Archived: Woodham House Daneswood

At the last inspection on 20 and 24 July 2017, we found that the service did not meet the fundamental standards. We found four breaches of regulations relating to the management of risks to people's health and welfare, fit and proper persons employed, person-centred care and good governance. We also made four recommendations about seeking and acting on people's views about their nutrition, access to areas of the home, managing complaints and person-centred planning. We requested the registered manager send us an action plan to tell us how they planned to make improvements to the service.

At this inspection we followed up on the breaches of regulations to see if the registered provider had made improvements as required. The registered manager had taken action to address some of our concerns from our previous inspection. We found action had been taken on meeting people's nutritional needs and managing complaints. But, we found continued breaches in person centred care, safe care and treatment and good governance. We found a new breach in staffing. We made one recommendation about seeking current guidance and best practice on infection control.

The service has a registered manager. 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.

Medicines for people were not always managed safely. People had their prescribed medicines. Staff had their competency assessed to ensure they were safe to administer medicines for people. There were systems in place for checking room temperatures, storage, ordering and disposal of medicines. However, we found medicine administration records were not always completed accurately.

There were not enough staff working at the service. Records also showed that the provider’s recommended numbers of staff were not always on duty to provide people with safe care and support.

Pre-employment checks were not completed thoroughly to ensure the suitability of the staff working at the service. We found one member of staff provided inconsistent documents relating to their previous employment, identification and permission for the right to work in the UK. These concerns were shared with the registered manager.

There were systems in place to monitor and review the service. Audits of the service occurred on a regular basis. However, the audits did not find the concerns we found with some aspects of the service.

Care records did not contain end of life decisions. People did not discuss how they wanted the care and support delivered at that time. Staff had not completed end of life training or had developed knowledge of palliative care. But no one living in the service was receiving end of life care during the inspection.

People had some activities arranged for them. Staff supported people outside the service with attending activities they enjoyed. However, staff did not offer therapeutic activities that people could benefit from being involved in their home. The therapeutic area was locked during our visit so people did not have access to this area of their home.

The registered provider had a safeguarding policy. Staff followed this policy and process to protect people from harm and abuse. Staff managed allegations of abuse and reported them to the local authority for investigation.

Staff identified risks to people’s health and wellbeing. Risk management plans were developed to manage and mitigate those identified risks for people.

Staff were supported with an induction programme, training, supervision and an appraisal. Staff records held copies of meetings staff had.

Staff understood the Mental Capacity Act 2005 (MCA) and protected people’s rights. People gave staff their consent to receive care and support. Care documents were signed and agreed to by people or their relatives.

People had enough to eat and drink throughout the day. Meals were cooked on site by staff and some people cooked meals for themselves with the staff support. The menu was flexible enough to meet people’s individual preferences and nutritional needs.

Staff attended to people’s health care needs. People had access to health care services when their needs changes. People attended regular health care appointments and annual health care checks.

People said staff were kind and respectful to them. Our observations showed that staff had promoted people’s dignity. The service had communal areas where people had the privacy they needed if they wanted some time alone or if they had visitors.

Assessments were completed with people and their relatives. Health and social care professionals were involved in their assessment of needs. These determined whether staff could manage people’s needs appropriately.

There were systems in place for people to make a complaint about the service. People said they could discuss their concerns with a member of staff if they needed.

The registered manager understood their responsibilities in relation to their registration with the Care Quality Commission (CQC). The registered manager kept CQC informed of events that occurred at the service.

Staff enjoyed working at service. Staff said the registered manager was supportive and listened to their views.

Staff developed relationships with voluntary, health and social care services, this helped people to receive appropriate and co-ordinated care.

You can see what actions we took at the back of the full version of this report.

Woodham House Daneswood provides accommodation, supervision and support for up to 15 males with enduring mental health needs, some with a forensic history. At the time of the inspection there were 15 people using the service.

People have their own rooms and en suite facilities in the home. There is a shared communal kitchen, lounge and an activity room that is located at the rear of the large garden. CCTV is in operation in communal areas.

The last focused inspection took place on 24 May 2016 where we found that staff were not taking sufficient breaks between shifts and there was no registered manager in post. The service was rated requires improvement.

During the comprehensive inspection on 25 August and 3 September 2015 the service overall was rated good but requires improvement in well led because the service did not have a registered manager in post.

At this inspection the service had a registered manager in post who was present on both days we visited. 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.

Systems were in place to manage risks and safeguard people from abuse. There was detailed guidance in place for staff to follow and manage incidents but we found this was not always followed. People told us they had no concerns with their medicines and staff had received training on how to manage people’s medicines but we found that medicines were not always managed safely.

The home required cleaning and appropriate steps were not always taken to ensure the prevention and control of infection. The home environment needed repairs, however, plans were in place to address this.

