Archived: Woodleigh Christian Care Home

We found the following examples of good practice.

At the time we inspected the service was following the current government guidance in relation to infection prevention and control.

There were restrictions on visiting the service. There was a clear system for visitors in place to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing. All visitors were screened for symptoms of respiratory or other infections before being allowed to enter the home. There was visible information about minimising the risk of infection throughout the home. This information was also presented in pictures and easy read formats. The home was clean and well maintained throughout.

The provider had ensured that people were able to maintain contact with relatives using technology. For example, people were supported to have video calls with relatives using a large screen so they could see better. The provider was planning how to arrange safe visiting during the winter in accordance with current government guidance.

The provider had regular newsletters sent to relatives updating them on visiting restrictions and other key information about infection control. The provider also posted regular updates for relatives on social media. This allowed relatives to see what was going on in the service, and photographs were only used where people consented to this. Feedback we saw from a recent relatives’ survey was positive about the steps the provider had taken to minimise the risk of infection.

The provider had arrangements in place to help prevent the spread of COVID-19 and other infections. All staff received training on the correct use of PPE and infection control. The management team did regular checks on staff to ensure they were following infection control procedures. The management team also regularly audited all their infection control practices to ensure staff were following them.

The provider had arrangements in place to ensure people and staff were tested for COVID-19 in accordance with current government guidance. Risk assessments were carried out with people and staff to ensure they could safely live and work at the service.

Further information is in the findings below.

Woodleigh Christian Care Home is a residential care home providing personal and nursing care to 31 people aged 65 and over at the time of the inspection. The service can support up to 44 people. Woodleigh Christian Care Home is based in an old convent and has been extended to provide additional accommodation. There are multiple lounges and communal areas for people and families to sit and chat, and access to a secure garden area.

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

People and relatives felt the service was safe. Risks relating to people’s assessed needs and the care environment were identified, and care plans told staff how to provide safe care. Staff were knowledgeable about risks and how to manage them. People received their prescribed medicines safely. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences. There were enough staff to keep people safe. The service was kept clean, which minimised the risk of people acquiring an infection.

People and relatives spoke positively about staff skills and experience. People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People were supported and encouraged to have a varied diet that gave them enough to eat and drink. People had access to community healthcare services. The provider had taken steps to ensure the environment was suitable for people's 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.

People and relatives spoke positively about the staff team. One person said, “They are marvellous. Nothing is too much trouble for them.” Staff had time to spend with people socially in addition to doing practical care tasks. Staff encouraged people to express themselves, and where possible, involved people in reviews of their personal care. People said staff always treated them with respect, and relatives confirmed this. Staff respected people's right to confidentiality.

People and relatives were offered emotional support, particularly when they first came to live at the service. Care plans were personalised and contained information about people's likes and dislikes. People and relatives were positive about the support they had to take part in activities both within the service and out in their local community. Staff were proactive in responding to people’s individual needs and encouraged them to do things which were meaningful to them and made them happy. Relatives were confident concerns or complaints would be dealt with. People and their relatives were encouraged to talk about their wishes regarding care towards the end of their lives.

People and relative spoke positively about the staff team and management of the service. Staff also felt supported to do their jobs well. The staff and management had values that placed people at the centre of the service and promoted their independence, enabling them to make choices about their lives as much as was possible. The provider undertook audits of all aspects of the service to review the quality of care, and identify areas where improvements were needed. The provider had a detailed action plan for improving the quality of care and this was reviewed monthly. The provider worked in partnership with others to ensure people maintained their health and social networks 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 (and update)

The last rating for this service was Inadequate (published on 12 March 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is a care home with nursing and is registered to care for 44 older people. On the first day of inspection there were 29 people living at the 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. Woodleigh Christian Care Home is based in an old convent and has been extended to provide additional accommodation. The two halves of the building are joined by a long corridor on the ground floor, there are multiple lounges and communal areas for people and families to sit and chat. There is access to a communal garden from the older building and a lift at either end of the building.

There was a registered manager in post. 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.

