Archived: Woodlands Manor Care Home Limited

Woodlands Manor is a care home. People in care homes receive accommodation and nursing or personal care as a 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 accommodation and nursing care for up to 40 people, however two bedrooms that were registered as shared rooms were only used by one person. At the time of this inspection there were 30 people in residence and two people were in hospital. There were two vacant rooms and four rooms were out of use because of the building works.

An extension was being built to the right side of the building. To the left of the building the area behind the car park was being used to store pile of rubbish, empty barrels and building materials. The area was not cordoned off and was unsightly. Although we have reported on this in the last three inspection reports , the provider has not taken any action to tidy and make safe, this area. We asked an inspector from the Health and Safety Executive to visit the site and check on building site safety. Relatives who had been asked to provide feedback about Woodlands Manor had commented about the rubbish and the appalling mess.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was also the registered provider.

Why we have rated the service as Inadequate.

The management of medicines was not safe. We found gaps on the medicine administration records for several people and two people who needed pain relieving medicine had not received their medicine as prescribed. The records to show that topical creams and ointments had been applied as prescribed were poor with no staff signatures and for one this meant they had sustained pressure damage because barrier cream had not been applied. We found that the auditing of medicines was not effective.

Risk management procedures did not take a holistic view of each person and we found that where two people had serious risks to their health and well-being, the risks were not being managed to ensure the risk was eliminated or reduced.

Improvements were still required with infection control and prevention procedures. The infection control audits were ineffective and did not cover all aspects, for example bed mattresses were not checked to ensure the covers were undamaged and the foam inserts were clean. Slings and slide sheets, moving and handling equipment was still being shared between people because there was not enough to go round. We observed laundry staff not following best practice when collecting washing for laundering. Workman from the building site were seen to be accessing the kitchen area and not putting on personal protective clothing.

The provider could not demonstrate training and supervision as we were told there had been computer failure and the records had been lost. The service had changed their training provider since the last inspection and all staff were expected to complete every module of the on-line training programme. The registered manager had not arranged specific training that was talked about at the previous inspection in January 2018 and had not shared learning with the rest of the staff team following a ‘resident for the day’ exercise. This was a missed opportunity to improve staff approach, communication and attitudes.

People were not always looked after with respect and some staff did not speak nicely to them. On two occasions it was senior members of the staff team who did not talk respectfully about people and this does not demonstrate a good ‘leading by example’ means of improving staff attitudes. People’s dignity was not always maintained and we have referred to an example in the main body of the report where improvements were needed.

People may not receive person centred care which is responsive to their particular care and support needs. Concerns have been raised regarding the standard of care given to five people and this was being investigated by the safeguarding adults team in South Gloucestershire Council.

The registered manager had introduced a new quality assurance system in order to check on the quality and safety of the service. The audits we saw were did not identify any shortfalls and did not cover all aspects of the service. Many of the audits were tick-box responses and where shortfalls has been identified, there was no action plan to address the issue. The audits had not picked up the breaches of regulations we have found in this inspection.

We found that improvements were required with care records and other records related to the running of the service. This included the room folders where staff were expected to monitor food and fluid intake, repositiong and topical medicines administration where applicable. The records were not maintained accurately or consistently. Medicine records were also not accurate or complete. Incorrect forms were used to report on any accidents, falls or incidents that had occurred.

On a more positive note we received favourable comments about the meals and drinks people were served with and the activities they were able to participate in. Each person was registered with a GP and arrangements were made for them to see the GP and other healthcare professionals as and when they needed to do so.

The number of nurses and care staff on duty each shift was calculated based upon the level of care and support needs for each person who lived at Woodlands Manor at that time. This was reviewed on at least a monthly basis or whenever any changes were identified. The recruitment of new staff to the service followed safe recruitment procedures to ensure unsuitable staff were not employed.

Staff were aware of the need to gain consent from people before offering care and support. The service worked within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted to the local authority where people were unable to consent to live at Woodlands Manor. The procedures in place for assessing people’s care and support needs prior to admission to Woodlands Manor ensured any placement in the service was appropriate.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can what actions we told the provider to take in the full version of the report.