Pre-employment checks were not completed thoroughly to ensure the suitability of the staff employed. Staff had access to appropriate training to meet the needs of people who used the service. People’s opinions were mixed about staffing levels and the provider was in the process of recruiting more staff. Night staff were working excessive hours that meant that they may not have received sufficient rest to meet people’s needs safely.

The principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed and for one person a DoLS application had been submitted and a best interests meeting planned. However, consent was not always sought from people about decisions affecting their use of areas of their home.

Staff promoted people’s privacy and dignity and maintained confidentiality. People using the service and their relatives told us they were supported by caring staff and the staff spoke positively about working in the home. People were referred to healthcare services as required but health action plans required more comprehensive information.

People's views were mixed about the meals that were provided and some people told us meals did not meet their nutritional needs. Suitable arrangements were in place to ensure people received enough food and drink.

People’s care plans and risk assessments were updated to show where there had been a significant change in their circumstances. Some people actively participated in activities that promoted their independence and safety in the community and dependency tools were used to monitor their recovery. However we found that the provider did not fully document how people attained their overall goals. People spoke about the things they enjoyed but there was insufficient evidence to demonstrate how staff supported them inside and outside the home. There was a plan in place to support people to move on to more independent accommodation where appropriate.

There was a complaint policy in place but this did not accurately identify the organisations that people could escalate their complaints to. People knew how to make a complaint but some people did not want to put this in writing and the provider did not keep a record of verbal complaints made about the service and how these were resolved.

Audits were not robust and did not pick up the issues we identified. People had the opportunity to voice their concerns but the feedback that was sought from people to obtain their views and comments regarding the service had not been evaluated to inform improvements at the service. Staff spoke positively about the registered manager and they had kept the Care Quality Commission (CQC) informed of any notifiable incidents that had occurred. The provider had links to other agencies who spoke positively about the service and worked in partnership with the service to deliver appropriate care.

We have made four recommendations about seeking and acting on people’s views about their nutrition, access to areas of the home, managing complaints and person centred planning. We found four breaches of regulations relating to the management of risks to people’s health and welfare, fit and proper persons employed, person-centred care and good governance. You can see what action we asked the provider to take at the back of the full version of this report.

We carried out an unannounced comprehensive inspection of the service on 25 August and 3 September 2015. We gave it an overall rating of good. The service did not have a registered manager in post. The manager was in the process of renewing their registration with CQC as they had left the service for a period of time and then returned. This inspection confirmed that the service still had no registered manager. A new manager was appointed for the post and was in the process of registering with CQC. This will be followed up during our next comprehensive inspection of the service.

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.

In late April 2016 we received concerns about the staff support at the service. We undertook a focused inspection on 24 May 2016 to look into these concerns. This report only covers our findings in relation to the concerns raised.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodham House Daneswood on our website at www.cqc.org.uk.

We found that staff occasionally covered two long shifts in a row with only two hours break in between the shifts. Staff told us they chose to carry out the shifts and were able to carry out their duties safely. We were concerned that staff were tired and that it was not safe for staff to be responsible for people’s support needs.

People and their relatives told us there was enough staff to provide safe care at the service. Staffing levels were assessed based on the number of people and their support needs. The service followed safe staff recruitment process to ensure that staff provided safe care for people.

Staff had knowledge and skills to meet people’s care needs as necessary. Staff told us they undertook relevant to their role training courses to ensure that the support provided was in line with good practice. Systems were in place to support newly employed staff during the induction period. This meant that new staff performance was monitored and assessed as required.

The service carried out regular supervision and appraisal meetings for staff. Some appraisal minutes viewed had the same information for different staff members, which meant that records were not accurately completed.

People chose what they wanted to eat and drink and were encouraged to cook meals for themselves.

We saw that care was planned and based on a structured assessment of each person's needs. Risk assessments were completed and reviewed to ensure people received effective and safe care that met their needs and protected their rights. Relatives we spoke with said '' The facilities and care is excellent, the staff are absolutely wonderful, they care and have such patience.''

We saw that medicines were handled safely securely and appropriately and that staff were appropriately trained to manage medicines.

We spoke with staff and saw evidence that staff were supported to provide care and treatment to people using the service and that they had been properly trained supervised and appraised.

We saw that people using the service had access to information and support to raise a concern or make a formal complaint. People we spoke with said ''If I made a suggestion it would probably happen, the staff do listen.''

We saw that staff treated people with respect and dignity. People we spoke with told us that the staff were kind and respected their privacy. We observed staff supporting people in a friendly and professional way and saw that people were being offered choice with regard to menus, activities and care preferences. People were positive about the care and treatment they received at the home. Records showed us that people who use this service had good access to a range of health professionals.

We spoke to people who told us that they felt safe in their environment and that they knew who to talk to if they did not.

We viewed policies and procedures that told us that the provider had effective systems in place to keep the people who use this service safe.