Woodleigh Rest Home Limited

Woodleigh Rest Home is a residential care home providing personal care to up to 33 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 19 people using the service.

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

People were not safe. Medicines were not managed safely. Routine checks were not in place and we were not assured people received their medicines as prescribed. Risks to people’s health and safety and wellbeing had not been effectively assessed and reviewed. This included risk relating to moving and handling, skin integrity and the environment. People’s nutritional needs were not always met.

The manager was unable to demonstrate effective leadership. This had not been effectively addressed by the provider and they were unable to demonstrate robust governance arrangements and evidence of lessons being learned. Specific issues we raised at the last inspection had not been addressed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staffing levels had been increased and staff had received support, training and supervision to carry out their role. Recruitment was managed safely. Most people and relatives told us they felt safe and there were enough staff to meet people’s needs. Staff were kind, respectful and caring.

The service had made some improvements since the last inspection. However, they were not consistent and some initial improvements had not been sustained. The provider was responsive to the inspection findings and provided assurances they would make the required changes to improve the quality and safety of care.

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 was inadequate (published 25 July 2022) and there were multiple breaches of regulation. 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 inspection of the service on 14,16 and 27 June 2022. 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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The report only covers our findings in relation to the Key questions Safe, Effective and Well-Led.

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.

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 has changed from Inadequate to Requires Improvement based on the findings of this inspection

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

Enforcement

We have identified breaches in relation to the management of risk and medicines, nutrition and hydration and good governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures.' We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Woodleigh Rest Home is a care home providing personal care and support for older people, people living with dementia and people with physical disabilities. The service is registered to accommodate up to 33 people, at the start of our inspection there were 23 people using the service. A further person moved into the home before the last day of inspection, increasing the capacity to 24. and by the last day there were 24 people using the service.

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

Medicines were not managed safely which put people at risk of harm. There were no protocols in place to guide staff on how to administer as and when required medication. Stock checks were completed but did not capture accurate amounts of medication received into the care home? and there were gaps in the medication administration records with no explanations as to why.

People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people’s health and care needs, as well as environmental risks. Infection control procedures were not always followed by staff as personal protective equipment (PPE) was not always worn correctly and social distancing was not maintained. Parts of the premises were not clean.

People were at risk of malnutrition and dehydration due to lack of monitoring of food and fluid intake. Daily records were not robust, and the provider did not have safe systems in place for monitoring the documentation. People who lost weight were not in receipt of support from external professionals as the service failed to monitor and respond to weight loss efficiently.

People did not always receive person centred care and care records did not fully reflect their current needs. Some staff were caring and kind to people, other staff were task focused and did not respond appropriately to people’s needs. There were activities taking place and despite this many people were not engaged or included in activities and they did not have their interests occupied.

Staff did not receive induction, training and support they needed for their roles. Staffing levels were not sufficient to meet the needs of the people in the home. We have made a recommendation to the provider about increasing the staffing levels.

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 an in their best interests. The policies and systems in the service did not support this practice.

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.

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

Rating at last inspection

The last rating for this service was good (published 10 June 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

the incident.

We received concerns in relation to the management of medicines, staffing and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well led only.

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 has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has not taken appropriate action to mitigate these risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodleigh Rest Home Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe handling of medicines, risk management, nutrition and hydration and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Woodleigh Rest Home is a care home which provides accommodation and personal care and support for up to 33 older people, people living with dementia and people with physical disabilities. At the time of the inspection there were 22 people using the service.

People’s experience of using this service:

Improvements to people’s hydration needs have been made since our last inspection in April 2018 and the service met the characteristics of good in most areas; more information is in the full report.

Staff were kind and caring and there were sufficient numbers to keep people safe and to meet their care needs.

People were supported by staff who were motivated, enjoyed their job and felt well supported through supervision and training.

The atmosphere in the home was warm and friendly, with lots of laughter between staff and people using the service.

Care plans were up to date and detailed what care and support people wanted and needed.

Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified.

People felt safe at the home and appropriate referrals were being made to the safeguarding team when necessary.

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.

Medicines were being administered safely and people’s health and dietary needs were met.

Activities were arranged to keep people occupied.

The home was clean and tidy.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The manager provided staff with leadership and was approachable. Audits and checks continued to be used to drive improvements to the service people received.

People’s feedback was used to make changes to the service, for example, to the menus and activities.

