Archived: Woodlands

Woodlands is a care home providing personal care for up to 20 older people. At the time of the inspection there were nine people living in the home. The service is an adapted building with a lift.

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

There were enough staff on duty to meet people's needs. Staff were kind and caring and people said they liked the home. Relatives spoke positively about the staff team and how caring they were.

People received their medicines safely as prescribed. There were suitable systems and processes in place to manage medicines safely. There were risk assessments in place which detailed risks to people's safety and guided staff on how to keep people safe.

There were suitable processes in place to prevent and control infection at the service, through regular COVID-19 testing, cleaning and safe visiting precautions. Safeguarding processes were in place to help safeguard people from abuse. Staff knew how to respond in emergency situations such as fire or ill health.

A new manager had been appointed since the last inspection and they had made many changes in the home which improved the quality of care provided. Staff and relatives of people living in the home spoke highly of the new manager and improvements they had made.

The provider had refurbished the home since the last inspection. The refurbishment had made the environment safer, more homely and more dementia friendly.

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

The manager and provider engaged well with health and care professionals who told us they acted on their advice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 22 January 2021 and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of most of those regulations.

At this inspection the rating has improved to requires improvement.

This service has been in Special Measures since October 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 23 October 2020. Multiple breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.The overall rating for the service has changed from inadequate to requires improvement. 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 on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Since the last inspection the provider and manager have made the necessary improvements. We were assured that people received safe care at this inspection.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Woodlands is a residential care home providing accommodation and personal care to people aged 65 and over, some of whom were living with dementia. The service is registered to support up to 20 people. At the time of the inspection there were 11 people living at the home. The home is a large adapted residential house.

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

We observed people to be happy and content living at Woodlands. People and relatives did not express any significant concerns with their care experiences. However, we found significant concerns around how the home was managed, documentation relating to care, health and safety and ensuring people were not placed at risk of harm.

Risk to people were not identified or assessed. Where risks were assessed, risk assessment documents were not always comprehensive and were generic. Guidance and direction to staff on how to minimise was not clear and detailed, placing people at risk of harm.

People were not always receiving their medicines safely and as prescribed. Systems and processes in place to manage medicines safely were ineffective.

Health and safety and infection control were not always well managed. We found the environment and furniture to be either unsafe or in a poor state of repair. Staff had not received any recent infection control training especially considering the current COVID-19 pandemic. Whilst the provider took remedial action when this was pointed out, there were not adequate systems in place to identify this prior to the inspection.

People did not always have a choice of what they wanted to eat and were not involved in menu planning.

People may not have always been supported to maintain healthy lives. There were no personal hygiene products available and people were not being supported with their oral hygiene.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Capacity assessments had been incorrectly complete and best interest decisions had not been considered.

There was a lack of managerial oversight of the home. There were no effective audits of any aspect of care delivery. Written records were ineligible or were not a true account of the care people received.

Staff understood safeguarding and how to keep people safe from abuse. Staff told us that they received training to support them in their role.

Relatives feedback about the provider and the deputy manager was positive stating that they were kind, caring and approachable.

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 24 January 2019).

Why we inspected

We received concerns in relation to staff not accessing emergency health and medical support where a person was found unresponsive. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore 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 for the service has changed from good to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified six breaches of regulation around person centred care, premises and equipment, safe care and treatment, safeguarding people from abuse, consent to care and good governance. The failings found are detailed in the main body of the report.

In response to the breach identified regarding good governance, regulation 17, we will be writing to the provider asking them to provide an action plan in response to the issues identified and to provider time specific updates on the progress of actions taken.

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

With regards to the breaches found regarding person centred care, premises and equipment, safe care and treatment, safeguarding people from abuse and need for consent, please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Woodlands is a care home for older people. The home is registered to accommodate 20 older people. At the time of our inspection there were 15 people living at the home.

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. At this home the provider (owner) was the registered manager. He is referred to as the registered manager in this report.

At the last inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to a limited choice of meals available to people, the hot water was above recommended safe temperature and there were no window restrictors to reduce the risk of falls from windows. At this inspection we found improvements had been made in all these areas.

People were positive about the service and the staff who supported them. People told us they liked the staff and that they were treated with dignity and kindness.

Staff treated people with respect and as individuals with different needs and preferences. The care records contained information about how to provide support, what the person liked and disliked, their preferences and interests.

The staff demonstrated a good knowledge of people’s care needs, significant people and events in their lives, their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Risk assessments were in place for a number of areas and were regularly updated. Staff had a good knowledge and understanding of many health conditions.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people living at the home.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s views on the service were regularly sought and acted on.

