Woolton Grange Nursing Home

Woolton 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.

The home is registered to provide nursing care and accommodation for up to 43 people; in a converted Victorian church building in a residential area of Liverpool. At the time of our inspection 38 people were living at the home.

The registered manager had not been working at the home since May 2018. The deputy manager was acting manager and had applied to become registered with the Care Quality Commission. 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.

At our inspection in July 2017 there were breaches of regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not sufficient numbers of staff available to meet people’s needs in a timely manner; and the systems in place to assess and monitor the safety and quality of the service had not always been effective.

At this inspection we saw that there had been improvements in these areas and the home was no longer in breach of these Regulations.

There were enough staff to meet people’s needs in a timely manner. This reflected the feedback from people, their relatives and visiting health and social care professionals. The home now had a much calmer environment.

The systems used to assess and monitor the safety and quality of the service was now more robust. The provider’s compliance team who support home managers had been increased in the previous twelve months from 2 to 6 people. They said this was done to help support the managers of their homes with monitoring and assessing the quality of the service provided. These checks and audits allowed the acting manager and provider to assess and monitor the safety and quality of the service being provided and when necessary make required improvements.

There was a quarterly meeting at the home were accidents, incidents, any safeguarding alerts and feedback from people living at the home, their family members and staff members was reviewed. Themes were looked for and incidents looked into to ensure that appropriate action had taken place.

People told us that they thought the staff at the home were caring. One person said, “The staff are adorable.” Another person described the staff as “very pleasant.” People’s relatives told us that the service provided was caring and they were made to feel very welcome when visiting the home.

People told us they felt safe living at the home. One person told us, “I feel safe. Safe and comfortable.” Staff had received training in safeguarding vulnerable adults, knew of signs that may indicate a person was at risk of abuse and knew how to raise an alert. The home had appropriately managed safeguarding concerns. The building was safe, the home was clean and the administration of people’s medication was safe.

People were asked questions and their opinion was sought before any care and support was provided. At lunchtime we saw that people were asked questions about their preferences and they were listened to and their requests were acted upon. People were treated with dignity and respect in all their interactions with staff.

The service was provided in line with the principles of the Mental Capacity Act. We saw that people’s consent and permission was sought with their day to day support needs; when this wasn’t possible with significant decisions appropriate procedures were followed to protect people’s legal rights.

People had an assessment of their needs before coming to the home. We saw that these were thorough including details on people’s health, life history and their likes and dislikes including seemingly small but important details. Appropriate care plans were in place using these details and any risks that had been identified.

The service was now responsive to people’s health care needs. Improvements had been made in the response from the service to the risk of people developing pressure sores. Appropriate referrals to health and social care professional had been made and the home worked closely with these professionals.

People told us that they enjoyed the food provided at the home. The kitchen was clean and well stocked. It had been awarded five stars by the Food Standards Agency at their last inspection. We spoke with the chef who had records showing people’s special dietary requirements and their likes, dislikes and preferences.

Feedback overall about activities and having things to do at the home was divided. Some people told us that there was lots to do at the home and others that there was very little to do. We saw a range of activities were provided for people, but these may not have always reflected people’s preferences.

Appropriate checks and induction was in place to help ensure that new staff were safe to support vulnerable adults. There was effective training in place and staff told us they had received appropriate support.

People, staff members and visiting health and social care professionals were all positive about the acting manager of the home. One person told us, “They do extremely well. I don’t think it can be improved.” Another person told us, “The manager is lovely.” We found the acting manager to be a good communicator and there was evidence that they had been effective in leading the service.

The home had appropriate policies in place, displayed the rating from the previous inspection and had sent through appropriate notifications to the CQC.

Woolton Grange Care Home is a privately owned care home providing personal care for up to 43 people. The home is in a converted Victorian church building located in a residential area of Liverpool. At the time of our inspection 38 people were living at the home. This is the first inspection of Woolton Grange Care Home since being taken over by a new owner.

The home required and had a manager who was registered with the CQC. 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 in the Health and Social Care Act 2008 and associated regulations about how the service is run.

During our inspection we found a breach of regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because there were not sufficient numbers of staff available at the home to meet people’s needs in a timely manner and the systems in place to assess, monitor and improve the quality and safety of the service were not always effective. You can see what action we told the provider to take at the back of the full version of the report.

The majority of people told us that they thought there was not enough staff at the home. Some people told us that this has had an impact on the care they received. During the morning we saw that staff at the home were overstretched, this put pressure on them being able to provide support in a timely manner.

People told us that they received their medication and it was on time. We saw that people’s medication was usually administered and recorded in a safe manner but we found areas that required improvement. There were systems in place to check this. However they were not being used effectively and they had not identified concerns that we highlighted during our inspection.

There was an ongoing programme of improvements at the home, such as new boilers, flooring and improvements made to the grounds. Some people’s rooms had been redecorated as part of the ongoing improvements. We also saw that adaptations had been made to the homes environment which may help people with dementia to locate their room and find their way around. A series of checks and audits were completed of the homes environment, including checks relating to fire safety, the environment of the home and equipment used.

We saw that staff received training and ongoing support to help ensure that they were effective in their roles. This included training in safeguarding vulnerable adults. New staff received induction training and initially shadowed a more experienced member of staff.

People’s relatives told us they had confidence that people’s medical needs were addressed promptly and effectively; some people were able to give us examples of this. People also told us that they were well supported with their health and it was easy to see a doctor if needed. Visiting health professionals told us that their experience was that senior staff at the home made referrals “straight away” when people at the home needed additional support with any health needs.

