Woodland Court

Woodland Court is registered to provide accommodation and personal care for up to 39 people who may also require nursing care. The service is located in a residential area of the seaside town of Torquay. On the time of our inspection, there were 21 people living at the service.

Peoples’ experience of using this service and what we found

Some people were placed at risk of unsafe care or inappropriate care and treatment. We identified care was not always planned to reduce risk and records were not always accurately maintained.

Governance systems and processes to assess, monitor and mitigate the risks relating to the health, safety and welfare of people at the service were not always fully effective.

People received their medicines as prescribed, however we have recommended the provider seeks guidance from an accredited source to ensure medication polices are reflective of published best practice and that this is fully embedded in the service.

Staffing levels in the service were safe. We received some mixed feedback in relation to staffing levels which related to the timeliness of support received at night. Staff we spoke with felt staffing levels were sufficient. Staff recruitment was completed safely.

Staff received training in safeguarding and knew about the different types of abuse. Staff were able to explain reporting processes. We were assured the service was preventing and controlling the spread of infections.

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. Where required, applications had been made to lawfully deprive people of their liberty.

People said staff were caring and treated them with dignity and respect. One person said, “I’m confident in the staff. They help me to shower. They are always respectful.”

There were processes in place to ensure that accidents and incidents were recorded and analysed to identify trends or patterns. Regular health and safety checks of the environment and equipment used within it were completed.

The provider and registered manager encouraged feedback from people, relatives and staff through questionnaires to improve the service people received. People, relatives and staff were positive about the registered manager.

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 Good (published 8 December 2017).

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.

Enforcement and Recommendations

We have made a recommendation in relation to medicines management.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

Follow Up

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

Woodland Court is registered to provide accommodation and personal care for up to 39 people who may also require nursing care. The service is located in a residential area of the seaside town of Torquay. On both days of the inspection there were 26 people living at the service.

A registered manager was employed 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 2008 and associated Regulations about how the service is run.

People and their visitors told us they felt safe living at the service. One visitor told us they trusted the staff to care for their relative and didn’t feel the need to visit every day. Staff had a good knowledge of different types of abuse and had received training in keeping people safe. Safe staff recruitment procedures were in place. This ensured, as far as possible, that only suitable staff were employed at the home.

People and their visitors told us staff were very good and caring and all the interactions we saw between people and staff were positive. One visitor told us “Can’t fault the place, nothing too much trouble.” Another relative told us “It’s like having a second family here. I will still come and visit when mum’s not here.”

Risks to people’s health, safety and well-being had been assessed and plans were in place to help minimise the risks. Risk assessments contained good details on how risks were managed. Some people were at risk of pressure area damage to their skin and there was equipment in place to minimise the risk of damage occurring.

There were sufficient numbers of staff to ensure people’s needs were met safely. A recent review of staffing levels had highlighted times when more staff were needed. A new rota was due to be implemented the week following the inspection with extra staff being on duty early mornings and evenings. Following the inspection we received confirmation the new rotas had started.

Medicines were stored securely in a locked cupboard and only registered nurses (RNs) administered medicines. Records were kept for medicines received and disposed of and regular audits were made.

Procedures were in place to protect people in the event of an emergency. Accidents and incidents were analysed to identify any trends and where issues were identified action was taken to minimise the risk of reoccurrence. Arrangements were in place to minimise the risk of cross infection. There were maintenance contracts in place for the servicing of equipment such as hoists and gas and electrical installations.

There was a comprehensive staff training programme in place. Where people had specific needs specialist training was arranged such as pressure area care, death and dying and caring for people living with dementia. There was an effective system in place to ensure staff were putting their learning into action and remained competent to do their job. Staff records showed they received regular supervision and yearly appraisals.

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. We heard staff asking people for their consent when carrying out care tasks and offering them choices. Staff had received training on the Mental Capacity Act 2005, they knew that everyone should be assumed to have capacity unless assessed otherwise.