Medicines were not managed safely. We found examples of errors in medicine administration records. People did not always receive their medicines as prescribed and we found some people had missed their medicines, with gaps in-between doses or incorrect doses. We also found occasions when the provider had run out of medicines for people.

Incidents were not always identified or investigated. Inadequate recording meant improvements were not made to people’s care and similar incidents were often repeated. Risks to people from known health conditions were not always managed safely and risk assessments and care plans were not consistently reviewed after incidents.

Staff did not always follow advice or recommendations from specialist healthcare practitioners, or senior staff. Communication across teams was not always effective and staff were not always informed of changes to people’s needs in a timely way. There were inadequate staffing levels at night and a lack of permanent nursing staff to ensure consistent care. This impacted on the quality and consistency of care people received and increased the risk of errors and poor communication about people’s changing needs.

Staff did not effectively monitor people’s food and fluids when they were identified as at risk of weight loss, poor skin integrity and diabetes. People who were dependent on others to provide food and drink were not always offered drinks or snacks in-between meals. Record keeping was inconsistent and could not always be relied upon when people’s care was being reviewed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The principles of the Mental Capacity Act (2005) were not consistently applied. Mental capacity assessments were not always decision specific and best interest decisions were made without full consultation of relevant people. Appropriate steps were not always made to keep people safe.

Staff had access to relevant training that supported them to meet the individual needs of people. Staff used evidence based guidance and tools to assess people’s needs.

We observed occasions when staff did not always promote people’s dignity. The service was not always adequately staffed to meet people’s needs and this was impacted by the design and layout of the building. The chaplain provided a pastoral and spiritual service which staff and relatives said they found comforting and reassuring. Where possible staff promoted people’s independence and decision making. People and families were involved in care plan reviews and said staff were respectful and considerate.

We found concerns and complaints did not always lead to improvements in people’s care and people’s needs were not always met. There was a variety of activities and events for people to join and people’s spiritual needs were met.

Senior management were not always clear about incidents and changes that occurred which impacted on the quality of care people received. Quality assurance and monitoring of the service had not supported managers to identify where improvements were required. A lack of provider oversight, management and leadership of the service had led to continued concerns regarding people’s care.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will act to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Woodleigh Christian Care Home is required to have 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 home is run. At the time of our inspection a registered manager was in place but not available on the day of our inspection. The provider’s operations manager had day to day responsibility for the service and was present during the inspection.

People could not be assured their prescribed medicines were managed appropriately. Some concerns were identified with the deployment of staff that meant staff were not always available in communal areas placing some people at risk. Whilst action was taken on the day to address this, continued review and monitoring is required to ensure people’s safety is not compromised. Safe staff recruitment procedures were in place and being used.

People’s needs had been assessed and any associated risks were planned for. However, staff did not always follow information provided impacting on some people’s safety. Accidents and incidents were recorded and reported by staff. These were analysed to ensure appropriate action had been taken to protect people, and to consider if there were any themes or patterns that required further action. Contingency plans were in place to support staff to provide a safe service in the event of an untoward incident affecting the service.

Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm or if they needed to report concerns.

People were not always supported effectively by staff. Some staff required further training and support to improve their practice. New staff received an induction and all staff had ongoing training. Staff had not received the required frequency of supervision meetings to discuss and review their development needs as stated in the provider’s supervision policy and procedure.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Whilst people’s mental capacity had been assessed where required, best interest decisions had not been recorded to show who and how decisions had been made and that less restrictive options had been considered. This is a requirement of this legislation.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People were appropriately supported with their eating and drinking needs if required, choices were offered and respected, and independence encouraged as fully as possible.

People’s health needs had been assessed and planed for. However, further improvements were required in some areas of clinical care.

Staff on the whole were kind and caring; experienced staff knew people well and supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt staff were understanding of their needs and that they had developed positive relationships with them. Information about an independent advocacy service was available for people should this support have been required.

