Archived: Winsford Grange Care Home

We found the following examples of good practice.

Infection control policies and procedures were in place. Risk assessments had been carried out and zoning measures were in place along with the cohorting of people to reduce the risk of infection spread. The provider had implemented a “Gold command” team to guide and support the home during the outbreak.

The service was clean and tidy, and processes were followed to ensure cleaning tasks were consistently completed. Equipment was being utilised to ensure areas were sanitised. Appropriate testing was being carried out and results were swiftly acted upon as required.

Personal protective equipment (PPE) was available throughout the service. Staff were wearing appropriate PPE in line with government guidelines. Staff had completed infection prevention and control (IPC) training.

Procedures were in place and followed to ensure any visits were undertaken in line with guidance. An anti-viral dry mist tunnel had been introduced for visitors to use on entry and departure of the building.

Ongoing supernumerary time had been assigned to the clinical leads, to enable them to focus on training, guidance and monitoring of practice and procedures around IPC.

A fortnightly webinar had been introduced for friends and family to share information and updates and also enable people to ask questions. The registered manager had worked closely with other stakeholders, such as the Local Authority and Public Health England.

Further information is in the detailed findings below.

Winsford Grange is a purpose-built care home for up to 60 people across four separate units. The service provides nursing care for frail older people and people with dementia. At the time of our inspection there were 36 people being supported across three units as one unit remained closed.

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

Since the previous inspection a new manager had been recruited, along with a non-clinical lead and nurses. The manager showed great awareness for the changes needed in order to improve the quality of the service and the care being provided. They had good insight into the previous issues and the impact this had on staff morale and was working to change this.

Staff told us that a long history of inconsistent management had resulted in a lack of faith and trust. They recognised the changes being made were required in order to improve care and clearly understood the new manager’s vision and values to provide people with the best care possible. It was evident there was a strong desire amongst all staff and managers to promote a person-centred culture.

Whilst there were enough staff on duty, a lack of team work and support from some senior staff and nurses created additional pressure on care staff and resulted in people receiving task-based support. The service used agency staff to cover gaps in staff levels; some agency staff were not familiar with the people they were supporting. Regular staff told us they felt rushed and at times unable to provide the person-centred care that people deserved. The manager was aware of the staffing issues and was working to address this through the changes being made.

People told us they felt safe living at Winsford Grange and family members were confident their loved ones were well looked after. Care plans provided staff with the information they needed to help keep people safe from harm and they knew what action to take if they had any concerns. Appropriate equipment was in place to support people’s mobility and alert staff to any concerns.

People’s medicines were managed safely by nursing and senior staff who had received appropriate training and who had their knowledge and abilities checked regularly by the manager. Where people received their medicines covertly (hidden in food), appropriate records had been completed and professionals involved in the decision making process.

People’s individual needs had been fully assessed in line with current best practice guidance. Care plans contained information and for staff to follow in order to provide safe and effective care. Where people received additional support from other health and social care professionals, this was clearly recorded and staff followed the guidance provided.

Meals were provided by an external food supplier who was aware of people’s individual dietary needs and requirements. Where people required additional support with their meals, staff provided this. Risks associated with poor food and drink intake were clearly recorded and guidance in place for staff to follow.

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.

Despite the low staff morale, people continued to receive kind, caring and compassionate care. It was evident that staff knew people well and were keen to give the best care possible. People and family members spoke positively about the caring nature of staff. Family members told us they felt welcome when visiting loved ones.

Care plans were in the process of being updated to provide more person-centred information. Those looked at contained detailed information about people’s life histories to help staff get to know people before providing support. People had access to a range of activities; the new activities coordinator was in the process of researching and implementing activities that provide better outcomes for people living with dementia. They showed passion for their role and were keen to improve this aspect of the service.

The service worked closely with health and social care professionals and community groups to help promote better outcomes for people and ensure their health needs were met. Regular meetings were held to enable people, family members and staff to provide their views about the service.

Effective systems were in place to check the quality and safety of the service. Regular checks and inspections were completed by the manager and provider and action plans created to aid improvements. There was a strong desire amongst the manager, clinical lead and quality business partner to improve 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): The last rating for this service was requires improvement (report published 9 January 2019). There were multiple breaches of regulation. The provider completed an action plan 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 regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected - This was a planned inspection based on the previous rating.

