Woodford House

Updated 17 November 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 three inspectors 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

Woodford House 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. Woodford House 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, however they were in the process of working their notice.

Notice of inspection

This inspection was unannounced.

What we did before 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. The provider was not asked to complete a 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 7 people who used the service and 19 relatives about their experience of the care and support at Woodford House. We spoke with 12 members of staff including the nominated individual, registered manager, deputy managers, operations and compliance manager, head of care, clinical lead, nurse, senior carers and carers. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with 2 healthcare professionals.

We reviewed a range of records including 8 care plans and multiple medication records. We looked at 4 staff files in relation to recruitment and supervision. A variety of records relating to the management of the service, including auditing and monitoring records were reviewed.

Updated 17 November 2023

About the service

Woodford House is a residential care home providing personal and nursing care to up to 39 people. The service provides support to people needing short term nursing or personal care, and some people living with dementia in 1 adapted building. At the time of our inspection there were 28 people using the service.

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

Although we received positive feedback from people and their relatives, we found multiple and significant shortfalls throughout most areas of the service. People were not always treated with kindness, dignity and compassion. Parts of the service were overwhelmingly odorous and staff had failed to identify and address this. People were referred to as numbers instead of using their names; people were not dressed in the manner they were used to which impacted severely on them.

There was a lack of oversight and effective leadership at the service. The provider took over the service in August 2022, however a compliance audit was only completed in March 2023. Although this audit identified areas for improvement, it did not give any deadlines for important actions to be completed, or detail any support needed to complete the actions. The registered manager completed some audits, however these were ineffective in implementing improvements. Opportunities to learn lessons were not used, and we could not be assured that accidents and incidents were documented by staff.

Guidance for staff to inform them how best to support people and mitigate health risks were not sufficiently detailed. Assessments completed before people moved into the service were basic and not detailed. When people received support from external healthcare professionals this was not always documented, and healthcare professionals told us staff were not open and honest.

Staff lacked understanding around mental capacity and had failed to document and review restrictions placed on people. Best interest meetings had not been documented and capacity assessments were not always completed. People were not supported to have maximum choice and control of their lives and staff did not 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.

Although staffing had been reviewed and matched the providers dependency tool, relatives, staff and healthcare professionals told us staffing levels were not sufficient. Staff lacked specific training on how to support people with a learning disability, and induction of agency staff was not sufficient. Recruitment processes were not robust.

People did not receive personalised care specific to their needs. Care plans were basic and difficult to read in places. People did not have specific communication plans in place, and activities did not focus on the needs of people living with dementia or those with a learning disability.

Complaints were not effectively documented and responded to. Relatives told us they found contacting the service challenging and that they were not always kept up to date with their loved one’s care.

The management of medicines was safe although there were areas we identified improvements were needed. People had end of life care plans in place however these were not detailed.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and/ or who are autistic.

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

This service was registered with us as a new provider on 30 August 2022 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 18 August 2021.

Why we inspected

The inspection was prompted due to concerns received about people’s safety, dignity and respect, staffing. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding vulnerable adults, management of risk and learning lessons, medicines management, staffing, recruitment, people’s rights under the MCA, person centred care, dignity and respect, complaints and management and leadership at this inspection. We have made a recommendation about accessible information and communication.

We took enforcement action against the provider and have applied a condition to their registration requiring them to send us monthly reports detailing the action they are taking to make improvements.

Follow up

We will monitor information we receive about the service including the providers monthly reports, 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.