People and their relatives were positive in their feedback about the quality and quantity of food provided at the home. Some comments from people were; “It’s excellent”, “It’s lovely” and “It’s quite good”. We spoke with the chef at the home; they told us each person has a diet plan that identified their needs. We saw that the kitchen was clean and food was stored safely. In 2016 the home had been awarded the highest food hygiene rating of 5.

The people we spoke with were very positive about the manner in which staff cared for them. One person told us, “They are very good to me here.” Another person said, “They make a fuss of you.” We saw that staff treated people with kindness and in a dignified manner. For example when people were helped to move about safely; staff addressed people by name, asked permission before taking action and explained what they were about to do, giving people plenty of time to respond.

We saw that staff at the home respected people’s privacy, knocking and seeking permission before entering their room and making sure that personal information was kept secure in a locked room accessed only by staff.

We checked whether the service was working within the principles of the Mental Capacity Act 2005, and whether any conditions on authorisations to deprive a person of their liberty were being met. If appropriate an application for a DoLS had been made to the local authority and any conditions on any DoLS that had been granted were met. As assessment of people’s capacity to make particular decisions was made as part of the pre admission process into the home. People were supported to make as many decisions as they could and take as much control as possible over their care. Each person at the home had an individualised care plan; the care plans were person centred and gave importance to people’s individual needs and preferences.

People living at the home, their relatives and staff told us that they had confidence in the registered manager. When we spoke with the registered manager it was clear that she had a good knowledge of and warm relationships with the people living at the home.

We saw that a series of checks and audits were completed at the home; many of these had proven to be effective. Other audits had not been effective at the home and the processes at the home had not always been followed to ensure that the registered manager and provider had appropriate information.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found:

Is the service safe?

We saw the provider had policies and procedures in place for safeguarding people who use the service and emergency events. All staff were aware of where to locate policies if need be. We saw staff using correct manual handling techniques and explaining procedures clearly before assisting people. The staff members we spoke to were all able to confidently and correctly tell us what they would do in an event of a person suffering a fall.

All the medication sheets we reviewed were clear and consistent, evidencing good record keeping and safe administration.

However we saw aspects of the service that was not safe such as staffing levels. The provider was not able at all times to meet the health and welfare needs of people who used the service.

Is the service effective?

We saw areas where the provider was able to provide an effective service although we also saw some areas that were not effective for the people who used the service.

We saw staff were knowledgeable about how to manage and care for people with challenging behaviour. We saw staff were responsive and effective in these situations. However staff members told us they felt they did not have enough time to give the level of care they wanted to give and felt the care was often hurried.

During the inspection we received five comments from people who used the service and three staff about the suitability of toilet facilities. People who used the service told us, 'The toilet situation was not practical' and 'Not appropriate'. We saw that people were distressed queuing and this also caused a hazard as the queue of people was occluding the lounge door way.

Is the service caring?

We spoke with five people who lived at the home and one relative. They all said that they were, "Very happy", at the home and described the staff as, "Helpful", "Friendly" and "Courteous". The three relatives told us that the staff liaise well with them and that the staff were, "Always happy to help". During our observations we saw staff being polite and caring.

Is the service responsive?

We saw the service was not always responsive. We saw staff were often taken away in the middle of caring duties such as assisting people to the bathroom. Some people who lived at the home told us they regularly have to wait twenty minutes to go to the toilet. There were found to be insufficient staff levels and unsuitable bathroom facilities which meant the staff were not able to always be responsive to people's needs.

We saw the provider employed an activities coordinator during the week and had activities planned each day. Three out of the five people who used the service that we spoke to said there could be more activities. Staff told us, 'There is not enough on [activities] to ensure everyone is content as there is only one of her [activities co-ordinator)] for 37 people' and 'People are often stuck in doors'. We saw staff playing bingo with people in the lounge in the afternoon. One person however, told us 'I don't want to (play bingo) but there is nothing else to do'.

Is the service well-led?

We saw in some areas the service was well-led although in some areas this needed improvement. We saw the provider conducted regularly monthly audits in order to review the service. This included scrutiny of falls, accidents and medication administration. We were told by the manager she would then act accordingly dependant on what she found.

We saw from staff meetings that the staff had raised comments of insufficient staffing levels to the manager but they were told that the dependency assessments indicated that the staffing levels were adequate. People told us that they do not always feel comfortable in addressing issues with the management. We saw people who used the service did not feel as though they could discuss issues with the manager.

People were appropriately supported to make choices and decisions about their care. Where needed, written agreements were in place obtaining people's consent to care and treatment. We did however find that agreements for some people had not been signed.

People were provided with care and support which met their assessed needs. Staff responded appropriately to any concerns they had about a person's care and welfare.

People told us they were treated well at the home and that they felt safe living there. Staff understood what abuse is and they knew what action to take if abuse occurred.

Strict recruitment processes had been carried out which ensured new staff were suitable to work with vulnerable people.

People told us they were confident about complaining if they needed to. A written complaints procedure which was available at the home detailed the process for complaining. The procedure for complaining was not available in any other format to aid people who have difficulty reading.

We found that people living at the home had been treated with respect and involved in planning and reviewing their care and treatment. Comments made by people who used the service and their relatives included, "I have settled here and like it" and "The family are so please with the home and the way mum has settled in, the care is really good".

We found that people had had their care needs assessed and that staff had information about how to meet people's needs.

People were being cared for by staff who were well supported and trained. People who used the service and their relatives told us they liked the staff alot and they were good at their jobs.

People told us they felt safe living at the home and their relatives said they had no worries about the way people were treated. People told us they knew how to complain and would do if they needed to.

Equipment used at the home had been properly checked and maintained so that it was safe to use and staff had received training around the use of equipment.

The were processes in place for assessing and monitoring the quality of the service, including obtaining peoples views about how the service is run and peoples feedback had been listened to and acted upon.