Woodside Residential Care Home

Woodside Residential Care Home is providing regulated activity of accommodation and personal care to up to 40 people in one adapted building. The service is registered to provide support to people living with dementia, learning disabilities, older people, younger adults and autistic people. At the time of our inspection there were 31 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: The model of care did not meet the Right Support, Right Care, Right Culture guidance. People did not benefit from an interactive and stimulating environment such as listening to music or the use of therapy lighting both specified within their care plans. People were also not supported with daily exercise and assisted to leave their room as required within their care plan.

Where appropriate, legal safeguards had been put in place and the least restrictive measures were used. We found people did have a choice about their living environment and were able to personalise their rooms.

Right Care: Peoples’ care plans were incomplete and entries were contradictory. Some clinical needs had not been identified and risks assessed. For example, people with diabetes did not have care plans in place to maintain foot care despite having poor skin integrity and sores on their feet. There were discrepancies over how foods should be pureed to mitigate the risks of choking. We found that all the food groups had been blended together into a liquid, as opposed to separately to the required consistency. Care plans lacked details of what pressure level people’s mattress should be inflated to and had not been set correctly so that it had the most comfort and support to mitigate the risk of scores. Staff did not have access to communication aides specified within people’s care plan to assist with their communication. However, we observed staff showing kindness to people and being polite and respectful whilst supporting them. Staff were able to tell us about the needs and individual preferences of people.

Right Culture: There was ineffective oversight of the service. Quality assurance processes were established and identified risks, but these were not followed up and mitigated in a consistent and timely manner. People were not always supported by staff who had been trained and assessed as competent. Staff had not completed mandatory training including in learning disabilities and autism. Whilst, people received consistent care from staff they did not always understand and support them with their basic care and specific health needs. Staff told us, “We have had a lot of agency (staff), but we tend to use the same agency, they know as much as we do about people.” Following our inspection staff told us, “Training (for staff) is ongoing” and changes had been made to how care was provided to people. A staff member told us, “We now have signs in the kitchen (to remind staff of how to puree food), we use moulds for the food, meat is separate from vegetables.” We observed staff to be kind, patient and attentive to people. Staff told us they liked their job and cared about the people. Relatives told us they felt their relatives were safe and well cared for in a home described as, “Bright, welcoming, clean and comfortable with good food.”

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

The last rating for this service was requires improvement (the report was published on 14 June 2022). Consequently, we followed up on previous breaches of legal requirements from their last inspection.

At our last inspection we recommended that improvements were required to ensure people were safe, specifically; People were appropriately assessed, care plans contained details of individuals needs and how best to support them, people were responded to in a timely and appropriate manner when seeking assistance, incidents were recorded, investigated and actions taken to improve care and medicines were managed safely.

Improvements were also required to ensure the service was well managed, specifically; Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements and continuous learning and improving care.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people and their dignity and care. A decision was made for us to inspect and examine those risks. As a result, we undertook an unannounced focused inspection to review the key questions of safe and well-led only.

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 the safe care and treatment of people, insufficient safeguarding systems and processes operating, the safe appointment of staff and overall governance systems at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Woodside Residential Care Home is a residential care home providing personal care to up to 40 people. The service provides support to older people, some of who live with dementia. At the time of our inspection there were 32 people using the service.

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

People and their relatives had positive feedback about the service, staff and the management. However, we found that care plans did not provide detailed guidance for staff on how to support people with health and other risks. Medicines were not always managed safely; staff did not always follow processes in place to store medicines safely. Staff were not consistently wearing face masks in line with guidance.

Although checks and audits were completed on most aspects of the service, they did not identify issues highlighted in this report.

Staff we spoke with understood their responsibilities to keep people safe. There were enough staff to meet people’s needs and keep them safe.

Relatives told us they were kept up to date with their loved one’s care and support. People were engaged in activities which they clearly enjoyed. There was a positive culture within the service, people were happy and relaxed. Staff worked with healthcare professionals to provide joined up care to people.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 30 October 2021).

