Archived: Woodlands View Care Home

We carried out this inspection due to concerns received about the service. These concerns related to poor management of pressure care, insufficient staffing levels and unsafe care practises. At their last inspection on 23 April 2015 the service was found to be meeting all the standards we inspected and was given a rating of good. At this inspection we found that they were not meeting all of the standards. This was in relation to people’s safety and welfare, staffing, cleanliness, person centred care and management systems. You can see what action we took at the back of our report.

Woodlands View provides accommodation and personal care for up to 120 people. At the time of this inspection 114 people were living at the service.

The service had a manager in post who had recently registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated regulations about how the service is run.

People did not always receive care that met their needs and kept them safe. People had not been supported by sufficient numbers of staff, however action had recently been taken to address this. Risks to people’s health and wellbeing had not been consistently identified and responded to. Staff were knowledgeable about how to keep people safe from harm.

People were not consistently supported to have a varied diet. People at risk of poor nutrition did not always have their needs responded to and people were not consistently able to access specialist healthcare professionals, particularly the dietician. People's consent was sought prior to care being delivered, however the requirements of the Mental Capacity Act 2005 had not always been followed. People were supported by staff that had been sufficiently trained to carry out their role effectively.

People’s dignity and privacy was not consistently met across the home, particularly for people who were cared for in bed. People felt staff were caring and kind in their interactions; however also felt that staff did not have time to meet their personal preferences that were important to them.

People were not provided with sufficient opportunities to engage in activities, hobbies or interests. People living with dementia did not live in an environment that promoted their independence or engaged them with meaningful activity. People felt confident in raising a complaint, however, opportunities to do so, such as meetings were not consistently held and people did not all know who the appropriate manager was to raise them with.

People gave mixed views about the management of the service, and some people felt the registered manager was not visible. Audits and systems in place to monitor and improve the quality of care people received had not been effectively managed. People’s records were not consistently accurate. The views of people living in the home had been previously sought; however the Registered Manager was awaiting the results of the recent survey. Notifications that were required to be submitted to CQC had been made without delay.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During the course of our inspection on 04 September 2014 we reviewed care plan documentation for 10 people who used the service. We saw that risks had been assessed in such areas as mobility, skin integrity, communication and nutrition. Where a risk had been identified we found there were clear plans for staff to follow to reduce the element of risk for the individuals.

We checked pressure mattresses for 12 people and found that all were set appropriately according the individuals weight. We found that the majority of people who required pressure relieving cushions to promote skin integrity were seated on them. However, we noted two people who were not using equipment as detailed in their care plans.

We reviewed the duty rota for two units for the period from 29 August 2014 to 11 September 2014. We noted that staffing provision was consistent throughout this time.

Is the service effective?

Care plans provided clear information for staff. For example, '[Person's name] struggles to see staff when they approach from the left side, so ensure that staff position themselves from the right hand side'.

All relatives that we spoke with told us that they felt that staff cared for their loved ones in a way that was appropriate to them and that there was nothing that staff needed to do to better this. One relative described how the staff had arranged a birthday party at the service with a marquee set up in the garden.

We found that some people had not been supported well with personal grooming. For example, we saw people with un-brushed hair and creased clothing.

People said that they would speak to the house manager or members of staff if they felt unwell and that they would then arrange for a GP to see them if necessary. In addition, people said that the GP came in to the home once a week and that the dentist, optician and chiropodist visited on a regular basis.

Is the service caring?

We spoke with 15 people who used the service. Most people felt that most of the staff were kind and caring and that they received good care. One person described how a member of staff brought them in an early breakfast tray as they had a hospital appointment first thing in the morning. Another person told us that they felt that staff took pride in their job and that staff cared for them in the way that they liked, or tried their best to do so.

Is the service responsive?

At our previous inspections we found that activities at the service were limited, especially for those people who were being cared for in bed. At this visit we found that there were no real improvements in this area. People who were being cared for in bed spent long periods of time with no staff interaction and no stimulation. A person told us, 'It would be nice to have a bit more activities going on'.

Relatives of people who used the service knew how to make a complaint if they were unhappy. We spoke with a person who had made a complaint and they told us that they were satisfied with the outcome.

Is the service well-led?

The management team had worked well with other agencies to make sure people received their care and support safely.

A member of the management team told us that there was a daily check of all units at 10:30am to ensure that medications and personal care had been finished. They said that, if necessary, they would move staff resources around the units to where they were needed to ensure that there was enough staff available to support people to be ready for the day by 11:00am.

We found that there was a clear system in place to monitor accidents and incidents and to identify those issues that needed to be investigated or reported to the appropriate authorities. This meant that people's health safety and welfare was being effectively monitored.

We issued a warning notice which stated that they must be compliant with this regulation by 15 July 2014.

At our inspection on 24 July 2014 we reviewed the safeguarding arrangements in place.

We set out to answer five questions. These were whether the service is caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service and the staff that supported them. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the staff team had received refresher training to enhance their skills and knowledge about keeping people safe from harm.

Is the service effective?

We looked at accident and incident forms. We found that where people had sustained unexplained bruises and skin tears that this had been investigated by the home management and referred to the local authority safeguarding team for further investigation.

