Winsford Grange Care Home

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.

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

A continued lack of management oversite, support and governance meant that the people who lived at the home remained at risk of their needs not being met. Fire extinguishers were out of service, fire doors were being wedged open because their automatic closing devices had broken and not been repaired, and the fires risk assessment, and other documentation was out of date. The provider was unable to demonstrate that staff had been recruited safely. Several vitally important checks had not been completed and important documents, such as references, had either been misplaced or never received.

Staffing numbers had been increased since our inspection in January 2022 and this had had a positive impact on the standard of care provided. The assessment tool used to determine correct staffing levels did appear to produce an accurate assessment. . We have recommended that the provider reviews this to ensure it can accurately determine correct staffing levels.

People were safe and protected from abuse. All people spoken with told us they were safe and well cared for and visiting relatives praised the staff for the standard of care they provided. Medicines were stored and administered safely so people received their medicine as their doctor had prescribed it.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Not all staff had the right skills, training, or experience to meet people's needs and some needed their basic training refreshing. We have recommended that the provider seeks to improve induction training for new staff.

People told us that the care was good. They said they were treated with respect and we could see they were generally involved in decisions about their care. A visiting doctor told us that there is a core group of staff who have worked at Winsford Grange many years. They said: “the staff are caring and courteous, respectful, and kind to patients and to family members”. Throughout this inspection we observed staff treating people with kindness, respect, promoting choice, seeking consent, and offering sensitive emotional support when needed. The atmosphere in the home was warm and welcoming and arrange of activities was on offer.

People told us that they received care that met their needs but some of their care plans lacked detail. We have recommended that care plans are audited to ensure they comprehensively address people’s needs.

The provider's quality systems were not sufficiently robust to identify the concerns we identified on this inspection. The management team were open and transparent throughout the inspection and responded to any requests positively.

Rating at last inspection

The last rating for this service was requires improvement (published 22 March 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 that improvements had be made and the provider was no longer in breach or regulations on staffing and safe care and treatment. The provider remained in breach of regulations on staff recruitment and governance.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Enforcement

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 have identified four breaches of regulations in relation to safe care and treatment, fit and proper persons employed, staffing and Governance and records at this inspection. Please see the action we have told the provider to take at the end of this report.

Prompt action was taken by the registered provider during the inspection to mitigate risk and improve the quality of care in response to the concerns we found during our inspection.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection program. If we receive any concerning information 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 and what we found

Risks presented to people and staff by the COVID-19 pandemic were not assessed or recorded and staff were not always being tested for COVID-19 in accordance with government guidelines.

Staffing levels were insufficient to ensure that staff could be deployed in three sperate teams during a recent COVID-19 outbreak. This increased the risk of spreading COVID-19. In addition, there were times when people, assessed as at risk of falls, where unsupervised which meant they were at increased risk of harm.

There was a lack of managerial oversite. There was no effective rostering of staff and staffing needs had not been determined by any formal assessment. Staff morale was low. Staff reported a lack of engagement with senior managers. There had been no staff meetings since the new owners acquired the home in October 2021.

The provider was unable to demonstrate that nursing staff and support workers had been recruited safely. Several vitally important checks had not been completed and important documents such as references had either been misplaced or never received.

The provider's quality systems were not sufficiently robust to identify the concerns we identified on this inspection.

The provider was very responsive in taking actions to address the issues we found on inspection however we could not fully assess the impact of these actions until they were fully embedded.

Medicines were stored and administered safely so people received their medicine as their doctor had prescribed it. Some records to support the administration of ‘as and when required’ medicines was missing.

We have recommended that the provider reviews management and audit of medicines in accordance with best practice guidance.

People were safe and protected from abuse. All people spoken with told us they were safe and well cared for and visiting relatives praised the staff for the standard of care they provided.

The management team were open and transparent throughout the inspection and responded to any requests positively.

Rating at last inspection

This service was registered with us on 10 October 2021 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 31 January 2020.

Why we inspected

The manager notified us of concerns relating to staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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. This included checking the provider was meeting COVID-19 vaccination requirements.

Enforcement

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 have identified four breaches of regulations in relation to safe care and treatment, fit and proper persons employed, staffing and Governance and records at this inspection. Please see the action we have told the provider to take at the end of this report.

Prompt action was taken by the registered provider during the inspection to mitigate risk and improve the quality of care in response to the concerns we found during our inspection.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection program. If we receive any concerning information we may inspect sooner.

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