Why we inspected

We received concerns in relation to staffing, and the management of behaviours of distress. As a result, we undertook a focused inspection to review the key questions of safe 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 Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

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

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 found breaches in relation to managing risks to people and checks and auditing at this inspection.

Please see the action we have told the provider to take at the end of the full version 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.

Woodside Residential care home is registered to provide accommodation and personal care for up to 30 older people living with Dementia. At the time of our inspection there were 22 people living in the service. Accommodation is arranged over three floors.

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

Everyone we spoke with was positive in their feedback. Comments included; “Seeing the way they are with others who are more in need of help, makes me realise how good they are.”; “They are very friendly and helpful; I’ve not found any problems.”; “They are caring.” And “Oh they are lovely girls.”

People were safe at Woodside Residential Care Home. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The provider followed safe recruitment practices. There were enough staff meeting people’s needs safely.

Medicines continued to be stored and managed safely by staff. There were policies and procedures in place for the safe administration of medicines, which staff followed. Staff training records confirmed staff had been trained in medicine administration.

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. For example, staff had the information they needed to support people to make choices. Staff knew people had the right to make unwise decisions.

The service continued to be well led. Effective quality audits continued to be in place and continuous improvement and learning were embedded in the service. This had been effective in identifying where improvements were needed and the registered provider actioned these.

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 23 January 2019).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This enabled us to review the previous ratings.

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 Woodside Residential Care Home on our website at www.cqc.org.uk.

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.

Woodside Residential care home is a ‘care home’. People in care homes receive accommodation and 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. Woodside Residential home is registered to provide accommodation and personal care for up to 30 older people. The service care for people living with Dementia. At the time of our inspection there were 27 people living in the service. Accommodation is arranged over three floors.

At our last inspection we rated the service as Good. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Woodside residential care home was undergoing an extension to the current building. This would add additional bedrooms to the service as well as additional communal space.. The new lounge would include large doors out to a secure garden area that people could use at any time. At present the service does not have any outside space. There would be a new kitchen and dining room. A library was planned and a volunteer had been found to read books and newspapers to people living at the service.

The builder understood they needed to make sure the work created the least disruption for the people living at the service; only the project manager entered the service, all other builders remained outside and all external work would be completed before doing anything inside. They anticipated the build to be completed by the end of 2019.

People experienced a service that was safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and people were supported to take positive risks. The premises were maintained and checked to help to keep people safe.

Staff were supported to fulfil their role in meeting people’s needs. The complaints policy was accessible to people using the service.

People were given their medicines safely and when they needed them. Policies and procedures were in place so that people received their medicines when needed. People were supported to remain as healthy as possible and they had been given access to healthcare professionals when needed.

People had access to the food and drink that they enjoyed. People were supported to choose what they wanted to eat and drink, their nutrition and hydration needs had been assessed and recorded.

People were treated with kindness and respect. Their needs had been assessed and support had been provided to meet these needs.

People were central to the support they received. Care and support was planned with people and their relatives and reviewed to ensure people continued to have the support that they needed. People were encouraged to be as independent as possible.

People took part in activities of their choice and could choose what they wanted to do each day. There were enough staff to support people to participate in the activities they chose.

Processes were in place to monitor quality and people were asked for feedback about the service provided.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall. The CQC rating was also displayed on their website.

Further information is in the detailed findings below.

Woodside Residential Care Home can provide accommodation and personal care for 32 people living with dementia. Accommodation is arranged over three floors and comprises of five double rooms for couples or those wishing to share, and twenty two single rooms. At the time of the inspection there were 26 people living at the service.

Rating at last inspection

At the last inspection, the service was rated Good and Requires Improvement in the ‘Safe’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 June 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodside Residential Home on our website at www.cqc.org.uk

At this inspection we found the service remained Good overall and is now rated Good in the Safe domain.

Why the service is rated Good

People told us they felt safe using the service and staff were helpful and kind. A visitor told us they would recommend the service.

