About the service: Wolston Grange provides accommodation and personal care for up to 39 people living with dementia. The service consists of three separate units, the residential home (main house) which accommodates older people living with dementia, adjoined with The Lodge and a separate building called The Barn which accommodates primarily people living with alcohol related dementia. A total of 23 people lived at the service at the time of our inspection.

People’s experience of using this service:

• Systems to identify people's individual safety risks and to promote people's safety within the home environment were not effective.

• No action had been taken when Health and Safety checks identified people could be exposed to unnecessary risk, such as potential scalds from excessive hot water temperatures. Fire safety measures had been taken following a fire authority visit in 2017, however staff responsible to check fire equipment such as doors and emergency lighting had not been trained. Where fire safety equipment was recorded as not working, this equipment remained defective.

• The general décor and maintenance throughout the service was poor and posed risks of injury to people because repairs were required. This included repairs to interior woodwork and window restrictors. Because of the overall disrepair of some areas of the home, this presented potential infection control risks.

• The provider’s quality assurance systems were not effective in identifying, responding and maintaining a good standard of service that people deserved. Where some improvement actions had been recorded and raised with the provider, limited or no evidence showed what actions had led to improvements.

• Risk assessments were not always clear to show how risk scores were used to assess individual risks to people and risk management plans lacked important information to keep people safe.

• Medicines were not always managed and administered in a safe way which increased risks to people’s health and wellbeing. Systems to store, record and dispose of medicines safely were inadequate.

• Improvements were needed to ensure people were supported to enjoy a wider range of activities which reflected their interests, and enhanced their lives. Staff sought ways for people to continue to do things they liked, whilst maintaining their safety, such as using outdoor spaces.

• People, their relatives, staff and other health and social care professionals worked together to assess people's needs and plan their care. This was done so people's needs and preferences would be met, and they would enjoy an enhanced sense of well-being.

• People were supported by staff to make decisions about their care. Staff used their knowledge of people's preferred ways of communicating, to assist people to make their own choices.

• Staff did not always promote people's right to independence, dignity and respect.

• Staff supported people to have timely access to external health care. This improved health and well-being outcomes for people living at Wolston Grange.

• Staff received an induction and on-going training to develop and maintain their skills, however this training was not always put into practice and for some staff, they told us it was ineffective.

• People, their relatives and staff were encouraged to make any suggestions through annual surveys. Staff had meetings which gave them a chance to share ideas and feedback.

• Most people were happy living at Wolston Grange and were cared for by staff who understood their preferences and were kind.

Following our inspection, we notified relevant stakeholders such as the Local Authority Quality Team, Local Clinical Commissioning Group (CCG) and the Fire Authority about the areas of concern we identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care a

The inspection took place on 9 January 2017 and was unannounced. The service was last inspected on 27 April 2015, when we found they were meeting the Health and Social Care Act 2008 and associated Regulations. Wolston Grange provides accommodation and personal care for up to 39 people living with dementia. The service is made up of three separate units, the residential home which accommodates older people with dementia, and the Barns and the Lodge which accommodate a mixture of older and younger people with dementia. A total of 26 people lived at the service at the time of our inspection.

The registered manager had been in post since 24 June 2013. 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.

People told us they felt safe using the service and staff understood how to protect people from abuse. There were processes to minimise risks associated with people’s care to keep them safe. This included the completion of risk assessments to identify and manage risks to people’s health and well-being and checks on staff to ensure their suitability to work with people who used the service. Best practice was not always followed in relation to storing and recording the administration of medicines.

There were enough suitably trained staff to deliver care and support to people. Staff received an induction and a programme of training to support them in meeting people’s needs effectively. Staff were encouraged to reflect on their practice and to develop their skills and knowledge and this improved people's experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having the capacity to make all of their own decisions, records showed that their families, legal representatives and healthcare professionals were involved in making decisions in their best interests. Staff understood the principles of the MCA, where people had capacity to make their own decisions, these were respected and consent was gained before staff provided personal care.

People told us staff were kind and caring and had the right skills and experience to provide the care and support they required. Staff treated people in a way that respected their dignity and promoted their independence.

People were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were reviewed. People were supported to maintain important relationships and their personal interests. People knew how to complain and were able to share their views and opinions about the service they received.

Staff felt supported and were encouraged to share ideas to make improvements to the service. The registered manager was dedicated to providing quality care for people. There were processes to monitor the quality of the service provided and understand the experiences of people who used the service. The process included regular communication with staff, surveys and a programme of other checks and audits.

We carried out this inspection on 27 April 2015. The inspection was unannounced.

Wolston Grange provides accommodation and personal care for up to 39 people living with dementia. The service is made up of three separate buildings. The main home, Wolston Grange, accommodates older people with dementia. The Barns and the Lodge, accommodate a mixture of older and younger adults with dementia. (For the purposes of this report ‘the home’ will refer to all three parts of the service.) Twenty five people lived at the service in total at the time of our inspection.

