Woodlands

Woodlands is an extra care service. The service provides personal care to older people who live in their own apartments in a modern building. At the time of our inspection there were 14 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

The provider’s quality assurance system was not effective and had not led to actions to improve the service or mitigate risks. People's care records did not reflect their current needs or risks to their well-being. Some records, including staff recruitment and training records, had significant gaps which had not been identified or acted upon.

People and relatives said they felt safe and comfortable when staff were supporting them. There were enough staff to cover most visits and agency staff were used as a contingency to cover gaps. Safeguarding processes were in place.

People and relatives described the service as "warm, friendly and welcoming". They had confidence in staff’s abilities and competence.

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

There had been no manager at the service for several months and the provider was actively trying to recruit one. Staff worked hard to promote a positive, teamworking approach but were concerned about the impact of the lack of management oversight.

People and relatives said there was good communication between the senior staff and people who used the service. External professionals said they found making contact with the service was sometimes difficult.

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 July 2018).

Why we inspected

We carried out this inspection due to the length of time since the last inspection.

This report only covers our findings in relation to the key questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this report.

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

Enforcement

We have identified breaches in relation to managing risk and effective governance at this inspection.

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

Follow up

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

Woodlands is located within a purpose built complex of flats set in its own grounds on the outskirts of Penrith

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. At the time of our visit 13 people were receiving care and support.

The home had a suitably qualified and experienced 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 service is run.

We previously inspected this service in February 2017 and found the following breaches of the Health and Social Care Act; Regulation 17 Good Governance and Regulation 18 Staffing . In December 2016 we rated the service as 'Requires Improvement'. Following the last inspection we met with the provider and asked them to complete an action plan to show what they would do, and by when, to improve the service.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Risk assessments and support plans provided guidance for staff. People who used the service were involved in writing support plans and were able to influence the content. The registered manager had ensured the plans reflected the person-centred care that was being delivered.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and talked to us about how they would identify any issues and how they would report them appropriately. Risk assessments and risk management plans outlined how people were to be kept safe. Arrangements were in place to ensure that new members of staff had been suitably checked before commencing employment. Any accidents or incidents had been reported to the Care Quality Commission as necessary and suitable action taken to lessen the risk of further issues.

The registered manager ensured that there were sufficient staff to meet people's needs. Our findings corroborated this. Staff were suitably inducted, trained and developed to give the best care possible. We met experienced and kind team members who understood people's needs.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People saw their GP and health specialists whenever necessary. They accessed hospital appointments as a matter of routine.

We saw that an assessment of needs was in place and that the staff team analysed the outcomes of care for effectiveness. Most people cooked for themselves or went out into the community for a meal. Those who chose to eat the food provided by the service were very complementary of it.

Suitable equipment was in place to support people including an adapted bath.

We observed kind, patient and suitable support being provided. Staff knew people well and made sure that confidentiality, privacy and dignity were maintained.

The registered manager had successfully improved the service since our last inspection and intended to develop it further. Staff were able to discuss good practice and issues around equality and diversity and people's rights.

Complaints and concerns were suitably investigated and dealt with. Good records management was in place in the service and there was a quality monitoring system in place which was used to support future planning. The registered manager promoted a 'lessons learned' culture.

At our last inspection of this service three breaches of the legal requirements were found. These related to safe care and treatment; staffing and governance. Requirement notices were issued to the provider. The registered manager developed an action plan to help keep improvements on track. We found during the inspection that the targets set in the action plan had mostly been achieved.

Woodlands is an independent housing with care scheme. The scheme consists of 57 private apartments for older people. The service is registered to provide personal care to people living at the scheme. Each apartment has its own bathroom, living room, one or two bedrooms and a kitchen. People are encouraged to remain as independent as possible. The services offered include help with personal care, meals, medication and general domestic duties if required. There are extra charges for these services. The scheme also has communal lounge areas, a dining room and communal gardens, which people can use if they wish.

At the time of our inspection there were 16 people receiving the personal care service.

The registered manager was in attendance during our inspection. 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 this inspection we found that the provider had made improvements to meet the requirements of the regulations about safe care and treatment, staffing and governance, although further improvements were needed, particularly around staffing.

We found that people’s care plans and risk assessments had been reviewed and updated to help ensure they received safe care and support that met their needs and expectations.

We spoke to people who used this service. They told us that they were “pleased” with the care and support they received. They told us that they were “confident” that staff knew what they were doing. People told us that they were aware of the complaints process and that they knew who to speak to if they were not happy with any aspect of their service. The people we spoke to were positive about their care and of the staff who supported them.

We found that the service supported people, if they wished, to access health and social care professionals when necessary. Independence was respected and people who used the service told us that they were treated with dignity and kindness.

We reviewed a sample of the staff records. The service ensured that appropriate checks had been carried out to help make sure only suitable people had been recruited to work with vulnerable adults. We found that staff had been provided with appropriate training to help make sure they kept their skills and knowledge up to date. We also saw that staff received supervision and had their care practices monitored by senior staff. This helped to make sure that staff worked safely and in line with the policies and procedures of the service.

People who used the service and staff working at the service told us that the manager or the senior were available to speak to if necessary. The registered manager told us that they welcomed feedback from people, whether positive or negative. Feedback had been used to help improve the service.

