Archived: Woodland Residential Care Home

We found the following examples of good practice.

There had been an outbreak of Covid-19 at the service. During this time the registered manager had communicated with people, staff and families regularly to ensure everyone understood the measures put in place to help keep people safe.

All areas of the service were clean and clutter free. Effective cleaning routines had been put in place to ensure infection control risks were minimised and people were kept safe. There were supplies of anti-bacterial wipes around the service for staff to use to clean surfaces and bathrooms, after each use, in addition to the increased cleaning routines. There were posters around the service to prompt and remind staff about the infection control procedures in place.

Staff put on and took off their uniforms in a designated room, close to where they entered the building, and uniforms were laundered at the service. This helped to reduce the risk of infection because staff did not enter areas of the home, where people lived, until appropriate infection control measures were in place.

Staff had completed online infection prevention and control and Covid-19 training. Additional PPE had been provided for staff, such as visors, to use during the outbreak. The service had maintained good stocks of PPE and the registered manager worked with care and domestic staff teams to ensure infection prevention and control measures were followed.

The registered manager had been well supported by the organisation. At the start of the outbreak a large proportion of the staff team were unable to work. Senior management arranged for dedicated agency staff to cover shifts. Care staff from other Cornwall Care services were allocated to specifically work at this service, to reduce the risk of cross infection. Management and administration staff from across Cornwall Care were re-deployed to cover other roles such as housekeeping. Some staff were anxious about returning home to their families, while working during the outbreak, and accommodation was provided for them by means of a motorhome in the grounds of the service.

The design of the service had enabled staff to create zones, where people who were Covid positive were cared for in designated areas, to prevent the risk of the virus spreading to others. Some people found it difficult to maintain social distancing and the service had created areas where they could walk around without meeting other people.

The registered manager had worked closely with external healthcare professionals to enable people to have access to the appropriate health care and equipment such as hospital beds and oxygen. There were daily calls with the GP where staff reported people’s daily observation results, such as oxygen levels. This meant, for people who were unwell with Covid, the right care could be provided in a timely manner.

At the time of the inspection the service was closed to visitors. However, staff helped people to stay in touch with family and friends through phone and video calls. The registered manager was in discussion with people and their families about resuming visiting, from 8 March, in line with recent government guidance.

The provider had reviewed the infection control policy in response to the pandemic. Specific Covid-19 policies had also been developed to provide guidance for staff about how to respond to the pandemic and the outbreak. These policies were kept under continuous review as changes to government guidance was published.

Further information is in the detailed findings below.

Woodland is part of Cornwall Care and is a care home which offers care and support for up to 38 predominantly older people. At the time of the inspection there were 38 people living at the service. Some of these people were living with dementia. The accommodation is spread across four wings. There are several lounge areas where people can choose to spend their time. There was a large garden to the rear of the building.

On the day of the inspection visit there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. People told us, “They (staff) are always careful about our privacy and dignity” and “They (staff) are very nice here.”

Details in care plans included the level of risk and how it was going to be managed. This had improved since the previous inspection when there was little evidence of how individual risks were being managed safely and effectively. There were examples of when people were at risk, for example from falls. Guidance for staff contained detailed information on the action staff could take to minimise the risk. All records relating to the care and support of people were complete and provided staff with current information about the needs of the person. This had improved since the previous inspection when gaps were noted in a number of records relating to the care and welfare of people.

Some people told us they thought the levels of staff could be improved on. The registered manager acknowledged there had been a period of instability when agency staff had and were continuing to be used, but far less than earlier in the year. On the day of the inspection there were suitable numbers of staff on duty to meet the needs of people using the service. There was one agency staff member who had worked at the service on a regular basis and knew people’s needs. Staff told us, “It’s been difficult at times but things have got a lot better. Comments were mixed and included, "The staff are pretty good, although there is never enough of them" and "When I ring my call bell I find that as a rule they respond quite soon.”

