Winsford Grange Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Staff were not aware of the homes visions and values. This had not been discussed or shared with them. Not all staff had received training to enable them to carry out their role safely. We observed one staff member on shift who had not received any training. Despite being a care home for people living with dementia, none of the staff had received specific training to ensure they could meet the needs of people living with dementia. The induction for agency staff was poor, staff told us they had to tell agency workers what to do and whilst they appreciated the additional staffing it provided them with additional work. There was no evidence staff received debriefs following on from any incidents. Staff said communication was staff to staff rather than from management. There were no effective audits in place to ensure the service was operating safely. Audits that had been completed had not picked up on all the areas of concern found during this assessment. When concerns had been identified there was no clear action plan moving forward to demonstrate improvements were being made. Staff were not encouraged to provide feedback. Lack of supervision meetings, staff meetings and appraisals resulted in staff not having the opportunity to raise concerns, receive feedback on their practice and to identify any learning they may require. Accident and incidents were not analysed effectively to mitigate risks, the limited audits of accident and incidents identified most incidents took place when staff were providing support to other people. There was no action in place to look at increasing staff numbers. The service did not utilise a dependency tool to ensure safe staffing levels to meet the needs of people. There was no evidence of any learning from incidents and accidents. Reflective practice was not 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.

When we asked nursing, care and ancillary staff about the home’s visions and values, how they knew what they were and how they demonstrated them in their role they all told us they did not know what they were. 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’s very vague on what are the homes values are there is a lack of any model of care practice, never raised or promoted in anyway that I'm aware of. There is very little support for the manager. She tries with very little support or input from senior managers. There is a lack of overall supervision”.

Not all staff had received training to enable them to carry out their role safely to meet the needs of people living within the home. There was no oversight to identify gaps in learning. The induction process for agency staff was poor with a heavy reliance on permanent staff providing support. There was no evidence of any team meetings to allow information to be shared amongst staff teams and to allow for concerns to be raised. There was no evidence of any debriefs following incidents.

Staff told us that the manager did have the required skills, was approachable and supportive but lacked support from senior managers. One nurse said “problem is resources, staff and maintenance of the home and grounds. Manager tries but hits a brick wall”. They also said: Manager “is under pressure, I'm concerned about lack of supervision and CPD but understands.” Another Nurse said: “There is very little support for the manager”. Manager “tries with very little support or input from senior managers”. Another staff member told us, “ registered manager does not have the support she needs". They also said, “Park Homes is shocking I would not have applied – they don’t want to spend money”. Agency staff members told us they did not receive any induction other than the carers telling them where the fire doors were. One staff member told us, “I just ask the carers what people need, I haven't seen anyone's care plan.”

Safe recruitment processes were being followed however induction for agency was poor. Despite there being an agency policy in place this was not being adhered too. There were no effective audits in place to ensure the home was operating safely. The service was not a nurturing or supportive atmosphere. There was no evidence of supervision or appraisals to ensure staff felt appreciated and motivated. Teamwork was not encouraged due to poor communication, there was no evidence the staff team were encouraged to be involved in decisions made in relation to the running of the service.

Staff told us that they feel free to speak up and have raised concerns with the manager about lack of staffing, including housekeepers, nurses and care staff and lack of maintenance. One nurse said Manager “Tries but hits a brick wall”. Staff told us they didn’t feel listened to, one staff member told us, “I raised concerns about the staffing levels and was told we can’t use agency they are too expensive and to get on with it.”

A whistleblowing policy was in place, but there was no evidence that it was being utilised or that staff were encouraged to speak up. Due to staffing pressures and a lack of supervision, staff had no opportunity to raise concerns. There was no evidence of any staff surveys. Although coffee mornings and "Whispering Wednesday" were advertised to facilitate family and resident feedback, there was no indication that feedback was sought through other methods of communication, particularly for those unable to visit the home during the day. Feedback was not clearly documented. Coffee mornings evidenced activities that took place such as listening to music, eating cake, watching a film, feedback was not captured and there was no evidence of any suggestions or actions taken following these meetings. Concerns were raised regarding the lack of reporting. Information shared identified some staff had raised concerns and they had not been followed up on, however other staff did not realise they could speak up.

Staff told us that they had done training on equality and diversity and had no concerns in this regard. However staff told us they had not been provided with the opportunity to have supervision and were concerned regarding the lack of opportunity to complete their continued professional development. Staff informed us they did not feel they had the necessary training to meet people's needs as it was all on line.

Some staff had been subjected to incidents of abuse from people they were providing support to during episodes of challenging behaviours. There was no guidance on how to mitigate risks to prevent this from happening and there was no evidence of staff debrief following on from accidents and incidents. Staff had received training in relation to equality, diversity, and human rights. There was no evidence of any additional support for staff who did not have English as their first language.

Staff were unfamiliar with the home’s quality assurance systems. A nurse said Manager is constantly checking PCS and does come on the unit from time to time, but I am not aware of any formal quality Assurances that she undertakes. One staff told us they made mistakes as they felt, “overwhelmed.”

There was a registered manager in place however the role of deputy was vacant. The governance systems in place were not robust. Audits to ensure the safe running of the home were not always completed and there was limited evidence of any actions taken. Accidents and incidents were not analysed to ensure risks could be mitigated. Staff did not receive supervision to enable them to reflect on their practice, identify any learning needs and to raise any concerns. There was limited oversight from the provider and management team and whilst some visits were being conducted there was little evidence changes were being made to drive improvements.

We received mixed feedback from people that they received support from health and social care professionals. For example, one person said “yes they ring GP” and “not seen a dentist since being here."

Staff told us the services involve and works with relatives and advocates to ensure people's needs are met. Effective handovers were not in place therefore, information was missed and not followed up on. Some staff we spoke to could not tell us why people were on modified diets. Referrals to professionals had not been made despite staff identifying this was a required action. One person's dietary needs had changed a referral to speech and language was identified however this had not been followed up.

Our partners continued to raise concerns regarding the service people were in receipt of. Numerous safeguarding referrals had been submitted and were being investigated. The Local Authority and health professionals were actively supporting the service to drive improvements and monitor care and support people were receiving.

There were limited activities within the local communities, and people did not regularly access these opportunities. Referrals to partner agencies were not consistently made when required. The systems for documenting communication with professionals were ineffective, as referrals to SALT and dieticians were not always initiated when necessary. Although actions to make referrals based on individuals' changing needs were identified, they were not consistently carried out. Due to inadequate record-keeping, it was not always possible for staff to follow up identified actions.

Staff were unfamiliar with the home’s quality assurance systems. There was little evidence of staff learning from accidents and incidents. A nurse told us following concerns raised all staff had received supervision however no lessons learnt were discussed.

There was no evidence of any lessons learnt following on from incident or concerns. Reflective practice was not encouraged.