Wood Hill Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found concerns around medicines management which resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured people were not supported to receive their medicines safely. Some people were prescribed medicines which needed to be taken at specific times, but they were not always given them at those times. When people were prescribed medicines to be taken ‘when required’ or with a choice of dose the guidance to support the safe administration was not person centred. This meant staff did not have enough information to tell them when someone may need the medicine or how much to give. Risks had been identified reported to the local authority when required. Action had been taken to mitigate future risks for example, risk of choking. Some care records required further information to ensure they directed staff to meet people's needs. This was shared with the registered manager. The service was aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person. The provider had systems in place to record and analyse accidents and incidents. People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. However, we found some areas required improvement. Environmental checks were in place and equipment checks were undertaken to support the delivery of safe care. Systems were in place to share information with professionals involved in people’s care to help ensure they received effective care and treatment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt confident they could raise concerns. One relative said, “It is well run, I have no concerns.” However, not all relative’s felt action was taken appropriately when issues were raised. One relative said, "There is no follow up as far as I can see.” We found no evidence to support this statement and saw concerns were documented and action taken.

The new registered manager was implementing new practices to continually improve the service ensuring new systems were embedded into practice.

The provider had systems in place to record and analyse accidents and incidents. Action had been taken to mitigate future risks. For example, liaison with professionals to manage falls and choking risks.

People and relatives told us the GP regularly visited the service. Relatives could ask for their family member to be seen by the GP if they felt they were unwell.

The registered manager explained how they monitored care needs to ensure information was shared, reviewed and they carried out root cause analysis and fact finding to ensure lessons were learnt to improve the service.

The local authority had received concerns about the quality of care and safety of people using the service. However, feedback was the registered manager had systems in place to analysis concerns and learn lessons.

Processes were in place to enable a smooth transition between services and to reduce the impact on people. The provider had a robust system in palace to record, monitor and review care needs this was in place to ensure information was passed on between staff and other professionals.

People told us they felt safe and had no worries or concerns and felt they could raise concerns if they needed to. Most relatives felt their family member was safe living at the service and said they would speak with staff if they had any concerns. Relaitives told us concerns raised were followed up and action taken.

The management team shared information of the action they were taking to ensure people were appropriately supported and safeguarded from abuse and possible harm. There was a commitment from the management team to provide staff with the skills and knowledge to keep people safe from abuse and neglect.

Staff supported people safely. We observed staff responded to people needs in a timely way.

There were effective systems, processes and practices to make sure people were protected from abuse and neglect. The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The service was aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

People and/or their relatives told us they were involved in assessing and managing risks. One visitor told us their relative had previously had a pressure ulcer and staff were vigilant in care provided and monitored regularly to ensure the risk was managed.

The management team assessed risk to ensure people were appropriately supported. Concerns had previously been raised regarding choking risks, the registered manager had ensured everyone had been assessed and had a choking risk assessment in place for staff to follow.

Staff supported people safely following risk assessments. Staff were knowledgeable about peoples needs and preferences and how to manage risks.

People had individual risk assessments in place. The risk assessments were relevant to the individual and promoted their safety and independence. However, some care records required further information to ensure they directed staff to meet people's needs. We shared this feedback with the registered manager.

People were cared for in a safe environment that was designed to meet their needs. People had a range of equipment available to use. Relatives said the environment was safe but felt some areas could be improved.

We did not receive any concerns from staff about the equipment within the service. Staff said there was enough equipment available to meet people’s needs. However, felt some improvements could be carried out.

We saw evidence that environmental and equipment checks had been completed. Equipment was available in different areas of the service for staff to access easily.

Environmental safety checks were in place, ensuring the environment and equipment was safe for people to use. This included fire safety, legionnaires and lifting equipment precautions.

People and relatives told us there were enough staff on duty. One person said, “If you want them [staff] you notify them [use call bell], they come straight away.” Another person said, “At night when you call the staff they come quickly.” People told us staff were knowledgeable and were kind and caring.

Staff told us there were predominantly enough staff on duty to meet people’s needs. one staff member said, “Staffing levels are based on an Assessment of needs, if there are less residents then there will be more staff needed. In general, it is manageable. They [management] are very supportive if we think we need more staff or if someone calls in sick”. The registered manager told us they completed a dependency tool which was used to determine staffing levels.

Staff told us there were predominantly enough staff on duty to meet people’s needs. one staff member said, “Staffing levels are based on an Assessment of needs, if there are less residents then there will be more staff needed. In general, it is manageable. They [management] are very supportive if we think we need more staff or if someone calls in sick”. The registered manager told us they completed a dependency tool which was used to determine staffing levels.

The provider had processes in place to determine staffing levels, which were followed. There was a robust, safe recruitment process in place. Staff received appropriate training and support to fulfil their roles and responsibilities.

People and relatives felt the service was predominantly clean. However, some relatives did comment that some areas could be improved. For example, kitchenettes and some areas of decoration.

Staff had ensured people were protected from the risk of infection because premises and equipment were kept clean and hygienic.

We observed some areas of the service that were not well maintained or able to be effectively cleaned. These included, kitchenette units which were badly damaged and not clean, fridge seals broken and dirty, tea, coffee and sugar canisters dirty, dining chairs were dirty underneath and fabric was splitting and armchairs were heavily worn.

The systems used by the provider to monitor infection, prevention and control practice were not always effective they had not identified all the issues we found. Therefore, did not always ensure people were protected from the risk of infection. Following our site visit the registered manager addressed these issues.

Some people were prescribed medicines which needed to be taken at specific times, but they were not always given them at those times. This included medicines to control Parkinson’s symptoms and medicines than needed to be given at specific times with regard to food which meant they may suffer unpleasant symptoms, or the medicines may not be fully effective. When people were prescribed medicines to be taken ‘when required’ or with a choice of dose the guidance to support the safe administration was not person centred. This meant staff did not have enough information to tell them when someone may need the medicine or how much to give. Some people needed to be given their medicines covertly, hidden in food or drink. The information from a pharmacist to explain how to give each medicine safely was not always available.

The manager told us about multiple measures they had put in place to ensure medicines were managed safely. However, the measures that were in place were not effective in ensuring that medicines were managed safely. Staff told us that they were unaware of some systems and processes involved in making sure accurate records about medicines were made.

The system for checking that medicines were in date and currently prescribed was ineffective. Three medicines in current use were out of date. There were also medicines for 5 people who no longer lived in the home Medicines could not always be accounted for which meant that it was not always possible to tell if people had been given their medicines as prescribed. Records about prescribed thickener, creams and transdermal patches were not always properly completed so it was not possible to tell if they had been given as prescribed. People’s allergy status was not recorded for over half the people whose records that were looked at during the inspection. Medicines, including insulin, thickening powder and waste medicines, were not always stored safely or at the correct temperatures.