes had been made to the physical environment and the risk management and quality assurance processes. However, further improvements were required to ensure checks on quality were embedded and to ensure care was delivered effectively to meet people’s needs.

People received support from staff, however, some people told us they waited for support and did not always have enough to occupy them during the day.

Improvements were required in securely storing hazardous substances, such as cleaning products.

The provider had not identified some risks associated with lone working in parts of the service.

Staff understood how to identify and report abuse. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

People were supported to have their medicines as prescribed. People were supported to have enough to eat and drink to maintain their well-being and were supported to obtain advice from healthcare professionals when required.

Staff understood and practised infection control techniques and had access to protective equipment to promote this.

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 supported this practice. However, staff had limited understanding of some aspects of the Mental Capacity Act 2005 (MCA).

People were supported to make choices about their day to day lives. People and their families understood how to complain if they wanted to.

Rating at last inspection and update

The last rating for this service was inadequate (published 16 March 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 16 March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

• Systems to identify people's individual safety risks and to promote people's safety within the home environment were not effective.

• No action had been taken when Health and Safety checks identified people could be exposed to unnecessary risk, such as potential scalds from excessive hot water temperatures. Fire safety measures had been taken following a fire authority visit in 2017, however staff responsible to check fire equipment such as doors and emergency lighting had not been trained. Where fire safety equipment was recorded as not working, this equipment remained defective.

• The general décor and maintenance throughout the service was poor and posed risks of injury to people because repairs were required. This included repairs to interior woodwork and window restrictors. Because of the overall disrepair of some areas of the home, this presented potential infection control risks.

• The provider’s quality assurance systems were not effective in identifying, responding and maintaining a good standard of service that people deserved. Where some improvement actions had been recorded and raised with the provider, limited or no evidence showed what actions had led to improvements.

• Risk assessments were not always clear to show how risk scores were used to assess individual risks to people and risk management plans lacked important information to keep people safe.

• Medicines were not always managed and administered in a safe way which increased risks to people’s health and wellbeing. Systems to store, record and dispose of medicines safely were inadequate.

• Improvements were needed to ensure people were supported to enjoy a wider range of activities which reflected their interests, and enhanced their lives. Staff sought ways for people to continue to do things they liked, whilst maintaining their safety, such as using outdoor spaces.

• People, their relatives, staff and other health and social care professionals worked together to assess people's needs and plan their care. This was done so people's needs and preferences would be met, and they would enjoy an enhanced sense of well-being.

• People were supported by staff to make decisions about their care. Staff used their knowledge of people's preferred ways of communicating, to assist people to make their own choices.

• Staff did not always promote people's right to independence, dignity and respect.

• Staff supported people to have timely access to external health care. This improved health and well-being outcomes for people living at Wolston Grange.

• Staff received an induction and on-going training to develop and maintain their skills, however this training was not always put into practice and for some staff, they told us it was ineffective.

• People, their relatives and staff were encouraged to make any suggestions through annual surveys. Staff had meetings which gave them a chance to share ideas and feedback.

• Most people were happy living at Wolston Grange and were cared for by staff who understood their preferences and were kind.

Following our inspection, we notified relevant stakeholders such as the Local Authority Quality Team, Local Clinical Commissioning Group (CCG) and the Fire Authority about the areas of concern we identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment.

Regulation 17 Regulated Activities Regulations 2014 - Good governance.

Rating at last inspection: Good. The last report for Wolston Grange was published on 9 March 2017.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The previous ‘good’ service provided to people had not remained consistent. At this inspection the rating has now changed to Inadequate overall.

Enforcement: Action provider needs to take (refer to end of report).

Follow up: Due to level of risks identified from this inspection, we wrote to the provider under Section 64 of the Health and Social Care Act 2008, to request for provision of an action plan to address our concerns. We will continue to monitor progress made against the provider’s action plan and any regulatory action as an outcome of this full inspection report.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The registered manager had been in post since 24 June 2013. 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.

People told us they felt safe using the service and staff understood how to protect people from abuse. There were processes to minimise risks associated with people’s care to keep them safe. This included the completion of risk assessments to identify and manage risks to people’s health and well-being and checks on staff to ensure their suitability to work with people who used the service. Best practice was not always followed in relation to storing and recording the administration of medicines.

There were enough suitably trained staff to deliver care and support to people. Staff received an induction and a programme of training to support them in meeting people’s needs effectively. Staff were encouraged to reflect on their practice and to develop their skills and knowledge and this improved people's experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having the capacity to make all of their own decisions, records showed that their families, legal representatives and healthcare professionals were involved in making decisions in their best interests. Staff understood the principles of the MCA, where people had capacity to make their own decisions, these were respected and consent was gained before staff provided personal care.

People told us staff were kind and caring and had the right skills and experience to provide the care and support they required. Staff treated people in a way that respected their dignity and promoted their independence.

People were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were reviewed. People were supported to maintain important relationships and their personal interests. People knew how to complain and were able to share their views and opinions about the service they received.

Staff felt supported and were encouraged to share ideas to make improvements to the service. The registered manager was dedicated to providing quality care for people. There were processes to monitor the quality of the service provided and understand the experiences of people who used the service. The process included regular communication with staff, surveys and a programme of other checks and audits.

We saw there were 17 people living at the home. The service provided a mixture of supported living accommodation and accommodation for people requiring nursing or personal care. No nursing care was being provided at the time of our visit.

The people who lived at the home had complex needs. This meant they were not always able to tell us in detail about their experiences. Therefore we observed care practice and staff's interaction with people when they delivered their care.

We found that staff understood the needs of people using the service and we observed positive interactions between the people using the service and staff members.

During our visit people who lived at the home engaged in different activities. Some people were supported by staff to have a hand massage. Some people were watching a film on television. Another person spent time with the home's pet dog.

Staff told us they received staff rotas at least a week in advance. They told us if there was a problem with the rotas they could speak to the manager about it.

Staff told us that they had agreed their working hours with their manager in advance of working them.

We spoke with four people who lived at the home, three members of staff delivering care and the manager. The manager was new in post, she had been at the home for approximately four weeks and was not yet registered with us. We read the care records for four people who lived at the home, observed care practice and staff's interaction with people when they were delivering care.

During our visit we saw people enjoyed a variety of activities. Some people were supported by staff to arrange flowers and some people had a hand massage. One person was feeding the hens, they told us, 'I love the dogs and chickens. I like it here. I take the dogs out 4 times a day.'

We saw that people's care was planned according to their needs and dependencies. We found that staff understood people's needs and followed people's care plans when they supported them.

The provider had a system for monitoring the quality of the service, which included regular audits. The provider responded to people's feedback and took actions to improve the quality of the service.

The care staff we spoke with told us they felt well supported by their manager, they felt able to raise concerns and they found the training and induction useful.

We last inspected the service on 28 May 2012 and we found the provider had not been supporting their staff to deliver care to people they looked after and care records and other records were not accurate and fit for purpose.

We were told by the provider that systems would be in place by 31 October 2012. We saw staff had received regular one to one meetings with their manager to discuss any training needs and to give them the opportunity to raise any concerns they had.

We saw that care plans for people who used the service and training records for staff were up to date and accurate.