People were supported to have enough to eat and drink in order to maintain good health. Everyone living at the service had their nutritional needs assessed and meals were provided in accordance with people's needs and wishes. There was a choice at each meal and people told us the food was always good. One person told us the food was “Fantastic – first class.” Some people received their food through artificial feeding systems. These were regularly reviewed and monitored by the RNs at the service and visiting healthcare professionals.

People were supported to maintain good health and were referred to healthcare services where required. Records showed people had seen their GPs, dieticians, opticians and palliative care nurses as needed.

The service was well decorated and furniture was of a good standard and a domestic style. The lounge furniture had recently been replaced and the dining furniture was also due to be replaced. A bathroom on the ground floor had been converted into a wet room.

People and their relatives were supported to be involved in planning and reviewing their care if they wished to be. Relatives told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

There were several activities and entertainments on offer. One recently admitted person told us they had enjoyed gardening before they came to live at Woodland Court. They told us they had been chatting to the gardener for the service and was going to help them maintain the service’s garden.

People’s care plans were comprehensive, individualised and reviewed regularly. The plans contained details of people’s preferences, such as what they liked to eat and how they spent their day. For example, one person’s plan stated they took pride in their appearance and staff were to ensure the person’s hair was washed twice weekly. Staff were aware of the details of the plan, and we saw the person’s appearance was well groomed. One person told us how well they were being looked after and said “I’m a good advertisement for the place!”

Several people living at the service had specific communication needs. One person communicated with staff by use of a special board that contained letters of the alphabet and ‘yes’ or ‘no’. Staff held the board in a particular position and the person moved their eyes to identify letters which staff built up into words. Staff had received training in using the board. We spent some time with the person and staff helped us communicate with them.

People and visitors told us they felt able to raise any concerns and said they would speak to staff if they needed to. One visitor told us they had only had to raise one minor issue “not really a complaint”, which had been dealt with straight away.

The registered manager took an active role within the running of the home and had good knowledge of the staff and the people who used the service. There was a staff management structure in place to maintain the running of the home.

There were effective systems in place to assess, monitor, and improve the quality and safety of care. A series of audits were undertaken by the registered manager and clinical lead. Monthly audits were undertaken including medicines, care plans, the environment and accidents and incidents. We saw that where issues had been identified action was taken to rectify the matters. A new ‘addressable’ fire alarm is due to be fitted at the end of 2017. This is so that it if a fire broke out staff would be able to identify the exact location more quickly.

Staff told us they enjoyed working at the service and described it as “A very caring, homely, friendly place for staff and residents alike” and a “Hardworking friendly home where we try our best to make their [people] lives a bit better.”

Records were well maintained. They were accurate and complete and recorded the care provided. All records we asked for were kept securely but easily accessible. he registered manager had notified the Care Quality Commission of all significant events which had occurred in line with their legal responsibilities.

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.

On the day of the inspection the Registered Manager was not at the home. The provider's representative was present throughout the inspection.

At our previous inspection on 18 February 2014 we found that improvements were needed to the quality assurance system and the way records were managed. At this inspection in August 2014 we looked to see if the improvements had been made.

Before this inspection we received some concerns about the way the home managed the end of life care for people who lived at the home. We looked at the care records for people who received end of life care and following our inspection we spoke to a visiting health care professional. We found that people received appropriate end of life care.

Some people living at the home were unable to tell us about their care. Therefore as well as speaking with people we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences of living at the home were. The SOFI tool allowed us to spend time watching what was going on in the home and helped us to record how people spent their time and whether they had positive experiences.

Is the service safe?

We found care and treatment had been planned and delivered in a way that was intended to ensure people's safety and welfare. For example, we saw a comprehensive assessment of people's needs and a range of risk assessments had been completed. We saw that where people had been assessed as being at risk from pressure sores, suitable equipment had been provided to minimise the risks.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards aim to ensure that people are protected from the risk of inappropriate restraint in any form. The provider's representative told us no applications had needed to be submitted. We saw no evidence that anyone was being inappropriately restrained or detained. The provider's representative told us that the Registered Manager had received training to enable them to understand when an application should be made, and how to submit one. The provider's representative was aware of recent changes to the interpretation of the legislation.

