About the service:

Withy Grove House is registered with CQC to accommodate up to 54 people on two units, each of which have separate adapted facilities. One of the units specialises in providing nursing care to people living with dementia. At the time of the inspection there were 31 people living in the home.

At the last comprehensive inspection 24 and 27 July 2018 inspection we found that Withy Grove House was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, the need for consent, person centred care and good governance. The service was rated inadequate and placed in special mwithin this time frame. During this inspection the service demonstrated to us that improvements had been made and it was no longer rated as Inadequate overall or in any of the key questions. Therefore this service is now out of special measures.

After the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. We found improvements had been made in all domains and the six breaches of regulation from the previous inspection had been met. Work needs to continue to show all the improvements can be sustained in the long term.

People’s experience of using this service

•Relatives told us the home had “improved immensely” since the last inspection. People told us they were aware of and appreciated the improvements that had been made to their home to improve their environment and care.

•People commented positively on the improvements in the standard of care and the quality of staff. Everyone felt they or their relative were safe and that the home was meeting their needs.

•The environment had been improved to support people living with dementia. There was signage to help people to find their way about their home and promote their independence.

•Staff were more aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care.

•People received their medicines when prescribed and these were stored safely. However, medicine allergies were not consistently recorded. This could put people at risk of receiving inappropriate medicines. We have made a recommendation about this.

•Staff had received training on safeguarding people from abuse and knew how to raise concerns to keep people safe. Risks to people were assessed and action was taken to address them. There were enough suitable staff working to support people safely.

•Care plans had been improved to provide more detailed information about people and their care needs and behaviour management. Risk assessments were being done and recorded in care plans along with the action to be taken to try to mitigate identified risks.

•Assessments obtained from other health and social care professionals were being used to plan care for people.

•Accidents and incidents were monitored to see if lessons could be learned and changes made to help keep people safe.

•The cleanliness of the home had improved. Effective infection control procedures were in use.

•Staff were receiving training appropriate to their roles and supervision was being given to support staff development and performance.

•People enjoyed the meals and their dietary needs and nutritional risks were being assessed and monitored. Pureed diets were provided but not well presented in an appetising way. We made a recommendation about this

•Weights were monitored but there were some people whose weight monitoring had been inconsistent. We made a recommendation about this.

•People told us they were given choice over their day to day lives and supported to maintain their independence.

•Staff were knowledgeable about people and their needs and care plans had been reviewed and updated

•There was a limited range of activities on

This focused inspection took place on 30 October 2018 and was unannounced. At our last comprehensive inspection of the service in July 2018 we rated it as Inadequate overall.

At the previous comprehensive inspection in July 2018 we found that Withy Grove House was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, safeguarding service users from abuse and improper treatment, the need for consent, person centred care and good governance. The overall rating for the service was 'Inadequate' and the service was therefore placed 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 receive a comprehensive 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 insufficient improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Following that comprehensive inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. The registered provider has provided an action plan and this is ongoing and being updated as actions are completed.

We undertook this unannounced focused inspection of Withy Grove House following receipt of information from people about the service regarding standards of care, nutritional support, the management and oversight of the service, staffing levels and skill mixes and safeguarding. We also wanted to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection were being made.

The team inspected the service against two of the five questions we ask about services. Is the service safe and is the service well-led? This is because the service was not meeting some legal requirements.

Withy Grove House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Withy Grove House is registered with CQC to accommodate up to 54 people in two units, each of which have separate adapted facilities. One of the units, on the ground floor, specialised in providing nursing care to people living with dementia and the first-floor unit was for residential use. At the time of the focused inspection there were 38 people living in the home with 18 on the nursing unit and 20 on the residential.

We could see that an experienced interim management team had been put into the home to support improvement and gradual progress was evident to meet the action plan provided by the registered provider. However, the home remains in breach of Regulation 12 [safe care and treatment] Regulation 13 [safeguarding service users from abuse and improper treatment] and of Regulation 17 [good governance].

At this inspection in October 2018 we observed that the home environment was cleaner and tidier than at our previous inspection and that it was calmer. People appeared well dressed and tidy. Redecoration was underway in areas of the home and improvements had been made to some environmental issues.

At the time of this inspection the home did not have a registered manager 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

This comprehensive inspection took place on 24 and 27 July 2018. The first day of the inspection was unannounced and the second was announced. At our last inspection of the service in November 2017 we rated it as Good overall.

Withy Grove House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Withy Grove House is registered with CQC to accommodate up to 54 people in two units, each of which have separate adapted facilities. One of the units specialises in providing nursing care to people living with dementia.

There was a registered manager in post at the time of our visit. The registered manager was new in post and had just received confirmation of registration with 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 for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that Withy Grove House was in breach six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing deployment, the need for consent, person centred care and good governance.

We spoke with the registered manager, the regional manager and the operations manager about the shortfalls we had identified in the running of the service. They were aware of the seriousness of the concerns and took immediate action to begin to mitigate the risks we had identified on the first day of our inspection. This indicated an understanding of what needed to be done and a willingness to engage with us to make the service safer for the people living there. We wrote to the registered provider and registered manager notifying them of the seriousness of our concerns. We requested that they draft an urgent action plan setting out, how they intended to address the concerns in the letter. They should respond to each concern, with a specific time frame for implementing the action, who would be carrying the action out and the action taken to mitigate the risks during the time taken to complete. They did this as requested.

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 act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This may 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. 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.

We spent time in the communal areas of the home and spoke to staff, people living in the home and their relatives. We were told by one relative that they were “Quite satisfied.” A person who lived there

The inspection took place on 13 November 2017 and was unannounced. We last inspected the service in August 2015 and rated the service as good. This inspection found that the service remained good.

