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Inspection carried out on 6 August 2020

During an inspection looking at part of the service

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

We found the following examples of good practice:

The staff were following up to date infection prevention and control guidance to help people to stay safe. The registered manager ensured staff understood why every measure was in place.

The provider provided training to ensure staff knew how to keep people safe during the COVID-19 pandemic.

Staff supported people to occupy themselves whilst maintaining their safety. A marquee has been set up in the grounds called ‘Woody’s bar’. This enabled people to access fresh air and have barbeques. There had been an increase in activities and mental health awareness week was celebrated. People baked cakes and wrote on them to describe how they were feeling. A collage had also been created with regards to the impact of Covid 19 on people’s mental health. The four seasons were the focus with winter being the start of the pandemic and summer being where things have changed for the future.

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The service ensures people have been tested for COVID-19 before the service agrees to admit them.

Residents are assessed daily for the development of a high temperature (37.8°C or above), a cough, as well as for softer signs such as shortness of breath, loss of appetite, confusion, diarrhoea or vomiting.

Staff helped people to stay in touch with family and friends through phone and video calls.

The manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.

Further information is in the detailed findings below.

Inspection carried out on 10 December 2019

During a routine inspection

About the service

Woodtown House is a nursing home in one adapted building providing personal and nursing care to 14 people with mental health difficulties at the time of the inspection. The service can support up to 28 people.

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

The service now had a registered manager in post since October 2019. Until then, there had not been a registered manager since March 2016, with several managers coming and going. As a result, there had been a clear lack of leadership, oversight and scrutiny of the service.

Robust audits had now been implemented following guidance from the Quality Assurance Improvement Team (QAIT) of the local authority, which needed to be fully embedded in practice as the registered manager had only been in post for a short period of time.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service provided safe care to people. People felt safe and supported by staff. Comments included: “I feel safe here.” Comprehensive risk assessments were in place. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff treated people with dignity and respect when helping them with daily living tasks. The service ensured people led meaningful and fulfilled lives.

There were safe staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

Staff spoke positively about communication and how the registered manager worked well with them and encouraged their professional development.

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 requires improvement (published 11 June 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 3 May 2019

During an inspection looking at part of the service

People said they felt safe, but some were expressing some levels of anxiety due to their mental health. There was a high proportion of agency being used to staff the service. This impacted on people because agency staff were not insured to drive the home’s vehicle. It also meant that, at times, newer agency staff may not know people’s needs well. Some agency staff had completed regular shifts at the service and two said “There is a good handover and we are always regarded as part of the team.”

People’s needs were at risk of not being fully met because of reduced staffing levels. We judged that with the reduction in staffing plus the high number of agency workers, there was an increased risk that people’s needs were at risk of not being met. We fed this back to the provider who agreed that they would immediately re-instate the staffing numbers back to one senior or nurse plus three care staff.

People with nursing needs were at risk of having their needs unmet because the providers continued to struggle to get nurse cover, but their contingency plan was to have one nurse at least across one shift i.e. one 24-hour period. During other times they would have a senior support worker who was trained to give medicines. The provider said they have looked at ways to attract more nurses. To date they were still reliant on using agency senior support workers and sometimes this was for more than their own contingency of 24 hours. Some shifts had gone for two days without nurse input.

We raised some concerns around “as required medicine practices”. This was addressed quickly by the provider to ensure these practices were improved. This should have been picked up by the provider’s quality assurance systems and by having more nurses available.

We identified some issues with fire safety and have referred this on to Devon Fire and Rescue Services.

We were made aware that some people struggled to access the service’s vehicle safely and were using the wheelchair ramp which was an unsafe practice.

Communication between the provider and the service appeared to be an issue and this had the potential to place people at risk.

The providers quality assurance system was not always effective or had led to enough improvements which placed people at risk of inappropriate care.

We have issued two requirements in relation to staffing and to good governance.

More information is in the full report

Rating at last inspection: Requires Improvement in all key questions except caring which was rated as good. Overall rating of requires improvement. Report published November 2018.

Why we inspected: We completed this focussed inspection because we had received some information of concern about staffing levels and people’s safety. We looked at two key areas, Safe and well led during this inspection. At the last inspection these areas were rated requires improvement. At this inspection we have judged that well-led had deteriorated to inadequate. Safe remains requires improvement.

Enforcement: Action we told provider to take. We have told he provider to keep the staffing level under review and ensure nursing cover is consistent. We have issued two requirements notices in relation to regulation 18 - having sufficient and suitably qualified staff, and 17- good governance.

