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Woodside Grange Care Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 14 December 2017

This inspection took place on 3 and 10 October 2017. Both days were unannounced which meant that the staff and provider did not know that we would be visiting.

The service was last inspected in December 2016 and received an overall rating of ‘Good.’ This inspection took place due to concerns raised about someone having a recent fall. During this inspection we found falls were quite low but were all monitored with an outcome and possible reason for the fall. However, we did find one fall was not documented therefore not investigated. This was not the fall we were alerted to.

Woodside Grange is a purpose built care home for up to 121 people, which provides care for both older people with a dementia and younger people with mental health needs. There are three floors to the building, each connected by two vertical passenger lifts. All bedrooms are lockable, spacious single rooms, with en-suite facilities. The building is surrounded with private grounds and has on site car parking facilities.

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.

Records showed risks to people arising from their health and support needs were not always assessed and plans were not always in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use. We have made a recommendation about fire drills.

Staff received medicine training and had their competency assessed. Medicines which required refrigeration were stored in a fridge, however the fridges on two units were not always maintained within the recommended temperature ranges. Records regarding medicines were not always maintained accurately as we saw gaps in the recording of administration and inconsistencies with the application of patches and there was very little evidence of the application of topical medicines.

Systems were in place to monitor the safety and quality of the service; but they were inconsistent and did not identify all of the issues we highlighted during the inspection.

Staff were not given effective supervision and there were gaps in training.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. We found the provider had taken appropriate action to comply with the requirements of the MCA and therefore people's rights were protected. At the time of inspection 51 people had a DoLS authorisation in place. However, MCA assessments were generic and not fully completed and consent was not always sought.

We have made a recommendation about mental capacity assessments.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it. However where people were on weekly weights these were not happening regularly.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, district nurses and other professionals.

We found the interactions between people and staff were cheerful and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity.

People and their relatives spoke highly of the care they received.

People had access to a range of activities, which they enjoyed. However, the activity coordinators needed support to ensure people were not socially isolated and due to the service being so large, with a large variety of activity needs. A plan was in place to provide activities on a weekend.

Procedures were in place to support people to access advocacy services should the need arise. The service had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any issues they had.

Care was planned and delivered in way that responded to people’s assessed needs. Plans contained detailed information on people’s past life history.

Feedback was sought from people and relatives assist with the quality of the service. However, we could not see any records of action following the feedback.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Requires improvement

Updated 14 December 2017

The service was not always safe.

People did not always receive their medicines as prescribed and medicine records were not consistently kept.

Risks to people were not all recorded or mitigated.

Staff understood safeguarding issues and felt confident to raise any concerns they had.

Staff were recruited safely and there were adequate numbers of staff on duty to meet people's needs. We made a recommendation about fire drills.

Effective

Requires improvement

Updated 14 December 2017

The service was not always effective.

Staff had not received training to ensure that they could appropriately support people and were not always supported through supervisions and appraisals.

There was a system in place to seek and record consent, however this was not consistently followed and MCA assessments were generic. We made a recommendation about mental capacity assessment.

There were systems in place to support people to maintain their health and people had a balanced diet provided.

The service worked with external professionals to support and maintain people’s health.

Caring

Requires improvement

Updated 14 December 2017

The service was not always caring as the provider was not ensuring the service was caring overall

People were happy with the level of support they received and felt staff were kind and caring.

Staff knew how to treat people with respect and dignity.

People were encouraged to be independent where possible and given the right level of support when they needed it.

Responsive

Requires improvement

Updated 14 December 2017

The service was not always responsive.

People were supported to access activities.

The service had a complaints policy, and people and their relatives knew how to raise issues.

Care plans were specific to the individual person and provided staff with sufficient detail to enable them to provide care based on people's needs and preferences.

Well-led

Requires improvement

Updated 14 December 2017

The service was not well-led.

Work needed to be done on records. For example, supervision, kitchen and medicine records.

Checks to monitor and improve the quality of the service were not always carried out and where they were action plans were not monitored.

A registered manager was in post and feedback regarding the service was positive.

The registered manager understood their responsibilities in making notifications to the Care Quality Commission.