The Woodlands Care Home

We found the following examples of good practice.

There was a restriction on visiting the service at the time of the inspection. There were procedures in place for visitors to the service, including healthcare professionals and relatives to reduce and prevent the spread of infection.

The provider ensured people-maintained contact with relatives by staff supporting them with video calls and telephone calls. The operations manager told us the service accommodated end of life visits and had a visiting pod (a specific area to accommodate safe visits) for other family and friends visits. The service had reviewed current guidance for accepting visitors.

There was a clear regular programme for staff and people living in the home to be tested for COVID-19. This meant swift action could be taken if or when positive tests were received. The provider had robust monitoring systems in place for when people required a retest. The service was participating in the vaccine roll out and a number of staff and people had received their first dose of the vaccine.

Staff followed procedures for donning and doffing personal protective equipment (PPE) and how to dispose of it safely, in line with government guidelines. All staff wore appropriate PPE, which was in good supply. The provider was working with Public Health England and local infection control teams to ensure they had appropriate safety measures in place.

A robust contingency plan was in place and used, for when positive testing or isolation for staff or people arose. Agency staff were used to cover shortfalls in nursing staff, due to staff testing positive for COVID-19.

Handover meetings were completed in line with safe distancing guidelines. Limited number of senior staff attended the meeting and they then cascaded information to other staff.

There was a generic risk assessment in place that included people and staff in high risk groups. The operations manager gave an example of vulnerability for people and the staff team. They had noted the risk but had not recorded it for relevant individuals. The operations manager told us they would address this immediately. They assured us that adjustments if required to staff working practices would be put in place as and when required to keep them safe. Staff who were identified as being at increased risk were shielding at this time.

People using the service who had tested positive had isolated in their own rooms when appropriate. Arrangements were in place to reduce the spread of infection.

The home was very clean and tidy. Housekeeping staff told us they had increased the cleaning regime since the start of the pandemic. Cleaning schedules had been under review and incorporated new ways of working. For example, more regular cleaning of frequently touched parts of the care home. Staff confirmed they had recorded when touch points or increased cleaning had been completed. Deep cleaning had taken place in all communal areas and people’s individual bedrooms, but this had not always been recorded. We found gaps on the cleaning schedule record. The providers IPC audits had identified these issues and they were in the process of addressing this. The operations manager told us they were implementing a more robust monitoring process to ensure the cleaning schedules were accurate and concise.

People’s experience of using this service:

People that we spoke to said that The Woodlands Care Home was a good place to live and that staff treated them well with kindness, respect and patience.

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.

There were enough staff to meet people’s needs and staff told us that they worked well together as a team. People told us that staff were kind and caring and treated them respectfully.

People’s health and social care needs were managed well and people were referred on to health professionals should they need specialist attention. There were positive relationships with professionals which supported people’s overall wellbeing.

Medicine was administered safely and there were clear protocols in place for medicine which was taken when required. Records were kept up to date and Medication administration records (MAR) were all correct and checked by staff and the registered manager.

The registered manager showed evidence of ongoing quality monitoring across all aspects of the service. Any concerns raised by residents’ relatives or staff were investigated and addressed. This was also used to inform improved practises throughout the home.

People had enough to eat and drink. People were offered choices and had an input into the menu planning. The lunchtime experience was relaxed, and staff were assisting with serving meals and assisting people where necessary.

There were a variety of activities both to keep people occupied and entertain them and physical activities to assist with people’s mobility. There was an activity co-ordinator employed at the home and they also engaged with local churches to ensure people had their religious needs met.

There was a focus on improving end of life care and the registered manager had refurbished a room for relatives to stay when people were receiving palliative care. The registered manager had plans to make improvements to the home and make it more person centred.

Rating at last inspection: At the last inspection on 11 March 2017 The Woodlands Care Home was rated as Good at this inspection the home remains the same.

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

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager had left in April 2016.The provider had appointed a new manager in June 2016 who was in the process of registering with the CQC as manager. 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.

When we last inspected the service in September 2016 we found people were not always receiving safe care and treatment. This related to some care records missing some essential assessments and care plans to assist staff manage people’s care. Staff did not always use the information in people’s care plans and risk assessments to maintain people’s safety and did not always follow safe practice when moving and handling people.

At this visit we found the provider had made significant improvements in these areas. Care plans contained clear information for staff to manage risks to people’s safety and staff were observed using the information to keep people safe. Staff were also observed following safe practices when moving and handling people.

During out last inspection we also found the provider had not always followed safe practice when employing staff. During this inspection we saw the provider had undertaken the necessary checks on staff to ensure staff who had been employed were fit and safe to support people who used the service.

People were safe as the provider had ensured staff had the correct training to enable them to recognise and report abuse. The manager ensured the appropriate authorities were notified and undertook investigations into safeguarding incidents reported to them.

People’s needs were met by the appropriate numbers of adequately trained staff and there were safe processes in place to ensure people received their medicines when required and the storage and ordering of medicines were well managed.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care.

People were treated in a caring and respectful manner and staff delivered support in a relaxed and considerate manner.

People who used the service, or their representatives, were encouraged to be involved in decisions, and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously. We saw evidence to show that any complaints received had been acted upon.

We carried out an unannounced comprehensive inspection at Woodlands Care home on 7 8 25 and 29 April 2016 following concerns raised about a number of retrospective RIDDOR reports sent to us by the local authority. During this inspection we found breaches of requirements.