Follow up: We will continue to monitor the intelligence we receive about the service. We will continue to liaise with the local Authority safeguarding team, commissioners and the providers to ensure people’s safety. We will complete a comprehensive inspection within the next six months. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 11 September 2018

During a routine inspection

This unannounced comprehensive inspection took place on 11 and 18 September 2018.

Woodtown House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Woodtown House provides accommodation and personal care to a maximum of 28 people with a past or present mental illness in one adapted building. At the time of our inspection there were 16 people living at the service.

This inspection was brought forward due to concerns raised by health and social care professionals about the lack of nursing cover on each shift; staff’s lack of understanding of people’s needs; poor documentation; lack of meaningful occupation for people and poor leadership and quality monitoring. As a result, a safeguarding meeting was held on 6 September 2018. The outcome of the meeting was that Woodtown House met the threshold for whole home safeguarding. This meant an increased oversight and scrutiny by health and social care professionals to ensure people were receiving appropriate care and support.

At the last inspection in May 2016, the service was rated as good overall. This inspection the overall rating has declined to requires improvement in safe, effective, responsive and well-led. Caring remains good.

There has been no registered manager in post since March 2016. 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. There had been various managers in post since 2016 but none of them had gone on to register with CQC, despite them stating to the provider they were in the process of registering. The new manager was currently in the process of registering to become the registered manager.

Both people, staff and health and social care professionals felt there was a lack of meaningful activities on offer to aid people’s mental health well-being. Daily notes also lacked detail about people’s mental health well-being. For example, notes stated: ‘Has been out…, unsettled when they returned and very vocal during mealtimes. Advised to eat in another room. Experiencing distressing thought disorder…’; ‘Awake early and went out… Returned agitated, very confrontational’ and ‘Out for much of the day… On returning they seemed quite upset and frustrated.’ None of these entries went into detail about what was distressing them, what support was offered or any interventions to help them with their mental health difficulties. We discussed both the lack of meaningful activities and detail in daily notes with the manager and provider, both agreed the lack of detail in daily notes would not enable any care plans to be updated with what helps at times of distress to guide staff appropriately.

The quality of the service was not continually monitored and improved. There was a clear lack of leadership, oversight and scrutiny of the service. Staff spoke about how it had been difficult with managers coming and going, with it being unsettling at times. However, they spoke positively about how they had worked as a team. The provider explained how they had recognised that the leadership at Woodtown House was not strong enough. As a result, they had increased the regional support provided to the service from once a month to every two weeks. A registered manager from another of the provider’s services also spent increased time at the home to provide some stability to the staff team.

Staffing levels met people’s personal care needs. However, meaningful interactions were limited. We recommend the deployment of staff is managed more effectively in order for people to be able to engage in s

Inspection carried out on 27 May 2016

During a routine inspection

This unannounced inspection took place on 27 May 2016. We returned on 1 and 2 June 2016 as arranged with the manager to complete the inspection.

Woodtown House is registered to provide 24 hour nursing care to 28 people with a past or present mental illness. At the time of our inspection there were 23 people living at Woodtown House.

There was no 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 manager had started the process of registering, but due to personal circumstances was now not going to proceed with registration. The previous registered manager still worked for the organisation as a clinical director and continued to support the home. We were assured that measures were in place to manage the service whilst they recruited. These measures included, the deputy manager stepping into the role, supported by both the clinical lead and clinical director.

The organisation recognised the importance of staff receiving regular support to carry out their roles safely. However, due to management changes between spring and autumn of 2015, staff had not been receiving formal supervision to identify any specific needs. Staff did confirm they felt supported at this time due to the strong team working which took place. The manager had recognised this deficit and a supervision schedule had been developed. The schedule confirmed that the majority of staff had received supervision in May 2016.

There were effective staff recruitment and selection processes in place. Staffing arrangements were flexible in order to meet people’s individual needs. Staff received a range of training to keep their skills up to date in order to support people appropriately. Staff spoke positively about communication and how the manager worked well with them, encouraged team working and an open culture.

People felt safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate. People engaged in a variety of activities and spent time in the local community going to specific places of interest.

A number of effective methods were used to assess the quality and safety of the service people received.

Inspection carried out on 23/04/2014

During a routine inspection

Woodtown House is a care home registered to provide nursing care to 28 people with mental health needs. At the time of our visit there were 20 people living at the home.

The home has a manager registered with the Care Quality Commission.

People we spoke with confirmed that they felt safe and supported by staff. They had no concerns about the ability of staff to respond to safeguarding concerns. Comments included: “Staff are very good” and “They take account of my views and are okay”.

Staffing was maintained at safe levels and were reviewed on an on-going basis in line with the monitoring of risk, such as a person’s current mental state.

