Woodrow Retirement Home Limited

People’s experience of using this service and what we found

Quality assurance processes and checks were not always in place or effective and had not identified the concerns raised during the inspection.

People’s medicines were not always managed in a safe way. Medicine recording systems did not demonstrate people received their medicines as prescribed.

People were not always protected by safe recruitment procedures.

People’s capacity had not been assessed following the principles of the Mental Capacity Act 2005 (MCA).

People’s care and risk assessment records were not always reflective of people’s care and support requirements. However, staff demonstrated a good awareness and understanding of people’s individual needs.

People, their relatives and staff spoke highly of the management team. Feedback was positive about staffs’ approach and understanding of people’s care and support needs.

The provider failed to notify us of incidents that happened in the service as is required by law.

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 good (published 3 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Concerns were identified. As a result, we undertook a focussed inspection to review the key questions of safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodrow Retirement 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 monitor the service and will take further action if needed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will also continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

Staff were attentive, understanding and kind. People praised the caring manner of the staff. Comments included “Lovely caring bunch” and “I have always found them lovely. A member of staff told us “We do get very attached to people.” They also told us “We treat people like they are our own parents”. The staff team spoke with fondness of people who had received end of life care. A relative praised the care given to her mother and all the family at the end of her mother’s life, saying “They were lovely with me”. They went on to say “They kept her as comfortable as possible.”

People continued to live in an environment that was well maintained, comfortable, clean and safe. People were encouraged to bring items of furniture to personalise their rooms and make them feel homely. Equipment was regularly serviced and maintained. The provider had placed a high priority in ensuring the home met current safety standards to reduce the risk of fire.

People were supported by sufficient staff to meet their needs. People living in the home and relatives told us there were, “Plenty of staff, whatever the time of day.” The provider had taken care when recruiting staff to carry out checks to ensure they were entirely suitable for the job. People and relatives told us the staff were competent. Staff training records showed many of the staff held relevant qualifications and had received training and regular updates on a wide range of topics relevant to the needs of people living there. Staff were well supported and supervised. There was a stable staff team. A member of staff told us there was a happy atmosphere and it was a “Good place to work”.

Medicines were stored and administered safely. Records of medicines administered were well maintained. The provider and staff had worked closely with the local pharmacy and health professionals to ensure people’s medicines were safe and met their health needs.

People were offered a variety of meals and drinks to suit their preferences and dietary needs. People praised the food. Their comments included “The food is very good”. A relative told us “She eats very well. She enjoys lots of different foods.” The staff had information about each person’s dietary needs, and sought specialist input and guidance where necessary.

Each person was carefully assessed before they moved into the home. People and relatives were involved and consulted in drawing up and reviewing their care plans. There were systems in place to help them identify risks and risk assessments were regularly reviewed. Where care needs changed, care plans were updated to ensure staff had up-to-date information about each person’s needs. Staff were observant and noticed changes in people’s health. They sought medical advice and treatment promptly when needed. A health professional told us “They follow our advice.”

There was a strong emphasis on treating each person as a valued individual. All staff had received training on Equality and Diversity. The registered manager had sought information, support and training from local organisations and reputable internet resources on topics to help staff understand the effects of disabilities such as partial sight, and dementia to enable staff to offer positive support to people. People were supported to make choices and decisions about their lives. Where people lacked capacity to make important decisions, staff ensured decisions were made in accordance with the principles of the Mental Capacity Act 2005 (MCA).

People were involved and consulted in the home. Residents’ meetings were held and people were encouraged to offer suggestions and makes choices about the things they wanted to do. A range of activities were offered to meet each person’s individual social needs. Since the last inspection there had been no formal complaints received by the provider. People told us they were confident they could speak to the provider or a senior member of staff at any time if they had any concerns or grumbles. People were encouraged to speak out in a variety of ways including “You said, we did” forms, questionnaires, and through informal daily conversations with the provider and staff. A relative told us “We have no concerns but would not hesitate to speak with any member of staff. We couldn’t have chosen a better place.”

Since the last inspection the provider has made a number of changes and improvements to ensure all aspects of the service are regularly monitored and the service is now entirely well-led. They had worked closely with the local authority Quality and Improvement Team to implement audits and checks and to take action promptly when any improvements were needed. People, relatives, staff and professionals told us the home was well-run. The registered manager had many years of experience as a home owner and manager. He had kept his learning up to date to ensure people received care that met current legislation and good practice.

Further information is in the detailed findings below

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found care and treatment had been planned and delivered in a way that was intended to ensure people's safety and welfare. For example, we saw an assessment of the person's needs and a range of risk assessments had been completed. We saw that where people had been assessed as being at risk from pressure sores, suitable equipment had been provided to minimise the risk.

People living at the home told us that staff were always polite and respectful. One person told us that staff 'Always speak nicely to me'.

