Wood Green Nursing Home

Wood Green Nursing Home is a care home providing nursing and personal care to older people. The care home is registered to provide support to 37 people. At the time of the inspection 35 people were living at the home. The accommodation is provided over two floors each of which has its own communal areas.

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

People felt safe in the home. Risk assessments were in place for all people. Staff were recruited safely. People’s medication was managed well. The provider was preventing the spread of infection through good hygiene practice.

People’s health and care needs were assessed when moving into the home. People were cared for by a staff team who had received regular and appropriate training specific to people’s needs. People enjoyed the food. The layout of the home allowed people to choose where they spent their time. The provider was working in line with The Mental Capacity Act 2005 (MCA).

The provider had systems in place to assess, monitor and improve the service. People and their relatives told us they felt able to raise any issues they may have, felt listened to and felt the registered manager and wider management team were good. People told us they felt involved in the running of the service.

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 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 requires improvement (published 8 December 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. This was due to the local authority identifying this service as likely to improve their rating.

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.

Follow up

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

We found the following examples of good practice.

Monthly infection, prevention and control (IPC) audits were completed by the registered manager and all actions addressed in good time.

The home was visibly clean and tidy, free of clutter and well ventilated.

Staff were observed correctly using personal protective equipment (PPE).

Robust checks were completed to ensure visitors and staff minimise the risk of contamination when entering the home.

Robust policies, procedures and risk assessments were in place to protect the staff and people living in the home.

Wood Green Nursing Home is a care home providing nursing and personal care to older people. The care home is registered to provide support to 40 people. At the time of the inspection 32 people were living at the home. The accommodation is provided over two floors each of which has its own communal areas.

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

The home had improved since the last inspection. New systems were in place to record and monitor the service. Further improvements were required to fully embed the new systems and improved working practices.

People felt safe living at the home and staff were aware of people’s individual risks. People received support to take their medicines. However, we found some medication recording errors which the provider had not identified. The provider took immediate action following the inspection to address this.

People were supported by staff who were deployed in sufficient numbers to meet their needs. Staff were

aware of how to safeguard people from abuse and had good knowledge on how to recognise and respond

to concerns.

Appropriate Personal Protective Equipment (PPE) was made available and worn by staff and they had received information and training, so they understood the importance of this.

The provider had quality monitoring systems in place, however, this inspection found they did not always identify issues and therefore were not fully effective. Further time is needed to fully embed the new systems.

The home worked in partnership with other professionals and the community when able to do so. Relatives

we spoke with felt engaged with the home during COVID. We saw no evidence people's needs were not

being met.

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 Requires Improvement (Published on 11 December 2019).

Why we inspected

The inspection was prompted due to concerns about poor infection prevention and control (IPC), whistleblowing and environmental concerns. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. We only looked at safe and well led during this inspection. We did not look at the key questions of effective, caring and responsive. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found evidence the provider needs to make improvements.

The overall rating for the service remains as Requires Improvement. This is based on the findings at this inspection.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wood Green Nursing Home provides accommodation, personal and nursing care for up to 40 people. On the day of the inspection 32 people were in residence.

Wood Green Nursing Home is situated on two floors which are accessed by stairs or a passenger lift. Bedrooms and bathrooms were located on both floors. Communal areas were located on the ground floor and people had access to a garden.

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

The potential risk to people were identified but prompt action to mitigate them was not always taken. Risk assessments and safety checks relating to the environment was not always carried out in a timely manner to ensure people’s safety. The management of medicines needed to be reviewed to ensure people receive their medicines safely. The provider’s governance was ineffective to assess and monitor the quality of service provided to people.

People were protected from the risk of potential abuse. People were cared for by sufficient numbers of staff who were recruited safely. Hygiene standards were maintained to reduce the risk of cross infection. Lessons were learned when things went wrong, and remedial action was taken to avoid a reoccurrence.

The assessment of people’s needs were carried out to identify their preferences. People were cared for by skilled staff who were supported in their role by a senior staff member. People were always provided with a choice of meals and had access to snacks and drinks at all times. People were supported by staff to access healthcare services.

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.

Staff were kind and attentive to people’s needs. People were actively involved in decisions about their care and support needs. People’s right to privacy and dignity was respected by staff.

People were involved in their assessment before they moved into the home. Information relating to lesbian, gay, bisexual, and transgender and those questioning their sexuality (LGBTQ) was displayed in the home. People had access to social activities outside and within the home. People could be confident their concerns would be listened to, taken seriously and acted on. Staff had received palliative care training to ensure they have the skills to care for people at the end of their life.

People who used the service, visitors and staff were aware of who was running the home. People told us the registered manager was very friendly and approachable. Staff told us they felt well supported by the management team. The registered manager worked with other organisations in providing a service for people.

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 Good (published 22 March 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.

Wood Green Nursing Home is registered to provide accommodation, nursing and/or personal care for up to 40 older people. At the time of our inspection 31 people were using the service.

