Archived: Woodlands House

At the last Care Quality Commission (CQC) inspection in March 2015 the service was rated ‘good’ overall. However in the key question ‘Is it well led? we rated the service ‘requires improvement’. This is because we found a breach in legal requirements. The provider was not submitting notifications about significant events that took place at the service in a timely manner. We carried out a focussed inspection in June 2015 and found at that time the provider was meeting the legal requirement. We were able to improve their rating for the key question, ‘Is it well led?’ to ‘good’ because we saw evidence of consistent good practice in relation to the submission of notifications.

At this inspection we found the service remained ‘good’ overall. The service demonstrated they met the regulations and fundamental standards. However in the key question ‘Is it responsive?’ we rated the service ‘requires improvement’. This is because we found people may not be having all their social and physical needs met. People told us there was not enough to do to keep them active and engaged. Senior managers were already aware, prior to our inspection, that improvement was needed in the planning and organisation of activities and were taking steps to address this at the time of our inspection.

Although people said the provision of activities at the service needed to improve, they were generally satisfied with other aspects of the service. The provider maintained appropriate arrangements to deal with people’s complaints and concerns if they were dissatisfied with any aspect of the service.

People continued to be safe at Woodlands House. Staff knew how to protect people from the risk of abuse and followed appropriate guidance to minimise identified risks to people's health, safety and welfare.

Some people said at busy times the service appeared short staffed. However there were enough staff to keep people safe and the provider reviewed staffing levels monthly. The provider had arrangements in place to check the suitability and fitness of all staff. However senior staff were reviewing arrangements for carrying out criminal records checks on existing staff, after our inspection, to ensure they had full assurance about staff’s on-going suitability to work at the service.

People had a current support plan which reflected their choices and preferences for how their care and support needs should be met by staff. These were reviewed regularly by senior staff. Staff received relevant training and were well supported by senior staff to help them to meet people’s needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services when needed. Medicines were managed safely and people received them as prescribed.

Staff were kind and treated people with dignity and respect. They ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The environment was clean and clear of slip and trip hazards. The premises and equipment were regularly maintained and serviced to ensure these were safe.

Since our last inspection there had been a change in leadership at service and provider level. People and staff spoke positively about the new home manager and said they were open, approachable and supportive. Senior managers at provider level had oversight and scrutiny of the service and supported the home manager to ensure quality standards were met. Audits were used to identify areas of the service that needed to improve to ensure people experienced good quality safe care and support. The home manager took responsibility for ensuring these improvements were made.

Senior managers were working proactively with the service provider for intermediate care. Managers from both services acknowledged there had been challenges in ensuring people using this service received joined up, seamless care and support. However they were working together to address issues and improve standards so that people received the care and support they needed.

Further information is in the detailed findings below.

Woodlands House provides accommodation for up to 64 people who require personal care and/or nursing care. People using the service had a wide range of healthcare and nursing needs, some of whom are living with dementia. The home is able to accommodate up to 12 people who require intermediate care. Intermediate care is provided to people who need extra support for a short period of time to help them recover from illness or injury. There were 60 people living at the home at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found people received their medicines as prescribed and in a timely manner. We saw staff administered medicines in a safe, caring and effective manner. Our checks of records showed these were maintained accurately and indicated people received their medicines as prescribed.

People’s medicines were reviewed regularly by their GP. There was regular involvement and input from GP’s who visited the home every week to review and carry out checks of people's healthcare needs and medicines they were taking.

Appropriate guidance was available to staff on how and when to administer ‘as required’ medicines. ‘As required’ medicines are medicines which are only needed in specific situations such as when a person may be experiencing pain.

Medicines were stored appropriately in the home. These were disposed of appropriately and arrangements were in place for their collection by an external contractor.

The provider had taken appropriate action to put in place measures to reduce the risk of errors reoccurring following a serious error that occurred in November 2105. The registered manager told us there had been no further incidents or errors reported since that time.

The provider followed current and relevant professional guidance about the management and review of medicines. The results of internal and external audits were used by the provider to identify any action needed to improve the management of medicines.

The provider sent us an action plan to tell us how they would become compliant with this regulation. We found that at this inspection, records were accessible and most care plans were up to date, regularly reviewed and contained relevant medical information.

People we spoke with told us they were consulted about their care. For those who could not take decisions for themselves appropriate support had been offered or their relatives consulted. Generally people spoke positively about the care they were given. One person said 'It's just like a hotel.' Another commented of the staff 'they are lovely, can't do enough for you.'

We spoke with three visitors and two professionals who visited the service that day. They thought the staff interacted well with the people and kept them informed about any changes. One visitor said 'they are so kind.' Appropriate safeguarding procedures had been followed when required and there were adequate arrangements for the management of medicines.

We found that the provider and staff had taken action to address the compliance action made at the last inspection on staff training. Staff told us that they had attended a number of training events. One person said, 'There has been a lot of training here. '

There were systems in place to assess and monitor the quality of the service. We saw that complaints had been addressed, and feedback from people who used the service and their relatives obtained and improvements considered as a result. However care plan records were not always accessible or adequately maintained. This meant people could be at risk of unsafe or inappropriate care.

People said they felt well cared for and spoke positively about the care and support they received. Comments included, 'I am very happy with the care given here', 'The staff are very good, it is a nice home', 'They look after me well' and 'I am comfortable, the staff are kind.' Comments from visitors included, 'We are very comfortable with the decision to place my X here', 'The home has a good reputation locally" and 'The care is wonderful and I am quite happy with what they do for X.'

People knew who to talk to if they had any worries or concerns, and felt assured that staff would respond to these in an appropriate manner.

Individuals commented that they enjoyed the meals in the home and found the staff to be helpful and attentive. There was a stable staff team who have worked at Woodlands House for a number of years. Staff told us that they were happy working at the home and felt there was good teamwork. We found that the arrangements for staff training were in need of improvement however.