People and relatives told us they thought Woodland was a safe place to live and that staff were kind, friendly and treated people well. They told us that the registered manager was always available and approachable. Comments included, “Always there if I need to speak about anything” and “I have every confidence in the manager and staff. There have been some changes but I think they have improved the home.”

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.

The registered manager used effective and systems to record and report on, accidents and incidents and take action when required.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. 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 were provided with choices and their wishes were respected.

People received their medicines on time. Medicines administration records were accurate and consistently completed. Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Staff were supported by a system of induction, training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training support and development. More specialised training specific to the needs of people using the service was being provided. For example, dementia care and clinical nutrition support.

There were a range of activities available to people which were being extended by a newly appointed activity coordinator. Visitors were made to feel welcome at the service and staff recognised the value of these relationships to people.

The environment supported people living with dementia. For example signage was throughout the service with pictorial images to indicate the rooms function. An activity board was pictorial to support people and the daily menu board showed pictures of the food available each day.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

There were effective quality assurance systems in place and appropriate action had been taken to address and resolve issued identified during previous inspections. People’s feedback was valued and the results of the service’s most recent quality assurance survey had been consistently positive and complimentary. Overall satisfaction with the service was seen to be positive.

Equipment and supply services including electricity, fire systems and gas were being maintained.

Woodland is part of Cornwall Care and is a care home which offers care and support for up to 37 predominantly older people. At the time of the inspection there were 35 people living at the service. Some of these people were living with dementia. The accommodation is spread across four wings. There are several lounge areas where people can choose to spend their time. There was a large garden to the rear of the building.

The service had 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. The registered manager had been in post since December 2015.

Some people found it difficult to manage their emotions which could lead to them becoming distressed and agitated. This meant they could put themselves and others at risk of harm. Risk assessments were not always in place to describe the risk and guide staff on how they could deal with it in order to keep themselves and others safe. Staff had not had training to enable them to deal with these potentially risky situations.

In order to help sustain the correct staffing levels agency staff were frequently used, either from an external agency or Cornwall Cares' own flexible staff team. This happened more often at weekends. Although five new members of staff had recently been recruited they were not yet working at the service at the time of the inspection. This was because they were waiting for pre-employment checks to be completed. Staff were effectively deployed across the service and people’s needs were usually met in a timely manner.

At the last inspection on 18 June 2015, we asked the provider to take action to make improvements to the management of medicines and this action has been completed. Systems for the administration and storage of medicines were robust. People received their medicines as prescribed.

Staff received a thorough induction when they started working for Cornwall Care. Training was regularly refreshed and staff told us it was effective. Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure staff were suitable to work in the care sector.

At the last inspection on 18 June 2015, we asked the provider to take action to make improvements to the way in which they responded to reported defects within the service and this action has been completed. A caretaker was employed who had oversight of the maintenance of the building. They helped ensure any repairs or necessary refurbishments were carried out within a reasonable time frame. Since our previous inspection most of the service's communal areas had been redecorated.

Staff supported people to be involved in and make decisions about their daily lives. People chose where they spent their time, when they got up and when they went to bed. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were protected from the risk of abuse because staff had a good understanding of the potential signs of abuse and how to report it. All were confident that any allegations would be fully investigated and action would be taken to make sure people were safe.

Staff were caring and cheerful in their attitude and approach to people. People told us they were well cared for and described staff as; “lovely” and “very kind.” Throughout the day we saw staff engaging people in conversation as they went about their work. Staff remained calm and sympathetic when demands on them were difficult or challenging.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Some activities were provided at the service. However, the programme of scheduled activities was limited with only occasional visits from entertainers. An activities co-ordinator was employed two days a week. The rest of the week care staff initiated activities when they had the opportunity. Due to the time pressures on the staff team to complete care related tasks this was not always possible. On the day of the inspection the only organised activity we saw was a quiz for a small group of people shortly before lunch. We discussed this with the registered manager and nominated individual who described plans they had to improve people's experiences. We have made a recommendation about providing activities for people living with dementia in the report.