The service had improved since the last inspection. Care records included risk assessments of people’s mobility, and their potential risk of falls, together with detailed guidance to move people safely and consistently. People’s risk assessments regarding the use of bed rails had been reviewed and measures were in place to reduce the risks of people falling out of bed.

People were positively supported with their behaviour. There was guidance in place about what action the staff needed to take to make sure the person and everyone else was safe. Health care professionals told us that the staff followed their recommendations to support people with their behaviour and systems were in place to ensure people’s needs were reviewed and updated. Communication within the staff team had improved to ensure that people’s health care needs were being monitored and met.

Staff knew how to recognise and respond to abuse. They had received training on how to keep people safe.

Regular checks were made on the premises and equipment to ensure it was safe. Each person had a personal emergency evacuation plan (PEEP) in the event of an emergency, A PEEP sets out the specific physical and communication requirements that each person has to ensure that they can be safely evacuated from the service in the event of a fire. Staff were involved in regular fire drills.

Accident and incident records and monthly fall audits were reviewed. Any concerns were investigated and action taken such as referrals to the falls clinic for further assessment.

There were sufficient numbers of staff on duty at all times to ensure that people’s needs were met.

New staff had been recruited safely and checks were carried out on staff to make sure they were suitable and safe to work with people.

People received their medicines safely and there were robust systems in place to ensure that medicines were stored correctly and safely.

Woodside Residential Care Home can provide accommodation and personal care for 32 people living with dementia. Accommodation is arranged over three floors and comprises of five double rooms for couples or those wishing to share, and twenty two single rooms. At the time of the inspection there were 26 people living at the service.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

People were protected against the risks of potential abuse. All staff had attended training about safeguarding people from harm and abuse, and staff knew about different types of abuse and how to raise concerns. People were supported with their finances to ensure they had access to cash when they wanted to.

Risks to people were identified and assessed. Care records included risk assessments of people’s mobility, and their potential risk of falls; however they did not always have step by step guidance to move people safely and consistently.

There were systems in place to identify and manage any risks to people’s health and wellbeing. Accident and incident records and monthly fall audits was reviewed. Any concerns were investigated and action taken such as referrals to the falls clinic for further assessment.

The staff carried out regular health and safety checks of the environment and equipment. This helped to ensure that people lived in a safe environment and that equipment was safe to use. People had a personal emergency evacuation plan (PEEP) in the event of an emergency, and staff were involved in fire drills.

People received their medicines safely and there were robust systems in place to ensure that medicines were stored correctly and safely.

There were sufficient numbers of staff on duty at all times. Staff had support from the registered manager to make sure they could care safely and effectively for people. The registered manager and head of care were involved with supporting people on a day to day basis. Staff had received regular one to one meetings and an annual appraisal with a senior member of staff.

People received care from staff who had been trained to meet their individual needs. Staff completed induction training when they first started to work at the service, which included shadowing established staff before they worked on their own.

The policies and procedures to recruit staff ensured that staff employed to support people were suitable to do so. All the checks that needed to be carried out on staff to make sure they were suitable and safe to work with people had been completed.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection some people had DoLs authorisations in place and the registered manager had applied for further authorisations for other people who were at risk of having their liberty restricted. There were mental capacity assessments in place to assess if people needed to be considered for any restrictions to their freedom.

Before people decided to live at the service their support needs were assessed by the registered manager to ensure their needs would be met. People and their relatives were involved in the assessment. Care plans contained details of people’s preferences and choices, however, in some cases further detail was required to show how people’s personalised care was being provided. This was an area for improvement. The plans had been reviewed to make sure staff were aware of people’s current care needs. People’s health care needs were monitored and met, with health care professionals being involved in people’s care when required.

People were encouraged to eat a healthy diet. The cook knew people’s preferences and choices. . People enjoyed their lunch, which looked appetising. If people needed further support with their dietary needs, food was monitored and if required further advice and support from health care professionals such as a dietician was sought.

People were engaged in activities throughout the inspection. Staff explained to people what they were doing and respected their wishes if they did not want to take part. The activities were tailored to individuals to encourage people to join in. People’s bedrooms were personalised with their own possessions and other things that were important to them.