We saw that medication was being stored safely. Medication was supplied to the home in a series of colour coded blister packs and stored in a locked trolley in a locked room. Medication was transported around the home safely by means of the locked trolley. We saw the medication storage areas were clean and free from a build-up of excess stock.

We saw that where reviews of care plans had taken place, updated information had not always been transferred to the current support plans. For example, we saw no updated support plan for a person who sometimes refused medication. This meant staff may not always have the most up to date information available to them. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. For example, we saw that where people had been assessed as needing help with personal care, there was some evidence in the daily records that this help had been given. We saw information recorded in one person's care plan about how staff were to support them to use oxygen. This meant that people's needs were being met effectively.

We saw that care plans had been signed by the individual or their representative. This showed us that people were involved in planning their care.

We found that staff received appropriate training and professional development. For example, staff told us they had received training in safeguarding vulnerable people, food hygiene, diabetes, Mental Capacity Act 2005 and moving and handling. This meant that staff were suitably trained to be able to effectively meet people's needs.

We saw there was an effective system in operation which was designed to enable the provider to regularly assess and monitor the quality of the services provided. For example, we saw a 'quality matrix' that indicated what audits should be conducted and when. We saw that a series of audits were undertaken including, care plans, rooms and health and safety. However, the provider may wish to note it was not always possible to see where issues identified had been completed.

Is the service caring?

People living at the home spoke highly of the care received. One person told us the staff were 'On the whole very good ' some go that extra mile', another person said 'It has been a very positive experience, whatever time I have left, I want to spend here'.

We saw a variety of thank you cards that had been received by the home. Comments included 'You all were without exception, all very kind and made my time with you very pleasant' and 'Thank you for looking after X and helping us through some difficult times'.

We saw people being supported to take their medication. We saw that staff were patient and kind allowing people time to take their medication and ensuring it had been taken. We heard people being offered choices about what they wanted to drink. Any personal care that was needed was offered in a discreet way, ensuring people's privacy and dignity.

Is the service responsive?

We discussed people's care needs with staff. They told us about people's needs and how they liked their care to be delivered. Staff we spoke with were able to tell us what they did to support people and knew what to do for them if they needed any additional support. For example, one staff member told us how they supported an individual with changes in their mood.

We saw directions to staff on how to prevent one person's eyes becoming infected. There was evidence in the person's daily records that these directions had been followed.

We found that generally people's personal records including medical records were accurate and fit for purpose. For example, everyone living at the home had a care plan that included a series of risk assessments.

Is the service well-led?

We spoke with two care staff and one registered nurse who told us they felt supported to ensure they were effective in their role. One told us we 'can always go to the manager if we need anything'. We saw that risks relating to the health, welfare and safety of people who used the service and others who may be at risk had been identified. For example, we saw that the time and place of accidents had been recorded and action taken where needed.

The provider took note of reports prepared by the Commission following an inspection. We know this because some improvements had been made following our last inspection in February 2014.

We spoke with four members of staff and watched them interacting with people who used the service and other healthcare professionals in the home. We saw that people living in the home were responded to quickly when they requested assistance, and the staff were polite in asking people to wait while they prioritised care needs for people who used the service.

We looked in three care plans and saw audit paperwork relating to risk assessing and found that there were regular reviews and systems in place to ensure staff knew about care specific care needs of individuals.

We found that some care plan documentation was not completed correctly and other records were not completed which were required.

We saw that people had a full access to health care services and had their care needs met.

People liked the staff that cared for them.

People using this service felt safe and were confident that staff had the skills needed to safeguard them and to meet their needs. Staff training, supervision and annual appraisals were linked to ensuring that staff had the skills to meet people's needs.

Systems were in place to involve people in the service, and their suggestions were encouraged and acted upon. Systems for assessing quality and managing risk were in place.