Archived: Wellcross Grange Care Home

A registered manager was in post. 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 and associated Regulations about how the service is run.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were treated with dignity and respect and felt well looked after and supported. We observed friendly relationships had developed between people and staff.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and palliative care (end of life). Staff had received both supervision meetings with their manager, and formal personal development plans were in place.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, bingo, exercise, quizzes and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

Wellcross 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. People living at Wellcross Grange Care Home were older people, living with physical health conditions and physical frailty. Some people were living with early dementia. However the service is not a specialist service offering support to people to whom dementia is their main need for care. The service accommodates up to 45 people in one adapted building, divided into two separate wings with their own staffing complement and shared spaces.

The home had 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. The registered manager was not available on the days of the inspection, so this was carried out with the clinical lead nurse and operations manager for the provider organisation.

The last inspection of Wellcross Grange Care Home took place on 11 June 2015, when the service was rated as good in all areas. On this inspection although we found some good practice, we identified some areas of concern and the service was rated as requires improvement.

Immediately after the inspection the operations manager from the provider organisation gave us an action plan detailing what actions they were taking to address the concerns.

Systems had not always been operated effectively to assess, monitor and improve the quality and safety of the services provided, or mitigate the risks. During the inspection we identified areas of concern about the environment and people’s care. For example information was not always sufficient to ensure risks to people from poor hydration could be properly assessed. Recent information of concern had not been acted upon immediately, which could have left people at risk of poor care. We asked the service to make a safeguarding referral about this incident during the inspection.

We identified systems to analyse accidents and incidents were not robust enough to identify learning to prevent a potential re-occurrence. Accident forms had been collated but these did not contain a management review or records of what changes were made as a result of the incident or actions taken. Bruising was not always investigated or included on incident forms.

We found staff were not always using positive or respectful language when supporting or describing people and their care. We also saw people being supported in ways which did not demonstrate their dignity was respected. The operations director told us they would be reviewing this immediately.

We received positive feedback about the staff and service. People told us the registered manager was approachable and fair. They told us there was a positive atmosphere, and the service worked well with other agencies to support people’s needs. Staff were attentive to people’s needs, making sure they were well presented and attention had been paid to cleaning spectacles and helping people co-ordinate clothing. The organisation had a set of positive and person centred values, which the operations manager was taking action to ensure were well understood and shared across the staff group. We found the service had an open culture, and saw staff working well as teams, to ensure people’s needs were met. The service had a clear organisational structure where people’s responsibility and accountability was identified.

A new system for training was being implemented at the service. The service’s training matrix showed there were some gaps in staff member’s core training skills. However staff we spoke with felt they had received sufficient training to meet people’s needs, and we saw staff meeting them confidently. For example, staff understood how to deliver good end of life care and nursing staff had recently been on courses to support people at the end of their life. Registered nurses were completing their re-validation to ensure they were still fit to practice.

People were involved in having a say about the service and people were consulted in a meaningful way about their experiences. People were supported to share their views of the service at regular meetings, and through a series of questionnaires. These were then analysed and action plans drawn up to address any issues raised. Senior staff attended meetings with residents and relatives to ensure any concerns could be immediately understood at a senior level.

There were enough staff on duty to meet people’s needs. A full recruitment process was in place which ensured staff were recruited safely. This included the taking up of disclosure and barring service (Police) checks and references. We found some staff were working very long hours. The service was actively recruiting for new staff and the staff we spoke with told us they didn’t mind working long hours and made sure they had time off to rest.

People received their medicines as prescribed. Medicines for ‘as required’ use did not always have clear protocols for their administration recorded. The service agreed to address this with the prescriber. The medicine we saw, which was to manage one person’s anxiety had not been needed in the last month. People received good healthcare support. We had feedback from a visiting healthcare professional who told us the service called for assistance early if they had any concerns over someone’s well-being. We have made a recommendation with regard to the service requesting treatment escalation plans or ‘Do not attempt resuscitation’ (DNACPR) forms are updated by the person’s GP. This is to ensure they remain an accurate reflection of the person’s wishes.

People’s rights with regard to the Mental Capacity Act 2005 were respected. Not all staff had received training in the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards (DoLS). However we saw where DoLS had been granted or applied for the service and staff had a clear understanding of the importance and implementation of this. Systems were in place for the management of complaints.

