Archived: Woodtown House

Updated 2 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Woodtown House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection the service did not have a manager registered with the Care Quality Commission. This means the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to the inspection we reviewed the information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law.

During the inspection

We spent time observing the interactions between people and staff. We spoke with six people living at Woodtown House and seven members of staff, which included the new manager. We also toured the premises, looked at infection control practices and medicines management.

After the inspection

After our visit we sought feedback from health and social care professionals and staff to obtain their views of the service provided to people. We spoke with two additional staff and various health and social care professionals as part of a northern locality multidisciplinary meeting.

We also had a meeting with the provider to discuss the initial findings of our inspection.

We continued to seek clarification from the provider to validate evidence found. We looked at various documents including care plans, risk assessments, progress notes, staff rotas, policies and procedures and specific audits/reports relating to the quality and safety of the service to ensure people received safe care and support specific to their individual needs.

Updated 2 December 2021

About the service

Woodtown House is a nursing home in one adapted building providing personal and nursing care to 19 people with mental health difficulties at the time of the inspection. The service can support up to 22 people.

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

There were not enough staff to meet people’s needs. In the two weeks prior to the inspection and including 17 June 2021 staff rotas showed staffing levels fell below the planned levels on six occasions during the day, on four occasions this was for full shifts and on two occasions this was for partial shifts. As a result, staff in other roles had to provide cover to ensure the safety of the service. This had an impact on people’s ability to engage in meaningful occupations to aid their recovery, rehabilitation and physical and mental health well-being. People commented: “We sometimes cannot go out due to staffing levels.” and “There are not enough staff here to see to everybody’s needs. There is a lack of staff to do activities. The staffing ratios are not right. It is so frustrating.”

Staff morale was low due to them feeling unable to provide people with therapeutic and holistic opportunities. Staff felt unable to adopt the home’s ethos of recovery and rehabilitation. Staff were not supported through adequate supervision with constructive feedback on their performance.

Staffing issues impacted on the ability of the service to manage risk. Staff raised concerns about accessing key care and risk assessment documentation due to poor internet access at the home. Concerns were also raised in relation to agency staff access to key documents due to the IT issues which meant they did not have access to a summary of people’s care and support needs which they could refer to quickly. This, impacted on staff ability to provide people with safe care and support in line with their specific needs. A staff member commented: “Risk assessments are on the care plans, but they are online, so if the internet is down you cannot see them.”

Following our inspection, we asked several times from 22 June 2021, for information relating to care plans, risk assessments and progress notes from the home. We received this information on 7 July 2021. We were informed that issues with internet access meant, there had been difficulties sending the requested information. This time lag demonstrated that staff access to key information was compromised impacting on their ability to proactively support people in line with their individual needs in a safe way. The provider was aware of the need to improve internet access at the service, with actions being taken but currently unsuccessfully.

We were not assured that the provider was promoting safety through the layout and hygiene practices of the premises. They had not identified where damage to the fabric of the building made it difficult to clean effectively.

The service was unsafe and was not well-led as shown by two breaches of regulation linked to good governance, and staffing.

The provider had not fully recognised the quality of the service had significantly deteriorated. Systems in place to monitor and review the quality of care and ensure the service was meeting people's needs safely were not adequate. This therefore put people at risk of unsafe care.

People said the service was not always well-led. There was a poor culture that did not engage with people, and staff, to deliver a person-centred, open, inclusive and empowering service. Staff said they felt the provider did not value them or their work, which was having a negative impact on their own physical and mental health well-being. The provider’s statement of purpose aims, and objectives were not being followed.

There was no registered manager in post. A new manager had started on 3 June 2021 and was due to apply to register with the Care Quality Commission.

There were systems in place to safely monitor medicines from the point of ordering to administration.

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 21 January 2020).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing levels being inadequate to safely meet people’s care and support needs and the overall lack of governance of the service by the provider. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with staffing and governance arrangements, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodtown House 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.