Archived: Woodlands Nursing Home

Woodlands Nursing Home is a residential care home that provides accommodation and nursing for up to 18 older people, some living with dementia. At the time of this inspection 11 people were living in the home.

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

Systems remained in place to protect people from abuse and staff had been trained in safeguarding adults.

There were enough staff working at the service to meet people's needs and checks were carried out on new staff to make sure they were suitable to work in a care setting.

People’s risk had been identified and systems were in place to make sure staff knew how to manage and reduce risk. Staff knew what to do in an emergency and had additional information, training and meetings to keep their knowledge and skills updated. People’s medicines were managed safely.

The home was clean and free of unpleasant odours. People were protected from the risk and spread of infection because staff followed the provider's infection control procedures.

The provider recorded and monitored accidents and incidents in order to identify trends and put systems in place in order to minimise recurrence.

Systems were in place to monitor the quality of care people received at the home, learn lessons when things went wrong and make improvements to the care and support people received.

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 this service was good (published 23 October 2018).

Why we inspected

This inspection was prompted in part by notification of a specific incident, following which a person using the service died. At the time, we undertook enquires to establish the circumstances around the person’s death and we worked with the local authority and the provider to make sure people were safe. We carried out this unannounced focused inspection to review the key questions of safe and well-led to make sure the changes the provider had made were embedded and people remained safe. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report .

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. Therefore, we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating of good for the service has not changed. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor the 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.

At our last inspection in March 2017 the service was rated requires improvement overall. We rated the key question ‘Responsive’ requires improvement because there were limited opportunities for people to participate in activities or leave the home. We also found that the provider’s systems to assess and monitor the quality of care people received were not as effective as they needed to be. After the inspection the provider sent us an action plan detailing how and when the required improvements would be made. These actions have been completed.

The home had 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.

People remained safe at the home. People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse. Staff had been trained in how to follow these procedures. Risk assessments were conducted and risk management plans were in place which enabled people to receive care with minimum risk to themselves and others.

The provider recorded and monitored accidents and incidents in order to identify trends, and put systems in place in order to minimise recurrence. The home was clean and free of unpleasant odours. People were protected from the risk and spread of infection because staff consistently followed the provider’s infection control procedures. Equipment used to support people was clean, in a good state of repair and was regularly serviced.

Staff were recruited through a rigorous process which was consistently applied. Appropriate checks were carried out before staff were allowed to work with people alone. There were sufficient numbers of staff to meet people’s needs. Staff received regular, relevant training as well as supervision and appraisal. This helped to ensure they had the skills and knowledge to support people effectively. Staff were caring and treated people with respect. They knew people well and understood how to meet their needs.

People’s rights were protected. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. People had been consulted about their care and support needs which were assessed before they moved into the home. Care plans and risk assessments included information and guidance for staff about people’s needs and how they preferred their needs to be met.

Staff supported people to maintain their independence. People were enabled to maintain relationships with their family and friends; visitors were made to feel welcome. People had the opportunity to participate in organised activities and to go out on trips.

There were appropriate arrangements in place to ensure that people received their medicines safely. People were supported with their nutrition and hydration needs and people who required support at mealtimes had the support they required. People were supported to maintain their health and had access to a variety of healthcare professionals.

The home was well-managed. The registered manager communicated effectively with staff and relatives. They sought the views of people using the service, their relatives and friends through residents’ meetings and satisfaction surveys. The provider had a complaints procedure in place and people said they were confident their complaints would be listened to and acted on. The registered manager had effective systems in place to regularly assess and monitor the quality of the service provided to people.

The service did not have a registered manager. However the manager had submitted their application to become registered. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. Like registered providers, registered managers 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 last inspection in June 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to there being a lack of effective systems to prevent the risk and spread of infection, the lack of staff appraisal, the failure to follow the requirements of the Mental Capacity Act 2005 and associated code of practice, how staff supported people to maintain good health and the lack of effective systems to assess and monitor the quality of care people received. The provider sent us an action plan setting out when the required improvements would be made. Some of these actions have been completed.