The service has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

On Thursday 15 November Woodlands Manor Care Home entered administration. Since that date CQC have been working with the administrator and the care management team employed by them to manage Woodlands Manor Care Home.

CQC are assured by the steps taken to ensure that people living in the home are safe and that the shortfalls identified in this inspection report are being addressed. The new care management team are voluntarily providing CQC with weekly updates on their progress in addressing the shortfalls, ensuring people are safe and how they are improving the quality of care provided at Woodlands Manor Care Home.

Woodlands Manor Care Home is registered to provide accommodation and nursing care for up to 40 people, however two bedrooms that were registered as shared rooms were only used by one person. At the time of this inspection there were 22 people in residence. The numbers were low because the local authority and NHS had not been making placements, enabling the service to consolidate and make the required improvements.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was also the registered provider.

Since the last inspection the registered provider had been working with a healthcare consultant to make the required improvements with the service and to rectify the breaches. A new clinical lead nurse/ deputy manager had been appointed since the last inspection and new qualified nurses had been recruited. These measures had brought about a marked improvement in the leadership and management of the service.

The service was safe however some improvements were still required with infection control and prevention procedures. Whilst infection control audits had been carried out it was not evident what actions had been taken as a result of identifying shortfalls. The slings to be used with hoisting equipment were shared between people. Although the registered manager knew this was a priority issue, it had not been addressed.

Staff received safeguarding adults training and knew what to do to report any concerns regarding people’s care of bad practice. Three safeguarding alerts had been raised by other parties since the last inspection and the staff team had worked hard to address the concerns raised. The service remains the subject of on-going organisational safeguarding monitoring however this will be reviewed 5 March 2018.

Risk assessment processes and the management plans in place ensured any risks to people’s health and welfare were reduced or eliminated. Moving and handling procedures were carried out following safe procedures. The use of sensor equipment was in place where people were at risk of falls. There was a regular programme of checks in place of the premises, facilities and equipment.

The number of nurses and care staff on duty each shift was calculated based upon the level of care and support needs for each person who lived at Woodlands Manor at that time. This was reviewed on at least a monthly basis or whenever any changes were identified. The recruitment of new staff to the service followed safe recruitment procedures to ensure unsuitable staff were not employed.

The management of medicines had significantly improved since the last inspection. There were robust audit and checking procedures in place to ensure people received their medicines as prescribed by the GP. Some changes were identified regarding the times of day specific medicines were administered and this was discussed with the clinical lead nurse.

The procedures in place for assessing people’s care and support needs prior to admission to Woodlands Manor ensured any placement in the service was appropriate. The service had however not admitted new people who were funded by the local authority or the NHS since the last inspection.

The registered provider now ensured staff received the training they needed to do their jobs effectively and had changed their training provider. Improvements had been made to the induction training programme for new staff. Staff were receiving regular supervision sessions with a line manager and the qualified nurses were now more actively involved in supervising staff work performance and the delivery of care to people.

People were provided with sufficient food and drink, or dietary supplements to meet their requirements. They were complimentary about the food and were given choice about what they would like to eat. Each person was registered with a GP and arrangements were made for them to see the GP and other healthcare professionals as and when they needed to do so.

Staff were aware of the need to gain consent from people before offering care and support. The service worked within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted to the local authority where people were unable to consent to live at Woodlands Manor.

People were looked after by staff who were kind and caring. The registered manager had received many complimentary letters and cards and we saw positive interactions between staff and people. Care staff spoke about the people they were looking after nicely and ensured they were treated with respect and dignity. People were supported and encouraged to express their views and have a say in how they were looked after.

People were provided with personalised care that meet their specific care and support needs. Whilst care planning arrangements had improved since the last inspection improvements were still required in respects of the care notes kept where staff were monitoring certain aspects of a person’s care. For example food and fluid charts, re-positioning charts, topical medicines administration charts. These charts were not consistently being checked by the qualified nurses at the end of their shift, nor had this shortfall been identified by their auditing process.

People were able to participate in a range of meaningful activities. The activities and care staff liked to find out what people wanted to do and where possible incorporated this information in to the activities programme. The provider had a complaints procedure in place and provided a copy of this to each person. People felt able to raise any concerns or complaints they had and the records of those that had been raised evidenced they had been handled correctly.