We have made a recommendation about improving the response time to making essential repairs.

Rating at last inspection: Requires improvement (report published 24 May 2018). The overall rating has improved to good following this inspection

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Woodleigh Rest Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 33 older people in one adapted building. Accommodation is provided over two floors.

The last inspection was carried out in April 2017 and the overall rating for the service was ‘requires improvement.’ The provider was in breach of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to ‘safe care and treatment’ (Regulation 12) and ‘good governance’ (Regulation 17). We took enforcement action and issued a warning notice in relation to the breach of regulation 17 (good governance). We issued a requirement notice in relation to the breach of ‘safe care and treatment’ Regulation. We asked the provider for an action plan, which they provided telling us how they were going to make the necessary improvements.

During this inspection we found improvements had been made.

A registered manager was in place. 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.

There were enough staff to keep people safe and to meet their care needs. Staff were receiving appropriate training and they told us the training was relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. We saw appropriate referrals were being made to the safeguarding team when this had been necessary.

People’s healthcare needs were being met and medicines were being stored and managed safely.

In the main we saw staff were kind, caring and patient. However, we did see some practices which showed a lack of respect for people.

People were offered a choice of meal and they told us the food was nice. However, we were concerned people were not getting enough to drink.

The home was clean, comfortable and improvements to the lighting were on-going. Some areas of the home had been refurbished and redecorated and this was on-going. However, we did find staff were not always following infection prevention procedures which potentially could put people using the service at risk.

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 complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

Some activities were on offer to keep people occupied but these needed to be more person centred.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had a more active role in the running of the service. We saw systems had been introduced to monitor the quality of the service. We saw these had identified areas for improvement and action had been taken to address any shortfalls. People using the service and relatives were consulted about the way the service was managed and their views were being acted upon. It was too early for the provider to be able to demonstrate that the quality processes were fully embedded and that these improvements could be sustained over time.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Woodleigh Rest Home is situated in the Queensbury area of Bradford. The property has been adapted and extended to provide personal care for 33 older people both in single and double rooms on the ground and first floors. The rear entrance provides disabled access to the ground floor with a stair lift enabling access to the first floor. There are two lounges and one dining room on the ground floor.

On the day of the inspection there were 26 people using the service.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our last inspection took place on 8 September 2016. At that time, we found the provider was not meeting the regulations in relation to safe care and treatment, premises and equipment and good governance. The service was rated ‘requires improvement’ overall. We told the provider they needed to make improvements and they sent us an action plan telling us what they were going to do in order to become compliant with those regulations. However, on this inspection we found continued breaches in relation to safe care and treatment and good governance.

We found staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

People who used the service told us they felt safe at Woodleigh Rest Home and we found staff understood the safeguarding process.

We found action was not always being taken to mitigate risks within the service in relation to the premises. We found there were on-going issues with the heating and hot water in one area of the home. This had been reported to the provider, however, no resolution had been found. We also found two bedrooms with unpleasant odours, one with an unsuitable lock and poor lighting levels throughout the home, which all posed potential safety issues for people using the service and staff.

People who used the service were receiving personalised care and were very happy at the home. They told us staff were kind, caring and compassionate. Some activities were on offer to keep people occupied and staff provided people with some companionship. People’s healthcare needs were being met and healthcare professions spoke highly about the care and support people received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

We found although people’s medicines were generally being managed safely, for prescribed topical lotions and creams the records did not show these were being administered as prescribed.

People who used the service told us they liked the meals, however, we found menus were limited and not everyone always received a choice of meal.

Care plans and risk assessments were not always up to date and it was not always easy to find relevant documentation. However, staff did know people well and understood their needs and preferences.

Quality assurance systems were in place, however, they were not always effective in identifying areas which required improvement such as medicines management. In addition, where risks had been identified no action had been taken to rectify the problem.

We identified two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Woodleigh Rest Home is situated in the Queensbury area of Bradford. The property has been adapted and extended to provide personal care for 33 older people both in single and double rooms on the ground and first floors. The rear entrance provides disabled access to the ground floor with a stair lift enabling access to the first floor. There are two lounges and one dining room on the ground floor. There were 26 people living at the service on the day of the inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager 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 2008 and associated Regulations about how the service is run.