Follow up - We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Since the previous inspection the registered provider has worked to address the issues identified to ensure a more person centred, effective and safe service for people living at Winsford Grange.

The current registered manager has been in post since October 2018 and is supported by an interim manager, clinical lead, area manager and the registered provider's quality team. Since their recruitment into the role the registered manager has made numerous improvements to the service. These improvements remain on-going.

The new leadership of the service now promoted a positive culture that was person centred and inclusive. People and family members commented on the previous concerns about the service but were aware of the current improvements being made. Staff described the registered manager as supportive and approachable. The management team showed a continued desire to improve on the service and worked closely with other agencies and healthcare professionals in order to do this. Effective systems were now in place to check on the quality and safety of the service and improvements were made when required.

Whilst improvements had been made, we identified a continued breach of regulation in relation to records and safe care and treatment.

People told us they felt safe living at Winsford Grange. In the majority of cases risks that people faced were identified through assessments and measures put in place to manage them and minimise the risk of harm occurring. However not all risks assessments had been fully completed and some potential risks had not been assessed and planned for. The registered manager was in the process of updating care records and assessments to accurately reflect people’s needs.

Most aspects of the environment were safe however some environmental safety issues were identified that could place people at risk of avoidable harm. These issues were in the process of being addressed by the registered manager. People had access to appropriate equipment where needed. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received their prescribed medicines at the right time.

The recent recruitment of permanent staff and the closure of one of the units within the service had helped to ensure that sufficient numbers of suitably qualified and skilled staff were deployed to meet people’s individual needs. The service had previously relied heavily on the use of agency staff to cover shortfalls in staffing numbers, however this had since reduced. Staff received a range training and support appropriate to their role and people's needs.

Staff showed genuine motivation to deliver care in a person-centred way based on people’s preferences and likes. People were treated with kindness, compassion and respect. Staff used techniques to help relax people with positive outcomes. Staff had developed positive relationships with people and some family members and were seen to display kind and compassionate support to people.

People’s needs and choices had not always been assessed and planned for; some care records lacked detail in relation to some aspects of people’s care and support needs. Most care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us they received all the right care and support from staff who were well trained and competent at what they did. People received the right care and support to maintain good nutrition and hydration and their healthcare needs were understood and met. People who were able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interest in line with the Mental Capacity Act.

People received personalised care and support which was in line with their care plan. However, some care plans lacked detail in relation to people’s care and support needs. This was currently being addressed by the registered manager. People, family members and others knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

Rating at last inspection: Inadequate (Published 27 June 2018)

About the service: Winsford Grange is a purpose-built care home for up to 60 people. The service provides nursing care for frail older people and people with dementia. There are four separate units. During inspection 40 people were being supported over three units as one unit has recently been closed.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved from inadequate to requires improvement and has been taken out of special measures.

Enforcement: You can see at the end of the report what action we asked the provider to take.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. We will meet with the registered provider to discuss how they plan to address the issues identified during this inspection.

At the last inspection on the 24 and 25 March 2015 the service was rated as good. We did however ask the provider to take action to make improvements in relation to capacity and consent. We found at this inspection that the required improvements had been made.

During this inspection we found multiple beaches of the Regulations in regards to safe care and treatment, personalised care, dignity and respect, record keeping and good governance.

Winsford Grange Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Winsford Grange accommodates up to 60 people in one building across three separate units, each of which have separate adapted facilities. At the time of the inspection 57 people were living at the service.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Management of medicines was not safe. Medication was not checked to ensure that it was in date and stored correctly. Adequate information was not available to staff to ensure that medication was correctly administered.

Where risks to health and welfare were identified, robust risk assessment and management plan were not always in place to assist staff in minimising the risk of future harm. Equipment used to manage the risk of developing pressure ulcers was not checked to ensure it was set correctly.

Care plans were in place which aimed to assist staff in providing the correct level of care and support to a person. These however were not accurate or up-to-date. This meant that there was a risk that staff less familiar with the person may not provide the right level of care treatment. Other records, used to evidence care provided were incomplete. Therefore, we could not ascertain whether people had received care and support to meet their needs.

People who used the service and their relatives described it as being "unsafe" due to their concerns about staffing levels. People did not receive their care in line with the needs and wishes. At other times, a person's dignity or respect was compromised due to interventions or lack of response by staff. The register provider could not demonstrate that staffing levels were sufficient to meet people’s needs.