The Care Quality Commission received good feedback from one family regarding the standard of care provided for one person who was receiving palliative and end of life care.

The procedures in place to monitor the quality and safety of the service were more robust that when we inspected the service in June 2017 however still require improvement. The audits and checks were more in-depth but where shortfalls had been identified it was not evident what action had been taken to address this. For example an audit of housekeeping and infection control procedures scored only 92.3% on three consecutive months with no record of any action taken to improve the score.

The registered manager ensured that any accidents, incidents or complaints that occurred were analysed in order to identify trends. This meant the opportunity to make any changes to reduce or eliminate a reoccurrence was now being acted upon.

Woodlands Manor Care Home is registered to provide accommodation and nursing care for up to 40 people, however two bedrooms that were registered as shared rooms were only used by one person. At the time of our inspection there were 33 people in residence. One of these people was having a short stay at the home,

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 and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was one of the two directors, who runs the home.

The service was not safe. The nursing staff did not ensure that stocks of medicines were always available and this meant there were occasions when people did not receive their medicines as prescribed. The records regarding how often some medicines were to be administered were not always correct. Not all medicines were stored correctly and clinical supplies and equipment was not checked to make sure it was fit for purpose.

Not all staff had received safeguarding training and told us they relied upon the nurses, the clinical lead nurse and registered manager to report any concerns. There have been recent occasions when neither the nurses or the registered managers have reported concerns to the local authority safeguarding team. The service has been the subject of organisational safeguarding monitoring since May 2016.

The measures in place in respect of infection control and prevention were not adequate. No checks had been undertaken to ensure people and the staff team were safe. People had to share some equipment, for example hoist slings and commodes. We found the storage areas for the bins to be littered with rubbish and the clinical waste bins to be open and faulty.

The registered provider did not ensure the staff received the training they needed to do their jobs effectively. New staff were uncertain what the plans were for their induction training. The new training package we were told was being introduced last year in June 2016 had not been implemented and the registered manager and clinical lead were unsure how far they had got.

We were provided with examples where the staff had not treated people with respect. We saw where one person’s bedroom had been left open whilst they were sat on the commode and we had seen this happening when we visited last year. We had to ask the care staff to respond to requests for assistance from people who had rung their call bells. The staff were task orientated and did not have a person centred approach towards the people they were looking after.

Improvements were required with the standards of care delivered to those people who were receiving palliative or end of life care. The qualified nurses did not demonstrate their competence in ensuring that people would be kept comfortable and their death would be peaceful. There are further details in the main body of the report.

Assessment and care planning required improvement to ensure that each person received the care and support they needed. Before admission, the service should ensure a person’s need for any specific equipment was identified. Changes in people’s health care needs were not always acted upon by the nursing staff and when advice from specialists was required, this might not be done in a timely manner. People did not consistently receive person-centred care that met their own specific needs.

Whilst some improvements had been made to the care records for each person we still found that not all records were accurate. Where people’s health care status required greater monitoring, the records kept were not complete and did not evidence that the care had been delivered.

The management of complaints was not in line with the providers own complaints procedure. Relatives had raised complaints with the nurses and with the registered manager but had not received a satisfactory response. This meant people and their relatives cannot be assured that any concerns they had about the way they were looked after would be listened to.

The procedures in place to monitor the quality and safety of the service remained inadequate. Any audits and checks that were completed were brief and superficial. The audits were not always carried out by the most appropriate member of staff. The registered manager did not use information from any accidents, incidents and complaints to identify trends. This meant the opportunity to make any changes to prevent a reoccurrence was missed.

The procedures in place to recruit new staff were safe. Pre-employment checks were completed to ensure unsuitable staff were not employed. The service did not use a specific formulae to calculate their staffing numbers per shift but these appeared to be adequate at the time of the inspection. There was a plan in place for staff supervision however this needs to be strengthened.

Staff were aware of the need to gain consent from people before offering care and support The registered manager worked within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted to the local authority where people were unable to consent to live at Woodlands Manor. .

