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Inspection carried out on 10 December 2018

During a routine inspection

This inspection took place on 10th December 2018 and was unannounced. At our last comprehensive inspection in October 2017 the service was rated 'Requires improvement’.

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 refurbishmen

Inspection carried out on 31 October 2017

During a routine inspection

This inspection took place on 31 October 2017 and was unannounced. At our last comprehensive inspection in April 2017 the service was rated ‘Requires improvement.’ At this inspection the service has again been rated as ‘Requires Improvement’ but there have been significant improvements made at the home in the six months since the last inspection.

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.

Inspection carried out on 12 April 2017

During a routine inspection

This inspection took place on 12 and 13 April 2017 and was unannounced. At our last comprehensive inspection in August 2015 the service was rated ‘Good’. At this inspection the service has been rated as ‘Requires Improvement’.

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.

Inspection carried out on 31 August 2016

During an inspection to make sure that the improvements required had been made

This unannounced inspection took place on 31 August 2016 and was undertaken by one inspector.

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.

Inspection carried out on 25 August 2015

During a routine inspection

This inspection took place on 25 August 2015 and was unannounced. At our last inspection in June 2014 the service was not meeting the standards in relation to risk management and quality assurance. At this inspection we found that the service was now meeting these standards.

Woodlands is a care home for older adults. The maximum number of people they can accommodate is 20. On the day of the inspection there were 14 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.

People told us they felt safe at the home and safe with the staff who supported them. They told us that staff were attentive, kind and respectful. They said they were satisfied with the numbers of staff and that they didn’t have to wait too long for assistance.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks could be reduced.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. Staff told us it was not right to make choices for people when they could make choices for themselves.

People told us they were happy with the food provided and staff were aware of any special diets people required either as a result of a clinical need or a cultural preference.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were able to demonstrate that they had the knowledge and skills necessary to support people properly. People told us that the service was responsive to their needs and preferences.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service and staff were positive about the registered manager. They confirmed that they were asked about the quality of the service and had made comments about this.

Inspection carried out on 18 June 2014

During a routine inspection

A single Inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

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.

Inspection carried out on 2 January 2014

During an inspection to make sure that the improvements required had been made

We visited Woodlands on 17 October 2013 and 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 consistent and communal areas and people's rooms and communal areas were not all suitably maintained. We asked the provider to address our concerns and set compliance actions. During this inspection, we returned to follow up the compliance actions to see whether improvements had been made. .

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

Inspection carried out on 13 September 2013

During a routine inspection

People we spoke with were generally happy about the home. Comments included "it's good in this place, I would know as I've been here for eight years" and "the staff are so caring towards me, they will even come and sit with me and wipe away my tears when I am upset."

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.

Inspection carried out on 7 March 2013

During a routine inspection

People using the service told us that they could make a choice about what they wanted to do, want to eat, get up, go to bed and chose to take part in activities. Comments made by people using the service included, "staff always knock on the door", "they cook me something different if I don't like the food" or "I don't like to take part in activities, they don't force me."

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.

Inspection carried out on 21 March 2012

During a routine inspection

People told us that staff involved them in decisions about care and treatment. One person said, "I get what I want." People said that they received the care and support they needed. A person said, "Staff help me to do things for myself." People spoken to confirmed that they trusted staff and felt safe. A person said, “I can trust the staff.” People told us that staff knew how to support them. A person told us when asked about how staff treated them, "The staff were helpful." People told us and we observed that staff listened to them. Staff responded to any suggestions they made about the home.