Archived: Woodland Care Home

Woodlands 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.

Woodlands care is an established building which has been adapted to become a care home. People had their own room with access to three communal areas and an outside courtyard. The service can accommodate up to 15 working age adults and older people living with a mental health condition or learning disability who require personal care. It is not registered to provide nursing care. At the time of the inspection, there were 13 people using the service.

The registered manager has been registered with the Care Quality Commission since 1 October 2010. 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.

At the last inspection of the service on 30 July 2016. We rated the service to be Requires Improvement. We asked the provider to make improvements to become a Good rated service.

At that inspection, we found that people did not always receive care and support in line with their individual needs, wishes and preferences. Staff knowledge of fortified diets for people with diabetes was limited. As a result staff did not provide the support for people with diabetes which was outlined in the care plans. Bi-monthly meetings with people were not person-centred and goal orientated as stated in the providers Philosophy of Care Policy and Statement of Purpose. People did not have the opportunity to be involved in activities of daily living, such as the preparation and cooking of food. There were no funds in place for activities and as a result, the provision of activities was limited. People were encouraged to attend events in the community; however this was because they were free rather than centred around people’s preferences.

We also identified that an ineffective auditing system was in place. The provider did not carry out their own quality monitoring of the service. This meant that areas for improvement had not been identified. The refurbishment plan lacked detail and we found that improvements were not made in a timely manner.

At this inspection, we found the required improvements had not taken place.

Safeguarding alerts had been made when needed, however risks had not been fully assessed and care plans updated as a result. There was no evidence of procedures in place to ensure lessons had been learned. Risk assessments for behaviours which challenge were not in place and care plans did not contain the detail needed to provide safe care and support. Medicines were not safely managed.

Robust procedures were not in place for staff at night to ensure they remained safe from behaviours which challenge. Ineffective procedures were in place to cover staff absence. This meant the deputy manager worked additional hours, six days per week and was on-call every night.

Unsafe water temperatures were in place, increasing the risk of potential harm to people and staff. Doors to equipment such as the gas boiler and electrical switches, which needed to be locked for safety and prevent misuse, had been left open. All areas of the service needed to be cleaned. No colour coding system was in place for cleaning equipment

The registered manager and deputy manager had not received supervision or appraisal. Training for all staff was not up to date. Some training had been undertaken by the registered manager but they did not hold appropriate training qualifications to complete this, which meant the training received by staff was not valid. This included moving and handling, infection control and food hygiene.

People who needed a specialist diet because of diabetes or high cholesterol did not receive one. People were not involved in menu planning and menus did not reflect their choices. Consistent choices are mealtimes were not provided. All aspects of the service needed updating. This included paintwork and plasterwork, torn furniture and mattresses, broken furniture and worn flooring.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service do support this practice. Staff did work in line with the Mental Capacity Act 2005. However staff knowledge on the Mental Capacity Act 2005 was limited.

People told us they were happy at the service and received good care from staff who knew them well. However minutes of staff meetings and feedback from surveys showed some staff were unkind to people. In feedback respondents thought some staff could be more compassionate to people and treat people the same. No evidence was available to show that thorough action had been taken to address this.

Some staff practices meant that people’s privacy and dignity was not always protected. Records did not show if people were routinely involved in planning and reviewing their own care. Staff did support people to maintain meaningful relationships.

People did not have access to regular meaningful activities. There was no evidence of innovation or use of technology to encourage people to participate in activities. Staff missed opportunities to provide activities to people at the service and in the community.

Care records lacked detail about how to provider person-centred care to people. We identified records did not reflect current needs. There were gaps in many of the records looked at. There were no systems in place to archive records.

People were aware of how to make a complaint and told us they would speak with staff or the deputy manager if they needed to. However, in meeting minutes and surveys people had raised concerns and there were no robust measures in place which showed these concerns had been listened to and action taken to resolve them.

The provider and registered manager did not have adequate oversight of the service. An ineffective auditing system was in place. Information from meeting minutes and surveys did not result in action plans and had not been used to drive improvement at the service.

People and staff told us the provider and registered manager were not visible and were no responsive to them when concerns were raised about their care or aspects relating to the service. There was no evidence to show the service was integrated in the local community and no evidence to show how equality and diversity was embedded into the service or what the goals for these were for the next year.

No improvements to the service have been made since the last inspection. There was evidence of further deterioration at this inspection. Robust systems and adequate oversight had not been put in place to support the service to provide and deliver a good service to people.

Registered managers and providers are required to notify the Commission of specific events which take place at the service without delay. When notifications were submitted, some were sent late. Some incidents such as police incidents or safeguarding incidents had not been reported to the Commission. This will be dealt with outside of inspection.

We found seven breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity, safe care and treatment, meeting nutritional needs, the premises, good governance and staffing. We identified one breach of the Care Quality Commission (Registration) Regulations 2009 in relation to submitting notifications.

“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.”

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

We previously inspected Woodland Care Home on 27 January 2014, at which time the service was compliant with all regulatory standards.

Woodland Care Home is a residential home in Bishop Auckland providing accommodation and personal care for up to 15 people living with a range of mental health needs. There were 14 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were clean and well maintained.

People who used the service and their relatives expressed confidence in the ability of staff to protect people from harm. Staff we spoke with displayed a good knowledge of safeguarding principles and how to look out for signs of abuse.

We saw there were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks, to reduce the risk of unsuitable people working with people who may be vulnerable.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE).

We found all areas of the building to be clean, although areas such as the first floor toilet and bathroom were in need of further refurbishment and urgent repair.

We saw individualised risk assessments were in place to manage the risks people faced. One risk assessment we saw was not sufficiently detailed and the deputy manager rectified this immediately.

Visiting professionals had confidence in the experience and knowledge of staff and told us they liaised well with them. There was regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff were trained to meet people’s needs and provide appropriate care, for example food hygiene, health and safety, medication, safeguarding, moving and handling and dignity. Staff were supported through regular supervision and appraisal processes.

We saw people had choices at each meal although people with diabetes were not always supported or encouraged to choose healthier options.

Group activities were planned via a weekly activities chart but we found more could be done to ensure people’s individual likes and preferences contributed to activity planning. Care plans were regularly reviewed but we found the registered provider had failed to deliver the person-centred, goal-orientated care they described in company literature.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. The registered manager displayed a good understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

The atmosphere at the home was welcoming, relaxed and homely. People who used the service, relatives and external stakeholders told us staff were familiar to them, caring and kind and we saw numerous instances of warm interactions.

The service had built and maintained good community links.

Staff, people who used the service, relatives and external professionals we spoke with knew the registered manager and deputy manager and spoke positively about their approachability, flexibility and knowledge of people who used the service.

Quality assurance and auditing systems were not effective and meant concerns were not always identified, nor were opportunities to share good practice. The registered provider did not play an active role in auditing aspects of the service to ensure service delivery could be improved.

We found the service to be in breach of two of the regulations. You can read more about the action we told the provider to take at the back of the full version of the report.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We saw people were treated with respect and they were involved in all decisions with regard to their daily living needs. One person said;" There's plenty to do and I'm looking forward to trips out again in the summer."

Records showed care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

There were enough qualified, skilled and experienced staff to meet people's needs.

We saw people's health and welfare was protected when more than one provider was involved in their care and treatment. This was because the provider worked in co-operation with others.