Woodside Nursing and Residential Care Home

We found the following examples of good practice.

Systems were in place to support safe visiting at the care home. All visitors were requested to provide a negative lateral flow test prior to their visit and share the result with the care home. In addition, visitors were also required to complete screening questions and have their temperature checked.

People had been supported to maintain contact with their families and friends during the COVID-19 pandemic through video and telephone calls. In addition, in line with government guidance window visits, garden visits, face to face visits and the role of the essential care giver had been promoted by the registered manager.

Staff and visitors were required to wear personal protective equipment (PPE) in line with government guidance. Training had been provided to staff and essential care givers regarding the safe use and putting on and taking off of PPE.

The care home was clean and free from mal odour. Cleaning schedules were completed daily and checked by the registered manager. Daily walks of the floor were completed by the registered manager to monitor cleanliness, hygiene and safe practice of staff.

The registered manager had rented a local community hall during the COVID-19 pandemic to hold wellbeing and emotional support sessions for people and their relatives. Transport and staff escorts were provided for people who chose to attend these meetings.

We found the following examples of good practice.

The home was clean and there were pleasant aromas about the home. The re-decoration programme was continuing to promote Infection Prevention Control (IPC) standards at Woodside. There were good processes for staff and visiting professionals to enter and leave the home in a safe way. Staff were being allocated to only support those people who had positive COVID19 results in order to reduce the spread of the infection. The registered manager had made effective plans to support people who had mental health needs and who would not agree to isolate when they had a positive result from their recent COVID19 test.

When we inspected the service in May 2017, we found the provider was in continuing breach of Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s care plans lacked information that enabled staff to provide person centred care. Medicines were not always managed safely, staff were not always deployed in a way that promoted safe care, and the provider did not have robust quality monitoring processes in place. Following the inspection, we met with both the nominated individual and the registered manager to discuss our findings, and they gave assurances that action would be taken to address the shortfalls identified.

This was the second consecutive inspection where the overall rating for the service was 'Inadequate'. This meant that the service remained in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

This unannounced comprehensive inspection on 15 and 22 November 2017 was carried out to check if sustained improvements had been made. We found the provider had made improvements to all areas where we had previously identified shortfalls. Well-led was rated ‘requires improvement’ because a longer period was required to ensure that systems and processes had been embedded to enable staff to provide consistently safe, effective and good quality care. We were also still concerned about the level of the nominated individual's involvement in driving sustained improvements. However, the service demonstrated to us that improvements have been made and is no longer rated 'Inadequate' overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Woodside Nursing and Residential Care Home is a ‘care 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.

The care home accommodates 27 people in one adapted building. At the time of this inspection, 19 people were being supported by the service.

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.

People’s medicines were now managed safely and accurate records were kept. The provider had effective recruitment processes in place. More staff had been employed to ensure that people were supported safely and consistently. There had been further improvements in the level of cleanliness and people were now protected from potential risks of acquired infections. The provider had effective systems to keep people safe, and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. Environmental risks were assessed and there was evidence of learning from incidents to reduce the risk of recurrence.

Staff training, support and supervision was now more robust. The requirements of the Mental Capacity Act 2005 were being met and people’s consent was sought in line with guidance. People’s needs had been assessed so that they had effective care and treatment. People were supported to have enough to eat and drink, and they had access to healthcare services when required.

Staff were kind and caring towards people they supported. They treated people with respect and as much as possible, they supported people to maintain their independence. People were happy with how their care was provided and they valued staff’s support. People made decisions and choices about how they wanted to be supported and staff respected this.

There had been improvements in the quality of care plans and these now contained personalised information that enabled staff to provide person-centred care. Staff were responsive to people’s needs and where required, they sought appropriate support from healthcare professionals. People were supported to take part in activities they enjoyed. The provider had an effective system to manage people’s complaints and concerns. People were supported in a caring and dignified way at the end of their lives.

More robust quality audits were now carried out and prompt action taken to make improvements. Everyone we spoke with was complimentary about the new manager’s pro-activeness in making improvements in their short time at the service. Staff felt supported and motivated to carry out their roles. People and their relatives had been enabled to provide feedback in order for them to contribute to the development of the service.

