Winsford Grange Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Most people and their relatives told us the staff were kind, caring and respectful. One person told us, “The carers are fantastic.” However, we observed some people being left in an undignified way due to staffing levels. People were left waiting for support with personal care. One person was told to “wait” for the toilet and “have a cup of tea.” We observed some people being visibly distressed and staff did not have the time to comfort or reassure them. One staff member told us, “People just need someone to sit with them and spend time with them, they are bored.” Permanent staff knew people well and knew what was important to them however agency staff were not provided with the time to read peoples care plans and to get to know their likes and dislikes. One relative told us, “[staff name] been here 3 days but he doesn't know my [relative], I always go to someone else first”. Two of the bathrooms within the service were out of order this resulted in people having to use another bathroom outside of their unit. People were not always given a choice of what they wanted, and independence was not encouraged. We observed 2 people wearing damaged clothing, 2 people being left without socks due to there being none available and meals being given without them being informed what it was. The visiting policy ensure people could maintain relationships and networks important to them. Staff did not feel supported, one staff member said, “morale is very, very low, reason is due to staffing levels, staff are exhausted and can’t provide care.” Staff were not given the time to have a break, one staff member told us, “I have had10 minute break during a 12-hour shift” another staff member told us, “I have my break with the residents, it means I can sit with them and can see what is going on.”

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people and relatives told us staff were kind, caring and respectful. Comments included “they (staff) are nice, treat me well - have a little bit of banter with them” and “the carers are fantastic”. One relative told us “staff are very caring and loving.” However, some relatives did not feel all staff knew their loved one well. Staff were observed telling people to wait for the toilet.

None of the staff spoken with had any idea about the home's, values, beliefs, or evidence-based care practice. They told us that these were never raised as an issue or promoted in any way by the registered manager or representatives of the provider. Nurses assumed that care would be based on a person-centred approach to care such as Roper Logan and Teirney Activities of Daily Living . One nurse said, “I could guess they're similar to every care home, but I don’t know them, not put on agenda at staff meetings, never discussed at supervision". No evidenced based approach to care of people with dementia or distressing behaviours. Another nurse said: “It very vague on what are the home's values there is a lack of any model of care practice, never raised or promoted in anyway I am aware of. There is very little support for the manager. The manager tries with very little support or input from senior managers. There is a lack of overall supervision”.

Partners told us they had observed positive interactions between some permanent staff and people who lived within the service however, due to staffing levels, staff did not have the time to spend with people which meant people's needs were not being met.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed staff not interacting or engaging with people when sat in the lounge. Whilst some staff showed warmth and were inclusive, other staff did not listen when people spoke to them. We observed people waiting for prolonged periods of time to receive personal care and attending the toilet. We observed people who were visibly distressed, and staff not having the time to comfort or reassure people.

While the people we spoke to expressed that they were generally happy with their care, our assessment found due to staffing issues, staff could not give individual care and attention. One relative told us “(staff name) here 3 days but he doesn't know my dad, I always go to someone else first”.

A nurse told us that they get to know them, what they like the way they like it. One staff gave examples one person smokes, and it is important to her, another person wears lipstick, and this is important to her. They said I can tell you something personal to everyone on this unit. Another staff member told us how on the 1st to the 15th day of every month they have resident of the day on every unit, where they focus on each person in turn ensuring that their care plans reflect their needs, and their needs are met. Some staff told us they didn’t have the time to get to know people or spend time with them. One staff member told us, “People are just bored they need us to spend time with them, but we just haven’t got the time.” Staff told us an information board in the unit’s kitchenette had been removed. This detailed who had allergies, diabetes and which cups to use which corresponded to the names of individuals and room numbers. This had been replaced with an International Dysphagia Diet Standardisation Initiative (IDDSI) poster which detailed the food textures and drink thicknesses to improve safety for individuals with swallowing difficulties. Agency staff no longer knew vital individual information.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed staff were rushed and did not have time to engage with people. One staff member sat in the lounge and did not engage with people unless they were asked a question.

