Background to this inspection
Updated
15 February 2023
The inspection
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 Health and Social Care Act 2008.
Inspection team
The inspection was carried out by an inspector, specialist advisor 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. The specialist advisor was a nurse.
Service and service type
Winsford Grange is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Winsford Grange is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We reviewed information we had received about the service since the last inspection including notifications about important events which the provider is required to tell us about by law. We used all this information to plan our inspection.
During the inspection
We spoke with 7 people who used the service about their experience of the care provided and 4 relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We spoke with the nominated individual, executive director of operations, registered manager, clinical lead/deputy manager and 10 members of staff including nurses, care staff, the chef, kitchen assistant and administration assistant. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included 7 people’s care records, multiple medication records and 5 staff recruitment files. We reviewed a variety of records relating to the management of the service including policies and procedures. We continued to seek information and clarification from the provider to validate evidence found.
Updated
15 February 2023
About the service
Winsford Grange is a care home providing personal and nursing care for older people, people living with dementia and physical disabilities. The service can support up to a maximum of 60 people across 4 separate wings. At the time of the inspection there were 33 people living at the service supported across 3 wings as 1 had been temporarily closed.
People’s experience of using this service and what we found
Oversight and quality assurance systems of completion of the recently introduced staff induction programme were not sufficiently robust. Several newly recruited staff had not been added to the training matrix or been allocated or/completed relevant training.
People felt safe living at Winsford Grange. Staffing levels were determined using a dependency tool and during the inspection there appeared to be sufficient staff to meet people’s needs. People told us they felt there were enough staff although staff felt there had been a negative impact from a recent change. People were supported by a consistent group of agency staff when needed. People’s medicines were managed and administered safely and measures were in place to protect people from the spread of infection.
People were supported by trained staff, however, due to an omission some staff had not completed relevant training when they commenced employment. People’s needs were assessed before they received a service to ensure the provider could meet them. Areas of the home needed redecoration. The registered manager provided a list of areas requiring remedial action and confirmed supplies for completion had been ordered. Staff supported people to access healthcare and support.
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 told us staff treated them with kindness and respect. Systems were in place to ensure people were treated without discrimination.
Each person had a personalised care plan detailing their support needs, likes and dislikes. Although people were happy with the care they received we received comments that people had not been made aware of or had not seen their care plan. We have made a recommendation that the provider reviews the process for people’s involvement in their care planning to clearly demonstrate their, and/or, relevant person’s, involvement and agreement is clearly evidenced. People felt able to raise concerns and felt confident they would be listened to.
People spoke positively about the care and culture within the home. Staff were complimentary about the registered manager, however, felt that staff morale was “at rock bottom” and some felt that “higher management” were not always supportive and were less approachable. Systems were in place to assess the quality of the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update and update
The last rating for this service was requires improvement (published 1 July 2022). 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 improvements had been made and the provider was no longer in breach of the regulation relating to safe recruitment however, remained in breach of part of the regulation in relation to good governance.
At our last inspection made recommendations that the provider reviewed the dependency tool to ensure it accurately reflected the required staffing levels; improved induction training for staff and supported new, previously inexperienced, staff to gain the Care Certificate. At this inspection we found that the provider had acted on the recommendations. However, were unable to assess the ongoing effectiveness until systems were fully embedded.
Why we inspected
This inspection was carried out to follow up on actions we told the provider to take at the last inspection and, in part, due to concerns received about staffing and the heating system.
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 regulation in relation to good governance at this inspection.
We have made recommendations that the registered provider reviews systems for completion and oversight of the new induction programme and the process for people’s involvement in their care planning.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.