Woodbury House

Woodbury House is a care home providing personal and nursing care to up to 45 people including people who live with dementia. At the time of our inspection 31 people were using the service.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not ensure compliance with the fundamental standards and identifying when the fundamental standards were not met.

When incidents or accidents happened, it was not always clear that it was fully investigated, and if any lessons were learnt. The provider did not ensure that clear and consistent records were kept for people who use the service and the service management. The provider did not inform us about notifiable incidents in a timely manner. Effective recruitment processes were not in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines was not always safe. Risks to people's health and wellbeing were not consistently assessed and staff did not always follow guidance to support people in the right way. Staff deployment was not always managed effectively as we observed people did not always receive timely support. People were at risk of social isolation because the provider did not ensure activities were more personalised and people had opportunities for social engagement according to their interests.

People and their families felt they were not always involved in the planning of their care. People's and relatives' feedback were sought but not always used to make improvements to the service. People were not always 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 were in place but did not support this practice. People had sufficient meals to meet their nutrition needs. Hot and cold drinks and snacks were available between meals. However, we were not assured people’s hydration needs were monitored and met in a consistent way. Relatives said they were kept informed about their relative’s health and welfare. care plans and related documents had information about people but it did not always contain information specific to people's needs and how to manage any conditions they had.

The provider had not ensured staff including agency workers were provided with appropriate training, knowledge and skills so they could do their job safely and effectively. Staff said they felt supported to do their job and could ask the home manager for help when needed.

People and relatives gave us mixed feedback about the staff and the service, but they also were positive about the staff and the care they provided. Staff upheld people's privacy and responded in a way that maintained people's dignity. However, we observed a mixture of interactions between people and staff which did not always show kind, caring and effective practice.

We have made a recommendation about the premises being suitable for people living with dementia. We have made a recommendation about the compliance with the Mental Capacity Act 2005. We have made a recommendation about compliance with the Accessible Information Standard. We have made a recommendation about gathering and acting on people’s and relatives’, and staff feedback.

There had been management changes since the last inspection, which affected the service management and the culture at the service. The new home manager was in the process of getting to know the service to ensure they could review, assess and monitor the quality of care in a consistent way.

People were safe living at the service and relatives felt their family members were kept safe. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. The management team was working with the local authority to investigate ongoing safeguarding cases.

The dedicated staff team followed procedures and practices to control the spread of infection and keep the service clean. There was an emergency plan in place to respond to unexpected events and the premises and equipment were kept clean. People were able to access healthcare professionals such as their GP. The service worked with other health and social care professionals to provide effective care for people. Relatives felt the management of the service had improved and that they could approach manager and staff with any concerns. Most of the staff felt the management was open with them and communicated what was happening at the service and with the people living there. The management team appreciated staff contributions and efforts during pandemic to ensure people received the care and support.

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 (report published 20 September 2017).

Why we inspected

This was a planned inspection based on the previous rating and 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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 identified breaches in relation to quality assurance; risk management; notification of incidents; record keeping; effective and person-centred care planning; privacy and respect, management of medicine; staff training, competence, and recruitment. We have made a recommendation about the premises being suitable for people living with dementia. We have made a recommendation about meeting the Accessible Information Standard and Mental Capacity Act legal framework. We have made a recommendation about seeking and using feedback from people, staff, others to improve the service.

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.

The home is a large detached Victorian building in a country location, not far from the shops and amenities of Wokingham, Reading and Camberley. People had their own bedrooms and use of communal areas that included enclosed private gardens. The people living in the home needed residential or nursing care and support from staff at all times and had a range of care needs. These included dementia care and palliative care.

The service has a registered 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 2008 and associated Regulations about how the service is run.

People received safe care. There were sufficient numbers of staff to keep people safe and meet their needs. However, we found that staff deployment at lunchtime on the memory unit had not provided the assurance that people were being checked and supported effectively regardless of staff numbers being of a good ratio. We had discussed this with the registered manager who had taken immediate and appropriate action to improve.

We have made a recommendation about the assessment of staff numbers to meet people’s individual needs within the environment they live.

Staff were knowledgeable about how to keep people safe from harm. Risks to people's safety were assessed and plans were in place to manage and reduce risks. There had been a high turnover of staff in the 12 months prior to our visit. Staff were recruited safely using robust procedures. Medicines were managed safely by staff who had received appropriate training and had their skills monitored. The home had been refurbished. The kitchen and laundry were being reviewed for refurbishment and consideration of changing door closures to soft-closures.

People received effective care. Staff were trained and competent to carry out their roles effectively. Training updates were scheduled to cover staff induction and refresher training, which included dementia awareness, equality, diversity, and personal care. They were supported in their job roles through one to one meetings, appraisals and team meetings. People were supported to eat a choice of freshly prepared meals. They were supported with special diets if required and when necessary their dietary intake was monitored. Frequent snacks and drinks were available.

People were supported to maintain their health and wellbeing. Advice was sought from healthcare professionals when necessary. People were supported by staff to have maximum choice and control of their lives in the least restrictive way possible. The policies and systems in the service supported this practice.

The service was caring. Staff were kind, considerate and compassionate in the way they delivered support to people. They encouraged people to be as independent as they possibly could be. They addressed people in the way they liked and spoke respectfully to and about people.

The service was responsive. People's relatives and visitors were welcomed into the home and activities were designed to consider people’s individual interests. One to one sessions were a regular feature for people who were at risk of being isolated. People received person centred care that focussed on their individual needs and recognised their preferred routines. People and their relatives were comfortable to raise concerns and speak with the registered manager and staff team if they wished.

The service was well-led. There were systems in place to assess, monitor and analyse the service in order to make improvements. The manager has a proven record of having made improvements in people’s best interest since becoming the manager at Woodbury House. There was a high level of confidence in the registered and deputy manager amongst people, their relatives and professionals. They were complementary of the improvements made by the registered manager that protected people and promoted a respectful culture within the home.