Winsford Grange Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People did not always receive person centred care. People care plans were not always accurate and up to date so did not fully reflect peoples physical, mental, emotional and social needs. Care was task focused as opposed to genuine person-centred care. Communication between staff was poor placing people at risk of not receiving continuity of care. Care plans were not updated following a change in need therefore people were at risk of receiving care that was not responsive to their changing needs. People and relatives were not aware of any meetings for information to be shared and for feedback to be provided to drive improvements. Processes did not always ensure information about people met data protection legislation requirements; we observed personal information about people being left in communal areas. Relatives did not always feel listened to, and feedback was not actioned. Staff informed us they did not always have the time to respond to people needs including providing them with a shower or bath. One staff member told us, “Sometimes it's as late as lunchtime before we can get people up.” The service did not demonstrate it was inclusive, People with complex needs were not always provided with the same opportunities as people who required less support. We observed people who required support with mobilising and accessing activities not being encouraged to participate however those people who were independently mobile were encouraged.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found people did not always experience care that was person centred as staff lacked sufficient information on people’s individual needs, wishes and preferences. People's feedback demonstrated people were not involved in regular discussions about their care and progress. This did not show people were at the centre of their own care.

There was no effective or consistent leadership. One staff member informed us they would consult a manager for advice, but were then redirected to another staff member, who ultimately sent them back to the original manager. This resulted in a haphazard and uncoordinated approach to meetings people's needs.

People’s care plans were not always accurate and up to date, so did not fully reflect people’s physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. People’s care records did not evidence they were regularly involved in planning and making shared decisions about their care and treatment, so it was centred around them and their needs. We observed care to be ‘task orientated’ as opposed to people receiving genuine person-centered care. For example, people did not appear to have a choice about where or how they wanted to spend their day or eat their meals.

We were not assured people received well-coordinated and consistent care from staff. One relative stated they had to request their family member sat in the lounge with other people to prevent isolation and told us “we ask can we get him out of bed”.

Staff told us that communication was poor. They gave differing views on adequacy of shift handover, on one unit the nurse told us that handovers continued despite changes to staff working conditions. Another staff member told us that handovers did not take place anymore and referred to reading the handover sheets to find any information out and these were not always completed. This lack of effective handover was likely to be a contributing factor as to why people’s care and treatment was not always delivered in a way that met their needs or was sufficiently responsive when needs changed. Two House keepers made disparaging remarks about agency staff because they lacked knowledge of people's basic care needs.

Partners were concerned regarding the level of care people were receiving and the lack of engagement. Partners were concerned regarding the inconsistencies in people care plans.

Processes did not always ensure people received continuity of care and treatment. People’s care records evidenced that decisions had been made about people’s care without consulting relevant external agencies. This meant care was not always co-ordinated and responsive. For example, decisions about the consistency of people’s fluids and decisions to crush up people’s medicines. This meant people were at risk of choking or receiving medicines which were unsafe as they were not suitable to be crushed. People's care records did not contain any information regarding the location of ‘hospital passports." Hospital packs could be generated to provide 'live' information however, this information is reliant on care records being updated and an accurate reflection of people's needs. We found evidence care plans were not always updated following a change in need and did not sufficiently guide staff on a persons current care and support need. This meant people were at risk of receiving care which was not responsive to their changing needs.

People and relatives were not aware of any meetings for information to be shared. Staff had not received specialist dementia training meaning communication with people living with dementia was difficult. Written information about people's needs was not accurate or up to date. This meant if people or other professionals requested this information, their health and care records were not a true reflection of their needs.

Staff informed us there were no staff meetings to attend and they did not have access to their rota in advance. Some people's personal information was found in public places within the home, this included the front entrance. There was a lack of staff supervision, lack of staff meetings and information sharing was poor.

People's care plans contained information and guidance for staff on how to best communicate with the person in a way they understood, and which met their communication needs. However, people's care records did not evidence these needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. Processes did not always ensure information about people met data protection legislation requirements; we observed personal information about people in the reception area of the home.

People told us they were not involved in creating their care plans, one person told us “not seen my care plan and (they) don’t talk about my support.” Relatives told us feedback to staff is not actioned. One relative told us they had raised a concern with the management team and this had not been dealt with, they had not received any feedback. People and relatives informed us there were not enough activities, one relative told us “use it or lose it. I don't feel like there is any interaction” and another told us “there are long in-betweens before they get something else.”

Staff gave competent answers around the provision of person-centred care. However staff told us, they didn't have the time to sit and listen to people. One staff member told us people just need staff to sit with them and talk about things they like. Staff were never asked for feedback.

Processes were in place to ensure people knew how to give feedback about their experiences of care and support including how to raise any concerns or issues and could do so in a range of accessible ways. Processes did not always ensure learning from complaints and concerns was seen as an opportunity for improvement.

People expressed they had access to GP but not other services. Some people needed their glasses fixing or dentures replacing, these had not been acted on. Some people were waiting for an optician and did not know when they were visiting.

Staff gave competent answers around the provision of person-centred care. However some staff told us people with complex needs did not get the support they required and were sometimes excluded from activities as they did not have the number of staff required to support them safely.

Partners were concerned regarding the lack of support provided to people living within the service. There was minimal interaction from staff and people did not have access to regular activities.

Processes did not always ensure peoples’ care, treatment and support was accessible, timely and in line with best practice, quality standards and legal requirements. We observed examples where people were waiting for care and support. Staff shared with us they didn't always have the time to bath or shower the person, or often, people were not washed and dressed until late morning or sometimes as late as lunchtime. Processes for monitoring the quality of care had not been effective at identifying this as an area for improvement. The service did not ensure that all people, regardless of their communication abilities, had a voice in their care and could access advocacy services if needed. The service did not demonstrate it was inclusive. Some people with complex needs were not provided with the same opportunities as those people whose required less support, this included access to activities within the home and choice of care and support, particularly for those people who could not communicate verbally.

People and their relatives were not always happy with the service provided. We found people had not always been listened too and had experienced an inequality in their experience due to not receiving care and support to meet their needs.

Whilst nursing staff gave competent answers to questions around person centred care, they were concerned as to how a lack of resources and poor communication impacted on their ability to provide co-ordinated care and support from a team of staff that worked well together with the benefit of shared aims and objectives. Staff told us that they had not always had opportunity for debrief to discuss incidents with the team. A nurse lacked information about a recent significant event and told us the manager had held a group supervision the evening before about continuing concerns raised by the LA but had said nothing said about Lessons learned.

Care plans did not evidence people’s involvement in either their care plans and the setting of meaningful goals and outcomes as part of care planning. We could not be assured that people were empowered by the provider to properly give their views.

People were not encouraged to plan for the future. Some care plans in place stated, “did not want to talk about this at this time.” However there was no evidence attempts were made to discuss this at a later date.

Although nursing staff understood the importance of person-centered care, it was challenging to implement due to the staffing levels. Staff informed us end of life care plans were in place but could not demonstrate an understanding of people needs when approaching their end of life.

Although peoples’ care plans contained information about their wishes for end-of-life care, we could not always be assured people were supported to make choices about their future care. Reviews of care did not evidence that people had been involved. We heard from a relative about a person whose end-of-life wishes had not been adhered to.