After this visit we then received further information of concerns from the local authority in relation to a number of areas following several safeguarding investigations and quality monitoring visits.

As result of this we undertook a focussed inspection on 31 May 2016.

This report only covers the areas in Safe and Well Led focussed on during this inspection. You can read the report from out last comprehensive inspection by selecting the ‘all reports’ link for Woodlands Care Home on our website at www.cqc.org.uk.

At the time of this inspection the service did not have a registered manager 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 and associated Regulations about how the service is run.

We found that although the registered provider had engaged a consultant team to drive through improvements in the service, this had not resulted in people being given safe care and support, and the service lacked the leadership to improve the quality of care given to people.

People were still not protected from the risk of abuse, as staff were not escalating concerns made to them by health professionals to the management team and as a result some serious safeguarding issues had not been investigated by the management team.

People were still not protected from the risk of harm, due to ineffective systems in place to protect them. There was a lack of information in people’s care plans to show how risks to their safety should be managed.

People were exposed to environmental risk as equipment used in the service was not properly maintained and there were a lack of assessments to ensure safe use of this equipment for people

Staffing levels were sufficient to support people’s needs but staff were not supported by the management team and there was a lack of supervision and performance monitoring.

There was still a lack of appropriate governance and risk management framework and this resulted in us finding ongoing breaches in regulation and negative outcomes for some people who used the service. There was still a lack of effective systems in place to monitor and improve the quality of the service provided.

The overall rating for this service remains 'Inadequate' and the service therefore remains in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from

operating this service. This will lead to cancelling their registration or to vary the terms of their registration.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager had left in April 2016 the provider had appointed a new manager in June 2016 who was planning to apply to be registered with the CQC as manager. Following our visit we checked and the manager had begun the registration process. 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.

When we last inspected the service in April and May 2016 we found there were significant improvements needed in relation to how people received safe care and treatment. People were not adequately supported to have their needs met. Poor staffing levels and unsafe recruitment of staff, poor medicines management and staff training, with the lack of oversight of the quality of the service meant the service provided for people was inadequate. The provider sent us an action plan telling us they would make improvements by the end of July 2106. We found at this inspection that although the manager and provider had made significant improvements to the care people were receiving, there were still further improvements to be made.

These related to the management of risk to people, some people were still exposed to risks. This was due to a lack of, and contradicting information, on risk assessments and care plans.

Previously the provider had not undertaken robust recruitment processes when employing people and we saw the provider had still not taken all necessary steps to protect people from staff who may not be fit and safe to support them. The principles of the metal Capacity Act 20155 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were still not always followed in relation to managing best interest decisions for people who lacked mental capacity to make their own decisions.

Significant improvements had been made to improve person centred care. However due to some conflicting information in some people’s care plans which had not been identified by the internal auditing processes there were further improvements to be made.

People were safe as the provider had ensured staff had correct training to enable them to recognise and report abuse. The manager ensured the appropriate authorities were notified and undertook investigations into safeguarding incidents reported to them.

Staffing levels had improved and there was sufficient staff to meet the needs of people who used the service. There were safe processes in place to ensure people received their medicines when required and the storage and ordering of medicines were well managed. Staff had been given suitable training for their roles.

There had been appropriate applications made to the local authority for DoLS applications. People were supported to eat and drink enough and We saw a number of examples of appropriate referrals to health professionals and we found management of people’s health needs were improved.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care. People were treated in a caring and respectful manner and staff delivered support in a relaxed and considerate manner.

People felt able to raise issues of concern and complaints, and we saw evidence to show the complaints had been acted upon.

The provider and manager had taken steps to improve the level of over sight. The manager and provider had undertaken some significant work to improve their auditing process to improve the quality of care given to people who used the service. However there were still some areas which required improvement to maintain the safety of people in their care monitor the quality of the service.

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

The service had a registered manager in place 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 and associated Regulations about how the service is run.

People who lived at the service were not always protected from the risk of abuse as the registered manager had not ensured all staff working at the service had received safeguarding training and some new members of staff were unaware of how to report issues of concern. The registered manager had not followed safe practices when recruiting staff. Some staff had commenced work without going through the Disclosure and Barring Service checks and some people lacked appropriate references.

People were not always protected from risks as appropriate risk assessments had not always been completed. The risk assessments in place did not give staff enough information on how to manage the risks. Some of the information about risks in people’s care plans was contradictory.

Staffing levels were insufficient to support people’s needs and people did not always receive care and support when required.

Although people received their medicines as prescribed the management of medicines was not always safe.

Staff did not always receive appropriate training and supervision to assist them in their roles. The principles of the Mental Capacity Act were not always followed as people had been deprived of their liberty without the required authorisation to do so.

People were not always protected from the risks of inadequate nutrition and referrals to health care professionals were not always undertaken when needed.

Although people were treated in a caring and respectful manner, staff did not always engage with people when given the opportunity. People who used the service, or their representatives, were not always encouraged to contribute to the planning of their care.

People did not receive person centred care as the care records did not give adequate information required for individualised care. People and their relatives felt able to raise concerns or complaints to the registered manager but the issues raised were not always responded to and acted up on.

The service lacked an open culture serious incidents which had occurred had not been reported to the appropriate authority in a timely way

Systems in the service that were meant to monitor and identify improvements were not effective and records were not always maintained and completed in full. This lack of effective governance led to some people not receiving safe and consistent care.

This resulted in us finding multiple breaches in regulations and negative outcomes for some people who used the service. You can see what action we told the provider to take at the back of the full version of the report.