Woodham Grange

Updated 9 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by an inspector.

Service and service type

Woodham Grange is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Woodham Grange is a care home with personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post although they were on annual leave during our visit.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service. Some of the people who used the service had complex needs or limited verbal communication. This meant they could not always tell us their views of the service or did not wish to engage with us. Including the 2 people we spoke with, we observed 4 people who used the service interacting with staff. We also spoke with 2 relatives by telephone and one during the inspection visit. We spoke with 6 staff including; the deputy manager, senior support staff, a visiting manager and support staff.

We reviewed a range of records. This included 3 people's care records and multiple medication records. We looked at a variety of records relating to the safety and management of the service, including policies and procedures, staff recruitment, risk assessments and safety checks.

Updated 9 June 2023

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Woodham Grange is a residential care home providing personal care to 8 people at the time of the inspection. The service is provided over 2 floors in a purpose built house.

Right Support:

Records relating to accidents and incidents, behaviour monitoring and risk assessments were lacking in oversight and detail. Handwritten medicine records also required improvement and we have made a recommendation about this. This meant people may be at risk of not receiving safe care. There was some damage to bedroom furniture within the home that may pose an infection control risk and other broken items left in the corridor. Infection control measures were in place in relation to staff duties and people were supported by staff to keep their home safe and clean. There were effective staff recruitment and selection processes in place. There were enough skilled and experienced staff who knew people well to safely meet people's needs, for example their communication needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse but records relating to risk, medicines and accidents and incidents required improvement. We also found that records relating to one person and their dietary intake were not as robust as they should be meaning they could be at risk of dehydration. The service needed to ensure recorded outcomes for people were more focused on aspirations for people and how the service demonstrated it provided meaningful choice. We saw menus only had one item and we observed people weren't asked if they wanted anything different prior to staff supporting them with eating their evening meal. The service worked well with other agencies to ensure people received ongoing health and social care support.

Right Culture:

Since the last inspection there was a new registered manager. They and staff were working to a development plan with a strong focus on improving the culture and positive outcomes for people. The service was working with two different recording systems that highlighted the gaps and inconsistency in records relating to safety. There was an action plan in place to address this and the registered manager stated they would prioritize this work. Many of the people and staff we spoke with told us they saw an improvement in the service and the culture. Relatives commented on the positive atmosphere and caring attitudes of staff.

Staff valued and acted upon people’s views but further work needed to be undertaken to show how the service was supporting people to achieve outcomes and to develop meaningful engagement and increase opportunities for people to have their say.

The service had strong links with health and social care partners and were active in the local community.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service under the previous provider was good, (published on 14 February 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a breach in relation to the governance of the service, risk management and record keeping.

We have made recommendations for the provider to review their records relating to medicines. We found no evidence during this inspection that people were at risk of harm from these concerns. The registered manager told us they would prioritise recording on one single system to ensure records were contemporaneous and accessible when needed.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodham Grange on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.