Archived: Withy Grove House

Withy Grove House is registered with CQC to accommodate up to 54 people on two units, each of which have separate adapted facilities. One of the units specialises in providing nursing care to people living with dementia. At the time of the inspection there were 31 people living in the home.

At the last comprehensive inspection 24 and 27 July 2018 inspection we found that Withy Grove House was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, the need for consent, person centred care and good governance. The service was rated inadequate and placed in special mwithin this time frame. During this inspection the service demonstrated to us that improvements had been made and it was no longer rated as Inadequate overall or in any of the key questions. Therefore this service is now out of special measures.

After the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. We found improvements had been made in all domains and the six breaches of regulation from the previous inspection had been met. Work needs to continue to show all the improvements can be sustained in the long term.

People’s experience of using this service

•Relatives told us the home had “improved immensely” since the last inspection. People told us they were aware of and appreciated the improvements that had been made to their home to improve their environment and care.

•People commented positively on the improvements in the standard of care and the quality of staff. Everyone felt they or their relative were safe and that the home was meeting their needs.

•The environment had been improved to support people living with dementia. There was signage to help people to find their way about their home and promote their independence.

•Staff were more aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care.

•People received their medicines when prescribed and these were stored safely. However, medicine allergies were not consistently recorded. This could put people at risk of receiving inappropriate medicines. We have made a recommendation about this.

•Staff had received training on safeguarding people from abuse and knew how to raise concerns to keep people safe. Risks to people were assessed and action was taken to address them. There were enough suitable staff working to support people safely.

•Care plans had been improved to provide more detailed information about people and their care needs and behaviour management. Risk assessments were being done and recorded in care plans along with the action to be taken to try to mitigate identified risks.

•Assessments obtained from other health and social care professionals were being used to plan care for people.

•Accidents and incidents were monitored to see if lessons could be learned and changes made to help keep people safe.

•The cleanliness of the home had improved. Effective infection control procedures were in use.

•Staff were receiving training appropriate to their roles and supervision was being given to support staff development and performance.

•People enjoyed the meals and their dietary needs and nutritional risks were being assessed and monitored. Pureed diets were provided but not well presented in an appetising way. We made a recommendation about this

•Weights were monitored but there were some people whose weight monitoring had been inconsistent. We made a recommendation about this.

•People told us they were given choice over their day to day lives and supported to maintain their independence.

•Staff were knowledgeable about people and their needs and care plans had been reviewed and updated

•There was a limited range of activities on offer but staff encouraged people to participate in things of interest to them.

•The service displayed the latest rating at the home and on the website. When needed notifications had been completed to inform us of events and incidents and this helped us to monitor the action the provider was taking.

•We could see the registered provider interim management team and staff had been working hard to complete the action plan they had for improvement.

Rating at last inspection: Inadequate. (The report was published 5 September 2018).

Why we inspected: This was a planned comprehensive inspection based on the rating of Inadequate at the last inspection.

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

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

At the previous comprehensive inspection in July 2018 we found that Withy Grove House was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, safeguarding service users from abuse and improper treatment, the need for consent, person centred care and good governance. The overall rating for the service was 'Inadequate' and the service was therefore placed 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 receive a comprehensive 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 insufficient improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Following that comprehensive inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. The registered provider has provided an action plan and this is ongoing and being updated as actions are completed.

We undertook this unannounced focused inspection of Withy Grove House following receipt of information from people about the service regarding standards of care, nutritional support, the management and oversight of the service, staffing levels and skill mixes and safeguarding. We also wanted to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection were being made.

The team inspected the service against two of the five questions we ask about services. Is the service safe and is the service well-led? This is because the service was not meeting some legal requirements.

Withy Grove House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Withy Grove House is registered with CQC to accommodate up to 54 people in two units, each of which have separate adapted facilities. One of the units, on the ground floor, specialised in providing nursing care to people living with dementia and the first-floor unit was for residential use. At the time of the focused inspection there were 38 people living in the home with 18 on the nursing unit and 20 on the residential.

We could see that an experienced interim management team had been put into the home to support improvement and gradual progress was evident to meet the action plan provided by the registered provider. However, the home remains in breach of Regulation 12 [safe care and treatment] Regulation 13 [safeguarding service users from abuse and improper treatment] and of Regulation 17 [good governance].

