The inspection of Woolton Grange Care Home took place on 31 October and 7, 14 November 2018; the first day of the inspection was unannounced.

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 de

This inspection took place on 13 and 21 July 2017. The first day of the inspection was unannounced.

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

We carried out an unannounced comprehensive inspection of this service on 08 December 2014. At which a breach of legal requirements was found. This was because the provider was failing to protect people from the risks of infection.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 14 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements, which they had. We also received prior to this inspection some information of concern about the quality of the care records at the home, these concerns were not substantiated during the inspection.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘ Woolton Grange Care Home’ on our website at www.cqc.org.uk’.

Woolton Grange provides accommodation and personal care for up to 43 people. Some people who live at the home have dementia. Bedrooms, bathrooms and toilets are situated over three floors with stair and passenger lift access to each of them. People have use of communal areas including a lounge, conservatory and dining room. The home is within walking distance of local shops and other amenities.

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. The home’s manager was leaving the service shortly after this inspection. The provider is in the process of recruiting a new manager for the home.

The home was clean and well maintained. We saw that significant improvements had been made to the cleaning schedules and practices within the home. There were sufficient supplies of antibacterial hand gels, soap dispensers and paper towels in the home for both people and staff to maintain good hand hygiene. Two people spoken with told us that the home was always clean.

The home had two male and female dementia units. We visited the female unit and saw that it had been completely re-decorated to ensure it was dementia friendly. We were told by the manager, that similar refurbishment plans were in progress with respect to the male unit.

We looked at care files and saw that they were informative and well maintained. People needs and risks were identified and planned for in the delivery of care. We saw that activities for people had been improved and there was more choice on the types of activities available.

Woolton Grange Care Home is owned by Hill Care Group. Woolton Grange Care Home provides accommodation and personal care for up to 43 people who have dementia. There were 39 people living at the home at the time of this inspection. This unannounced inspection took place on the 8 December 2014.

During the inspection we spoke with thirteen people who lived at the home, eleven staff, a visiting doctor, and five people visiting their relatives. We spent time with the new manager who is currently registering with the CQC to be the registered manager. 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 requirements of the law; as does the provider.

We last inspected Woolton Grange Care Home on the 4 July 2014. At the last inspection we found that the service was not meeting all of the essential standards that we assessed. We identified areas of concern as the safety and suitability of the premises, the staffing levels and the monitoring of the service. At this inspection we found that these standards had improved.

At this inspection we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 as the provider had failed to protect people against identifiable risks. Staff were not following universal safe hand hygiene procedures and some areas of the home and equipment required cleaning.

The manager told us that the people living at the home, people acting on their behalf, staff and other visiting professionals had been requested to complete feedback about the care and provision.

People using the service told us they felt safe. Staff were knowledgeable in recognising signs of potential abuse and followed the required reporting procedures to inform the manager or senior on duty. Of the thirteen people spoken with eight people were able to tell us they felt safe living at the home and with the staff who supported them. Comments included, “I do feel safe living here” and “The staff are lovely, they make me feel safe”.

People were treated with kindness, compassion and respect. The staff took the time to speak to the people they were supporting. We saw positive interactions with staff and the people living at the home.

People living in the home were not stimulated and required more activities and support to be made available to them. We discussed good practice guidelines in providing an environment that was conducive to people’s wellbeing with the manager, who agreed that they needed to do a lot more in meeting people’s individual needs in relation to their mental wellbeing by providing fulfilling activities.

Although there were some systems in place to assess the quality of the service provided in the home they were required to be more robust in following guidelines for infection control, staff receiving training relevant to ensure they are competent in meeting the needs of people with dementia and in ensuring that people living at the home were having all of their needs met by staff, specifically stimulation to enhance their wellbeing.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

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.

Some people who used the service were not able to tell us directly about their experiences of using the service or comment about the care and support they received, due to a variety of complex needs. We therefore spent time observing how those people were cared for, viewed records and spoke with family members and visiting healthcare professionals. Other people confirmed they were happy living in the home.

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 spoke with nine people who used the service, five of their relatives and seven staff.

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.