People were provided with sufficient food and drink, or dietary supplements to meet their requirements. They were complimentary about the food and were given choice about what they would like to eat. Each person was registered GP and arrangements were made for them to see the GP and other healthcare professionals as and when they needed to do so.

The registered manager had received many complimentary letters and cards and we did see positive interactions between staff and people. Care staff spoke about the people they were looking after nicely but need to ensure they maintain their need for respect and dignity.

People’s were able to participate in a range of different activities. There was a mix of group activities and external entertainers visited the service regularly. The activity staff team now consisted of three staff with the aim of increasing social and emotional support, on an individual basis, for those who were confined to their rooms of their bed.

We found six 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Woodlands Manor Care Home is registered to provide accommodation and nursing care for up to 40 people, however two bedrooms that were registered as shared rooms were only used by one person. At the time of our inspection there were 38 people in residence.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

The registered provider had not ensured the safety of people who live in the home, any visitors and the staff team. Access to unsafe areas in the grounds were not screened off therefore people could be injured if they went into these areas and fell. The registered provider had not reduced the risk of people being scalded because hot water temperatures at the point of delivery in some bedrooms were too high.

Improvements were required with some aspects of the management of medicines. Nurses need to ensure that all medicines received in to the home are recorded and any handwritten entries on medicines charts are checked by another member of staff. This reduces the risk of an error being made.

Care records were not always accurate and did not provide a sufficient level of detail. People could be at risk of not receiving consistent care. People’s plans were not always updated to reflect a change in their care and support needs. Long term people did not have their needs reassessed regularly with the result that some plans had been written many years ago. An accurate account of the care and support each person received on a daily basis was not maintained. Important forms to record do not resuscitate decisions were invalid because they had not been reviewed by the healthcare professional responsible for their care.

The procedures in place to monitor the quality and safety of the service required improvement. The registered manager had not used information from any accidents, incidents and complaints to identify trends. This meant the opportunity to make any changes to prevent a reoccurrence was missed. Although there was a programme of audits and checks in place these were not effective because the registered manager did not keep a log of improvements and actions taken to resolve the issues.

Staff did not have access to the registered providers up to date policies and procedures. Some of the key policies we looked at, which would be the ones they had access to had been written in 2007-2017. The safeguarding adults policy contained incorrect contact details and placed too much emphasis on internal investigation of any safeguarding alerts and concerns.

The staff team, including the registered manager understood their responsibility to protect people from harm and had received safeguarding adults training. A number of safeguarding concerns had been raised by health and social care professionals regarding people’s care and the service had worked with the local authority to address the issues. At the time of the inspection the service was still being monitored by the local authority safeguarding team.

Risks in respect of people’s daily lives or their specific health needs were assessed and appropriately managed. Plans were in place to reduce or eliminate those risks. Regular checks of the premises, facilities and equipment were undertaken but were not robust enough. We have referred to our concerns about the hot water temperatures in some of the bedrooms and the safety of outside space.

The staffing numbers for each shift were kept under review and were adjusted when people were unwell or where specific events taking place. There was always a qualified nurse on duty, two on a Tuesday when the GP visited. The registered manager and clinical lead nurse provided leadership and management for the staff team. Staff were provided with regular training and opportunities to develop their skills further. They had the necessary knowledge and skills to meet people’s individual care needs.

Staff were aware of the need to gain consent from people before offering care and support and will be completing further Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) training. The service had been slow to submit DoLS application to the local authority when a person was unable to consent to live at Woodlands Manor however, seven were submitted in May 2016.

People were provided with sufficient food and drink, or dietary supplements to meet their requirements. They were complimentary about the food and were given choice about what they would like to eat. The new chef was in the process of revising the menu’s to provide a greater variety of meals. Each person was registered GP and arrangements were made for them to see the GP and other healthcare professionals as and when they needed to do so.

People said the staff were kind to them and they were looked after. Staff spoke about the people they were looking after in a kind and respectful manner and ensured they delivered care in the way the person liked. People were involved in making decisions about how they wanted to be looked after and how they spent their time. People’s privacy and dignity was generally maintained however, there was one occasion during the inspection when we noticed one person’s dignity being compromised.