We carried out an unannounced comprehensive inspection of this service on 23 February and 16 March 2016 and identified breaches of legal requirements. We issued the provider with some enforcement action for these breaches and they wrote to us with an action plan explaining how they would take the necessary action to ensure that improvements were made.

On 13 and 22 December 2016, we carried out a focused inspection to see whether the provider had followed their improvement plan and to confirm that they now met legal requirements. At this inspection we found that insufficient action had been taken in some areas which meant that there were continued breaches of legal requirements. We again required the provider to take action in response to our concerns around medicines and quality assurance. The provider sent us a further action plan stating that they would make the necessary requirements by March 2017. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodside Nursing and Residential Home on our website at www.cqc.org.uk.

During the inspection on 24 and 31 May 2017, we returned to see if the service had made the necessary improvements. We found that the provider was now meeting some of these regulations; however they had failed to make improvements in other areas.

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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 take action 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 take action 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.

Woodside Nursing and Residential Care Home is situated in Slip End, close to Luton. The service provides accommodation for up to 27 older people who require nursing and personal care. At the time of our inspection there were 22 people living at the service, over two floors.

The service 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.

Staffing levels at the service were not always sufficient to ensure that people's needs were met in an individual manner. There remained no formal method of assessing the staffing levels required for people's needs; therefore the registered manager was unable to provide us with assurance that the staffing levels were suitable for the people living at the service. The deployment of staff was not always effective in ensuring that people's needs and preferences were being met. Staff members had however been through a robust recruitment process to ensure they were suitable for their roles and to work at the service.

Medicines were not always well managed. We found concerns in the way that some medicines were recorded and administered. The systems in place for checking this, had failed to ensure that medicines were robustly managed.

There was a lack of person-centred care at the service. People were provided with regular activities which engaged and stimulated them; however they were not always supported to take part in their own individual hobbies or interests. Care plans had been redeveloped but still lacked key person-centred information about people's individual needs and preferences.

Improvements had been made to the quality assurance procedures at the service. There were an increased range of checks and audits being carried out, however; they were not always effective in identifying those issues we found during our inspection. Concerns were not always identified as part of these processes and the action plans which were in place were not effective in driving improvements.

The provider had introduced improved systems for managing the cleanliness of the service. Additional cleaning staff had been recruited and robust cleaning logs and checklists were in place, to help guide staff and to demonstrate which areas of the service had been cleaned and when.

There was improved training for staff at the service and staff supervisions had been progressed. A formal schedule had now been implemented so that staff could receive more regular supervision. Staff received consistent supervision opportunities. Staff members did feel that the manager was approachable and were able to go to them if they had any issues or concerns. Staff culture was positive and they were motivated to perform their roles and meet people's needs, although this was not always in a person centred manner.

Consent to arrangements for care, treatment and support was sought from people or other relevant people where appropriate. We observed staff providing care by seeking consent. The principles of the Mental Capacity Act 2005 had been followed for those people who lacked the mental capacity to make their own decisions.

In general staff treated people with dignity and respect and worked to develop positive relationships with them, however; there were times when we found that care was task-orientated and staff provided people with little or no interaction or communication.

People felt safe living at the service and had confidence in the staff that supported them. Staff members were trained in abuse and safeguarding procedures, to ensure that people were protected from harm. People were happy with the food and drink provided and we found that their nutritional needs and preferences were well catered for. Appointments with healthcare professionals were also supported and facilitated by the service, to help ensure that people were as healthy as possible.

People knew who the registered manager was and felt they were accessible when they needed them. They were responsive to complaints or feedback and took action to address any issues they raised.

Full information about the CQC's regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded.

Woodside Nursing and Residential Home provides care and accommodation for up to 27 people, some of whom are living with dementia. At the time of our inspection there were 20 people living at the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 did not always receive their medicines as they had been prescribed and medicines administration records were not always correctly completed. Stocks of medicines held did not always correspond with the amount recorded. Medicines were not therefore managed in a safe way.