Processes did not always ensure people were treated as individuals in their day-to-day care and support. Audits had not effectively highlighted shortfalls with the environment. For example, on some of the units the bathrooms were not in working order. Processes did not ensure staff responded to peoples’ needs quickly and efficiently, especially when they were in pain, discomfort, or distress. We witnessed people in visible distress, the lack of staff meant people were not comforted or reassured in a timely way. We asked for call bell monitoring audits to check if the provider quality monitored people’s waiting times for care, but they were not provided to us.

Most people felt they had independence, choice and control, however, our assessment found people could not freely go outside when they wanted to. Activities were arranged for most days, however, we were not assured everyone had access to these activities or that the activities were tailored to individual needs. There were no activities in the evening.

There was no mention of values, beliefs or evidence-based models of care. Staff relied upon conventional wisdom, humanity, and prior training to inform care practice. One Nurse explained, through her own learning she was aware of “Making every relationship matter” and went on to give a competent answer regarding person centred care through involving people and families in the assessment through to involving them in care planning and review to ensure care is provided in the way they want it to be provided and their needs met.

Through observation we identified people were not always given choice. One person was distressed as they had no socks on and there were no socks available for them to wear. We observed people not being given choice of what they wanted at mealtimes. We observed some people who were not able to communicate verbally were provided with meals that were poorly presented. The staff were unable to inform us or the person being provided with a meal, what it was they were eating.

Processes did not always ensure people were supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. Peoples’ care records did not evidence that their understanding of their care and treatment was reviewed. The visiting policy ensured people were supported to maintain relationships and networks that were important to them. People had access to their friends and family. Processes did not ensure people had access to activities and the local community to promote and support their independence, health and wellbeing. Staff numbers and deployment did not facilitate this practice. Systems and processes did not ensure there was a range of appropriate equipment to support and maximise people’s independence and outcomes from care and treatment. Peoples’ care records lacked details and guidance for staff about what equipment should be used to mobilise people safely.

People we spoke to expressed that they were generally happy with their care. People told us that on the whole staff responded quickly to their calls. One person told us “have used call bell and they come quick”. However we observed people distressed and having to wait for their needs to be responded to.

Staff raised concerns about a lack of staff resources and how this impacted on their ability to meet people's needs. Two staff gave examples as to how they had raised concerns with GPs and other care professionals to ensure people's needs were met.

We observed there were not enough staff to attend to people’s needs, views, wishes and comfort. Staff did not have the time to treat this as a priority and were not able to anticipate peoples’ need to avoid any preventable discomfort, concern or distress. Staff did not have the time to observe, communicate and engage people in discussions about their needs. We observed people to be visibly distressed, anxious, upset and left in an undignified way during our assessment and staff not having the time to address this in a timely way.

Staff told us that staff support systems were almost non-existent resulting in low morale and high levels of absenteeism. One nurse said: “One Staff meeting in 14 months- not good enough, not useful, nothing changes anyway, communication is staff to staff not management led. Another staff member when asked about staff morale said “very very low, reason staffing levels exhausted staff can't provide care”. One staff member told us they only had a 10 minute break during a 12 hour shift; we observed 2 hot drinks they had made prior to their shift at 8am, still sat on the side (cold) at 1.40pm untouched.

Processes did not ensure that people receive safe, effective and person-centred care as the provider did not recognise and meet the wellbeing needs of staff. Staff numbers meant that staff did not always receive regular breaks. Processes, such as staff supervision and appraisal, did not always ensure staff had regular opportunities to provide feedback, raise concerns and suggest ways to improve the service or staff experiences. Staff told us they were stressed and were not fully supported despite struggling with the workload. This meant people were not supported by staff who felt valued by their leaders, meaning people were at risk of not receiving a positive experience.