19 and 20 November 2015
During a routine inspection
This unannounced inspection took place on 19 and 20 November 2015. Woodham House Newlands provides accommodation, care and support for up to nine people living in the community with mental health needs and forensic histories. At the time of our inspection there were nine people living at the service.
At our last inspection on 7 and 8 August 2014, we found several breaches of legal requirements. The provider had not protected all service users against the risks associated with the unsafe management of medicines, adequate steps were not taken to ensure the welfare and safety of people and some people’s needs for stimulation were not met as planned. Notifiable incidents were not notified to Care Quality Commission. (CQC). The provider sent us an action plan telling how they would address these issues and when they would complete the action needed to remedy these concerns.
A registered manager was in post. A registered manager is a person who has registered with 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 service had not adequately assessed, monitored or managed risks at all times to ensure safety of people who use the services. The provider’s policy for ‘zero tolerance’ towards substance misuse was not followed. The provider did not have robust system to analyse accidents and incidents in order to reduce reoccurrence. Sufficient numbers of staff were not on duty at all times to meet people’s needs and some staff worked long hours without a break.
Two staff members were working at the service without the registered manager confirming their identity, recruitment checks and qualifications. Following our inspection we sent a letter to the provider to show us evidence of these staff recruitment checks. We have received the requested documents from the provider within the stipulated time in our letter. The service followed safe recruitment practices.
People were not supported at all times to access relevant health care services they required when they need to. The service did not consistently refer to key professionals about untoward occurrences, incidents and concerns. There was no record to show in the supervision records what staff had said or what their line manager had said in the supervision meeting, and if any improvement plans proposed to monitor their learning and development.
People had access to a varied menu and an alternative choice of food was offered when someone did not like the day’s menu.
People told us staff were caring and treated them with respect. However, people’s identified needs and preferences were not met at all times. People were not always involved in making decisions about their care and treatment,
People’s needs were assessed, but care and treatment was not planned and delivered in line with their assessed needs. Care plans were not person centred and did not provide adequate guidance for staff to meet individual needs.
Although people’ complaints were responded to and addressed, the complaints policy and procedure did not provide accurate information for people and required improvement.
The service had not carried out audits to monitor the quality of the service in relation to people’s risk assessments and management, incidents and accidents, care plans, Random Urine Drug Screening Test Results and their follow up actions, staffing, involvement of people and staff, health and safety of people’s rooms and therapeutic room. Some of the service records were not accurate, complete and contemporaneous.
Appropriate arrangements were in place for the safe management of medicines. The provider had notified CQC all notifiable incidents.
We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We are currently considering the action to take in relation to some of the more serious breaches and will report on this when it is completed. You can see what action we took for other breaches at the back of the full version of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to consider the process of preventing the provider from operating this service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement and there is still a rating of inadequate for any key question or overall, we may take action to prevent the provider from operating this service. This may lead to cancelling their registration or to varying the terms of their 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.