Since our last inspection, the provider, area manager and manager had worked hard to improve staff practices and the standard of care people received. People were satisfied with the care they received and told us they were treated with respect and kindness. Staff ensured people received a nutritious, balanced diet. People were happy with the quality of their meals and said they were given enough to eat and drink.

However people felt there was little for them to do during the day. We found that people did not receive sufficient social stimulation. Staff did not enable them to participate in a variety of activities or support them to go out in the community.

People felt safe living in the home. There were procedures and risk assessments in place which staff implemented to reduce the risk of harm to people. Staff had been trained in safeguarding adults. They knew how to recognise the signs of abuse and how to report any concerns.

Staff asked for people’s consent before delivering care. Staff understood the main provisions of the Mental Capacity Act 2005 and how it applied to people in their care. People and where appropriate, their relatives were involved in the assessment and care planning process.

There were procedures in place to ensure that people received their medicines safely which staff consistently followed. People were protected against the risk and spread of infection. People’s healthcare needs were met by suitably qualified staff. Staff carried out regular checks on people’s health and well-being but the information obtained from these checks was not always acted on which meant there was a risk of people's health deteriorating.

Appropriate checks were carried out on staff and they received an induction before they began to work with people. Staff had the skills, training and experience to meet people's needs. There was a sufficient number of staff on duty to care for people safely and effectively. Staff understood their roles and responsibilities.

A lot of work had gone into improving the cleanliness, décor and furnishings in the home. There were systems in place to assess and monitor the standard of care being provided but these were not as effective as they needed to be and did not always identify areas which required improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to people not being supported to maintain their independence and access the community and the lack of effective systems to assess and monitor the quality of care people received.

You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection in September 2015, we found the provider was meeting all the requirements and regulations we inspected.

The service had a manager who had submitted an application to be registered with the Care Quality Commission (CQC) to become the registered manager of the service. Like registered providers, registered managers 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. The manager's application is in the process of being considered.

On entering the home there was an unpleasant odour. The home was in need of maintenance and re-decorating. We found that there were poor standards of hygiene and parts of the home were not clean. This meant that people were not protected from the risk and spread of infection.

People felt safe. Staff had a good understanding of how to protect people from abuse. Care was planned and delivered to ensure people were protected against identified risks.

People received their medicines in accordance with their care plan but the arrangements in place to ensure people's medicines were stored safely were not always followed by staff. We have made a recommendation that the service consider current guidance on storing and managing medicines in care homes and take action to update their practice accordingly.

The provider did not adequately support staff to deliver care effectively through an annual appraisal. Staff had received training in the mandatory areas required for their role such as, safeguarding people from abuse, moving and handling people and infection control.

The manager and staff did not have a good understanding of the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards. Care was not always delivered in accordance with people's care plans. This meant the care people received was not always as effective as it could be.

People were as involved in their care planning as they were able. Where appropriate, their relatives were also involved. Care plans provided information to staff about how to meet people’s individual needs.

People were satisfied with the quality of their meals and told us they had a sufficient amount to eat and drink.

Staff were recruited using an effective procedure which was consistently applied. People told us the staff were kind and caring. People were treated with respect and their dignity was maintained. People were supported to express their views and give feedback on the care they received.

There were systems in place to assess and monitor the quality of care people received. However, these systems were not always effective. Where these systems identified areas for improvement, action was not always taken.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to there being a lack of effective systems to prevent the risk and spread of infection, the lack of staff appraisal and the failure to follow the requirements of the Mental Capacity Act 2005 and associated code of practice. We also found breaches in relation to how staff supported people to maintain good health and the lack of effective systems to assess and monitor the quality of care people received.

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 describes what we observed, the records we looked at and what people using the service and staff told us.

Is the service safe?

People we spoke with told us they felt safe and that they would tell their relatives or the manager if they had any concerns about their safety. Comments we received included, 'I have no concerns about my safety, the staff are very caring." The provider had systems in place to protect people from abuse and to minimise the risk of abuse. Staff had received training relevant to their role such as safeguarding vulnerable adults, moving and handling people and administering medicines which enabled them to deliver care safely and to an appropriate standard.