Recruitment practices were safe and relevant checks had been completed before staff worked at the home.

People participated in a range of social activities.

The registered manager and staff ensured everyone was supported to maintain good health.

Medicines were managed safely. Staff had received relevant training and regular medicine audits were taking place.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration.

There was an open and transparent culture and encouragement for people to provide feedback.

People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

Staff told us they really enjoyed working for the organisation and spoke very positively about the culture and management of the service. Staff told us that they were encouraged to openly discuss any issues.

People, staff and health and social care professionals spoke highly of the registered manager; they found them to be dedicated, approachable and supportive. The registered manager understood their responsibilities and ensured people, relatives and staff felt able to contribute to the development of the service. Staff were supported to be valued members of the organisation.

The provider’s governance framework ensured quality performance, risks and regulatory requirements were understood and managed. The service learnt and made improvements when things went wrong.

The home appeared clean and maintained and there was a refurbishment program in place.

Woodlands is a care home for older people. The home is registered to accommodate twenty older people. At the time of our inspection there were fourteen people living at the home including one who was in hospital. A number of people were living with dementia.

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. At this home the provider (owner) was the registered manager. He is referred to as the registered manager in this report.

At the last inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to lack of meaningful activities, inadequate hydration, management of complaints, involving people and lack of training for staff. At this inspection we found that the manager had made improvements in all these areas.

The manager had employed an activities organiser to plan and carry out activities with people. This had led to staff engaging more with people and improvements to some people’s wellbeing. There had been one outing which people enjoyed.

There had been improvements in encouraging people to drink since the last inspection where we found people not being offered drinks between meals. At this inspection we found that people were given regular drinks throughout the day and jugs of drinks were available in the lounge.

There were risk assessments in place to manage risks to people's health and safety. Medicines were generally managed safely though some staff had not been assessed for competence in administering medicines .

Staffing levels were satisfactory to meet people's needs at the time of this inspection when there were only fourteen people in the home.

There were improvements in managing complaints and the registered manager had taken action to consult and involve people living in the home and their relatives and listen to their views. He had also employed a new training company and ensured staff attended relevant training for their jobs.

There was a limited choice of meals available to people. People who preferred Indian food were well catered for but other people had a lack of variety in their diet.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians. The manager was working alongside other professionals to make continuous improvements in the home.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to nutrition and safety issues in the premises. This was because the hot water was above recommended safe temperature and there were no window restrictors to reduce the risk of falls from windows. You can see what action we told the provider to take at the back of the full version of the report.

We undertook a focussed inspection of this service in August 2016 because we had concerns about how risks to people’s safety were being assessed and managed. At that inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to risk assessments and infection control. At this inspection we found that the registered manager had addressed these breaches.

Woodlands is a privately owned care home for older people. The home is registered to accommodate 20 older people, most of whom are living with dementia. At the time of our inspection there were 11 people residing at the home.

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.

Staff where not being supported by effective induction or training in order to have the knowledge and skills necessary to support people effectively.

Effective systems were not in place for auditing medicines to ensure accurate records were being maintained.

People were not always being provided with regular activities to keep them occupied and engaged so as to maintain and enhance their well-being.

The complaints system was ineffective and did not provide the information required to evidence that complaints were investigated thoroughly and any necessary action taken where failures were identified.

There was no effective system for obtaining and acting on feedback from people living at the home in order to continually evaluate and improve the service provision.

People did not always have access to drinks between meals.

People told us the staff were kind and that they felt safe at the home. Staff were aware of their responsibilities to keep people safe from potential abuse.

Individual risks to people’s safety had been identified, acted on and were being reviewed.

Bathrooms and toilets all contained soap and paper handtowels in order to limit the risk of cross infection.

People were 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 supported this practice.

People told us they enjoyed the food and staff knew about any special diets people required either as a result of a clinical need or a personal preference.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff understood that people’s diversity was important and something that needed to be upheld and valued.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to quality assurance systems, adequate hydration, complaints, activities, and staff training and induction. You can see what action we told the provider to take at the back of the full version of the report.

We carried out this focussed, responsive inspection because we received information of concern regarding pressure care management at the home. This report only covers our findings in relation to pressure care management and risk assessments within the safe section. 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.

Woodlands provide accommodation and personal care to a maximum of 20 people some of whom are living with dementia.

There was a registered provider for the service. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Relatives and people who used the service were very positive about the staff and the way they were being supported at the home.

However, not all risks to people’s safety had been properly assessed and therefore risk reduction strategies were inconsistent.