The home had not been cleaned to an acceptable standard to prevent the risk of infection or provide an environment free from unpleasant odours. The underlying causes of some maintenance problems, such as toilets not working, had not been addressed and consequently any improvement that was made was only temporary.

Neither people nor their relatives had been involved in determining their care needs or the way in which their care was to be delivered. Care plans were not person centred, contained inaccurate information and were task orientated. There were insufficient staff to provide care and support to people at times when their needs were at their highest. This did not ensure that people were provided with appropriate care at all times. The staff were, however, kind and caring, treated people with respect and supported people in a way that allowed them to be as independent as possible.

The recruitment and selection processes in place were robust and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. Staff had not received all the training that they needed to ensure that people were supported safely and effectively and could not remember all the training that they had completed. Staff were supported by way of supervisions and appraisals and were encouraged to acquire and maintain relevant professional qualifications.

The quality assurance system was not robust. Documentation was often inaccurate and incomplete. Audits were carried out by members of staff who had responsibility for the areas being audited. Errors and omissions had not been identified through the auditing processes. The provider organisation had no oversight of the quality of the service provided.

Information was available to people about how they could make a complaint should they need to. People and their relatives were able to make suggestions for the development of the service. People were assisted to access other healthcare services and professionals to maintain their health and well-being.

During this inspection we identified that there were breaches of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any 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 take action 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 take action 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.

Woodside Nursing and Residential Home provides care and accommodation for up to 27 people, some of whom are living with dementia. At the time of our inspection there were 19 people living at the home.

The home had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The service was not always safe. People did not always receive their medicines as they had been prescribed and medicines administration records were not always correctly completed. Medicines were not therefore managed in a safe way. In addition the home had not been cleaned and maintained to an acceptable standard to prevent the risk of infection. Improvements had been made and more had been planned to both the level of cleanliness and the maintenance of the building to reduce the risk.

People had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met. Although care plans were reviewed on a monthly basis they were not updated following receipt of advice from other healthcare professionals until the next monthly review. This did not ensure that people were provided with appropriate care at all times.

People had enough variety of nutritious food and drink available to them. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly.

Staff were aware of the safeguarding process. There were enough skilled, qualified staff to provide for people’s needs. The necessary recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. They received training to ensure that they had the necessary skills to care for and support the people who lived at the home and were supported by way of supervisions and appraisals.

Staff were kind and caring and protected people’s dignity. Staff treated people with respect and supported people in a way that allowed them to be as independent as possible.

The quality assurance system was not robust. There was no documentation to show that actions were taken to address areas identified as requiring improvement during the regular audits and the same areas for improvement had been identified in subsequent months. Documentation was often incomplete and this had not been identified.

Information was available to people about how they could make a complaint should they need to and the services provided at the home. People were assisted to access other healthcare professionals to maintain their health and well-being.

People were asked for feedback about the service to enable improvements to be made.

During this inspection we identified that there had been breaches of Regulations 12 and 17 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 considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

People had up to date risk assessments in place to enable them to be as independent as possible. People's medication was managed by trained staff and stored safely. We saw that temperature checks were undertaken and staff were assessed on their competency to administer medication.

Is the service effective?

People's care needs were assessed and care plans written to reflect individual needs. We observed that people were happy and staff were available to provide support quickly. We saw that people had their personal care needs met and that staff were at hand to assist people when needed. We observed that staff spent time with people singing and talking with them. We also noted that people were provided with drinks at regular intervals.

Is the service caring?

We observed that staff were responsive to people's needs, and treated them with respect and dignity. We saw that the atmosphere in the home was relaxed and people enjoyed the company of the staff. Staff were aware of people's preferences and provided them with choice. For example, we saw that when offering drinks some people were unable to decide. We saw that staff were patient and talked them through the different flavours available and what they had tried previously. People told us that the staff were 'lovely'. One person openly expressed their fondness of a staff member through conversation with them. We observed that one person was confused with a fastening on their clothes and was getting distressed, we saw that the staff member sat with them and showed them the fastenings and provided reassurance.

Is the service responsive?