The manager in post at the time of our inspection was in the process of registering with us. There was a registered manager for the service, but they had left this post and as yet had not deregistered as manager of the home with us. 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.

Staff were knowledgeable about the types of abuse and harm people may experience and were able to describe how they would deal with and report any concerns they had. Potential risks to people were assessed in relation to their individual health and support needs. Incidents that occurred were reported to the appropriate external agencies and bodies, including the Care Quality Commission [CQC]. The provider ensured sufficient skilled staff were available and employed in order to meet people’s individual needs and keep them safe. The systems in place ensured that staff recruited had the right skills, experience and qualities to support the people who used the service. Staff effectively administered medicines and supported people to take them appropriately.

Staff were caring towards people, frequently asking about their well-being and ensuring they were comfortable. People or their representatives were involved in decision making and received a good level of level of communication from the provider. Information was available and displayed for people in relation to local advocacy services. Staff were patient and took time to ensure that people understood what was said to them. People received care that was delivered by staff in a respectful and dignified manner.

People using the service and their relatives were involved in the assessment of needs and planning of care and support. People were supported to follow their interests and take part in social activities. The home had a friendly and homely environment and people received care that was personalised to their particular needs and wants. People were clear about how to make their views known and information was displayed about how to make a complaint. People were supported to maintain relationships with those important to them.

The provider had made the necessary level of improvement in relation to medicines and the analysis of incidents that was required in relation to our findings at our last inspection in June 2016. Recommendations made in relation to areas of fire safety at the home had not all been addressed and some issues identified remained a potential hazard. Staff were well supported in their role and demonstrated a clear passion for their work. Management of the service provided staff with the support required for them to deliver effective care. Staff benefitted from regular supervision and meetings. People were actively encouraged to provide suggestions and opinions about the service, this included through regular meetings and surveys supplied to them for their completion. Staff could make suggestions and give their opinions openly to the manager or provider.

Wood Green Nursing Home is registered to provide accommodation, nursing and/or personal care for up to 40 older people. At the time of our inspection 29 people were using the service.

The manager was registered with us as is required by law. 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 found that medicines management within the service was not robust and checks being completed were not always effective in identifying issues, omissions or errors.

Staff were trained in how to protect people from abuse and harm; they knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risks to people were assessed and included measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. The recruitment process was robust and the provider was as sure, as possible, that staff employed at were suitable and safe to work with people who were cared for by the service. We found that there were a suitable amount of staff on duty.

Formal staff supervision was not always regularly undertaken and in line with the contract agreed with its employees; however staff told us they could access the support they needed when they needed it. Staff attended regular training in areas that were relevant to the needs of people using the service. However, training and updates in relation to end of life care was lacking. People enjoyed their meals and were supported by staff to eat and drink enough to keep them healthy. People were supported to access input from health care professionals as and when they needed it. Evidence of any support provided whilst people waited to be seen by healthcare professionals was not consistently demonstrated.

Staff interacted with people in a positive and caring manner. People were satisfied with the way staff communicated with them and the information they were provided with. We found that staff were respectful and maintained their privacy and dignity whilst supporting them. People were encouraged to remain as independent as possible by staff. Information for staff and people in relation to how to access advocacy services needed to be sourced.

Activities available within the service were limited and not always centred on people’s interests. People were clear about how to make their views known and information was displayed about how to make a complaint. People described to us how staff supported them to maintain relationships with their friends and families.

People were positive about the leadership of the service and had confidence in the registered manager. The provider’s quality assurance systems were not always effective in identifying issues or demonstrating how improvements to the effectiveness and safety of the service would be actioned. Peoples’ feedback in relation to the quality of the service and complaints were acted upon and improvements made as a result.

Below is a summary of what we found. We used all the information to answer the five questions that we always ask

Is the service safe?

We saw that the people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to them. Some care plans did not reflect the level of care that was being given because reviews and checks had not identified gaps such the lack of risk assessments for specific health conditions or out of date pain management systems. This meant that staff did not always have the information they needed to meet people's needs safely.

Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

We saw that people generally received good and safe care and the majority of the relatives spoken with told us that they were happy with the care provided. The relative of one person said, 'They are brilliant here, staff are very caring. Mum's safe and loved here.' However one relative did say, 'If I had any complaint it would be that my relative waits too long for staff to assist her in using the toilet and, at times I had to ask staff for their help.'

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. No applications to restrict anyone's liberty had been made. The majority of staff had received Mental Capacity Act 2005 and DOLS training and understood their role in protecting people's rights.

We saw in some care plans that assessments of people's mental capacity were needed along with reviews of their advanced instructions for emergency medical situations. This meant that the manager and staff understood how this legislation applied to people and protected their rights but that people's safety wasn't protected in an emergency because updates and reviews planned for had not taken place.

All staff had been given the knowledge and information to be able to be alert to the signs of, or potential for abuse of vulnerable adults. All people spoken with told us that they were safe in the home. However, we found that people were not fully protected from the risk of abuse, because staff had failed to recognise and record unexplained bruises and scratches and ensure that they were adequately investigated. The manager had not appropriately reported all important events that affected people's welfare, health and safety to us and act on incidents that were classified as safeguarding. This meant that the provider had not taken action to fully protect people.

