Archived: Winsford Grange Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation 11 in relation need for consent.

This service scored 38 (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 made changes to care plans, and they included more person-centred information however, we found some of them contained contradictory information for example, one person care plan stated they needed a hoist for transfer and another care plan stated they required a stand aid. Another person’s care plan stated they continued to walk throughout the day however, this person was not mobile and required the use of a hoist for transfers. Contradicting information placed people at risk of receiving the wrong support and being injured. There was no evidence people were involved in planning their care, although relatives told us they had been involved in reviews.

People were not always involved in planning their own care and support, and what mattered most to them was not always considered.
During our visit, we saw that while two meal options were generally available, however, people who needed a modified diet were only given one option, without a choice. Kitchen staff told us the evening meal for people requiring a modified diet was often leftovers from lunch, served again at teatime instead of being freshly made or chosen as a preferred option. We were informed the kitchen staff had a limited budget so can only work with what they have. There was no diabetic menu or an alternative option available for people living with diabetes, and the management team did not demonstrate an understanding of the risks associated with poor blood sugar control.

The provider did not always work well across teams and services to support people. Due to inconsistencies within care plans information shared across teams including visiting health care professionals may not have always been accurate or up to date.Staff reported they worked well as a team, but oversight and a lack of funds from the provider at times hindered their ability to provide effective care and support. Staff told us there were enough staff to support people safely, comments included, “There’s enough staff now, lots of new ones, we have a good staff team.” However, we found that at times there were not enough suitably qualified staff available to provide appropriate support, due to a lack of clinical training amongst the nurses in charge. Staffing rotas showed instances where no staff on shift had completed the required clinical training to safely and effectively meet people’s needs. This included training in catheter care, syringe driver use, diabetes management, and epilepsy and seizure support. There were people living with these health conditions or who may potentially require this type of support, which placed them at risk of not receiving safe and appropriate care. Some staff told us they received a handover when they started their shift, other staff told us they had the option to read the handover records within the person-centred software (PCS.)

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Although the home employed 2 activity coordinators, there was insufficient evidence of meaningful activity provision during weekends, which may have negatively impacted peoples emotional and physical health. The main dining room was not utilised during breakfast or the evening meal, people were observed to be eating from small tables. Eating meals in the dining was considered as an activity and was incorporated into the activity planning. Whilst the environment had improved and is more adapted for people living with dementia we identified rooms with no signs. Lack of signage could make it harder for people especially those with memory or sight problems to move around safely and independently. The home had a regular GP who visited the home once a week. People told us they could see a GP when they wanted, one person told us, “I can see GP when I want to.” One relative said although they didn't have direct contact with the GP of their loved ones the unit tells them if something changes.

Care plans did not consistently demonstrate that identified outcomes were regularly reviewed, nor did they show that people were actively involved in these reviews. While some care plans were personalised, the outcomes recorded were often not person-centred. Instead, they were task-focused, concentrating on staff responsibilities rather than supporting people to work towards greater independence. For example, nutrition care plans included general goals such as meeting dietary and fluid needs and maintaining a healthy weight. However, these goals were not tailored to people or designed to encourage them to take an active role in managing their own health. There was limited evidence of specific, achievable goals that promoted personal involvement.

The provider did not consistently inform people about their rights around consent. They did not always follow the principles of the Mental Capacity Act. Although some mental capacity assessments had been completed, they often lacked detail and there was little evidence that relatives or advocates were involved when people were assessed as lacking capacity. This meant there was no clear assurance that decisions were being made in the person’s best interests. In addition, there was limited evidence to show that less restrictive options had been considered before decisions were made. We observed several people utilising postural chairs and lap straps. While this constitutes a form of restriction, it was not always accurately assessed or recorded in the person’s best interest. We observed some staff talked to people and asked if they would like to wear protective clothing at mealtimes however, we observed staff placing protective clothing on someone without gaining consent. Staff told us they understood the principles of the Mental Capacity Act, one staff member told us, “We help people to choose options we use the least restrictive options.”