Archived: Thelwall Grange Care Home

Thelwall Grange is a care home providing accommodation, and personal care for up to 47 younger and older adults; some of whom lived with dementia and physical disabilities. At the time of the inspection 47 people were using the service.

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

Systems and processes to safeguard people from the risk of abuse were not followed. Staff and managers had failed to raise safeguarding concerns when people had been placed at risk from harm and abuse.

Lessons were not learnt, and improvements made when things went wrong within the service. Appropriate action was not taken in response to incidents which occurred at the service and there was a failure to follow disciplinary procedures and address staff performance.

There was a failure to promote a positive culture within the service. The provider resisted information sharing and engagement with stakeholder organisations who were working to keep people safe. There was a culture of staff not reporting concerns which placed people at risk of harm and abuse. Staff told us they didn’t feel confident in raising concerns directly with the provider or managers.

We were assured that Infection prevention and control measures were followed to minimise the risk of the spread of infection, including those related to COVID-19.

Medicines were managed safely. Medication administration records (MARs) were completed with up to date information about people’s prescribed medicines and when they were given.

The recruitment of staff was safe. A range of pre- employment checks were carried out on applicants to assess their fitness and suitability for the role.

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 good (published 12 June 2021).

You can read the report from our last inspection, by selecting the ‘all reports’ link for Thelwall Grange Care Home on our website at www.cqc.org.uk.

Why we inspected

We received concerns in relation to people’s safety and the leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

Our report is only based on the findings in those areas at this inspection. The ratings from the previous inspection for the effective, caring and responsive key questions were not looked at during this visit. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

We looked at infection prevention and control measures under the ‘safe’ key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have identified breaches in relation to safeguarding people from the risk of abuse and harm and the governance of the service. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Thelwall Grange is a ‘care home’ providing accommodation, and personal care for up to 47 younger and older adults; some of whom lived with dementia and physical disabilities. At the time of the inspection 45 people were living at the home.

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

People received their medicines as prescribed, by trained and competent members of staff. However, not all medicine management policies and procedures were followed. We identified a number of administrative errors that were not being identified in the providers medicine audits.

We were somewhat assured that infection prevention and control (IPC) measures were appropriately followed. However, we provided some signposting in relation hygiene practices to prevent / reduce the transmission of COVID-19. The home itself appeared clean and well-maintained and regulatory health and safety compliance checks and certificates were in place.

The provider had a variety of governance and quality assurance measures in place; however, we did note that some areas of governance needed strengthening. We have made a recommendation regarding this.

People’s level of risk was appropriately assessed, recorded within their care records and were regularly reviewed. Staff told us they received updates in relation to people’s health and well-being in a safe and timely manner.

Care records contained relevant risk assessments and information staff needed as a measure of providing safe and effective care. One relative told us “Risks are managed really well. Staff are very attentive.”

Staff told us they felt valued and supported and people living at the home received high quality care. One staff member told us, “I believe it’s a fantastic company, staff and management are really caring, it’s homely and family orientated.” One person told us, “I enjoy being here, staff are kind and caring.”

Staffing levels were routinely monitored, and people received care and support by a consistent staff team who were familiar with their support needs. The provider prided themselves on having a full complement of staff, without having to utilise the support of any bank / agency staff. One relative told us, "There is always enough staff to sit around and talk with residents.” Recruitment processes were safely in place; people received safe care and support by staff who had been appropriately recruited.

Rating at last inspection and update

The last rating for this service was ‘good’(published 14 January 2020).

Why we inspected

We carried out an unannounced inspection to follow up on risks we were concerned about. The information The Care Quality Commission (CQC) received indicated that there were concerns around safe care and treatment and governance procedures. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the effective, caring and responsive key questions were not looked at during this visit. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

We looked at infection prevention and control measures under the ‘safe’ key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively

The overall rating for the service has remained ‘good’. This is based on the findings at this inspection. However, we did find evidence that the provider needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thelwall Grange Care Home on our website at www.cqc.org.uk.

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.

Thelwall Grange Care Home is a residential care home providing personal and nursing care and registered to support up to 47 people. There were 46 people living at the service at the time of the inspection.

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

People and their relatives gave us positive feedback about the quality of care and staff approach. We observed many caring interactions and people were treated with dignity and respect by kind and caring staff. Staff knew people well and understood how to care for them in a personalised way. Care plans were informative and regularly reviewed to support staff. 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.

People enjoyed the wide range of activities and trips on offer. There was a busy activities programme, and people were encouraged to join sessions that stimulated both their mind and kept them physically active. People had a choice of where they spent their time and were supported to remain independent.

People enjoyed the homemade meals, drinks and snacks throughout the day and their dietary needs and preferences were met. People’s needs had been assessed and planned for before they moved into the service and kept under review. Staff supported people to access support from healthcare services when needed and ensured any advice they provided was followed. People received their medicines when they needed them from appropriately trained staff.

People received safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and potential abuse. There

were systems to analyse when things went wrong to understand the cause and try to avoid repetition. People received their medicines safely from appropriately trained staff.

There were effective systems in place to monitor the safety and quality of service being provided. People, their relatives, professionals were involved in people’s care. Staff had the opportunity to give their views on the service through quality assurance surveys, the results of which were used to bring about improvements. People and their relatives felt the service was managed well and that the registered manager and staff were approachable. There was a complaints policy and we saw that procedures were followed when dealing with complaints about the service so that a positive outcome was achieved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 June 2017).

Why we inspected

This was a planned inspection based on our previous rating.

Follow up

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

This was the first inspection of Thelwall Grange following a change of service provider.

Thelwall Grange Care Home provides accommodation and personal care for up to 43 older people, many of whom have dementia care needs. Respite care is also offered. It is located in an attractive rural part of Thelwall, a suburb of Warrington in Cheshire. The service is provided by Staffordshire Care Limited. At the time of our inspection the service was accommodating 38 people.

Thelwall Grange is a three-storey building situated within its own grounds. There is a large car park at the front of the building for visitors to use and a sensory garden with seating areas at the rear of the building for people to access.

At the time of the inspection there was a registered manager at Thelwall Grange. 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.

The registered manager was present during our inspection and was supported by the owner / director. The registered manager and the owner were open and transparent throughout the inspection process, supportive towards the inspection team and were seen to interact with people using the service, their representatives and staff in a caring and helpful manner.

We saw that people living at Thelwall Grange Care Home presented as clean, appropriately dressed and happy in their appearance. Staff demonstrated an understanding of the need to safeguard people’s dignity, individuality and human rights and the importance of providing person centred and compassionate care. We saw lots of positive interactions, banter and humour being exchanged between staff and people living in the home appeared comfortable and relaxed.

Holistic assessments of need had been undertaken and care plans and risk assessments produced to ensure staff understood how to meet needs of people living in Thelwall Grange and to keep people safe.

Recruitment practices were robust and relevant checks had been completed before staff commenced work which helped to safeguard the welfare of vulnerable people. Staff also received training, supervision and support to enable them to understand their role and how to deliver person centred care.

Policies and procedures relating to the Mental Capacity Act and Deprivation of Liberty Safeguards had been developed to provide guidance to staff on this protective legislation and the need to protect the rights of people who may lack capacity. Likewise, systems were in place to safeguard people from abuse and to ensure complaints were listened to and acted upon in a timely manner.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. People also had access to health care professionals and referrals were made for specialist input when required.

There was a quality monitoring system in place which involved seeking feedback from stakeholders and people who used the service and their relatives about the service provided periodically. This consisted of surveys and a range of audits.

Medicines were ordered, stored, administered and disposed of safely.