We saw that the systems that were in place to make sure that learning took place following accidents, incidents, complaints and investigations were not sufficiently robust to protect the safety and welfare of the people who lived there. Some staff spoken with were not aware of the providers reporting system.

We looked at the management of medicines and raised a number of concerns with the management team about the administration of some medicines. We found that the home did not have a system to record where the analgesic patches had been applied to the body, and that instructions to administer some medicine prescribed with specific administration times had not been adhered to. This meant that people did not always receive their medication as prescribed by their GP to protect their health and wellbeing.

Is the service effective?

People's care and health needs were assessed and planned in a personalised way. We saw that people's changing needs were not always monitored and care and support appropriately adjusted. This meant that people's care was planned but not always delivered in line with their individual needs.

We saw that people weight was recorded regularly. This is important as a significant loss or gain of weight could be an indicator of an underlying health need. Referrals had been made to external professionals so that people got the support they needed to maintain their health and wellbeing and we saw that staff followed their advice.

We saw that information was displayed about activities that were planned for. We also saw that residents meetings took place regularly and people who lived here were involved in menu planning and choices for entertainment and activities. Some people told us that they enjoyed the activities that took place. One person told us, 'I enjoyed the barbeque. We have a lot of fun here.' This meant that group activities were planned for and took place.

Is the service caring?

Some staff spoke with people in a tone that expressed friendship and support and offered people choices throughout the day whilst other staff were observed to ignore the presence of residents and failed to engage in conversation with them when they delivered care or gave support with meals. Some staff told us that they felt there weren't sufficient staff to support people who had dementia with all of their needs.

Most people we spoke with told us they were happy and the carers were nice and worked hard. One person said, 'I am very happy here. It's beautiful and we do lots of things. The staff are so kind. Nothing is too much trouble.'

Is the service responsive?

We saw that there was a system to review people's care plans and risk assessments on a regular basis to ensure that their changing needs were planned for. However these reviews did not always identify peoples changed needs so that staff appropriately adjusted their care and support.

We saw that actions were taken to protect people's health as needed. We saw that staff acted on peoples deteriorating health and liaised with doctors and other professionals regularly. One relative said, 'Any concerns are dealt with straight away. They are great and always keep me informed about mum.' This showed that the service was responsive and kept relatives informed about people's health.

We observed that some staff responded to some people's needs in a caring and appropriate way. However, people told us and we observed that care was not always delivered in a timely manner to all people. We also observed that people who were nursed in bed on the upper floor spent long periods of time without the stimulation of conversation or activity. Some people did not have call bells close at hand. This meant that some people did not have their health and well-being promoted and protected by interactions or social activities.

Is the service well led?

The manager at the home is newly appointed and we have not registered them to be responsible and competent to manage the home. The registered provider was reminded of their legal obligation to have a registered manager in place in compliance with their registration requirements.

People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.

Whilst people and relatives spoken with had few or no concerns about the service they received. We found that effective systems were not in place to monitor the quality of the service. This has led to shortfalls in a number of the regulations that we assessed.

We saw that some care records and medication administration records lacked relevant, up to date information. This meant that people may not always receive safe and effective care that met their needs. We saw that confidential information about people's care was in the main kept securely.

Overall most people that lived at the home felt they were being looked after. One person told us, 'As far as I know I am being looked after.' We found that care and treatment was planned in a way that was intended to ensure people's safety. However, care was not always delivered in a timely manner and with sufficient social activities to fully maintain people's well-being.

We saw that people generally enjoyed their meals and choices were available. We found that people's nutritional needs were being met.

People told us that they were safe in the home. However, we found that people were not fully protected from the risk of abuse, because the provider had failed to recognise where there was a risk of abuse.

We found that people were for, or supported by, suitably recruited and qualified staff.

Overall people were satisfied with the care they received. One person living at the home told us, 'I can't find fault with it.' We found that an effective system was not in place to monitor the quality of service that people received.

We found that significant events affecting the care of people were not being reported to enable a full assessment of these events.

We found that confidential information about people's care was not kept securely.

People told us that their privacy and dignity was respected and that they had choices.

People and their relatives that we spoke with were happy with the care they received at the home and felt that their needs were being met. One person told us, 'Oh yes my needs are being met.' We found that people's needs were being met.

People told us that they enjoyed their food and got enough food to eat. We found that people were not always supported to eat and drink in a timely manner.

People told us that they received their medication when needed. We found that systems were in place to ensure that people received their medication safely.

People told us that there was usually enough staff to meet their needs. One person told us, 'Always plenty staff around and if you ask them for something it's done and never ignored.' We found that there was sufficient staff to support the needs of the people currently living at the home.

People that we spoke with were confident that they could tell staff about any concerns they had and it would be addressed by the manager.