Relatives told us that they did not have any complaints but would speak to the registered manager if they had any concerns. The complaints procedure was on display in the hall with information to encourage people to raise any concerns or issues. Staff told us that they had not received any complaints from people and they would know if people were unhappy through their behaviour.

Staff knew people well and supported them with their daily routines. They spoke with people in a caring manner, taking their time to let people speak at their own pace and responding patiently to their requests. People were treated with dignity and people were supported to go back to their rooms if they wanted some privacy.

There were regular checks carried out on the service being provided. Feedback was sought from people, relatives, staff and health care professionals involved in the service. People spoke positively about the service and were satisfied with the care being provided.

The registered manager and head of care were passionate about continuous improvement of the service. The visions and values of the organisation were promoted and staff were motivated and enthusiastic to make sure people received the care they needed. There was a culture of openness and transparency within the service and staff felt valued.

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.

Below is a summary of what we found. The summary describes what people using the service, their relatives 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.

This is a summary of what we found:

Is the service safe?

The service was safe.

People told us they felt safe and we observed staff who understood how to protect people's rights and safeguarded the people they supported.

People's care needs and the qualifications, skills and experience of the staff were taken into account when making decisions about staffing numbers required to the meet the needs of people who used the service.

Is the service effective?

The service was effective.

People received the care outlined in their care plan in the way it was agreed. Staff understood people's care plans and knew what people's needs were.

People's health and care needs were assessed and they were involved in their plans of care. Specialist needs including nutrition and dementia care needs had been identified in care plans where required.

Is the service caring?

The service was caring.

People that we spoke to said they were happy living in the home. Relatives said they thought staff were kind and caring.

Staff were patient when supporting people and treated them with respect. People's preferences and interests had been recorded, and care and support was provided in accordance with people's wishes.

Is the service responsive?

Records showed the service responded to changes in people's health needs and made referrals to other professionals when needed.

We found that the managers was approachable and encouraged people to voice any concerns or ideas for change.

Is the service well led?

The service was well led.

There was a clear management structure in place.

Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team.

Systems were in place to ask people who used the service, relatives and staff for their views about the service. People's views were taken into account to improve the service.

Audits of the service provided had been completed to assess the quality of the care.

You can see our judgements on the front page of this report.

The provider had taken steps to make sure people were protected from abuse.

We found the home to be clean and tidy and free from unpleasant odours. There was a system in place for infection control to protect people from the risk of infection.

The systems in place to manage the administration of medication did not ensure that people received their medicines at the times they needed them and in a safe way.

Although there were checks on the quality of service being provided we could not be assured that these were effective to make sure people were protected from inappropriate or unsafe care.

People using the services, relatives and visitors told us that they were satisfied with the care being provided. Relatives said: 'We took my relative out and when we arrived back at Woodside she said 'it's lovely to be home! That confirmed to me that she is happy here". 'The staff are excellent, kind, friendly and cheerful' 'I have nothing but praise for the care given at Woodside'. A visitor said: 'I visit many different homes in the area. I can honestly say this is the best ' first class care".

The staff told us that consent for care and support was obtained from people using the service or their representatives during discussion about the care and support the person needed.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

People and relatives told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

People we spoke to and visiting friends and relatives told us that they were very happy with the care provided. One visitor said 'we are happy with the care' and the staff 'are always happy'.

We saw that people experienced safe and effective care based on detailed care plans that encouraged independence. There were risk assessments that met individual needs and provided good guidance to staff to minimise potential risks. We saw that good nutritional care was provided in a way that met people's needs and preferences.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. People we spoke to told us if they had any concerns they would report them to the manager or senior person on duty.

Staff we spoke to and records we reviewed, demonstrated that there were the appropriate number of staff on duty at the right times, to meet people's needs. Staff were appropriately inducted and supported. They received ongoing training and supervision which provided them with the skills and knowledge to meet the changing needs of the people they were supporting.

The provider had systems in place to monitor and assess the quality of the service. Information was used to review and improve the way care was delivered.