We spoke with five people who told us that staff were always available to ensure they are assisted to get up at appropriate times in the morning. Comments received were very positive:
'Staff are great. They are always busy. No problems. They look after us well.'
'Staff are very good ' they are always around to help.'
'We still could have more staff but they are very good and helpful.'
Two people said that they sometimes get up late which was not their choice but said there are sometimes not enough staff to assist them [see outcome 13].
Those people spoken with were very relaxed around staff and said they were listened to so that any concerns could be addressed. People, when asked, said that they felt 'safe' and they were confident that any concerns would be listened to and addressed.
We spoke with the safeguarding team at Liverpool City Council and they told us that generally things had improved at Woolton Grange and that there is now more awareness amongst the managers and staff so that events are reported and there is appropriate management of peoples care needs.
We did not ask people specifically about the standards of hygiene on this visit but we were told spontaneously by some people that the home is maintained in a clean state and that they were pleased generally with the cleaning regime.
We spoke with seven people who live in the home about their medicines. One person said they were happy to let care workers manage their medicines and they left them to it. Another said they always got them at the same time of day usually at meal times and between 9pm and 10pm for their evening medicines.
None of the people we spoke with raised any concerns about the way there medicines were handled. When we reviewed the medicine records we found a number of concerns however and these are addressed in the report.
People we spoke with told us that staff were very caring and were always willing to assist them with personal care. We spoke with two people who told us that staff were not always available to ensure they are assisted to get up at appropriate times in the morning. Sometimes they can miss breakfast as they get up very late.
People living at Woolton Grange told us that generally the home is run well.
We had discussions with social service safeguarding team as there have been issues around the general management of people with dementia including the ability of the home to understand people's rights in terms of mental capacity. This was of particular concern as the home has started to admit people with dementia.
When we visited the home we asked about progress regarding providing care for people with dementia and we were advised that staff have had no training to make them more aware of the process involved in assessing mental capacity and people's rights. Care records of the people we reviewed also contained no information around these areas.
The home has developed a 'dementia care unit' in one section of the home. Following a review by social services it was felt this was inappropriate as there was a lack of adequate day space; inadequate bath and shower facilities and lack of appropriate supervision at night time. Also there had three examples of vulnerable people with confusion who had gone missing from the unit which put them at risk. Staff seemed inexperienced and not trained to care for people with dementia there were no plans to deal with people who had challenging needs.
When we visited we observed care and spoke with people. Managers had reviewed the care of people with dementia following the concerns and standards of care had improved. People we spoke with said that staff were supportive and were friendly and helpful. People were mixed in their responses to the home having more people with a level of dementia and confusion. Three people spoken with said there was 'no problem' but one person said that 'people wander at night and sometimes come in my room'.
We found some positive aspects of care for those people we reviewed and they were now included in the daily social life of the home. We found that staff had skills at approaching people with dementia although this had been learnt 'as we go along' rather than planned. We spoke with managers who advised us that there has been poor planning around taking people with dementia. They felt they have learnt and improved whilst also getting input from social services.
When we visited the home those people spoken with were very relaxed around staff and said that they felt 'safe' and they were confident that any concerns would be listened to and addressed. Relatives spoken with were also positive. All felt that staff approached care well. We remain concerned however as although there have been recent improvements overall people have not been effectively protected from poor care and treatment. Recent incidents highlighted gaps in the home's arrangements to prevent abuse. In addition there were some indicators from our visit that systems are still not tight enough. For example we looked at how accidents and incidents are monitored and although these are recorded there is currently no auditing process to look at these. This means there may be limited learning. Current evidence over the past few months suggests that risk management can be reactive rather than planned and proactive. There has been a lack of consultation with people regarding a major change to the service. The homes information has been updated to reflect the changes but we found this was not in general circulation.