Background to this inspection
Updated
15 April 2021
Background;
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection Team
Two inspectors completed a site visit. An Expert by Experience made telephone calls to relatives to seek their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Woodlands Care and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means that the provider was legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and local clinical commissioning group who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection we spoke with the manager, the area manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with a bank nurse, the cook, a domestic, a senior and a care staff member.
We reviewed a range of records. This included four people's care records; support plans, risk assessments and daily records and multiple medication records. We reviewed accident and incident records, the staff rota and infection prevention and control practice. Where possible we observed staff engagement with people in communal areas to help us understand people's experience of the care and support they received.
After the inspection
Following the inspection site visit, the Expert by Experience contacted relatives by telephone and spoke with nine people.
We continued to seek clarification from the provider to validate evidence found. This included but was not limited to the provider’s audit reports and action plan.
Updated
15 April 2021
About the service
Woodlands Care and Nursing Home is a care home providing personal and nursing care for up to 50 people. On the day of inspection 14 people were living at the service. Some people were living with dementia and some had nursing care needs. The service is built over two floors and bedrooms are accessed by both a lift and stairs. Communal areas are spaced throughout the service.
People’s experience of using this service and what we found
Improvements were required with the governance of the service. A lack of senior oversight and leadership had impacted on the service continuing to make required improvements to reach the expected rating of Good. The provider’s inspection history demonstrates improvements have not been sustained and embedded.
A schedule of works to improve the environment had commenced, whilst COVID-19 had impacted the service, there was a lack organisation, priority and oversight of this work. Risks associated with the environment and infection prevention and control practice had increased and put people at potential risk of harm.
The provider's internal systems and processes that monitored health and safety were ineffective. Concerns and shortfalls in the fundamental care standards identified by audits and checks completed by external agencies and during this inspection had not been identified.
People’s individual risks had been assessed and planned for. Guidance for staff of how to mitigate risks were in the main up to date. Where care records needed to be updated, the manager was aware of this and was taking action. Staff were knowledgeable about people’s care needs.
Improvements were required with the storage and management of medicines to ensure best practice guidance was maintained.
The registered manager had recently resigned, some concerns were identified in the recruitment of the new manager for this position.
Sufficient staff were deployed to meet people’s individual needs and safety. People’s dependency needs were regularly assessed to determine the staffing levels required. Agency or bank nurses were used whilst permanent nurses were being recruited. These were booked in advance to ensure consistency and continuity. Recruitment checks were completed before new staff were appointed to ensure they were suitable to care for people.
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 Requires Improvement (published 23 October 2020). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last five consecutive inspections.
Why we inspected
We received concerns from the local clinical commissioning group following an audit visit at the service, where concerns were identified with infection prevention and control, and risks associated with the environment. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.
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.
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 remained Requires Improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
The provider had taken some immediate action following the external audit completed by the local clinical commissioning group, and further improvements were being made.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodlands Care and Nursing Home on our website at www.cqc.org.uk
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 one breach in relation to governance of the service. Please see the action we have told the provider to take at the end of this report.
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.
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 work with the 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.