Wellcross Grange comprised a large period house, with extensive grounds and a small lake, which had been extended to the rear to provide a large ground floor extension with en-suite rooms and shared spaces. The building had been adapted to meet the needs of people with physical impairments, with the use of specialised baths and showers. However there was little adaptation to support people with dementia or low vision. We have made a recommendation about this, as there were people living with both of these conditions at the service.

People were supported to eat a nutritious and varied diet. People told us they ate well, and the chef was happy to make changes to meet people’s particular menu choices. Menus were available in a pictorial format and we saw staff working with a relative to understand one person’s specific meal choices to help encourage them to eat well.

People’s care was assessed and care plans developed as a result, and we saw people’s care was delivered in accordance with their agreed plans. A wide range of activities were provided, which people told us they enjoyed. People’s files did not always contain sufficient information on hobbies or activities they enjoyed, but we saw staff speaking with people to ask them what they wanted to do. Work was being undertaken to address this, and help gather additional information about people’s lives and choices.

We identified a number of breaches of Regulations on this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

On the day of our inspection we noted there were periods of time where people were left unattended in communal areas. Several people were sitting in wheelchairs. They had been left without call bells and were, therefore, unable to summon assistance if they needed to.

The manager was unable to demonstrate how staffing levels were calculated to ensure they were sufficient to meet the needs of people accommodated. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection the manager informed us no one accommodated was subject to a DoLS application.

There was a system in place to calculate how many accidents or incidents had taken place over a given period. The manager was unable to demonstrate how they had been analysed to make sure that the manager and staff learned from such events. This increased the risk of harm to people and failed to prevent such incidents from occurring in the future. A compliance action has been set in relation to this. The provider must tell us how they plan to improve the system to reduce the risk of accidents or incidents recurring.

Is the service effective?

People told us that they were happy with the care that they had received and it had met their needs. One person told us, "I believe I am well looked after. I think Wellcross Grange is quite pleasant. It is quite a good place to live". A relative told us, "I am quite happy with the way the home is run. Overall, it ticks all the boxes".

It was clear from our observations and from speaking with staff who worked in Wellcross Grange that they had a good understanding of people's care and support needs and that they knew them well.

People's health and care needs had been assessed, but some people's care plans had not been reviewed for over a year. This meant they did not provide up to date information for staff to follow to ensure they met people's current needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience, were attentive and gave encouragement when supporting people. People that we spoke with confirmed this. One person who was confined to bed told us, "I am well cared for. I could not ask for anything more." Our observations also confirmed this. For example, we noted that lunch time was well paced and allowed people the time they needed to eat their meal. People were provided with protective aprons to ensure they did not dirty their clothes if they spilled any food. We observed good interactions between people and staff. Care staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence.

People's preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people's wishes. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Two people told us that they had made a complaint but were not satisfied with the outcomes. We also found that the minutes of a relatives' meeting, that had taken place in October 2013 recorded some concerns about the service. We looked at how these complaints had been dealt with, and found that none had been recorded. This meant that the manager was unable to demonstrate that responses to complaints had been open, thorough, and timely.

Is the service well-led?

Since our last inspection we found that improvements had been made in relation to meeting people's nutritional needs. We noted staff were present in dining rooms to provide support to people who needed help with eating their meal.

The service had a quality assurance system. However the manager was unable to demonstrate that identified shortfalls were addressed promptly. Satisfaction surveys had been completed and returned by people and their relatives. The results had been summarised but an action plan had not been drawn up to identify the actions that need to be taken, by whom and with an agreed timescale for completion. As a result the system was not sufficiently robust to ensure the quality of the service had been continuously improved. A compliance action has been set in relation to this and the provider must tell us what they plan to do to improve.

We looked at peoples care plans. The care plans showed that people's ability to make choices and decisions for themselves had been assessed, and guidance was in place to inform staff as to how to support people with this.

We also spent time observing the interactions between staff and people. We found that people were not always supported to be able to eat and drink sufficient amounts to meet their needs.

We saw that people's complaints were investigated and resolved, where possible, to their satisfaction.