Risk assessments were not being appropriately undertaken in relation to the risks associated with pressure care, falls and nutrition and hydration.

People who were at risk of developing pressure ulcers were only being referred to the appropriate healthcare professionals when staff noticed a potential pressure ulcer and not when the risk had been first identified.

Not all toilets in the home contained hand washing soap or paper towels required to limit the risk of cross infection.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to safe care and treatment. 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 people using the service and staff told us, what we observed and the records we looked at.

Is the service safe?

We found that people's care plans and risk assessments did not always reflect identified risks relating to their care.

There were enough staff to meet people's needs, and the provider engaged additional staff when necessary to ensure that people could have one-to-one support when they needed it. Equipment used to support people was checked and serviced according to the manufacturer's instructions, however some equipment we saw was rusty and in need of replacing.

The cleanliness and infection control practices at the service were good, and people were cared for in a clean, hygienic environment. One person who used the service told us "I have no concerns about cleanliness. The floor is always very clean, and the staff make sure we are clean". Another person said "The staff always wear gloves and aprons" when supporting them with personal care.

The CQC monitors the implementation of the Deprivation of Liberty Safeguards (DoLS) in care homes. In this care home, no applications had been submitted to the supervising authority to deprive a person who used their service of their liberty. However, the senior member of staff in charge of the service did not have a clear understanding of the DoLS or the circumstances in which they apply, and there were no guidelines in place for staff.

Is the service effective?

We found there were not enough varied activities provided by the service to ensure that people were appropriately stimulated.

The provider had good contact with other professionals involved in people's care, and made referrals to health and other services quickly when necessary to ensure people's health needs were met. One person told us "I am always supported to my hospital appointments".

Is the service caring?

People we spoke with told us the staff and managers of the service were very caring. One person said "The staff treat me very well, I have no complaints". Another person told us "Most of the staff are very gentle when they provide personal care, although one could be more gentle". A third person told us "Staff respect my privacy. They always knock on my door unless it's the middle of the night, then they just poke their head around to make sure I don't need for anything".

Is the service responsive?

Risk assessments and care plans we viewed were not always updated to reflect changes in people's support needs.

Feedback from people who use the service was positive, with one person telling us "I don't need for anything, they look after me very well". Another person told us "I like that it's a small home, and there are plenty of staff. I never have to wait for too long when I need something". A third person told us "The care worker wanted to cut up my roast beef for me but while I still can I will! I'll do it myself while I still can".

Is the service well-led?

Care audits, and checks and audits relating to the management of the service, were not undertaken appropriately. Accidents and incidents were not properly reviewed, and there was little evidence of learning taking place when incidents occurred.

The provider had a system in place to ask people who use the service and their relatives for feedback, however their feedback was not acted upon.

At this inspection, one person we spoke with said, "there has been so much change in the overall decor, it's much nicer now." The provider had introduced a consent policy and procedure which had been mostly implemented and staff received appropriate training in the Mental Capacity Act 2005 in order to ensure people's representatives were involved so that people without capacity could make choices and ensure their rights were upheld. The provider had renovated parts of the home, removed unnecessary equipment, introduced fire safe latches on all doors and replaced equipment in people's rooms where required. People's and staff records had been reviewed and were up to date

We found that staff recruitment procedures were effective at ensuring that, before starting to work in the home, all appropriate information about them was in place and they were of good character. Staff training was provided before care workers commenced their roles, and staff received regular support from managers. The provider had quality monitoring processes and systems in place that ensured people's views were taken into account and acted on.

However, we found that capacity assessments were not completed correctly and did not routinely identify how decisions were made on behalf of those people or who was making them. People's records were not always consistent and appropriately maintained and provided limited guidance for staff in order to support people to manage risks safely. Communal areas and people's rooms were not all suitably maintained. Some rooms and communal areas contained broken furniture and fittings.

Care plans were reviewed regularly and people told us that they were involved and were able to contribute to the care planning and review process.

People told us that they were able to choose what they wanted to eat and that the food was nutritionally balanced and culturally appropriate. However some people required food in pureed form and we noted that there were no records in people's care plans and all pureed food was mixed together, which was not very appetising.

While people told us that they were 'safe' at Woodlands, we found that staff and management demonstrated no knowledge of the whistle blowing procedure, which may have an impact on staff under-reporting allegations of abuse and puts vulnerable people at risk.

We observed that appropriate medicines administration procedure, storage and disposal of medicines were followed. The majority of people using the service and relatives told us they felt staff cared for them well.

People told us that they would raise any concerns with the manager and were confident that the manager would deal with them.