The service 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.

Withy Grove House provides accommodation for up to 54 people who require nursing or personal care. At the time of our visit there were 50 people who lived there. The home provides care and support for people with dementia or physical disabilities. Withy Grove is a converted Manor House set in its own grounds and located in a residential area of Bamber Bridge, near Preston. The home is divided into two units that are staffed separately. The ground floor unit accommodates twenty four people who have personal care and nursing needs associated with dementia. The upper floor is a residential unit and can be accessed via a passenger lift. It accommodates thirty people with personal care needs.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. People said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were knowledgeable about strategies’ in place to keep people safe. There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support this was delivered quickly.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles. Training records showed that staff had received training in a range of areas that reflected their job roles. The provider operated safe and effective recruitment procedures. Medicines were stored and administered safely.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People and where appropriate their relatives were involved in their care planning, Staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

The registered manager was supported by the proprietor who was regularly in the service and who carried out a programme of quality assurance audits to identify areas of risk, and areas to maintain performance and drive improvement. The service had an open culture where people had confidence to ask questions about their care and was encouraged to participate in conversations with staff. Staff interacted with people positively, displaying understanding, kindness and sensitivity.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to look at the overall quality of the service.

We inspected Withy Grove House on 12 August 2014. This was an unannounced inspection which meant the staff and provider did not know we would be visiting.

Withy Grove House provides accommodation for up to 54 people who require nursing or personal care. At the time of our visit there were 51 people who lived there. The home provides care and support for people with dementia or physical disabilities.

Withy Grove is a converted Manor House set in its own grounds and located in a residential area of Bamber Bridge.  The home is divided into two units that are staffed separately. The ground floor unit accommodates twenty four people who have personal care and nursing needs associated with dementia. The upper floor is a residential unit and can be accessed via a passenger lift. It accommodates thirty people with personal care needs.

The manager at Withy Grove had been in post since March 2014. They had commenced the process to apply to register with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We used a number of different methods to help us understand people’s experiences of the care and support they received. This was because some people had complex needs and were not able to tell us about their experiences. During our visit, we spent time in all areas of the home, including the lounge and the dining areas. This helped us to observe daily routines and gain an insight into how people's care and support was managed.  During our visit we saw staff had developed a good relationship with the people they supported. Those people who were able to talk with us spoke very positively about the service and told us they felt safe and well cared for. One person told us, “The staff here are lovely, I am really well looked after.”

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Safeguards were in place for people who may have been unable to make decisions about their care and support.

People were involved and consulted with about their needs and wishes. Care records provided information to direct staff in the safe delivery of people’s care and support. Records were kept under review so information reflected the current and changing needs of people. Information was stored securely ensuring confidentiality was maintained.

The service worked well with external agencies such as social services and mental health professionals to provide appropriate care to meet people’s physical and emotional needs.

Staff spoken with were positive about their work and confirmed they were supported by the manager. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs.

People had a good assessment of their needs and they had consented to their care and support. Where people could not give their consent they were fairly represented and the service acted in accordance with legal requirements when necessary.

Family members visiting the home told us they knew how to formally make a complaint. One person told us, “Yes, but I think they are very good here. I’m sure if I did they would do something about it. I’ve no worries at all.” Another person told us, “I’ve never needed to raise any concerns. I can tell M……. she’s very good, always there for us even though she is busy. I would complain if ever the need arose”. We found comments and complaints people made were responded to appropriately.

We found the provider made sure people were cared for by staff who were trained. High standards of care had been set by the manager. Staff told us, “The change is better for the residents”, and “The manager has a clear vision for improvement”. They also told us the manager was “very professional” with high standards. She was described as “working very, very hard”. Staff told us "If someone is not meeting the right standard, this should be dealt with in private, perhaps supervision”. They also told us they had supervision, but this usually linked to “when you do wrong”, or “something is not right”. There was a general feeling that where shortfalls in staff performance were observed, this could be managed better. The manager told us progress was being made and formal supervision was planned.

Not all people could give their view of their experience of living in the home. We found people’s needs were assessed and care and treatment was planned and delivered in line with their needs. Their care and treatment was also planned and delivered in a way that ensured their welfare and safety.

We observed staff followed good principles of maintaining acceptable standards of hygiene when supporting people with personal care. There were effective systems in place to ensure cleanliness and infection control. People accommodated in the residential unit told us they had their rooms cleaned most days and their bedding changed regularly.

People accommodated in the residential unit told us they had confidence in the staff who had worked in the home for a long time. They did not like too many changes. They said, “It takes time to get used to each other, some staff are really nice.” We found there were effective recruitment and selection processes in place. It was usual practice for staff to have character checks completed before they started work.

People told us they could express their views and were involved in decision making about their care. Where legal requirements restricted peoples choices this was managed very well.

Care plans were individualised and were sufficiently detailed to make sure peoples’ care and support was provided according to their wishes and safety.

People were supported to be involved in the life of the home and given opportunities to take an active role in a wide range of activities such as gardening, dancing and crafts.

Family members were complementary about the service. “You wouldn’t believe the improvement in his general health and well being. He couldn’t walk and now he gets about. I visit every day apart from Sunday. The thing is they are not all sitting around. All the staff gets them involved in things. The other day we had ballroom dancing”. “Staff are very attentive keeping an eye on them all. They always keep up with assisting with personal care”. “I do think all the staff are very nice. They are patient with people”. “The staff are wonderful. We know they work hard and have to put up with mum’s changing needs so we appreciate that”. “They are lovely, very pleasant and the standard of food is always good”.

People received their medication when they needed it. Staff had been trained to do this safely.

The provider had an effective system to regularly assess and monitor the quality of service that people received and took into account their views.