Recording systems were not robust. We identified several examples of records which either had not been consistently completed or contained errors. This meant we could not always evidence if care had taken place in line with the care plan.

The registered manager was supported by a deputy manager and a group of senior carers who had received additional training to help ensure they were able to fulfil their role.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 you can see the action we have told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

At the previous inspection in April of this year we found the service to be potentially unsafe because some records were not up to date or accurate. At this inspection we found the service to be safe because record keeping had improved since the last inspection.

People told us they felt safe and we saw people who lived at Woodland spontaneously approaching staff for assistance or for a chat.

Woodland had regular support from the district nursing team and GPs from the six local GP practices. This ensured people received appropriate care in a timely way.

We saw that care plans had been updated, rewritten and reviewed with the involvement of the person concerned or their relative/representative shown by their signature on the documents. The information provided in the care plans was detailed and individualised. This helps to ensure people are provided with care that reflects their care needs.

The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) provide a legal framework that protects people who lack the mental ability to make decision about their life and welfare. We saw that appropriate assessments had been completed for people who did not have the mental capacity to make decisions in relation to specific issues, and we saw the home had made appropriate DoLS applications to Cornwall Council.

Staff told the inspector that Woodland was a happy place to work and that the manager and deputy manager were supportive. The manager and deputy manager were not available at this inspection.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe? People told us they felt safe. Complaints and reporting procedures were robust. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives. The registered manager wrote the staff rotas and took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. Woodland alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Woodland had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people's needs were met.

We inspected Woodland's medication systems and found them to be in order. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective? People's health and care needs were assessed with them, although it was not always clear that they were involved in writing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

Specialist dietary needs had been identified where required. Care plans were not always up-to-date. People who used the service, and their representatives, were not always involved in their care plan reviews. We saw people, or their representatives did not consistently sign care plan reviews to show they had read and agreed to the content of the care plan.

We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met. Woodland had regular support from the district nursing team and GPs from the five local GP practices. This ensured people received appropriate care in a timely way.

Is the service caring? We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, 'They're [carers] very nice' and 'Staff are kind'. Two relatives said 'This is a flagship of how dementia care should be, they keep us informed' and 'Since Mum's been here we've had no concerns whatsoever. It's more than a job for them; they put the care into caring'. When speaking with staff it was clear that they genuinely cared for the people they supported.

We saw people were able to have keys to their individual rooms. This promoted people's privacy.

There was a complaints procedure for people who used the service, their relatives, friends and other professionals involved with the service. Where shortfalls or concerns were raised these were taken on-board and dealt with. People's preferences, interests, aspirations and diverse needs had usually been recorded although this was not always evident.

Is the service responsive? Many people who lived at Woodland had complex health needs and were either not able, or chose not, to join in group activities. The care records did not evidence the lifestyle of these people, or show that they were routinely offered one-to-one or group activities.

At the time of the inspection there was enough staff on duty on each shift to meet the care needs of the people who used the service, but we could not see any documented evidence for how staffing levels were determined at the care home.

Is the service well-led? We saw minutes of regular meetings held with the staff. This showed management consulted with staff regularly to gain their views and experiences and improve support for people who lived at Woodland.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and of the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

We saw that people who used the service were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We observed the lunch time meal and saw staff respected peoples' dignity when assisting them to eat.

During our inspection, we found people's privacy, dignity and independence were respected. Where people were able to express their views and experiences, these were taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us training was provided, and also confirmed they had received supervision.

Care plans and associated documentation provided sufficient detail to direct and guide staff as to the actions necessary to take in order to meet people's assessed care needs. People's records were personalised and provided clear information about the person's wishes and abilities.

We spoke to a visiting community nurse who told us communication between the home and community nursing services was very good. She said 'they (staff) know what they are doing', 'I wouldn't mind living here myself'.

During our observations we saw staff helping people to mobilise. We saw staff assisting people to eat their lunch. We saw people talking to each other at lunch.

We witnessed staff interactions with people, which were generally positive.

We heard care workers ask people what they would like to do and gave them ideas if they could not make a choice.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.