Wood Hill Lodge

Updated 2 December 2023

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 Health and Social Care Act 2008.

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 2 adult social care inspectors, a medicines inspector, a regulatory co-ordinator, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Wood Hill Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Wood Hill Lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 8 people who used the service and 3 relatives about their experience of the care provided. We spoke with 13 members of staff including the registered manager, deputy, nurses, nursing assistants, team leaders, senior care staff, care workers, activity co-ordinator and domestic staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included people’s care records, multiple medication records, staff files in relation to supervision and training and quality monitoring records.

Updated 2 December 2023

About the service

Wood Hill Lodge is a care home that provides accommodation, nursing and personal care for adults living with physical disabilities and/or mental health issues, including older adults living with dementia.

The home can accommodate up to 99 people in one purpose-built building over four floors, each of which has separate adapted facilities. At the time of this inspection there were 44 people residing at Wood Hill Lodge.

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

Risk assessments and care records for people were not always in place or up to date to provide staff with the information they needed to support people safely. Medication systems were not managed safely to ensure people received their mediation as prescribed. We found people had not received some medicine and others had been given the incorrect dose. This put people at risk of harm. Infection, prevention, and control (IPC) systems were not robust. Staff did not always follow IPC procedures to manage the risk of cross infection. We found areas of the home were not clean and some areas not well maintained, so were unable to be effectively cleaned.

Some required staff training had been delivered since our last inspection. However, from observations it was not clear if this had been effective. For example, staff had received training and supervision regarding choking risks, yet we observed people being given incorrect thickened drinks and not positioned correctly to reduce risks of choking. We also found some training was still to be delivered to ensure all staff were trained in line with the providers policy.

The registered manager completed a dependency tool and a staff rota. However, it was not clear if adequate staff were effectively deployed to meet people’s needs. Some people were commissioned to receive 1 to 1 staffing hours and it was not evident if these hours were always provided.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. However, since our last inspection the registered manager had applied to renew the authorisations for Deprivations of Liberty Safeguards (DoLS).

Staff were aware of what actions to take to safeguard people from the risk of abuse. However, we identified issues during inspection that had not been picked up by the quality monitoring systems and we made 2 safeguarding referrals to the local authority.

We found governance and audit systems were not effective in identifying and reducing the risk to people’s safety. There was a lack of effective leadership and oversight of the service.

Accidents and incidents were recorded. However, the documented audit/log was not up to date, and it was not clear if all incidents had been reported correctly. Following our site visit we found 2 incidents that had not been reported.

We received mixed feedback, regarding management and staff from people and relatives. Some spoke highly of the staff and service provided, while others were not happy with the care and support. Staff we spoke with told us the management team were not approachable, they could not raise concerns as they were not listened to and they were not supported

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

Rating at last inspection and update

The last rating for this service under the previous provider was good (published 12 May 2021)

We carried out a targeted inspection on August 2023 and identified breaches of regulations. However, we did not provide a rating. (Published October 2023)

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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced targeted inspection of this service in August 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check if they had followed their action plan and to confirm if they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service is inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wood Hill Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment , person-centred care and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.