Winsford Grange Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People were not involved in their care planning and decision making. Some people had restrictions placed on them without the legal authority to do so. For people who were unable to make decisions for themselves there was no evidence of engagement with family members or the advocacy service in line with the Mental Capacity Act. People's needs were not always assessed. Staff were aware of the importance of person-centred care however this was not evidenced in practice and care plans. This was primarily due to lack of staffing and resources. There was no effective handover system in place to ensure information between day and night staff was communicated. There was no evidence of team meetings taking place. This resulted in information not being shared. People did not always have access to fluids, one person told us, “when good staffing drinks are regular however when short staffed only get one drink.” Processes in place to monitor people's dietary needs were not effective. Some people received the wrong modified diet due to inaccurate recordings. Not all people had access to health professionals when required, people were waiting to access a dentist or optician. The service only employed one chef, which resulted in limited meals being provided on the days the chef was not working. One person told us, “2-3 days a week the meals drop a bit.” There were limited activities available to encourage social interaction. The service employed one activity coordinator 3 times a week. Some people were isolated in their bedrooms with no stimulation.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not involved in the planning of their care. People had not seen their care plan and were not involved in reviews. Two people said, “not seen my care plan”.

Nursing and care staff spoken with understood the principals of person-centred assessment and care however, this was not evident in their care practice, primarily due to the lack of staffing and resources. One staff member said “I will read them (Care Plans and risk assessments) depending on staffing, when short staffed no time to read them. Sadly, no handover now on handover sheets and the PCS system”.

We were not assured people had always been involved in the assessment of their need. Care plans did not evidence people had been consulted about their care and support needs. Support was not always provided where needed to maximise peoples’ involvement. Care appeared to be delivered in a way which was task focused. There were no proper processes in place to monitor that people were receiving the right care and support for their needs.

People did not always have regular access to a drink. One person told us, “When good staffing drinks are regular, short staffed only get one drink”. Most people told us they received enough food; however, this lacked variety and was served cold. One person said “2-3 days a week the meals drop a bit”. We established this occurred as the service only had one chef, the RM and care staff covered the chef’s days off.

We spoke with four staff about the home's values beliefs and evidence-based care practice. They all told us that they had no knowledge of this. One staff member told us, “It very vague on what are the home’s values, there is a lack of any model of care practice, it’s never raised or promoted in anyway that I’m aware of”.

We were not assured people received care, treatment and support that was evidence-based and in line with good practice standards. Processes did not support this practice. There was no evidence in peoples’ care plans which referred to best practice guidance. Processes did not ensure people's nutrition and hydration needs were met in line with current guidance. Peoples’ care plans contained inaccurate information about their dietary needs and requirements. This meant people were at risk of choking as there was a risk they could receive a diet which was not compatible with their needs. For people on a diabetic diet, care records did not contain guidance for staff on what this meant. For another person, kitchen records contained inaccurate information about a food allergy. Processes had not been effective in ensuring information and guidance for staff was accurate and consistent to ensure people’s nutritional needs were met effectively.

Although the provider informed us they would ensure people were supported to appointments if necessary. People told this was by family members. One person told us “I am supported with appointments; my daughter takes me”.

There was evidence that the staff group did not work together as an effective team with shared values beliefs and aims and objectives. Staff views on communication and teamwork varied. One staff member advised they were happy with communication on that unit. However, we were concerned to find that she was unaware of serious failings on the other units. A senior care worker advised communication had been hampered because there was no handover only hand over sheets and the PCS system. Staff reported that they appreciated the support of colleagues but were concerned that the registered manager had too much to do, to ensure effective communication and supervision of staff. There was a lack of induction and supervision of agency staff. Two members of the ancillary staff team said : “Agency staff approach to care is nothing, do as little as possible. “

Concerns were raised in relation to communication between staff teams and external professionals. Concerns were not reported or followed up on.

There was no effective communication system in place. Agency workers relied on permanent carers to share information with them regarding people’s needs. Handovers between day and night staff were not effective due to changes in staff hours. There was no evidence of staff meetings taking place to enable information to be shared.

People had regular access to a GP. Some activities were on during the day, however, one person told us “long time between evening meal and going to bed, no activities then just sit and watch TV” and another person told us “don't keep me active, getting depressed staying in my room”.

Staff told us that they endeavoured to support people to live healthier lifestyles despite the lack of resources they did their best. They gave examples of good practice on how they had liaised with GPs and other health professionals when people had presented as unwell. One nurse said, “The Chef is particularly good provides fresh fruit salads; she is a major asset to this home”. One staff member informed us they can't support people to live healthier lives due to lack of staff, they only get time to support people with personal care. Two staff members told us people are just left in a room with no stimulation.

Processes did not ensure people were empowered and supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. Peoples’ care records did not evidence they had been involved in regularly reviewing their health and wellbeing needs where appropriate and necessary. Because of this we could not be assured people were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. Peoples' care records did not always evidence that referrals to external organisations had been made appropriately. '

People told us “staff are good” and “room isn’t bad”, however, all people told us the service needed more staff. Comments included “more staff and more time for them” and “more staff, more competent, caring and give me more time, I can't reach my feet, and I want my slipper on”.

In the absence of management overview and supervision staff conveyed that they do their best in difficult circumstances. One staff member told us, “with staffing levels as they are, pulling on us, a tough 12 hours to meet people's needs, its second nature to a nurse but other than end of life care nothing is planned”. Staff told us they didn't have time to provide support for ensuring people receive positive outcomes. Staff priority was ensuring people had received personal care, were comfortable and fed. There was no additional time for activities and people were bored.

Processes were not effective at ensuring people received consistently positive outcomes. Processes did not ensure that peoples’ care, and outcomes were monitored for effectiveness. Peoples’ care plans did not demonstrate that reviews of care had involved them as they should.

People expressed they had choices and consent was gained. However, where people lacked capacity to provide consent, there was no evidence of engagement with family members or the advocacy service in line with the Mental Capacity Act.

Some staff were aware of the Mental Capacity Act 2005,Depreivation of liberty safeguards (DoLs) and best interest decision making. Some staff were able to tell us they upheld people's rights to refuse care and advised what action would be taken to keep people safe if there were doubts about their capacity. However, some staff lacked this knowledge and were not aware of the importance of gaining consent and steps to take to support people to make their own decisions. One staff told us, “They [person] can’t communicate’ in relation to providing consent". We observed staff not informing people of what support they were providing and gaining consent. Another staff member told us, “They haven’t got capacity.” Staff were not aware they were placing restrictions on people without the legal authority to do so. Staff were locking doors to the gardens despite people being mobile and able to make choices.

Systems and processes did not demonstrate that people understood the care and treatment being offered or recommended. We were not assured people made informed decisions about their care and treatment. Peoples' care records did not always evidence people had provided their consent. We were not assured that processes enabled the service to act in accordance with the principles of the Mental Capacity Act. For people who were not able to consent, processes did not evidence the provider was acting in peoples’ best interests. The current DoLS register was not accurate or reliable. The register contained names of people who were no longer at the service. Where people had a DoLS in place, the date of expiry had past and there was no evidence that a renewed DoLS had been applied for.