The inspection took place over three days on the 23, 24 and 25 May 2018, the first day was unannounced and the other two days were announced. At the last inspection on the 24 and 25 March 2015 the service was rated as good. We did however ask the provider to take action to make improvements in relation to capacity and consent. We found at this inspection that the required improvements had been made.
During this inspection we found multiple beaches of the Regulations in regards to safe care and treatment, personalised care, dignity and respect, record keeping and good governance.
Winsford Grange Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Winsford Grange accommodates up to 60 people in one building across three separate units, each of which have separate adapted facilities. At the time of the inspection 57 people were living at the service.
The service has 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.
Management of medicines was not safe. Medication was not checked to ensure that it was in date and stored correctly. Adequate information was not available to staff to ensure that medication was correctly administered.
Where risks to health and welfare were identified, robust risk assessment and management plan were not always in place to assist staff in minimising the risk of future harm. Equipment used to manage the risk of developing pressure ulcers was not checked to ensure it was set correctly.
Care plans were in place which aimed to assist staff in providing the correct level of care and support to a person. These however were not accurate or up-to-date. This meant that there was a risk that staff less familiar with the person may not provide the right level of care treatment. Other records, used to evidence care provided were incomplete. Therefore, we could not ascertain whether people had received care and support to meet their needs.
People who used the service and their relatives described it as being "unsafe" due to their concerns about staffing levels. People did not receive their care in line with the needs and wishes. At other times, a person's dignity or respect was compromised due to interventions or lack of response by staff. The register provider could not demonstrate that staffing levels were sufficient to meet people’s needs.
There was a lack of stimulation and social engagement for people throughout the day. People and relatives commented that there were long periods of the day with nothing to do. We made a recommendation that the registered provider undertake a review of activities to reflect the needs of people at the service and best practice guidelines.
The systems in place to monitor the quality and safety of the service were ineffective. Where issues had been identified action had not been taken by the register provider to make positive changes in a timely manner. Audits undertaken by the registered provider failed to highlight a number of concerns which we found at this inspection.
People received meals that were nutritionally balanced. However, people felt that there was a lack of choice in regards to their meals. We observed that some people went a long period without food or drink. Staff did not keep accurate records detailing what a person ate or drank throughout the day which meant there was no guarantee that people had been provided with the food and drink they needed to keep them healthy and well.
Staff had an awareness of the Mental Capacity Act and how it impacted on their work. They knew that sometimes they were required to make decisions in a person's "best interest". Mental capacity assessments had been undertaken and where appropriate best interest decisions which were made on behalf of people were documented. Where restrictions have been placed upon a person's liberty, the deprivation of liberty safeguards had been requested. Staff were aware of what this meant for the person in regards to their care.
People complimented staff that provided their support and told us that they were kind, caring and very hard-working. People capable in the latter days of their lives and relatives commented that this was done with dignity and respect. Staff worked closely with colleagues such as district nurses, dieticians, tissue viability nurses and social work staff in order to meet people’s end of life needs and wishes.
Staff underwent induction training and received on-going training in relevant to their job role. Staff were encouraged to take on new roles and responsibilities. People felt confident that the staff caring for them have the right skills and knowledge to do so safely. Staff had not received a one-to-one supervision in line with a registered provider’s policy, however this was being addressed.
Staff had an understanding about safeguarding people and keeping them safe. Concerns reported to the management, to the local authority and the CQC where appropriate. Staff did not always feel able to raise concerns with the management team and a consequence a number of whistleblowing concerns had been raised with the CQC.
The service is advertised as a dementia specialist service. We found that the environment was not dementia friendly and not sufficient adaption had been made to aid and support people who are living with dementia.
Checks were undertaken to monitor the safety of the premises. This included ensuring that utilities such as gas, electricity, water, electrical equipment were serviced checked and repaired. A fire risk assessment had recently been updated and identified a number of areas required in order to keep people safe. A remedial action plan had been developed to monitor the required changes.
Processes were in place to ensure that staff recruited were of suitable character and skilled for the job role. The required pre-employment checks had been carried prior to each member of staff starting work at the service.
There was a complaints process in place which people were aware of. However, only written complaints were treated formally, logged and responded to. Some people felt that their verbal complaints not listened to and acted upon. We made a recommendation that the registered provider review how they record and respond to all complaints.
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 take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will 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. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
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.”