At this inspection in October 2018 we observed that the home environment was cleaner and tidier than at our previous inspection and that it was calmer. People appeared well dressed and tidy. Redecoration was underway in areas of the home and improvements had been made to some environmental issues.

At the time of this inspection the home did not have a registered manager in post. 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. A deputy manager had been recruited and was due to take up their post.

At this inspection there was an interim management team in the home with a temporary manager, a change manager and two clinical leads were being supported by the registered provider’s regional manager and operations director. The home was still using a high number agency care and nursing staff to cover gaps in the staff rota especially on night duty but did try to use the same staff for some consistency. Recruitment was underway to establish a permanent staff group. We observed that the recruitment process for new staff needed to be more closely monitored.

This fire risk assessment completed in October 2018 had recommendations for the registered provider to address. We asked the management team to consult with and confirm with the Lancashire Fire and Rescue Service that their policies and procedures on evacuation were acceptable with them and confirm when they had met all the recommendations. We also noted an inconsistency in the fire risk assessment about the home’s maximum occupancy numbers and they needed to address this.

Medication storage was satisfactory. Quantities of medicines were being carried forward for stock monitoring apart from ‘as required or PRN medicines’. PRN protocols were not always in place for individuals prescribed 'as and when required' medications to help make sure staff knew when and why the medicine should be used. We referred this to the management team and recommended that they review this procedure to promote better monitoring.

There were procedures in place to protect people from abuse. We saw that the management team were making referrals to, and working with, the local authority where there were allegations made of abuse.

At this inspection we found the clinical lead was reviewing and rewriting care plans and these were more detailed than previously. This was still in its early stages and some information was still not being included in care plans. Risk assessments for people who lived in the home were better managed than at our last inspection but had not always been done in all circumstances to keep people safe.

We found that nutritional risk assessments were being done and the clinical lead had identified areas for improvement where risks were not being correctly calculated by some staff. Improvements had been made to the dining experience for people who lived in the home.

There were systems in place to monitor the quality of the service at Withy Grove House however there was still inconsistency in the accuracy of some records and in care planning information. An audit programme had been established but was not yet fully effective in picking up all areas that needed to improve. Relatives and resident meetings had also taken place and people were being asked for their views and ideas about the service.

Further information is in the detailed findings below.

Withy Grove House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Withy Grove House is registered with CQC to accommodate up to 54 people in two units, each of which have separate adapted facilities. One of the units specialises in providing nursing care to people living with dementia.

There was a registered manager in post at the time of our visit. The registered manager was new in post and had just received confirmation of registration with CQC. 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.

At this inspection we found that Withy Grove House was in breach six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing deployment, the need for consent, person centred care and good governance.

We spoke with the registered manager, the regional manager and the operations manager about the shortfalls we had identified in the running of the service. They were aware of the seriousness of the concerns and took immediate action to begin to mitigate the risks we had identified on the first day of our inspection. This indicated an understanding of what needed to be done and a willingness to engage with us to make the service safer for the people living there. We wrote to the registered provider and registered manager notifying them of the seriousness of our concerns. We requested that they draft an urgent action plan setting out, how they intended to address the concerns in the letter. They should respond to each concern, with a specific time frame for implementing the action, who would be carrying the action out and the action taken to mitigate the risks during the time taken to complete. They did this as requested.

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 act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This may 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. 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.

We spent time in the communal areas of the home and spoke to staff, people living in the home and their relatives. We were told by one relative that they were “Quite satisfied.” A person who lived there told us “It’s alright.” Some relatives told us that they felt they were made welcome when they visited. The service had a programme of activities and supported people to follow their own beliefs. We looked at how medicines were administered and managed within the home. We noted that whilst overall management was satisfactory there were some medicines that had been missed.

Care staff were not always being deployed in the right way and there were occasions when there were not enough care staff available to provide people with the individual assistance they needed in a timely way. There were shortfalls in the support people received to maintain their personal hygiene and to eat and drink and maintain good hydration. People were not always well supported at mealtimes to maintain their independence. Whilst some staff took time to try to engage with people not all took up opportunities for interaction with people.

We found that risks to people were not always being well managed, such as risks within the environment, checking equipment, some care practices, recognising safeguarding issues and in record keeping. The provider's lack of effective quality assurance systems meant that issues were not being consistently found and acted on quickly to resolve risk and quality issues.