There was a registered manager in post at the service. 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.

People told us they felt safe living in the home. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Staff knew how to support people safely. Risks to people’s health and welfare were assessed and care plans gave staff instructions on how to minimise identified risks. There were processes in place to ensure people received their prescribed medicines in a safe manner.

There were enough staff on duty to meet people’s needs. Staff’s suitability to deliver personal care was checked during the recruitment process. Staff received training and support that ensured people’s needs were met effectively.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had made DoLS applications when any potential restrictions on a person’s liberty had been identified. Three people at the home had a DoLS application authorised. For people who were assessed as not having capacity, records showed that people’s families or representatives were involved in decisions regarding their care and treatment.

We saw staff offered people a choice of meals. Risks to people’s nutrition were minimised because staff understood the importance of offering appetising meals that were suitable for people’s individual dietary needs.

Staff referred people to other health professionals for advice and support when their health needs changed.

We saw staff supported people with kindness and compassion. Staff reassured and encouraged people in a way that respected their dignity and promoted their independence.

People and their relatives were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs, abilities and preferences and care plans were regularly reviewed.

People were encouraged to share their opinions about the quality of the service and we saw improvements were made in response to people’s suggestions.

The registered manager maintained an open culture at the home. There was good communication between staff members and staff were encouraged to share ideas to make improvements to the service.

There were effective processes in place to ensure good standards of care were maintained for people.

We visited Wolston Grange due to concerns raised by people about staff working long hours at the home. During our visit we spoke with all the staff in the home, which included the registered manager, a team leader, two care assistants and an agency care worker. We looked at staff files, staffing rotas and time sheet reports.

We saw there were 17 people living at the home. The service provided a mixture of supported living accommodation and accommodation for people requiring nursing or personal care. No nursing care was being provided at the time of our visit.

The people who lived at the home had complex needs. This meant they were not always able to tell us in detail about their experiences. Therefore we observed care practice and staff’s interaction with people when they delivered their care.

We found that staff understood the needs of people using the service and we observed positive interactions between the people using the service and staff members.

During our visit people who lived at the home engaged in different activities. Some people were supported by staff to have a hand massage. Some people were watching a film on television. Another person spent time with the home’s pet dog.

Staff told us they received staff rotas at least a week in advance. They told us if there was a problem with the rotas they could speak to the manager about it.

Staff told us that they had agreed their working hours with their manager in advance of working them.

When we visited Wolston Grange, we saw there were 19 people living at the home. The service provided a mixture of accommodation for people requiring nursing or personal care. No nursing care was being provided at the time of our visit.

We spoke with four people who lived at the home, three members of staff delivering care and the manager. The manager was new in post, she had been at the home for approximately four weeks and was not yet registered with us. We read the care records for four people who lived at the home, observed care practice and staff's interaction with people when they were delivering care.

During our visit we saw people enjoyed a variety of activities. Some people were supported by staff to arrange flowers and some people had a hand massage. One person was feeding the hens, they told us, “I love the dogs and chickens. I like it here. I take the dogs out 4 times a day.”

We saw that people’s care was planned according to their needs and dependencies. We found that staff understood people’s needs and followed people’s care plans when they supported them.

The provider had a system for monitoring the quality of the service, which included regular audits. The provider responded to people’s feedback and took actions to improve the quality of the service.

The care staff we spoke with told us they felt well supported by their manager, they felt able to raise concerns and they found the training and induction useful.

We visited Wolston Grange on 16 November 2012. The inspection was unannounced so that the provider, staff and the people who used the service did not know we were visiting.

We last inspected the service on 28 May 2012 and we found the provider had not been supporting their staff to deliver care to people they looked after and care records and other records were not accurate and fit for purpose.

We were told by the provider that systems would be in place by 31 October 2012. We saw staff had received regular one to one meetings with their manager to discuss any training needs and to give them the opportunity to raise any concerns they had.

We saw that care plans for people who used the service and training records for staff were up to date and accurate.

Following our last review of Wolston Grange in March 2012 we had concerns about the care and welfare of people using the service. We told the provider they must make improvements. We received an action plan from the provider telling us what they were going to do to ensure the necessary improvements were made.

We carried out an inspection on 28 May 2012 to check that improvements had been made to confirm the service was now compliant. We found that whilst there had been some improvements made, further actions were needed to achieve full compliance. We will continue to monitor the service to ensure improvements are made and sustained.

When we visited in May there were 15 people living in the main home. Wolston Grange is a home for people who have dementia care needs. This means that people may not always be able to verbally communicate. There is also a five bedded unit called The Barns.

We spent time sitting with people and observed how they were spoken to and treated and how they were encouraged and supported with their care needs. People told us:

“Staff are never rude to you” “they look after you” “food is alright, thank you”. However, we were told by one person “we don’t get out enough”.