People and or their relative where appropriate, were involved in the assessment and review of their needs. Care plans informed staff how to support people and were on the whole personalised to people’s needs, routines and preferences. Activity staff provided a range of one to one and social activities and opportunities. People and staff knew how to raise concerns and these were dealt with appropriately.

People who used the service and relatives or representatives, were given opportunities to share their experience of the service. Quality assurance systems were in place to regularly review the quality and safety of the service provided however, these were found to require improvement.

During this inspection we found concerns relating to the safe care and treatment of people and this was a breach 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.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodleigh Christian Care Home on our website at www.cqc.org.uk.

We found that the provider had carried out the improvements and met the legal requirements.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. The building was well maintained and regular safety checks were carried out.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff deployed. Appropriate pre-employment checks were carried out before staff began work at Woodleigh Christian Care Home.

People received their prescribed medicines when required and these were stored and administered safely. Procedures were in place to ensure people received their medicines safely when they were away from the service.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on.

Robust quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.

We inspected Woodleigh Christian Care Home on 7 and 8 September 2016. The inspection was unannounced.

Woodleigh Christian Care Home is situated in the Nottinghamshire town of Mansfield. The service is registered to provide accommodation for a maximum of 44 people, who require nursing or personal care on the premises. There is always a nurse within the home and they are also registered to provide Diagnostic and screening procedures and Treatment of disease, disorder or injury. At the time of our inspection, 37 people were living at Woodleigh Christian Care Home.

At the time of our visit the service did not have a registered manager in place. However the manager was progressing through the application process to become registered with CQC. The previous registered manager left the service in May 2016. 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.

Risks to people’s safety were not always identified and managed and assessments intended to minimise the risk of harm were not always effective or updated when required. The building was well maintained and regular environmental safety checks were carried out.

People did not always receive care and support in a timely way as sufficient numbers of suitably qualified and experienced staff were not always available. Appropriate pre-employment checks were carried out before staff began work at Woodleigh Christian Care Home.

People did not always receive their prescribed medicines when required. Medicines were not always stored safely and records of available stock were not always accurate.

Staff knew how to protect people from harm and referrals were made to the appropriate authority when concerns were raised.

Staff received training and support to enable to meet people’s needs but they did not always have the time and opportunity to do so. Ongoing training and assessment for care staff was scheduled to help maintain their knowledge.

Evidence that people had given consent to any care and treatment provided was not always available. Where they did not have capacity to offer informed consent their best interests and rights were not always protected under the Mental Capacity Act (2005) as thorough assessments were not always carried out. People’s wishes regarding their care and treatment were respected by staff.

People were not always supported to have sufficient food and drink to help them maintain healthy nutrition and hydration. People had access to health professionals, however, the service was not always proactive in making referrals and requesting input when required. Staff followed their guidance to ensure people maintained good health.

People were generally treated with dignity and respect, however we noted a number of occasions when people’s dignity was not protected. We observed limited opportunities for positive interactions between staff and noted that staff seemed to be task driven in their approach to ensure they were able to meet peoples basic needs.

People did not always receive personalised care that was responsive to their needs. Care staff had an understanding of people’s care needs but could not always ensure that the care was provided at the right time. They knew how to raise an issue and were confident these would be listened to and acted on.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Quality monitoring systems were in place to identify areas for improvement however these were not effective as their findings were not always acted on.

We saw evidence that people were consulted before receiving care. One of the people who used the service told us, 'They talk to me about my care, they don't force things.' A relative we spoke with told us, 'I am fully involved; they (staff) always gain my consent when it is needed.'

We saw staff were friendly and patient with people. One person we spoke with told us 'I receive good care here, and I get on great with the care workers.' A relative we spoke with told us, 'They (staff) never stop, they are fantastic.'

We saw that the building was safe, clean and adequately maintained. One relative told us, 'It is a nice, large building; it is airy, warm and clean. It never smells and it meets my family member's needs.'

We saw that staff were trained for their role. One staff member told us, 'The training meets my needs, I feel confident in my role.'

We saw that records relevant to the management of the service were accurate and up to date.