Staff completed inductions and training when starting work at the home. The induction required new members of staff to be supervised by more experienced staff to ensure they were safe and competent to carry out their roles. Staff continued to receive training throughout their employment, which enabled them to feel confident in meeting people’s needs and flagging up any concerns/changes in health.

Care plans were up-to-date, were written with clear instructions and demonstrated the involvement of other health and social care professionals. Alongside care plans we found information was available for staff to refer to and understand how particular conditions affected people.

Risk management considered the whole person and showed that measures to manage risk were as least restrictive as possible, such as the use of distraction techniques when a person was becoming distressed.

Staff showed commitment to working in partnership with people. For example, one to one sessions took place with people to look at future care and support needs.

Staff understood the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We found the service to be meeting the requirements of the Mental Capacity Act (2005). People’s human rights were recognised, respected and promoted.

Inspection carried out on 28 September 2013

During a routine inspection

On the day of our visit we were told that there were 23 people living at Woodtown House, with one person currently in hospital. We spoke to ten people living at the home, spent time observing the care people were receiving, spoke to five members of staff, which included the registered manager and looked at four people�s care files in detail.

People commented that they were fully involved and supported to make decisions about their care. For example, plans of care were reviewed with people living at Woodtown House involved and their needs and wishes were taken into account.

We spent time talking to people who lived at Woodtown House and observing the interactions between them and staff. Comments included: �The staff consider my welfare�; �I went out shopping yesterday, I do lots of activities with staff support� and �It�s alright here and the foods good.� During our visit, we saw that people appeared relaxed and contented.

Medicines were safely administered. We saw the medication recording records which were appropriately signed by staff when administering a person�s medication.

We observed that staff were well organised, motivated and competent in their roles. Staff provided support in a caring manner making sure that people were comfortable and content.

People�s personal details were kept securely to preserve confidentiality. Staff confirmed that they had ready access to people�s care records when needed.

Inspection carried out on 13 December 2012

During a routine inspection

We conducted an unannounced inspection on 13 December 2012. On the day of our visit we were told that there were 20 people living at Woodtown House. We spent time observing the care people were receiving, speaking to them informally, speaking to four staff members, which included the registered manager and looking at four people�s care files in detail.

We spoke to people about how staff gained consent from them before providing care or treatment. Comments included: �The staff ask me before helping me� and �I am always asked if I am ready to take my medication.�

People said that their care and welfare needs were being well met. Comments included: �I am well looked after�; �The staff are lovely here, so helpful� and �We do activities, I like skittles and monopoly.� We observed people living at the home and staff. We saw plenty of positive interactions taking place and people looked relaxed and comfortable asking staff for advice or information.

People confirmed that they felt safe and supported by staff at Woodtown House and had no concerns about the ability of staff to respond to safeguarding concerns. They felt that their human rights were upheld and respected by staff.

People informed us that staff met their needs in a timely manner. Everyone we spoke with were confident in the ability of staff to provide the care needed.

Inspection carried out on 4 January 2012

During a routine inspection

On the day of our visit there were 20 people residing at Woodtown House. We spoke with eight people who lived at Woodtown House. Overall they told us that they were very happy with the care and support they received and the staff were polite and easy to communicate with. Comments included:

�I am really happy here, I like to do my paintings.�

�We have social outings.�

�I feel safe here.�

�This is the best place I have lived.�

�The staff are lovely, I feel involved in my care.�

�If I have a complaint, I know I would be listened to.�

�I am encouraged to maintain my independence.�

People commented that they were fully involved and supported to make decisions about their care. For example, plans of care were reviewed with people living at Woodtown House involved and their needs and wishes were taken into account. People said that they were encouraged to maintain their independence and felt fully involved in their care.

We were told by people living at Woodtown House that staff supported them appropriately with daily living tasks, including personal care and meeting nutritional needs. During our visit, we observed staff supportively assisting people to meet their personal needs, such as transferring from one area of the home to another with the use of a wheelchair and serving meals.

People we saw and spoke with confirmed that they felt safe and supported by staff at Woodtown House and had no concerns of their ability to respond to safeguarding concerns. They felt that their human rights were upheld and respected by staff.

People we spoke to said that staff were supportive and helpful. Staff knew how to respond to specific health and social care needs and were observed to be competent with such. Staff were able to speak confidently about the care practices they delivered and understood how they contributed to people�s health and wellbeing.

People we spoke with confirmed that Woodtown House sought their views about the quality of the service they receive and that this information was sought by surveys and resident meetings. We were able to see that where improvements were needed they were followed up by the home, for example the food provided.

Reports under our old system of regulation (including those from before CQC was created)