On the day of our visit we found there were insufficient recording of staff training, supervision and appraisal. This did not demonstrate staff were receiving the correct level of training and support to meet the assessed needs of people in the home. We also found lack of recording of people’s health needs.

We made an unannounced inspection of Wolston Grange on 3 April 2012. Our inspection was to check whether the provider had taken action to improve the cleanliness of the care home.

In October 2011 we found that Wolston Grange did not provide a clean environment for people using the service. We told the provider they must make improvements and they sent us an action plan telling us what they were going to do.

We inspected Wolston Grange again on 27 January 2012 and found they still did not meet not meet acceptable standards of hygiene and infection control in a number of areas.

We served a warning notice to the provider on 14 March 2012 requiring them to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 by 31 March 2012 or we would take further action to make sure that they achieve compliance.

During our inspection on 3 April we spoke with the manager, care staff and cleaning staff. We looked at some records relating to the running of the home, such as cleaning schedules and staff rosters.

We toured the home and looked particularly at communal bathrooms, lounge and dining areas, the laundry and bedrooms of most of the people using the service.

People using the service at Wolston Grange have dementia care needs which might make it difficult for them to tell us what they think about the service they receive. However, the people we met and spoke with during our visit seemed to be comfortable and content. We observed that staff were aware of people’s likes and dislikes.

We found the standards of hygiene and infection control at Wolston Grange had improved. The provider has complied with our warning notice.

We made an unannounced visit on 15 March 2012 to check on improvements since our inspection in October 2011. We found that whilst there had been some improvements

made, further actions were needed to achieve full compliance.

In October 2011 we found the service was failing to promote people's ability to retain their skills and people were not supported to make choices. There was lack of recording of information in peoples care plans, for example advice provided by nurses was not being acted upon. Personal care was not maintained as there were examples of people with dirty finger nails and men unshaven. There were insufficient care staff to look after people living in the home and there was a lack of quality monitoring of the service. We told the provider they must take action to improve the service to people living at Wolston Grange.

When we visited in March there were 16 people living in the home. Wolston Grange is a home for people who have dementia care needs. This means that people may not always be able to verbally communicate. We spent time sitting with people and observed how they were spoken to and treated and how they were encouraged and supported within the scope of their care needs to retain their skills and included to make choices.

We looked at the care records of five people and spoke with the manager, five care staff and the cook. We looked at some records relating to the running of the home, such as staffing rotas.

We found the service did not always promote the dignity of people using it. People were not always supported with their personal hygiene needs and their personal care needs were not consistently met. Risks to people's health and welfare were not managed in a safe way. For example, there was evidence that people did not always get the support they needed to move safely.

At the last visit we found that the manager had failed to appropriately refer to the local safeguarding team. This is the team that investigates where vulnerable people could be at risk. Staff working in the home had not received training in recognising risk of abuse and the procedures to follow. At this inspection we found some improvements in the way the service recognised and responded to safeguarding concerns as the manager had been referring concerns. However the record of staff training showed that very little training had taken place.

On the day of the visit we saw there were not sufficient skilled care staff on duty with the appropriate skills and competencies to meet the assessed needs of people in the home.

We found the provider did not effectively monitor the quality of service people received at Wolston Grange.

In October 2011 we found that Wolston Grange did not provide a clean environment for people using the service. We told the provider they must make improvements.

The provider sent us an action plan telling us what they were going to do.

We decided to make another check because information shared with us indicated there were still concerns about the standards of cleanliness.

We made an unannounced visit to Wolston Grange on 27 January 2012.

We spoke with the manager and deputy manager and looked at some records relating to the running of the home, such as cleaning schedules and staff rosters.

We toured the home and looked particularly at communal bathrooms and toilets, the laundry and bedrooms of several people using the service.

Overall, we found that Wolston Grange does not meet acceptable standards of hygiene and infection control in a number of areas.

We decided to check this service because information was shared with us that raised concerns about whether people’s needs were met safely.

We made an unannounced visit to this care home on Thursday 27 October 2011. There were 28 people using the service when we visited. On the day of our visit we toured the lounge and dining areas, corridors, two communal bathrooms and several bedrooms.

We looked at three people’s care records and spoke with the manager, three care staff and a visiting district nurse.

People using the service at Wolston Grange have dementia care needs, which meant they might have difficulty engaging in complex conversations with us. We spoke with 13 people who were using the service when we visited and spent time observing their experiences in the care home.

When we asked people using the service what was good about it, their comments included:

“It’s just ordinary.”

“They’re just kind and they give us what we want; we don’t have to go on our hands and knees for it.”

When we asked people what they thought the service could do better, their comments included:

“I wish there was more to it than what we’ve got.”

“They get me up at nine whether I want to or not and it’s a long day with nothing to do.”

We found that the service was failing to meet the essential standards we checked.