Archived: Woolton Manor Care Home

Updated 14 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 16 July 2018 and was unannounced. The inspection was carried out by one adult social care inspector, an adult social care inspection manager and an assistant inspector.

Prior to our visit we looked at any information we had received about the home and any information sent to us by the provider since the home’s last inspection.

At this inspection we spoke with people who lived at the home, the acting manager, the support manager, three care workers, the cook and a domestic staff member.

We examined a range of documentation including the care files belonging to six people who lived at the home, staff files, staff training information, a sample of medication administration records and records relating to the management of the service. We also looked at the communal areas that people shared in the home and visited some of their bedrooms.

Updated 14 September 2018

Woolton Manor 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

The home provides accommodation for people who require nursing or personal care. The home is registered to provide accommodate for up to 66 people. The provider closed the nursing unit in the home. The home at the time of this inspection only provided support to people who required assistance with their personal care. At the time of our inspection, there were 21 people who lived in the home. This inspection took place on 16 July 2018 and was unannounced.

There was no registered manager in post at the time of our inspection. 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. At the time of this inspection there had been no registered manager in post for a number of years. This was a breach of the provider’s conditions of registration with CQC.

At the last inspection in February 2018, there was an acting manager in post who was being supported to manage the home by a consultant. At this inspection another support manager had also started to work at the home to support the acting manager too. This support manager told us that they were planning to apply to CQC to be the registered manager. They said however that they were not planning to work at the home for long as they had plans to work elsewhere. Another consultant from a different organisation had also been commissioned by the provider to audit the quality and safety of the home. The consultant identified that a range of improvements still needed to be made at the home. Some of the improvements identified by the consultant corresponded with the concerns and improvements that CQC has previously identified in the provider’s last three inspections. An action plan to improve the service had been developed by the consultant and the acting manager told us that they had been given a copy of this.

At our last inspection, we found breaches of Regulations 9,10,11,12,13,17,18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this visit we followed up the breaches we identified at our previous visit. We found that the provider had not taken appropriate action to address our concerns and all of the breaches we identified previously remained. This meant people who lived at the home continued to be placed at serious risk. The rating for the service has not changed. The service remains inadequate and in special measures. This is the fourth consecutive inspection where the service has been rated inadequate with multiple breaches of the health and social care regulations.

At our last three inspections people’s needs and risks had not been properly assessed and managed. Information in relation to people’s care was confusing, contradictory and difficult to follow. At this inspection, we found that no improvements to people’s care planning and risk management had been made. People’s care plans contained some person-centred information but this information was limited. Where people had made their preferences or needs known, support had not always been provided in accordance with them. This placed people at risk of unsafe and inappropriate care.

Concerns were raised at our previous inspections with regard to the implementation of the Mental Capacity Act and people’s capacity to make specific decisions about their care. At this inspection, people’s decision making was still not appropriately supported in accordance with this legislation. This meant that people’s consent was not always lawfully obtained.

People still had no access to social or recreational activities in support of their emotional well-being and we observed that the majority of people sat all day watching the TV. This was the same as at the last three inspections, yet despite this, no effort had been made to ensure that people’s social and recreational interests were catered for. People told us there was nothing to do at the home and the place was very quiet.

At our last three inspections, records showed that people did not receive the support they required with their personal care to preserve their dignity and skin integrity. We found the same at this inspection. Records showed that people went significant periods of time without a bath or shower and for the most part only received ‘strip washes’ or ‘bed baths. We also found that some of the records in relation to these issues were untrustworthy.

The number of staff on duty was not always sufficient to meet people’s needs. We heard call bells ringing constantly and people waiting unacceptable amounts of time for staff to respond. People we spoke with told us that there were not enough staff and they often had to wait for care and support.

Staff recruitment was not robust enough to meet the regulations. We spoke with one new staff member who had moved over from another care home. They had not been recruited safely and had only received a verbal induction in the home.

Staff were polite and pleasant to people but their support was not always provided in a dignified or respectful way and staff were not always attentive to people’s well-being. We saw examples of staff asking people personal questions in public places.

The condition of the building had deteriorated since our last inspection which resulted in people being placed at risk of serious harm from unsafe premises. We also had infection control concerns as continence equipment was not cleaned safely or appropriately which placed people at risk from cross contamination.

The provider’s governance arrangements were ineffective. The managerial systems and the provider’s oversight of the service failed to identify and address all of the concerns we identified. The provider’s lack of action to address these issues both at this inspection and three previous inspections demonstrates they lack the competency and accountability to ensure the service is safe, effective, caring, responsive and well-led. This means that people continued to be placed at serious risk.

At the end of our inspection, we discussed the concerns we identified during the inspection with the acting manager and the support manager. We found they lacked understanding of the issues to be able to ensure that sustainable changes were made in the home.

The overall rating for this provider is ‘Inadequate’. It has been inadequate since 2016. This means the service will remain in ‘Special measures’ by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.