We found that the service’s premises and equipment were not always safely maintained. Annual maintenance checks had not been completed for the fire alarm system. This was a breach of Regulation 12. You can see what action we told the provider to take at the back of the full version of the report.

We found that the premises were not properly maintained. Some furniture required replacing and the communal areas of the service required updating and redecoration. This was a breach of a Regulation 15. You can see what action we told the provider to take at the back of the full version of the report.

The registered provider had audits in place to check that the systems at the service were being followed and people were receiving appropriate care and support. However, we found the audits had failed to detect that equipment was broken and that parts of the premises were not adequately maintained. This was a breach of a Regulation 17. You can see what action we told the provider to take at the back of the full version of the report

Staff had a good knowledge of how to keep people safe from harm and abuse and there were enough staff to meet people's assessed needs. Staff had been employed following appropriate recruitment and selection processes. We found that the recording and administration of medicines was being managed appropriately at the service.

We found assessments of risk had been completed for each person and plans had been put in place to minimise risk. Apart from the entrance to the service all areas were clean, tidy and free from odour and cleaning schedules were in place.

Staff completed an induction process and had received a wide range of training, which covered courses the registered provider deemed essential. The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act 2005 (MCA) guidelines had been followed.

People's nutritional needs were met. People told us they enjoyed the food and that they had enough to eat and drink. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day.

People told us they were well cared for and we saw people were supported to maintain good health and had access to services from healthcare professionals. We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people using the service. People were able to make choices and decisions regarding their care.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported.

People were offered different activities and were supported to go out of the service to access facilities in the local community.

People's comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. Comments, suggestions or complaints were recorded, but action was not always taken as a result.

Is the service 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 describes what people using the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service caring?

People were supported by staff that were considerate and patient when dealing with people. They referred to people using their preferred names and followed what they were asked to do. We spoke with two relatives who told us staff are very caring and have positive relationships with their family members. People's preferences and interests had been recorded and care and support had been provided in accordance with peoples wishes.

Is the service responsive?

We spoke with two family members that told us they had been involved in the care plans for their relatives. They also told us they would immediately inform the manager or a senior if they wanted to make a complaint and they felt confident this would be acted on.

Is the service safe?

People told us they felt safe living in the home. Safeguarding procedures were robust and staff were clear on the process of reporting potential safeguarding issues.

We found care plans were linked with risk assessments when potential increased risk levels were identified. This reduced and removed risk from certain situations or practices.

The service was safe, clean and hygienic and we found equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

Care plans showed needs had been assessed and were altered when needs changed. We saw peoples preferences were taken into account and people were involved in their plans of care. Special dietary and pressure relief equipment had been identified in care plans when necessary.

Visitors confirmed they could see their patients or family members in private if they wished and that visiting times were flexible.

Is the service well-led?

We saw evidence that the service worked well with other agencies to make sure people received their care in a joined up way. One professional visitor said they are always listened to and take advice on board.

Staff told us they were clear about their roles and responsibilities and if they had any concerns with the practices or the homes itself they would not hesitate to speak to a senior or the manager.

At this inspection we found Woodleigh Residential Home had made some improvements to their systems to manage the administration of medications.

We spoke with three visitors and they told us they had no concerns at all about the standard of care their relatives received. One person said "I have visited the home at various times of the day and I am always made to feel welcome by the staff".

We asked people who used the service and visitors about the meals. Most people told us they were 'good'. However one person and a visitor said they would have preferred more variety.

Despite the positive comments people made, we saw evidence people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People who used the service were satisfied with the care they received. Individuals told us 'Staff are very good, we have a good laugh.'

People we spoke with were aware of safeguarding procedures and systems on how to raise a concern were in place. People were satisfied that staff or the manager would take action to solve their problems.

Our observations of the service showed that staff spoke with and interacted with people who used the service in a patient and pleasant manner.

The provider should note that we saw people sitting for long periods of time with little stimulation on the morning of our inspection. We spoke to the registered manager who told us the home planned to increased the activities organiser hours to enhance the existing activity programmes.

Following our last inspection we noted that care plan documentation had been redesigned. The provider should note that further work was still required to make the information in the care plans readily accessible to staff.

We saw appropriate systems and processes, policies and procedures in place. Report writing in the care records was adequate and reflected the changes in care and treatment that people received. We also found that staff were supported and monitored in their working practice and had training and appraisals programmes in place.