We looked at how people were supported with their medicines. Although medicines had not always been managed appropriately, we found that the registered manager had taken steps to make improvements.

People who used the service were able to express their views on the service during meetings, when they had their support plans reviewed and via an annual survey carried out by the provider.

Although the staffing levels in the early part of the day had been improved, concerns remained with regards to the staffing levels in the afternoon, evenings and night time. The concerns were raised by staff working at the service. They told us that they could not always meet people’s needs in a safe and timely manner. Staff gave us examples of how they had not been able to meet people’s needs in a timely manner on the evening shift. They gave us examples of when things hadn’t gone so well on the evening shift. However, we did not receive any adverse comments about this matter from people who used the service.

This remains a breach of Regulation 18 Staffing because sufficient numbers of staff were not deployed in order to make sure both emergency and routine work of the service was covered.

Some of the staff we spoke to were unclear about the ‘buddy’ system that was in place during the night. The registered manager provided us with information about the ‘buddy’ system and also confirmed that there were no formal on-call systems in place at the service.

The registered manager told us that there had never been a problem with the systems in place. However, we found that there were gaps in the emergency plans and on-call systems, which compromised the health, safety and welfare of people using the service and others.

This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider did not have adequate systems in place to assess, monitor and mitigate the risks to the health, safety and welfare of people, and others who used or worked at this service.

During our visit to the offices of the service and our review of records, we found that the registered manager had not always notified us of significant events as required. We also noted that the service had not displayed their CQC rating following the last inspection. However, the registered manager made sure that this was rectified before we left their offices and the rating was put on display.

We have made a recommendation about staff communication channels.

We have made a recommendation about notifications.

The inspection took place on 7 and 11 April 2016 and was unannounced.

Woodlands is an independent housing with care scheme. The scheme consists of 57 private apartments for older people. The service is registered to provide personal care to people living at the scheme.

Each apartment has its own bathroom, living room, one or two bedrooms and a kitchen.

People are encouraged to remain as independent as possible. The services offered include help with personal care, meals, medication and general domestic duties if required. There are extra charges for these services. At the time of our inspection there were 11 people receiving personal care service.

The scheme also has communal lounge areas, a dining room and communal gardens, which people can use if they wish.

There is a registered manager at this service.

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.

The people we spoke to during our visit to this service all told us that they were “satisfied” with the service received and that they felt “safe”.

People who used this service described the staff to us. They said; “The girls (staff) are very nice indeed. They treat me well.” And “The staff are smashing, and are really nice. They know me very well.” One person told us; “I think the manager is very particular who is employed. You couldn’t wish for nicer staff.”

People told us that the staff “know what they are doing.” There were some differences of opinion regarding staff continuity. For example, one person said that they had the same “one or two staff” visiting them; whilst another described the difficulties they had experienced explaining their routines to new staff. At the time of our inspection the service was undertaking a staff recruitment drive.

People who used the service also commented: “They (staff) are very friendly and kind. I have the best of both worlds here as I am quite independent but there is always someone here if I need help.” and “The staff always arrive when I expect them. They are very nice indeed and don’t rush me.”

We found that there were insufficient numbers of staff on duty and this impacted on the standard and safety of support provided to people who used this service

People who used this service were not properly protected from the risks of receiving unsafe or inappropriate care. This was because care plans and risk assessments had not been reviewed and updated as people's needs changed.

Medicines were not managed appropriately and safely. Medication errors had been identified and where people needed help and support with their skin care, risk assessments, care plans and medicine administration records had been poorly maintained.

There were policies and procedures in place to help keep people safe from the risks of abuse. Staff had been trained in this subject and were able to describe the actions they would take should they suspect someone was being abused.

We found that staff were appropriately trained and supported in their work. This meant that they had the skills and knowledge to carry out their roles effectively and efficiently.

The service had policies and procedures in place with regards to the Mental Capacity Act and the deprivation of liberties safeguards. Staff at the home had received training to help them understand the legal processes.

People who used this service were treated kindly and with respect and dignity by the staff supporting them.

We found that people were able to comment on the quality and standard of the service they received and were able to meet with the registered manager on a regular basis.

Personal information about people who used this service had been kept securely and staff had received training about keeping confidential information protected.

People who used this service had been consulted about and involved in the development of their care plans. The level and standard of information recorded in care plans varied, particularly where people had more complex needs. This meant that staff did not have clear and detailed guidance about supporting people appropriately and safely in order to meet their needs and preferences.

The service had developed a complaints procedure and this information was available to everyone who used the service. The people we spoke to during our visit told us that they had never had to make a complaint but were confident that if they did, it would be dealt with effectively by the registered manager.

We looked at the governance and quality management of the service. We found that although there were systems in place these had not been effectively monitored and managed. This potentially compromised the health, safety and welfare of people who used this service.

We have made a recommendation about person centred care and care planning.

We found breaches of the following Regulations:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People who used this service were not protected from the risks of receiving unsafe care and treatment.

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines administration was not safely managed. People who used this service did not always receive their medicines as their doctor intended.

Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The levels of suitably qualified, competent, skilled and experienced staff had not been kept under continuous review so could not be adapted to meet the changing needs of people who used this service.

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The systems in place to assess, monitor and improve the quality and safety of the service were not operated effectively.

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