Archived: Winsford Grange Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

There service was in breach of regulation 18 in relation to staff not being suitably qualified to meet the needs of people living within Winsford Grange.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some of the language used in assessments did not reflect a person-centred approach. For example, one person’s risk assessment described them as “Non-compliant because of dementia,” which may not acknowledge the person's lived experience or needs in a person-centred way. Another care plan referred to someone as ‘Waffling’. In addition, people were not always offered choices around mealtimes, such as where they preferred to eat, which limited opportunities for personalised care. However, we observed staff to know people well and positive engagement was observed.

Staff knew people well and were kind and caring in their approach. However, the service did not always recognise or respond to the different needs of people in the community, including how they communicate. This meant that care was not always well organised or flexible, and people were not always offered choices that suited them. Some people did not have access to the right communication aids or support to help them express themselves clearly or build meaningful relationships.

The provider did not consistently present information in a way that met people’s needs, particularly for people who had difficulty communicating. We were informed by one staff member there were no alternative methods of communication for a person who was hard of hearing. We did not observe additional aids to communication being utilised. For example, menus used during mealtimes were not pictorial, making them unsuitable for people living with dementia. Without visual cues, some people may struggle to understand or remember meal options which can lead to confusion, reduced appetite and a loss of independence when making food choices. Care records sometimes contained conflicting information, which could lead to confusion or result in care that didn’t accurately reflect the person’s current needs.

The welcome pack provided to new people contained incorrect information, it referred to another care home in the area therefore we could not be assured the information within it was relevant to Winsford Grange and could cause confusion for people living at the home or their relatives. We did not see evidence it was available in alternative formats.

Although there was evidence meetings with relatives had taken place, the relatives we spoke with stated they had never attended any such meetings. This highlights a discrepancy between recorded information and the actual experiences of relatives, suggesting a potential issue with how communication and engagement with families was being managed.

We did not see evidence that people in receipt of services, were actively involved in planning or reviewing their care. However, relatives told us they were regularly consulted. One relative shared that they had raised a concern with staff but felt it wasn’t listened to. We saw activity boards in communal areas showing that people were involved in activities, and during the CQC assessment, we observed activities taking place. However, not everyone was encouraged to take part, and there was limited evidence that activities were tailored to peoples interests or abilities. This may reduce opportunities for meaningful engagement and inclusion, especially for those who need more support to participate. Staff meetings did take place, but there was little evidence to show they happened regularly or were used effectively to improve care and communication.

The service did not always make sure that everyone had equal access to care and support. People who needed more help, for example, those people with complex needs, including those living with dementia and/or had difficulties in communicating were not always given the same opportunities to take part in activities or make choices about their care. There was no clear evidence that advocacy services were promoted or used to help people express their views particularly in relation to people who did not have relatives involved in their care. This meant the service was not fully inclusive, and some people may have missed out on having their voices heard and their needs met.

We did not see any evidence that people were supported to take part in decisions about their care. This included people living with dementia, who should be encouraged and provided with the opportunity to express their views and be involved in planning their care with extra support if required. Care plans did not show that any attempts had been made to involve people directly. They were often completed by staff, and while it was sometimes recorded that discussions had taken place with a relative, there was often no evidence of this. As a result, we were not assured that people’s own voices were being encouraged or heard and that their care was truly person-centred.

We were not assured that people were supported to be involved in or make informed decisions about their future care or that those preferences were reviewed regularly. Although care plans included information about people’s preferences for end-of-life care, outside of end-of-life planning, we saw no evidence of planning for other potential future life events for example the loss of capacity, or a significant life changing event such as stroke, or requiring an alternative service provision. Records of care reviews did not consistently demonstrate that people had been involved in discussions about how their care is delivered and what matters to them. Further we found that staff had not been provided with training in end-of-life care.

The clinical register used by the management team and clinical lead did not reflect that for some people anticipatory end-of-life medicines had been prescribed. The register was also not an accurate record of those people receiving end of life care, at that time. Clearer record keeping was needed to ensure accurate oversight and management of this area

Care staff had not undertaken any training in relation to end of life care however, some nursing staff had completed Restore 2 training which is additional training to enable them to recognise symptoms of a person’s condition deteriorating.