Woodfields Residential Home

Woodfields Residential Home is a residential care home providing personal care to up to 17 people. The service provides support to people living with dementia. At the time of our inspection there were 15 people using the service. The home accommodates people in one adapted building.

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

People did not always receive support with their medicines from trained staff. However, systems used for the management of medicines were effective and people received their medicines as prescribed. Some aspects of the environment required improvement to reduce risks associated with cross infection.

Risks were assessed and managed by staff who knew people well. There were enough staff to meet people’s needs and staff had been safely recruited. There were systems in place to ensure learning took place following incidents and events.

Improvements relating to quality audits and governance had been made since the last inspection. However, further action was required to ensure a proactive approach to identifying concerns and driving improvement. Action to address people’s concerns or queries was not always timely.

People and relatives spoke positively about the home. Staff felt supported in their roles and had the opportunity to share their views in team meetings as well as through one-to-one meetings with the manager. The staff and management team worked alongside other professionals to ensure people’s needs were met.

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 requires improvement (published 10 March 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. At this inspection we found the provider had complied with the Warning Notice and some improvements had been made. However, we identified a new breach of the regulations.

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 remained requires improvement. This is based on the findings at this inspection.

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.

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

Enforcement

We have identified breaches in relation to the safe management of medicines at this inspection.

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.

Woodfields Residential Home is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 17 people. Woodfields Residential Home accommodates people in one adapted building, most of whom were living with dementia.

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

Since our previous inspection improvement had been made at the home. However, further improvement was needed in some areas.

Improvements to the management of medicines had been made, but further improvements were needed to ensure the accuracy of medicine records. The provider had Processes in place to assess and manage risks to people, however we found one occasion where the process was not effective. People were supported by enough staff who were trained to recognise and report potential harm or abuse. Effective infection and control procedures were in place. Lessons were learnt when things went wrong.

The provider had made improvement to the personalisation of people’s care. People’s communication needs were met. People were supported to maintain relationships to avoid social isolation. Complaints or concerns were reviewed and acted on. Since our previous inspection, improvement had been made to include people’s end of life wishes.

The provider had made some improvements since our previous inspection to the quality assurance processes. However, further improvements were still required to ensure errors were identified and acted on. Staff demonstrated a shared culture that was positive and person-centred. People were engaged and involved in the service. Continuous learning was encouraged to improve people’s experiences of care. Staff worked in partnership with other health professionals.

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 requires improvement (published 07 March 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. During this inspection improvements were made however the provider was still in breach of regulation.

Why we inspected

We received concerns in relation to infection control and people’s safety. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

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 coronavirus and other infection outbreaks effectively.

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

Enforcement

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 to hold providers to account where it is necessary for us to do so.

At this inspection we have identified a continued breach in relation to the provider's governance systems, in ensuring continuous improvement is made for the safety of people.

Follow up

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

People were supported by sufficient amounts of staff who managed risks to keep people safe. There were effective infection control practices in place. Medicines had not been managed safely and it was not clear that medication had been given as prescribed.

People were supported by staff who had received training to enable them to support people effectively. People’s dietary needs were met and they had access to healthcare services when required. People’s needs were met by the design and décor of the service. People’s rights were upheld in line with the Mental Capacity Act 2005.

Staff were kind and caring to people. Staff promoted and respected people’s dignity and privacy. People were supported to maintain their independence where possible.

People’s care records did not always fully consider how to meet people’s individual needs. People did not feel there were enough activities available that met their individual interests. Complaints made had been investigated and resolved by the registered manager.

Audits completed had not been effective in identifying the areas for improvement we found at this inspection. People spoke positively about the leadership at the service and people had been given opportunity to feedback on their experience of the service.

Rating at last inspection: Good (Report published 02 June 2016)

About the service: Woodfields Residential Home is a residential care home that is registered to provide personal and nursing care to 17 people aged 65 and over. At the time of the inspection, there were 15 people living at the home.

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

There was a 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.

People may not have received their medicines as prescribed as records were not always completed in a consistent manner. People told us they felt safe and happy living at the home. Staff understood their responsibilities to identify and report potential harm or abuse. The provider had systems in place that kept people safe and protected them from the risk of harm. The provider reviewed incidents and falls to reduce the risk of people being harmed. People’s individual risks were known by staff and managed safely.

People’s care and support needs were met in a timely manner. People and staff said there were sufficient numbers of staff available to meet people’s needs. People were supported by staff that were recruited safely into their role. Staff said they were well trained to do their job and felt supported by the registered manager.

Staff understood the need to gain people’s consent to care before providing any support or assistance. People’s liberty was not being restricted and the registered manager understood how to promote people’s legal rights.

People told us that they had a choice of meals and that they liked the food and drinks provided. People told us that they were supported to have access to a wide range of healthcare professionals should they need to.

People were cared for by staff who knew them well. They said staff were kind and caring and they received care from a consistent staff group. People felt involved in their day to day choices and were supported to maintain their independence. People’s dignity and privacy was respected by staff.

People and their relatives said that they felt fully involved in developing their care plan and received care that met their needs. People told us they were happy living at the home and took part in a number of different activities. People and relatives knew how to raise any concerns and were confident any issues would be addressed.

The registered manager was aware of their role and responsibilities. People and staff told us they felt listened to and any suggestions made were listened to. There was evidence of learning from incidents and falls and changes were implemented to improve the service people received. Regular checks were completed to review and monitor the quality of the care that people received. Where issues were noted, action was taken by the registered manager and provider to put this right. However these checks had not identified some areas that needed improvement.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We found that where people had capacity their consent for care and treatment was obtained. However, where people lacked capacity the provider did not act in accordance with legal requirements.

The care plans we looked at contained basic information about people's assessed needs but we found that staff had a good understanding of how to care for them. A visitor said, 'I'm very happy with the care provided to my relative.'

People had access to a choice of meals to ensure their dietary needs were met. We observed that people were provided with support to maintain a healthy diet and fluid intake. One person said, 'The food here is very good.'

We found that the management of people's medicines was unsafe and placed them at risk of obtaining medicines that were not prescribed for them.

Appropriate staffing levels were provided during the day to meet people's needs. However, insufficient staffing at night time may compromise the support and care people received.