Wolston Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question Requires Improvement. At this inspection the rating has remained Requires Improvement. This meant people were not always safe and protected from avoidable harm.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a positive culture in relation to maintaining people’s safety. Staff listened to concerns about safety and investigated safety events. Lessons were learnt to continually identify and embed good practice.

People told us staff responded effectively to any concerns they had.

Staff told us there was a process for reporting accidents and incidents and sharing any learning. One staff member told us, “We have staff meetings quite frequently, we have handovers every morning (to share any updates on people’s health and care needs) and for the afternoon. We have the accident and incident books, and we have to fill those out even if it was a near miss.”

The registered manager told us they met with staff to discuss any near misses or accidents, and they double checked information at 3,6 and 9 monthly intervals. They told us “We always look to see what we can do better” and gave examples of changes they had made following incidents to improve.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made arrangements to help ensure there was continuity of care, including when people moved between different services.

Some people had moved to the home from another home and had found this a positive experience. One person said, “I came straight from another home, I like it here, I am not moving.” Another person explained how positive their transfer to hospital had been managed. They said, “I was supported all the way, and when I was there, they rang to check on me, the nurse said your home has called asking about you.”

Systems in place ensured people did not miss important medical appointments. One staff member explained the information that was sent with people should they be admitted to hospital. “[Name] went in with a copy of their medicine administration record, their DNAR (Do Not Attempt Resuscitation) and a copy of their hospital pack.” This was important to ensure people received safe care that met their needs which was also in accordance with their wishes.
 

The provider did not always work consistently to ensure actions helped to improve people’s lives while protecting people’s right to live in safety, free from bullying, discrimination and avoidable harm and neglect.

The provider is legally required to send to us statutory notifications when certain incidents arise. From reviewing accident and incident records, we found an incident that should had been followed up with a statutory notification to us, but this had not been completed. The incident record was also not detailed enough to demonstrate concerns had been sufficiently followed up. For example, a person made an allegation towards another person and there was insufficient information to rule out any injuries, abuse or potential anxiety. We raised this with the registered manager with a view to records being made clearer. The provider shared concerns (where appropriate) with the relevant agencies to enable them to take any required actions to keep people safe.

People told us they felt safe living at the home. One person said, “They treat me very well, if you treat people well, they treat you the same.” Another person told us about an issue they had raised about a staff member and said they had felt listened to. Appropriate legal authorisations had been sought in relation to any restrictions imposed on people. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Staff understood their role in protecting people from poor care, abuse and discrimination. When we asked 1 staff member what they would do in a given scenario, they responded, “I would remove the member of staff but then I would report it to safeguarding straightaway. I have reported a number of things to safeguarding over the years, so I know how to do it.” Another staff member said, “I would report to my manager instantly, failing that to my area manager and failing that to CQC.”
 

The provider worked with people to understand and manage risks. Staff aimed to provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Records to manage and monitor risks were not always clear. For example, it was not always clear if people received enough to drink in line with their targets. Some people were at risk of pressure related skin damage so needed to reposition regularly. The records were not always clear on whether they had been supported to reposition in line with assessed time intervals

Some people could become anxious or distressed which could impact on their emotional wellbeing. Personal behaviour support plans guided staff on what actions to take to distract and divert the person from their anxiety or distress. Risk management plans were in place linked to people’s needs such as mobility, continence care, skin and nutritional needs.

Staff understood the importance of managing risks without limiting people’s freedom. Staff told us they encouraged people to work with them to help mitigate risks to their health and wellbeing. They gave an example of checks 1 person had agreed to, so risks associated with the person’s condition were mitigated. Staff told us about people who were supported to take risks as safely as possible. This included people who smoked within the gardens of the home and people who used the kitchen. The registered manager told us about a person who used a tracker device when they went out independently (which a person had consented to use). This helped the service monitor the location of the person to check they were safe.
 

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

There were areas of the environment that needed attention to support the delivery of safe care. This included several specialist mattresses requiring a service and exposed hot pipes in two areas of the home which presented a potential burn risk if touched. The registered manager confirmed immediate action would be taken to ensure these were addressed.

People did not express any concerns in relation to the environment and were able to access communal areas freely. People had equipment to support their needs to keep them safe.
 

The provider aimed to ensure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. Although staff worked together to help provide safe care, some people did not always feel their individual support needs were met.

People spoke positively of the staff but felt sometimes more staff were needed. One person told us, “They could do with 2 extra just for taking people to the toilet. There is nothing worse than wanting to go and having to wait if they are busy with someone else.” Another said, “You have to hold on and hope you don’t have an accident.”

The provider used a dependency tool to ensure there were enough qualified, skilled and experienced staff on duty to support people with safe care. Staff told us staffing levels were sufficient to provide safe and effective care as set out in people’s care plans. One staff member said, “Obviously people call in sick and we have annual leave to cover so we do use agency (temporary staff), but yes, I do think there is enough staff.” We saw staff were responsive to people’s needs in communal areas and when people used call bells, these were responded to promptly.

Staff received effective supervision to support their role and development. Staff worked together to help ensure people’s individual needs were met. Staff told us they were given specific training to support people within the 3 different units at Wolston Grange. A staff member who worked on 1 unit told us, “To work here you have to have your Korsakoff training and to work in the other unit you have to have your mental health training and your ligature training.” Another staff member told us, “We have a 2-week long induction where we go through dementia training, moving and handling, first aid, CPR (cardiopulmonary resuscitation) and cover all bases. We have our in-house trainer who is based in head office so I can always talk to them. We can request any other training we think is suitable. I have requested ligature training and ‘better mood’ training so if someone is feeling low, it gives me the tools to help them.”

Staff were recruited safely. The provider sought references and completed DBS (Disclosure and Barring Service) checks to identify any information of potential concern such as convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People felt the home was clean and staff knew how to prevent the spread of infection. One person said, “It’s very clean, there is always someone wiping and cleaning.” People said staff wore aprons and gloves when providing personal care to them. People said they were told about any outbreaks, 1 person said, “Because everything spreads so quickly, they have to tell us.”

We saw personal protective equipment (PPE) was available to staff in several areas across the home so staff could practice safe infection prevention and control. We saw the home was clean and tidy and cleaning schedules completed daily confirmed cleaning completed. Schedules showed the frequency for all areas of the home to be cleaned.
Staff completed infection prevention and control training and knew to follow the provider’s policies and procedures to keep people safe from infection.
 

The provider did not always make sure that medicines and treatments were safely managed. Staff involved people in planning when changes happened.

Regular audits of medicines took place to ensure they were being managed safely. However, some prescribed medicines were not consistently managed safely. This included thickening agents (used to change the consistency of fluids to reduce the risk of choking) which were left unsecured in the dining room. This meant there was a potential risk people could access it and ingest this medicine. On informing the registered manager, they took immediate action for these to be removed and stored in a safe place.

Staff told us sometimes there was no night staff member on duty who could administer medicines if people needed them. The registered manager advised medicines trained staff could be called into the home if needed to administer any medicines required. Duty rotas showed that most of the time a night medicator was on duty.

Records showed people received their medicines. Each person had their own medication file although some of the records were not fully legible. In 1 unit there were handwritten amendments on the medicine records which were not signed or countersigned to confirm their accuracy. On 1 medicine record there were no dosage instructions, this risked the wrong dose being administered.

People told us staff explained what medicines they were taking to them. We saw staff followed safe procedures when administering medicines to people. One person said, “They give us painkillers, if we need them.”