Is the service caring?

We observed staff interaction with people who used the service and noted that interactions were positive and staff members were attentive and kind.

Is the service responsive?

We found that the service had made improvements following issue of the warning notices.

Is the service well led?

The home continued to be managed by an interim manager together with a newly recruited deputy manager and clinical services manager.

Staff members and relatives of people who used the service told us that the manager had made a significant difference to how the service functioned. Staff told us they felt that they were supported and could always access help if needed. Relatives told us that they felt people who used the service were safe.

At our inspection on 04 June we reviewed the care and welfare of people who used the service and the safeguarding arrangements in place. We will review the staffing arrangements at our next inspection.

We set out to answer five questions. These were whether the service is caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service and the staff that supported them. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was not consistently planned and delivered in a way that was intended to ensure people's safety and welfare.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Where applications had needed to be submitted, proper policies and procedures had been followed. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We found that there were continued shortfalls in relation to safeguarding people from the risk of abuse.

Is the service effective?

We saw that most of the risk assessments and support plans had been reviewed and updated following our last inspection. We looked at the care notes for people whose plans we had viewed and saw that in most cases care was recorded as being delivered in accordance with the plans.

We looked at accident and incident forms. We found that there were several unexplained bruises and skin tears that had not been investigated.

Is the service caring?

We observed staff interaction with people who used the service and noted that most interactions were positive. Most staff were attentive and kind.

Is the service responsive?

We found that the service had made some improvements following issue of the warning notices. There was a service improvement plan in place that the acting manager and support manager were working through.

Is the service well led?

The home was being run by an acting manager with the assistance of a support manager. We found that areas identified in relation to care provision were being addressed but were still in progress. Staff we spoke with felt that the acting manager had made a difference as did a relative that we spoke with.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service and the staff that supported them. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was not planned and delivered in a way that was intended to ensure people's safety and welfare.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Where applications had needed to be submitted, proper policies and procedures were not followed. Relevant staff had been trained to understand when an application should be made, and how to submit one, however, this had not be done.

We found that there were shortfalls in relation to safeguarding people from the risk of abuse and the service is required to make improvements.

Is the service effective?

People told us that they were happy with the care that they received but sometimes they needed to wait for long periods of time to receive the support they required. Care plans were written in a way which reflected people's needs and preferences. Staff asked for people's consent before providing care and support. However, we observed staff practice in regards to care delivery was not always provided in accordance with people's care plans.

We saw that most of the risk assessments and support plans had been reviewed monthly. We looked at the care notes for people whose plans we had viewed and saw that care was recorded as being delivered in accordance with the plans.

Is the service caring?

People told us that the staff were caring but were busy. One person told us, 'They do a good job, very friendly.' People also told us that the staff approach depended on how busy they were.

We observed staff interaction with people who used the service and noted that while some interactions were positive, there were several that were less positive. Some staff were attentive and kind. There was some conversation between people who used the service and staff that made for a friendly and comfortable atmosphere. Staff we spoke with had a good understanding of the people that they were supporting. However, we noted that they did not always put this knowledge into practice.

Is the service responsive?

We found that where the service had identified issues through their own monitoring systems, these had not yet been acted on. For example, the ineffective and broken call bell system and the lack of dementia training. We noted that this training had been booked for future months.

Is the service well led?

We noted that the manager for the service was relatively new in post at the time of our inspection and was in the process of implementing new systems. They were being supported by the regional manager. The staff told us that the manager was making changes within the home.

However, staff might not be clear about their responsibility to act in accordance with people's wishes if a medical emergency occurred. This was because information about people's wishes in relation to resuscitation in a medical emergency was not always available or accurately recorded.

We found that people's needs were assessed and care was planned and delivered in line with those individual needs. People's perception of the standard of care was generally positive whereas some people expressed mixed views with some positive and negative comments being recorded.

Staff members used people's care plans to help them to understand people's needs and to deliver care that met those needs.

We found that medicines were safely obtained, stored and administered. We checked people's records and counted medicine stocks and found no anomalies.

The provider had modified the staffing structure of the four houses to ensure that management functions were effective. There was a consistent level of staffing within each of the four houses and this level was maintained over time.

The provider had a quality governance system in place that ensured that the quality of service was effectively monitored and any identified shortfalls were dealt with.

The provider took account of complaints and comments to improve the service.

Relatives made positive comments about the care and support provided at the home and recent improvements that had been made. A relative told us that they were pleased with how they were consulted about their relative's care now. They said, "We don't have to go looking for staff, they come and tell us." A relative told us that the staff were kept up to date with their relative's care, they said, "No matter who you speak to they all know what's happening."

People with whom we spoke told us that the home was always kept clean. Most areas of the home were clean and fresh on the day of our visit however we noted that bathroom facilities in one house were not as clean and fresh as those in the rest of the home.

The staff team received the support and training they needed to support people safely. Staff members told us that there had been recent improvement in many areas of the service and that they felt supported by the current management regime.

People said they would have no qualms about raising any concerns directly with the manager. They said they had confidence that they would be listened to and taken seriously.