Providers of health and social care services are required to inform us of significant events that happen such as serious injuries and allegations of abuse. Whilst the provider had dealt with such events appropriately they had not always notified CQC. The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process

We found that the service was not acting within the principles of the Mental Capacity Act (MCA) as they were using the most restrictive means available to them to limit a person’s liberty rather than the least. It was not always clear that decisions had been made with the involvement of relevant others with the legal authority to speak for someone else.

The care provided was not always person centred in planning care and supporting individuals living with dementia. The service did not have a dementia care strategy setting out how they care for people living with dementia. We made a recommendation that the registered provider finds out more about best practice in dementia care and communicating with people living with dementia and the importance of engaging with people whilst supporting them.

The service had a complaints process and procedure available in the home. We were told by relatives that they did not always feel the complaints process was effective. We have made a recommendation that the registered provider seeks information and guidance on the management of and learning from complaints.

We looked at the staff training records which showed what training had been done and what was required. We could see that the registered manager was trying to make sure that staff received required training and had sourced some additional training to help staff in their roles. Not all staff had received all the up to date training they needed. We found that despite training on areas of practice staff had not always applied them in practice. We have made a recommendation that the management team look at guidance and best practice on implementing a dementia strategy that supported staff training and evaluates staff training, assesses staff learning needs and the correct application of training given in practice.

Work was underway to improve the environment in the home, this included putting in new windows, getting new furniture and work was due to begin on redecoration in the home the week following the inspection. This should improve the environment for people who lived there and make it more homely and attractive.

The provider had put resources into a staff recruitment programme since the start of the year and taken on new staff. We found that recruitment procedures covered all the appropriate security checks on staff. However, there were still times when sufficient staff were not available to support people with all their needs.

You can see what action we told the provider to take at the back of the full version of this report.

The service had 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.

Withy Grove House provides accommodation for up to 54 people who require nursing or personal care. At the time of our visit there were 50 people who lived there. The home provides care and support for people with dementia or physical disabilities. Withy Grove is a converted Manor House set in its own grounds and located in a residential area of Bamber Bridge, near Preston. The home is divided into two units that are staffed separately. The ground floor unit accommodates twenty four people who have personal care and nursing needs associated with dementia. The upper floor is a residential unit and can be accessed via a passenger lift. It accommodates thirty people with personal care needs.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. People said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were knowledgeable about strategies’ in place to keep people safe. There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support this was delivered quickly.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles. Training records showed that staff had received training in a range of areas that reflected their job roles. The provider operated safe and effective recruitment procedures. Medicines were stored and administered safely.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People and where appropriate their relatives were involved in their care planning, Staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

The registered manager was supported by the proprietor who was regularly in the service and who carried out a programme of quality assurance audits to identify areas of risk, and areas to maintain performance and drive improvement. The service had an open culture where people had confidence to ask questions about their care and was encouraged to participate in conversations with staff. Staff interacted with people positively, displaying understanding, kindness and sensitivity.

Care plans were individualised and were sufficiently detailed to make sure peoples' care and support was provided according to their wishes and safety.

People were supported to be involved in the life of the home and given opportunities to take an active role in a wide range of activities such as gardening, dancing and crafts.

Family members were complementary about the service. 'You wouldn't believe the improvement in his general health and well being. He couldn't walk and now he gets about. I visit every day apart from Sunday. The thing is they are not all sitting around. All the staff gets them involved in things. The other day we had ballroom dancing'. 'Staff are very attentive keeping an eye on them all. They always keep up with assisting with personal care'. 'I do think all the staff are very nice. They are patient with people'. 'The staff are wonderful. We know they work hard and have to put up with mum's changing needs so we appreciate that'. 'They are lovely, very pleasant and the standard of food is always good'.

People received their medication when they needed it. Staff had been trained to do this safely.

The provider had an effective system to regularly assess and monitor the quality of service that people received and took into account their views.

Family members visiting the home told us they knew how to formally make a complaint. One person told us, 'Yes, but I think they are very good here. I'm sure if I did they would do something about it. I've no worries at all.' Another person told us, 'I've never needed to raise any concerns. I can tell M'. she's very good, always there for us even though she is busy. I would complain if ever the need arose'. We found comments and complaints people made were responded to appropriately.