Winsford Grange Care Home

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• 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

This means we looked for evidence people were protected from abuse and avoidable harm. At the last assessment we rated this key question as inadequate. At this assurance visit the rating had remained inadequate. We observed improvements in the décor of three lounges with upgraded furniture and the kitchen was much improved, however, issues identified included wound care, staff training, reporting and analysis of accident and incidents and medication management, these were areas of concerns at the last assessment. Assurances were not gained at this visit.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We were not assured regarding the reporting of accidents and incidents and reporting of bruising, we observed bruising and a fresh small skin tear that was not reported and not evidenced on records, a safeguarding referral was made by the inspection team. Incidents were not always accurately recorded. The provider recorded incidents on multiply documents including, the incident and notification summary, the person centred software (PCS) and the notification and safeguarding tracker. There was an absence of root cause analysis of accidents or incidents to include organisational analysis and no documented preventative measures. Lessons were not learnt to continually identify and embed good practice.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We were not assured regarding safeguarding practices, including the reviewing information we conducted off-site. We identified incidents which required safeguarding referrals which had not always been referred or documented within the providers notification and safeguarding tracker. We referred numerous incidents to the local authority safeguarding team. Two safeguarding referrals were made by the inspection team due to unreported incidents and staff observed using inappropriate moving and handling techniques. However, staff safeguarding training compliance was at 83%. The provider had also demonstrated their recent piece of work on translating the safeguarding policy and procedure to other languages.

We were not assured regarding wound care management, there were differing internal interpretations of what a wound was, skin tears were not always managed as wound care. Internal dialogue, clarification and communication was required on the processes to follow. The recording for the management of wounds needed improving. For example, actions taken needed to be recorded on wound management plans. The wound tracker was not correctly reflecting actual wounds in comparison to peoples wound plans and the risk register was not fully accurate. Care plans were not always reviewed, and risk assessments were not always updated after people experienced falls and choking incidents. There was ineffective monitoring and oversight for a person who smoked, they had a cigarette lighter observed on their person which contradicted their smoking risk assessment.

The provider did not detect and control potential risks in the care environment. They did not make sure facilities and equipment supported the delivery of safe care. Empty bedrooms on 2 units were used to store equipment that were not secure. This included a room being used while the refurbishment was in progress, this had unsecured items in there. Out of use toilets were being used to store equipment which was unlocked, we observed a person accessing these rooms and using the facility. This posed a safety risk if people were to enter these unlocked rooms. Audits were not in place to monitor and check medical assessment equipment, this meant that medical equipment were not checked regularly for their effectiveness.

The provider did not make sure there were enough qualified, skilled and experienced staff, we observed staffing levels not safe at times. They did not make sure staff received effective training in moving and handling of people. Moving and handling training concerns were identified at the previous inspection. At time of the assurance visit 54% of staff were assessed as competent and had completed training. 46% of staff were rostered without the required training, this included nurses. We observed poor moving and handling practice; a safeguarding referral was made at the time of assessment by the inspection team. Staff did not have their competency assessments for the use of topical medications and the use of food and fluid thickening agents assessed. Staffing placement, supervision of people and staff visibility was ineffective and unsafe at times during observations. A staff member was observed asleep on duty in a main lounge who was meant to be supervising people.

The main kitchen was found to be much improved from the last inspection, three lounge areas were much improved and had been refurbished with new furniture in use. However, the provider did not manage the risk of infection effectively. Equipment was found to be soiled and requiring a deep clean, peoples pressure cushions for their wheelchairs required a deep clean, mattresses required cleaning and bedding needed to be changed as this was unclean., On the second day of the assurance visit, a mattress required replacing due to being malodorous. Kitchenette areas on units were dirty and stained. Food was stored in a fridge with no opening dates and included out of date food.

Records showed some people had not been given their medicine as there was no stock available to administer to them, placing their health and well-being at unnecessary risk. We found medicines to be given before or after food were not given following the manufacturer’s instructions so there was a risk they might not work effectively.

When people had thickening powder added to their drinks to prevent choking, the records showed they were not always thickened to the correct consistency which placed them at risk of choking. We found the thickening powder for people with swallowing difficulties was not always stored safely placing people at risk of harm. Several people were prescribed ‘when required’ medicines, person centred information to support staff to safely administer these medicines was not always available so there was a risk people might not have got their medicines when they needed them. Audits had been completed however; they had not identified the concerns found during the assessment. Therefore, we were not assured the audit processes were identifying and driving forward improvements needed. The provider was working with healthcare professionals to improve the management of medicines. When people were expressing feelings or an emotional reaction and were given a medicine to help them with those feelings, the reason for the medicine being given was not always recorded. Therefore, there was a risk people were being over sedated. When people had their medicines covertly, hidden in food and drink, there was no documentation to support staff to give the medicines safely. When people were prescribed topical preparations for example creams, the records were not accurately completed, placing people’s skin at risk of damage. Waste medicines were not always stored securely in line with national best practice guidance. The systems to ensure people always had their prescribed medicines available to be administered were not safe and effective.