In the care files we reviewed, we saw detailed and personalised risk assessments which were reviewed monthly. The risk assessments considered a variety of risks and where a risk was identified, control measures were put in place to minimise the risk.

The service had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although at the time of our inspection no applications had needed to be made. Staff were aware of the Deprivation of Liberty (DoLS) legislation and how it applied to the people in their care.

Is the service effective?

People were satisfied with their care and the way it was delivered. Comments we received from people using the service included, 'staff are very pleasant and I think the care is very good." Relatives told us, 'I can see that X is being well cared for and X has told me that without prompting." and "X quality of life is much better now. She is well cared for and always clean."

A range of entertainment and activities were available to people who use the service, such as dancing with wheelchairs, cooking and bingo. One person told us, 'I like it here, I can do the things I like doing." Another person told us, 'the activities are excellent." A hairdresser visited the home regularly. We saw evidence the home had arrangements in place to maintain people's health and that medical professionals such as dentists and chiropodists visited the home on a regular basis.

People were provided with a choice of suitable and nutritious food and drink. People told us they were satisfied with the quality and quantity of their meals. People told us, 'the food is good, better than I used to do for myself at home" and "the meals are fairly good. They do try to take account of the majority." People were able to have snacks and drinks between meals. One person told us, 'I've asked for a snack at 10pm and got sandwiches and cake." A staff member told us, 'this is their home, they can eat what they like when they like."

Is the service caring?

Comments we received from people using the service and their relatives included 'staff are caring and when I call they always attend quickly" and "the staff are caring, they know X habits and how he likes things done." The responses to the satisfaction survey were also positive. One relative commented." I am pleased with the care X is receiving. The staff are caring and go the extra mile. X has improved."

We observed that staff treated people with patience, dignity and respect. Staff assisted people at a pace that was suitable for their individual needs.

Is the service responsive?

People using the service were involved in their assessments and care planning. The care provided reflected people's individual needs and personal preferences. Many of the people using the service were living with dementia. We saw that staff had received training in caring for people with dementia and that the home had systems in place and activities tailored to meet the needs of people living with dementia.

People and their relatives told us their views on the quality of care they received and how they felt the service could be improved were sought regularly by the manager. We saw that satisfaction surveys were regularly conducted and the results analysed so that management had an overall picture of whether people's level of satisfaction with the service was increasing or decreasing. We also saw that action plans were drawn up based on people's feedback and that the plans were put in place.

People felt able to express their views and told us that staff listened to their comments. One relative told us, 'they are always asking for my views and calling me with updates on X care." Another relative told us, " we've been very involved in deciding how X is cared for and when we raise an issue they do listen."

Is the service well-led?

The manager understood what was required to deliver care that was safe, caring, effective and responsive and there were systems in place to regularly assess and monitor the quality of service that people received. A person using the service told us, "The care is remarkably thorough here." Staff told us their work was constantly being checked.

Staff were supported by the management to carry out their roles through regular supervision and staff meetings. Staff had regular training in areas relevant to their role such as infection control and dementia awareness. Staff were required to complete competency assessments in the areas in which they had received training to ensure they understood the training and knew how to apply it in practice.

We saw records which demonstrated that a senior member of staff conducted monthly audits in medication, care planning, accidents and incidents, infections, pressure sores and mental capacity assessments. This ensured that the management had an overview of the quality of care people received and whether the systems which were in place were appropriate and effective.

Comments from residents were generally positive, indicating that staff are kind and helpful in meeting their care needs. People were observed to be treated with respect by staff and to have their privacy and dignity respected.

Residents were able to make choices with regard to their daily lives such as what they would like to wear or to eat or whether they would like to join in any activities. Staff helped them in the way that they preferred and they had their wishes, privacy, dignity and independence respected. The staff interactions we observed were positive.

Residents who we spoke with indicated that they would speak with staff if they were unhappy about their care or if they had any concerns.