The Woodlands Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

We observed a lack of assessment and management of risk. Care plans lacked basic information on people’s medical conditions. There was a lack of advice for how staff support people with specific medical conditions. The pre-admission process was not robust.

Risk assessments were not always completed, reviewed regularly and did not always include plans for managing risks. A person’s admission record reflected the need for handrails to support with mobility and prevent falls. No handrails were in place for the person despite several falls and no action was taken to review the need for handrails within the person’s bedroom or outside corridor where the falls were occurring.

Care plans were not detailed and had not been reviewed for some time, with a lack of information to reflect changes in needs such as falls, incidents or specific health conditions resulting in gaps in the information available to staff. Some people with specific medical conditions such as diabetes did not have a care plan in place.

There was mixed feedback from people and relatives regarding involvement in decisions about care. One relative confirmed, “Not always no, they don’t involve me.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Malnutrition Universal Screening Tool (MUST) assessments for identifying nutritional risks were not updated regularly in response to people’s deteriorating health. There was a clear disconnect between clinical assessments and care planning, which limited staff’s ability to deliver responsive and preventative care.

Some people were living with dementia; however, the care environment was not always dementia friendly. There was some signage around the home, however, bedroom doors only contained numbers and no other identifying feature to help people’s orientation.

People and relatives told us they had regular drinks offered and the food was very good. One relative said, “The food is lovely, my relative has no complaints.”

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. Systems in place did not ensure any updates received from outpatient appointments with changes were reflected within care records. Medical letters with information for people’s future clinical support needs were not reflected in care plans for specific medical conditions.

Internal communication and information-sharing across the team was not always effective. Daily handovers were completed, however, one staff member stated they were not aware of a person refusing to take medication despite this being reflected within care records. This failure to communicate key information increased the risk of people receiving unsafe or inconsistent care.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

One person had a series of falls in a short space of time but had not been referred to healthcare professionals to assess how to support the person’s independence and well-being. A referral had not been made for an assessment of equipment to support with falls and the person’s bedroom had not been assessed to identify any hazards. There was a lack of evidence to reflect whether people had been referred to healthcare professionals appropriately.

There was no evidence of structured or meaningful activities aimed at supporting mobility, rehabilitation, or cognitive stimulation. Most people were sat within the lounge watching television or within their bedrooms. At the time of the assessment there was no activity co-ordinator in place and the chef was operating a dual role as chef and activity lead. During all our visits, the chef did not have the time to provide activities to people. People and their relatives confirmed there were no activities. The grounds of the property were overgrown and the fence at the rear of the property was propped up by a piece of wood, making it unsafe for people to access.

People spoken with advised they were frustrated with the lack of activities and events. One person told us, “I would like to do more with my life.” The person had not had a review of their placement since admission and there was no evidence to support what actions were taken in future planning or what community links/events were available to people. The placement of this person was discussed with the manager to review to ensure the persons needs were being met.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves.

There was limited evidence to demonstrate the provider was meeting people’s clinical or personal expectations. This was due, in part, to a lack of collaborative working with people to establish meaningful goals or outcomes. Care plans did not reflect person-centred objectives or agreed aspirations, and therefore there were no measurable achievements to track progress or evaluate the effectiveness of care. As a result, it was unclear how the provider ensured that people’s expectations, both clinical and personal, were being understood or met.

Assessment tools in place were ineffective. They, did not inform care, identify risk and encompass care planning. For example, one person had a falls risk assessment which referenced full support with mobilising to prevent falls. The person had multiple falls mobilising unattended. There was a lack of oversight and review of the falls and action to consider the use of technology or other adaptions.

Audits by management were completed for some aspects of the service however, these failed to identify the concerns found during the assessment. The lack of effective monitoring placed people at risk of further incidents and risk of harm.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

While initial consent for care tasks was reportedly obtained upon admission to the service, we did not find evidence of ongoing consent processes documented within people’s care records. There was a lack of evidence to support involvement from relatives or named representatives. One person had bedrails in place, there was no consent from the person or their representative. A Lasting Power of Attorney (LPA) was in place for the person, however, there was no evidence they had been involved in the decision-making process. A Deprivation of Liberty Safeguards (DoLS) was in place for the person with the Local Authority however, this had not been updated to reflect the use of bedrails. It was not evident decisions were always being made in people’s best interests.

CCTV was in use throughout the building and consent had been obtained by the provider. There was, however, a lack of signage for the use of CCTV on entering the service and within communal areas, the signage for CCTV was located within the acting manager’s office.