Care plans were reviewed and updated on a regular basis to reflect the changing needs of people. The service had employed activity staff in response to feedback received by relatives. The activity staff provided people with activities such as walks in the garden, painting and bingo. We observed on the day of our inspection that people were singing along to music in the communal lounge. We saw that the provider acted on feedback received and was quick to make changes, for example, the home replaced out dated televisions with new technology screens after receiving feedback from relatives.

Is the service well led?

The service had recently employed a registered manager. We saw that the new manager had been tasked to improve the standards within the home and had initiated action plans to ensure that improvements were made within acceptable timescales.

The quality assurance system was in place and we saw that this was also being reviewed by the new manager to ensure that all areas of quality assurance were maintained.

Staff and people who used the service were asked for their opinions and feedback was acted on.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

Is the service caring?

We spoke with two people and the relatives of two of the nineteen people who lived at the home on the day of our inspection. People told us that they were happy with the care that they or their relative received. One person told us, "It's very good. Luxury living this is." Another person said, "They look after me well." One of the relatives that we spoke with told us, "[Relative] has been happy here. They have always been caring and considerate."

We observed the staff members as they interacted with people. They mostly did this in a caring, respectful way. However, we observed that care workers sometimes failed to communicate with people as they supported them.

Is the service responsive?

There were care plans in place for all areas of need and these were kept under review. We saw that there were risk assessments in place to address any areas of identified risk, these were also kept under review. We found that some of the care plans did not give care workers clear direction on the way identified care needs should be provided. However, when we spoke with staff members they demonstrated that they had a good understanding of people's likes and dislikes and how they wished to be supported.

The provider took account of complaints and comments to improve the service. We noted that the provider had responded to a complaint from a relative in regard to the television sets that were provided. This complaint had been received on 25 March 2014 and the television sets had been replaced by large, modern wall mounted flat screen models within days.

Is the service safe?

We noted that the care records for people who lived in the nursing unit were detailed and some included an Alzheimer's Society information form that had been completed by people's relatives. These provided personal information about people.

People were not cared for in a clean, hygienic environment. We looked at the kitchen area before the chef arrived. We noted that there were a number of areas where the standard of cleanliness was not acceptable. These included cooking preparation bowls and cooking utensils that were soiled and stained.

When we voiced our concerns to the provider they contacted the environmental health inspector who visited the same day. The environmental health officer found a number of areas that required immediate action by the provider to meet legal requirements. These included replacing the hand washing instructions poster, as the one displayed was incorrect, and changes to the way cutlery, crockery and cooking utensils were cleaned.

We observed that care workers wore personal protective equipment, such as aprons and gloves, when they provided personal care. This demonstrated an awareness of infection control procedures by the care staff.

Appropriate arrangements were in place in relation to the recording of medicine. We saw that where medicines were in boxes these had been annotated with the date the box was opened and the initials of the person who opened it. This meant that it was possible to conduct an accurate audit of the medicines in the home.

The manager told us that the service was not registered with a training body but the induction programme used by the home was in line with the recognised standard. This meant that staff members had the right skills to care for the people who lived at the home. Two relatives who were visiting people who lived at the home told us that they felt there were enough staff members on duty to meet the needs of the people.

We found that people's records were not stored securely, nor could they be accessed readily. One of the care records that we looked at had been reviewed on 20 May 2014 and all earlier documentation had been removed from the file. We asked to look at this earlier documentation but, despite an extensive search, it could not be found.

People's personal records were not accurate and fit for purpose. We noted that staff members recorded information about when people had a bath in notebooks and later transferred the information to their care records. One of the care records we looked at had indicated that the person had not had a bath or shower for more than a week prior to our inspection. The senior care worker told us that they had not had time to record in the record that the person had a bath the day before our inspection. This information was, however, recorded in the 'bath book'.

Is the service effective?

People's care records contained care plans for all areas of their lives. These included mobility, personal hygiene, nutrition, pressure care, elimination and communication. There were also care plans for social activity, safety, self-administration of medicines and night care.