People’s were looked after in a person-centred way and were able to participate in a range of different activities. There was a mix of large and smaller group activities and external entertainers visited the service regularly. The activity staff were in the process of gathering life histories for people in order to find out about their social interests.

We found 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, seeking experience and views from people who use the service and the staff supporting them and from looking at records.

Is the service safe?

All of the people we spoke with told us they felt safe at the home. They did not express any concerns about their personal safety or for their belongings.

A variety of assessment tools were used for pain, nutrition and skin integrity. There were risk assessments completed as needed for manual handling and falls. Weight charts were used for monitoring purposes and there were records of blood pressure checks. We saw evidence these tools we regularly reviewed by trained nursing staff.

Is the service effective?

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs.

Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. The registered manager told us they were 'very well' supported by a local GP surgery who visited the home weekly.

Is the service caring?

People we spoke with made the following comments, 'I can't fault the staff, they're all lovely' and 'They're always very kind and help me if I want them'. One person gave us a big thumbs up sign when asked if the staff treated them well.

Is the service responsive?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Reviews of people's care plans were carried out at least monthly or when people's needs changed. Where assessments identified risks to the person's health and welfare, care plans had been developed to meet those needs.

The provider completed an analysis of accidents and incidents. We saw the home had a system that ensured that accidents and incidents were reviewed monthly by the home management in order to reduce or prevent further accidents or incidents.

Is the service well led?

The overall feedback we received from staff was positive. Staff we spoke with told us they had received sufficient training and felt competent to perform their roles. The registered manager told us staff were committed in attending training relevant to the care needs of the people they were caring for and relevant to the roles they performed.

People who used the service and their representatives were asked for their views about their care and treatment and they were acted on. The home had a quality assurance monitoring system in place.

Staff received appropriate professional development. We looked at the home's overall staff training matrix. The training matrix clearly showed the training staff had completed. The registered manager was able to determine whether staff had undertaken or were due for mandatory training.

We received various responses when we asked people about waiting times after they used the call bell. One person said they sometimes had to wait for assistance to get up from bed and found this “frustrating” and another said they sometimes “have to wait quite a time”. Another person who was being visited by a relative told us they do not have to wait long for a response and that the staff were more responsive than where they lived previously. We spoke with a visitor about the staffing level. They said they felt staff were “hard pushed”. We spoke with four staff. Two of them commented on shortage of staffing at times. One of them said they understood that there was recruitment on-going. We found there to be sufficient staffing with the intention to cover all shifts. the manager explained that the exception to this would be where there was late sickness reporting.

We were told there were no arrangements for the removal of clinical waste. When we visited we saw that following a dispute with the previous contractor a new service was in place. We looked at this and the other arrangements for infection control and found that the home had good systems in place based on relevant guidance.

The manager was not registered with the Care Quality Commission.

We spoke with four visitors. One visitor said they felt that areas of the garden were looking tired and another, that the home could be more responsive to requests for assistance. They were all happy with the care provided and were otherwise complimentary about the service.

We spent time with the manager, laundry person and cook, in addition to speaking with a member of the care staff and general assistant. They spoke about how much they enjoyed working in the home and the good team working.

The home’s statement of purpose clearly outlined the services provided and outlined the philosophy of care, and complaints procedure. Complaints about the service had been handled appropriately.

People’s needs were assessed and care plans had been developed. These included determining if people could consent to support and treatment. When people were unable to give informed consent appropriate arrangements were made.

Attention was paid to nutritional needs and people's food intake was monitored where necessary. There was a choice at mealtimes from a varied and well balanced diet.

There were appropriate arrangements for infection control and the management of waste.

Staff were recruited in accordance with legislative requirements and in line with good practice.

We took the opportunity to speak with people's relatives and friends. They told us how people had settled and how happy they were. Relatives said that they were happy with the care given.

We spoke with three visiting professionals (social worker, speech therapist and continuing health funding nurse). They also told us how they introduced a person to the home for a short break. The person remained in the home and needed end of life care. The social worker told us the staff had been very supportive to the person. Another of the professionals complimented the home as being one of the "most cooperative". The other professional said they would be working with the home to ensure that the needs of the person they were supported would be met.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.