We saw the medication systems in use meant people had their medicines at the time they needed them and in a safe way. Staff told us about one person who had to have their medicine at a set time and following particular guidelines. We saw these instructions detailed on the MAR sheet and staff signatures confirmed the correct administration.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The Registered Manager had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We discussed people's care needs with staff and they told us about people's needs and how they liked their care to be delivered. Staff we spoke with were able to tell us what they did to support people and knew what to do for them if they needed any additional support.

We found that staff received appropriate training and professional development. For example, staff told us and records confirmed that staff had received training in safeguarding vulnerable people, food hygiene, first aid, and moving and handling. A mixture of training methods was used. For example, DVDs, distance learning and 'hands on' training were all used to provide training.

Is the service caring?

People we spoke with told us that they were supported to make their own decisions and were able to make choices about how they spent their day. People living at the home told us that staff were always polite and respectful. One person told us that staff 'Always speak nicely to me'.

Staff supported people to make choices and decisions about their daily lives. For example, people told us they were able to get up and go to bed when they chose. We saw some evidence on people's care plans about how they liked their care to be delivered. People living at the home told us that staff always asked them what they wanted staff to do for them. One person said they (staff) 'Always ask if I'm ready to do this or that'.

People living at the home spoke highly of the care received. One person told us 'It's very nice here ' couldn't better it'. Another person told us that staff 'have to do everything for me, they are very nice'. Another person said 'Staff are very nice and obliging ' nothing is too much trouble'. Another told us that it was 'Not at all institutional'.

Is the service responsive?

People we spoke with told us that they were supported to make their own decisions and were able to make choices about how they spent their day. People told us that they mainly liked to spend the day in their rooms.

We saw the main lounge for the home was being refurbished. This had been ongoing for some time. We saw evidence that meetings had been held with people to let them know the plans for the lounge. People told us they were looking forward to it being completed and felt it would be a pleasant place to sit.

Information about visits from and to health care professionals had been recorded in individual care plans, showing clear evidence that people were supported to maintain access to specialist medical services. For example, we saw that a GP had visited following concerns raised by staff about one person's posture.

The Registered Provider told us that they generally had very few complaints raised and these were usually dealt with very quickly. We saw a leaflet on 'How to make a comment, suggestion or express a concern' was available in the hallway. The Registered Provider showed us one letter of complaint they had recently received. They told us that they had resolved the issue, but there was no evidence of this on the file.

Is the service well-led?

The Registered Provider had owned the home for some time, and there was a consistent staff team. Staff were aware of the needs of the people living at the home and were able to meet them.

We saw evidence that a training matrix was kept that identified which staff had received training in administering medicines. This was confirmed by training certificates and by the member of staff administering medicines. We also spoke with a new member of staff who told us that they would not be able to administer medicines until she had received the appropriate training.

We spoke with two care staff and the cook. They told us that they felt supported to do a good job. The Registered Provider took note of reports prepared by the Commission following an inspection. We know this because following our visit in July 2013 the Registered Provider made the required improvements in relation the administration of medicines.

We spoke with the manager, a senior care worker and a care worker about the way medications were managed at the home. One member of staff told us 'I go through the medication admin sheets religiously and there's also a whiteboard to prompt us'.

We also spoke with the new pharmacy provider for the home. The home had changed pharmacist's since our last inspection. The new pharmacist had worked with the home to make improvements.

We looked at relevant training records, medication care records and medication audits. We looked at security arrangements for medication and controlled drugs at the home.

We found that the provider had taken notice of the concerns raised in our July 2013 inspection and that improvements had been made.

People told us they were looked after well and were happy at the home. One person told us "I have lived here a very long time. The staff know me well, and they are very good. I was very poorly recently and I couldn't thank them enough for all the extra help they gave me. They really were wonderful." Another person we spoke with told us "I've no complaints. I don't think I could be better looked after anywhere else."

We found work had been carried out on the building to make it a more attractive and safe place to live. Additional work was still under way to provide a new lounge area and landscape the gardens.

We found that staffing levels were appropriate to meet the needs of people living at the home. The provider had assessed the quality of the services provided against guidance and instigated a more robust process for quality assurance, involving people who lived at the home.

Following the visit the provider sent us action plans of the changes he had made. He also sent us photographs or other evidence of the work as it was progressed.

On this visit we found that the majority of the areas we had identified had been improved. There had been substantial work undertaken on the building, and new systems were in place for staff training and support. The dining room had been redecorated and refurbished, the hallway re-plastered and decorated, and 2 rooms refurbished, along with new wet rooms installed.

Further work was planned to provide a new lounge once planning permission was resolved. This had been delayed due to the building being in a conservation area. We saw evidence that progress was being made on this, and that people living at the home had been involved in making decisions around this room and it's future use.

The care plans had been improved and further work was planned on these to ensure they better reflected people's needs and any risks associated with people's care.