We spoke with two people who lived at the home. Both agreed that the food was good and there was plenty of it. One person told us, "It's good food, very nice." Another person said, "It's very nice...tasty. There's plenty of it." However, they did not like the way in which their meal was presented. They told us, "It's all bits and pieces."

The manager told us that the provider had employed an additional care worker who had specific responsibility for obtaining the details of people's meal choices from them. They also supported those people who required assistance to eat their meals. We noted that the care worker completed a menu choice record which was given to the chef. The menu indicated the choice of main meals and snacks that the person had made. We saw that the sheet also indicated whether a person had specific dietary requirements, such as fortified foods, soft or pureed diet or if they required a diabetic alternative.

People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed the lunchtime meal serving. We noted that people's meals had been plated in the kitchen. We saw that a number of the care workers assisted people to eat their meals where this was required.

Is the service well led?

At the time of our inspection the manager had been in post for six weeks.

We saw that the provider had used an audit tool to check the quality of the service provided on an annual basis. However, they had discontinued the use of this following an audit completed in January 2013. The provider could not tell us why this had been discontinued and agreed that the tool had been useful for identifying areas where the quality of the service provided had failed to meet the required standards. The provider told us that they would consider reintroducing this.

We saw that the manager had completed audits for health and safety and premises. These audits asked 19 questions which were answered with a yes or no circled on the check list. Although the actions that were needed had been identified there was no record as to when or if these had been carried out or by whom. The provider showed us a new audit form that they had developed and planned to introduce. This form would address the issue of a lack of an action plan being produced following the completion of an audit.

This inspection of Woodlands Nursing and Residential Home was carried out in response to information of concern received by the Care Quality Commission (CQC). The concerns were that people's care and welfare were not appropriately met and medicines in the home were not safely handled and administered. This visit took place on the 10 February 2014.

We used a number of methods, including observation to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to communicate with us verbally. We observed that people appeared relaxed in the company of the staff supporting them.

Staff were aware of their legal obligation to act and obtain consent from people in relation to their care and treatment.

We found that people's care was not always delivered appropriately, to meet their individual needs and to promote their welfare. Medicines were not administered, stored and disposed of safely.

We found that people were looked after by staff who were trained and supported to deliver care safely.

People and staff records were not kept securely to ensure that confidentiality and privacy was not breached.

As part of this inspection we reviewed records relating to the cleaning, maintenance and safety checks in relation to the building. We found that the systems in place for infection control were inadequate and did not therefore ensure that the premises had appropriate standards of cleanliness and hygiene. We reviewed the environment and we found that it was not adequately maintained.

Due to the complex needs of the people who used the service, we were unable to get direct quotations from them; however, we observed that people appeared happy and relaxed in the company of staff supporting them. We spoke with four members of staff including the new home manager (who was in the process of applying to become a registered manager of the home), and observed staff interactions with several people throughout this inspection. We observed staff were respectful and treated people with dignity.

When we re-inspected the home on 29 April 2013, we spoke with six people who used the service, one visiting relative and four members of staff including the registered manager. We found that people were satisfied with the care and support they received. One person said, "I'm very happy here."

We observed that people were offered support at a level which encouraged independence and assured their individual needs were met. The staff were friendly and courteous in their approach to people and interacted confidently with them. One person said, 'I'm well looked after.'

We noted that people were encouraged to express their views about the quality of care in the home. They were also involved in planning their care, making decisions about their support and treatment, and how they spent their time.

We observed that most people were offered support at a level which encouraged independence and ensured that their individual needs were met, and staff were polite in their approach to people. However we witnessed ocassions where due to insufficient staff, care, particularly in the nursing unit, was hurried or delayed and therefore did not always demonstrate respect or meet people's needs efficiently.

We noted that people and their relatives were encouraged to express their views and were involved in planning their care and making decisions about their support and treatment. Within the care files we saw that care documentation had been signed by the individual or a representative to confirm their involvement and agreement with their particular care needs.

There were systems in place to ensure that the quality of service provision was monitored. People spoke highly of the manager who they said was visible and accessible to them. They said they were encouraged to voice their opinions and they felt listened to.