There was a lack of stimulation and social engagement for people throughout the day. People and relatives commented that there were long periods of the day with nothing to do. We made a recommendation that the registered provider undertake a review of activities to reflect the needs of people at the service and best practice guidelines.

The systems in place to monitor the quality and safety of the service were ineffective. Where issues had been identified action had not been taken by the register provider to make positive changes in a timely manner. Audits undertaken by the registered provider failed to highlight a number of concerns which we found at this inspection.

People received meals that were nutritionally balanced. However, people felt that there was a lack of choice in regards to their meals. We observed that some people went a long period without food or drink. Staff did not keep accurate records detailing what a person ate or drank throughout the day which meant there was no guarantee that people had been provided with the food and drink they needed to keep them healthy and well.

Staff had an awareness of the Mental Capacity Act and how it impacted on their work. They knew that sometimes they were required to make decisions in a person's "best interest". Mental capacity assessments had been undertaken and where appropriate best interest decisions which were made on behalf of people were documented. Where restrictions have been placed upon a person's liberty, the deprivation of liberty safeguards had been requested. Staff were aware of what this meant for the person in regards to their care.

People complimented staff that provided their support and told us that they were kind, caring and very hard-working. People capable in the latter days of their lives and relatives commented that this was done with dignity and respect. Staff worked closely with colleagues such as district nurses, dieticians, tissue viability nurses and social work staff in order to meet people’s end of life needs and wishes.

Staff underwent induction training and received on-going training in relevant to their job role. Staff were encouraged to take on new roles and responsibilities. People felt confident that the staff caring for them have the right skills and knowledge to do so safely. Staff had not received a one-to-one supervision in line with a registered provider’s policy, however this was being addressed.

Staff had an understanding about safeguarding people and keeping them safe. Concerns reported to the management, to the local authority and the CQC where appropriate. Staff did not always feel able to raise concerns with the management team and a consequence a number of whistleblowing concerns had been raised with the CQC.

The service is advertised as a dementia specialist service. We found that the environment was not dementia friendly and not sufficient adaption had been made to aid and support people who are living with dementia.

Checks were undertaken to monitor the safety of the premises. This included ensuring that utilities such as gas, electricity, water, electrical equipment were serviced checked and repaired. A fire risk assessment had recently been updated and identified a number of areas required in order to keep people safe. A remedial action plan had been developed to monitor the required changes.

Processes were in place to ensure that staff recruited were of suitable character and skilled for the job role. The required pre-employment checks had been carried prior to each member of staff starting work at the service.

There was a complaints process in place which people were aware of. However, only written complaints were treated formally, logged and responded to. Some people felt that their verbal complaints not listened to and acted upon. We made a recommendation that the registered provider review how they record and respond to all complaints.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

'The staff are very caring. When I was ill one night, they were with me all night.'

'I am getting the help I need.'

'The staff are lovely. I enjoy the food. If I need help I don't have to wait long.'

We spoke to five relatives who described the staff as supportive and caring. Some comments made were: -

'The staff are lovely. They are very kind.'

'The staff know my relative and she knows them. She's very settled. Staff always speak pleasantly to her.'

We observed that staff were respectful and caring towards the people who used the service.

The expert by experience considered that the home was well managed and that the people who used the service and relatives were very happy with the care and support provided and with the standards of the home environment.

We found that people had been assessed before they began to use the service and they had care plans that identified their needs and how they were to be met.

The home was clean with good systems in place to promote infection control.

The staff were provided with the support they needed to enable them to meet the needs of the people who used the service.

There were systems in place to monitor the quality of the service which meant that any shortfalls could be identified and improvements made when necessary.

We spoke to three relatives who told us that they were happy with the care and support provided. They said they were kept informed about their relatives' well-being. They described the staff as professional, caring and attentive.

We spoke to one professional who had made placements at the service. They said that a good service was provided at the home.

There were practices in place to ensure that the people who used the service were respected and that they were involved in the delivery of the service they received as far as this was possible.

Records showed that people had been assessed before they began to use the service and they had a care plan in place enabling staff to identify and address their needs.

The staff were provided with the training and support they needed to enable them to meet the needs of the people who used the service.

We found that there were good systems in place to monitor the quality of the service. Where issues had been identified action was taken to address any shortfalls.