Woodstock Nursing Home

Woodstock Nursing Home is a residential care home providing personal and nursing care to up to 28 people. The service provides support to people who live with dementia and other associated mental health needs. At the time of our inspection there were 21 people using the service.

Woodstock Nursing Home accommodates people in one adapted building and provides people with a safe garden so they can enjoy the outside.

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

Staff had not been recruited in accordance with the relevant regulation and guidance. The provider’s policy in this respect was not in line with the regulation requirements. Recruitment processes had not been sufficiently checked, to ensure these had been fully completed before staff started work.

It could not always be demonstrated that people were supported to have maximum choice and control of their lives and staff always supported them in the least restrictive way possible and in their best interests. This applied to when equipment was used to monitor people’s movements when in bed or in their bedroom, as part of falls prevention actions. Consent had not always been sought from people or their legal representatives before the use of this equipment. This was rectified during the inspection and people’s representatives were consulted about the equipment in use and relevant records completed.

Deprivation of liberty safeguards had been applied for when people could not consent to live in the care home.

We have made a recommendation that these applications are reviewed to ensure they include any additional areas of supervision and control, such as movement sensor equipment.

Although the provider had quality monitoring systems and processes in place, these had not always been effective in identifying the shortfalls identified during this inspection, which required improvement.

The provider had identified their policies and procedures required review to ensure they were robust and in line with current regulations and best practice guidance.

There were arrangements in place to protect people from abuse.

Risks associated with people’s health and safety were assessed and action taken to reduce and mitigate risks.

Action had been taken to improve the delivery and availability of people’s medicines and to ensure prescribed medicines were available when required. Medicines were administered safely, and people were supported to take their medicines as prescribed.

People’s needs were assessed prior to them moving into the care home and plans of care developed on admission to ensure people’s needs were met. People’s cultural and religious preferences were supported when planning and delivering their care.

People had access to a GP and other health care professionals when required and they were supported to attend external appointments.

Staff were provided with training, so they were able to carry out their tasks safely and improvements to this were planned so that staffs' knowledge could be broadened.

The environment was kept clean and there were arrangements in place to prevent the spread of infection.

There were arrangements in place to gather the views of people who used the service, relatives and staff to support service improvements.

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 21 January 2019).

At our last inspection we recommended the service consider current guidance on the Mental Capacity Act (MCA) 2005 and update its practices. At this inspection we found actions taken in response to this had not been maintained.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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 these were rated to calculate the overall rating. The overall rating for the service has changed from good to 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 see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to staff recruitment and the provider's quality monitoring systems and processes 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.

Woodstock Nursing Home is a residential nursing home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 28 people in one adapted building across three floors.

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

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.

People were safe. Staff were recruited and trained safely. Staff were knowledgeable about safeguarding and whistleblowing policies. There were systems in place to assess and manage potential risks to people and staff. Accidents and incidents were recorded and analysed to minimise any further risks. People were supported with the management of their medicines safely.

People were assessed with a person-centred approach, assessments and care plans took into account people’s individuality and considered different religious and spiritual needs. People were supported to access community healthcare services.

Staff treated people respectfully and kindly. People and their relatives told us they were happy with the care they received.

People were supported to maintain social networks with their relatives and community. There were regular activities available that people told us they enjoyed.

The service was well led. Management maintained oversight and encouraged learning and improvement within the service. Staff told us the registered manager was approachable and supported them to work effectively.

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 16 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our inspection on 15 March 2017, there was a manager in post who had been in post since October 2016. They were in the process of registering with the Care Quality Commission. 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.

We last inspected in June 2016 and found that the provider was not meeting a number of the regulations. We found that the provider did not always ensure staff were of good character before they were recruited and did not have effective systems to monitor the quality of the service. Additionally people did not always receive care which was personalised to their needs. The provider did not always notify CQC of notifiable events within the home. Following our inspection in June 2016, the provider sent as an action plan of the actions they would take to meet the legal requirements. We found some improvements had been made.

People and their relatives were generally positive about the home. They felt safe and well looked after. People enjoyed the food they received in the home and had access to food and drink. People and their relatives felt there were enough activities and we saw that a range of activities and outing were on offer. The provider was continuing to work on improving records in relation to people’s preferences and interest to ensure that activities they offered were tailored to people’s needs.

People’s medicines were mainly managed well and the manager and provider had systems to identify concerns and take effective action. However some people did not always receive their medicines as prescribed. Where people were prescribed topical creams there was not always clear guidance on the support they required to apply these creams. While immediate action was being taken we have made a recommendation to the provider.

The provider and manager had implemented systems to monitor and improve the quality of service people received. Where concerns had been identified the service were working to improve the service. People, their relatives and staff spoke positively about the improvements made at the service since the appointment of the manager. Relatives told us they felt their views were listened to and acted upon.

People’s care and risk assessments were now reflective of their needs. Care assessments give care staff and nurses clear information in relation to people’s needs. Care staff generally kept a clear and consistent record of people’s care needs.

Staff were deployed effectively to ensure people’s basic needs were met and kept safe. All staff had received training to meet people’s healthcare needs. Staff felt supported by the management and spoke positively of the new manager and improvements being made in the home.

We last inspected in July 2015. At the June 2015 inspection we found that the provider was meeting all of the requirements of the regulations at that time. A recommendation was made to the provider regarding record keeping in relation to maintaining a current record of people’s care.

There was a manager in post who was applying to become registered with the Care Quality Commission. The last registered left the service in May 2016. 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’s care records were not always personalised to their needs and preferences. They were not always current and accurate and did not always give staff adequate information and guidance such as people’s required fluid intake,

However staff monitored and recorded people’s support needs, such as repositioning or assisting people with their nutritional needs.

People were at risk of being cared for by unsuitable staff because recruitment processes were not as robust as they should be. People were at risk of not receiving their medicines as prescribed, however the manager and clinical lead were taking action to address this concern.

The management had systems to monitor the quality of service people received. These systems however were not always effective and were not always consistently used. People and their relative’s views were not always consistently sought. The provider had not always informed CQC of notifiable incidents.

The provider had assessed people’s mental capacity to make specific decisions and ensured the outcomes of these assessments had been documented. The provider worked with external healthcare professionals to ensure people’s legal rights were protected.

People and their relatives were positive about the home, the staff and management. People told us they were safe and looked after well. Staff managed the risks of people’s care and understood their responsibilities to protect people from harm. People, Relatives and staff felt there were enough staff to meet people’s needs.

People had access to plenty of food and drink and received a diet which met their needs. Staff ensured their on-going healthcare needs were met. There was a friendly, pleasant and lively atmosphere within the home. People enjoyed the time they spent with each other and staff. People were offered choices about their day.

The manager and clinical manager had plans to ensure that staff received support and had access to effective training, supervision and professional development. Staff spoke positively about the recent change in management and felt supported.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulation 2009.

You can see what action we told the provider to take at the back of the full version of this report.