Archived: Woodland Care Home

Woodland Care Home is a residential care home which provides personal care and accommodation for older people and is located in Oldham, Greater Manchester. The home is registered to care for up to 18 people. At the time of this inspection, there were 16 people living at the home.

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

Medicines were not managed safely and we identified similar concerns to those found at our last inspection of the service in 2021. Staff displayed a good understanding of safeguarding and whistleblowing, although some said they didn’t always feel comfortable reporting concerns due to a fear of repercussion. We also received feedback about a poor culture amongst the staff team.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not always support practice. We saw people’s movements around the service were restricted at times.

Record keeping needed to be improved, particularly regarding oral hygiene and some care plans were not always updated when people’s needs changed.

The service has a poor regulatory history with the Care Quality Commission (CQC) and has been in breach of regulations at the previous four inspections with the overall ratings being inadequate and requires improvement on three occasions. Warning notices were served at our last inspection in April 2021, although due to the concerns we identified regarding medication, these had not been met.

Staff wore personal protective equipment (PPE) throughout the inspection and lateral flow testing was carried out. There were enough staff to care for people safely and correct recruitment procedures were followed. Regular checks of the building and equipment were carried out to ensure they were safe to use.

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 8 June 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found not enough improvement had been made and the provider remained in breach of certain regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Enforcement and Recommendations

We have identified breaches in relation to people's safety, consent and leadership of the service.

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.

The overall rating for the service is requires improvement. This is based on the findings from this inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Woodland Care Home is located in Oldham, Greater Manchester and provides care for up to 18 people, some of whom have a mental health condition and are living with dementia. At the time of this inspection there were 12 people living at the home.

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

People still did not receive their medication safely and as prescribed. Infection control procedures were not always followed and were not assured safe practices were followed with regards to social distancing and the use of PPE. We observed some environmental risks within the home and some people did not always have appropriate equipment in place to ensure they maintained good skin integrity.

People’s care plans were not always updated when their care needs changed and records about the care people had received were not always well maintained by staff. We observed people were not always wearing sensory equipment, such as glasses, where this had been identified as a requirement in their care plan.

Further improvements were required to governance systems to ensure the concerns found during the inspection were identified as part of the home’s own auditing systems. Recent staff and residents meeting had not been held to enable feedback to be provided to ensure the home could continually improve.

Staff told us there was enough training available to support them in their roles, with supervision sessions also held to discuss their work. People told us they received appropriate support to maintain good nutrition and hydration and the home had good links with other health care professionals. 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 (and update).

The previous rating for this service was Requires Improvement (Published November 2020). At this inspection, breaches of the regulations were identified regarding safe care and treatment and good governance. At this inspection not enough improvement had been made and the provider was still in breach of these regulations.

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

Why we inspected

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.

The inspection was prompted in part due to concerns shared with us by the local authority prior to the inspection including the safe welfare of people living at the home, the environment, food quality and leadership. A decision was made for us to inspect and examine those risks.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good and request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the 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.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Woodland Care Home is a residential care home located in Oldham, Greater Manchester and is operated by Woodland Care Home Limited. The home is registered with the Care Quality Commission (CQC) to provide care for up to 18 people, some of whom are living with dementia and have mental health needs.

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

Further improvements were required to ensure people received their medication safely. Limited progress had been made to the environment to make it suitable for people living with dementia, who may not be able to orientate to their surroundings effectively. A new electronic care planning system had been introduced since our last inspection, however, we found certain care plans did not always provide sufficient detail about the care and support people needed. Auditing and governance systems had improved since our last inspection. However, these could be improved further to ensure the concerns found during this inspection were identified in a timely way.

People living at the home and their relatives told us the home was a safe place for people to live. Staff demonstrated a good understanding about how to safeguard people from the risk of abuse, with allegations of abuse submitted to the local authority when needed. Staff recruitment procedures were robust and there were enough staff to care for people safely.

The premises were well maintained, with regular servicing checks of equipment and the building carried out. Staff wore personal protective equipment (PPE) when delivering care and the home was seen to be clean and tidy.

Staff told us they received enough training and supervision to support them in their roles. People received enough to eat and drink, with appropriate referrals made to other health professionals as needed.

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.

Complaints were handles appropriately and we received positive feedback about the activities at the home.

The home had a new manager in post who had worked at Woodland Care Home for approximately six weeks at the time of our inspection. The feedback we received was positive regarding the changes they made since taking up the role. The current staff team spoke of a positive culture at the home, with good team work throughout.

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 Inadequate (Published 24 March 2020) and the home has been in special measures since this date. During this inspection the service demonstrated that improvements have been made. The service is no longer rated as inadequate overall, or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service between in February 2020. Breaches of legal requirements were found regarding need for consent, safe care and treatment, safeguarding people from abuse and improper treatment, good governance and staffing. The provider completed an action plan after the last inspection to show what they would do and by when to ensure they were compliant with the regulations.

Following this inspection, we issued a notice of proposal (NOP) to cancel the registration of both the provider and registered manager. Due to the Covid-19 pandemic however, this was withdrawn and we worked closely with the provider who demonstrated sufficient action had been taken to make the necessary improvements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion (Caring) were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Woodland Care Home located in Oldham and is operated by Woodland Care Home Limited. The home is registered with the Care Quality Commission (CQC) to provide care for up to 18 people. There were 17 people living at the home at the time of the inspection, some of whom had mental health needs.

People’s experience of using this service:

Medication was not always stored, recorded and administered safely. Potential risks within the home were not well managed and safeguarding allegations were not referred for further investigation to the local authority. Accident and incident forms were not always completed where incidents had taken place. People did not always have the right equipment to help keep them safe and robust infection control procedures were not always used. We identified concerns regarding fire safety and made a referral to Greater Manchester Fire and Rescue Service.

We have made a recommendation regarding night time staffing arrangements and updates to the environment.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support consistently good practice.

Staff supervisions did not take place as frequently as described in the policy and procedure and staff had not received all the necessary training to support them in their role. This included mental health and deprivation of liberty safeguards (DoLS)/mental capacity act (MCA). Where people had received visits from other health care professionals, this was not always clearly documented in care plans.

Inconsistent information was recorded in people’s care plans and not all care plans were in place. There were no activities taking place during our inspection we observed people sat in lounge areas for long periods without interaction and stimulation from staff. The feedback we received from people was that activities could be improved.

There was a lack of oversight at the home from both the registered manager and provider. A robust auditing system was not in place, particularly regarding the concerns identified during this inspection. We had concerns regarding the storage of confidential information and seeking and acting on feedback from the relevant persons in the carrying on of the regulated activity.

Statutory notifications were also not submitted where allegations of abuse had occurred. We are following this up outside of the inspection process.

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 inspection at Woodland Care Home was in December 2017. The overall rating was Good.

Why we inspected:

The inspection was carried out in response to whistleblowing information we had received about the home. A decision was made for us to inspect and examine any risks.

Follow up:

We will continue to monitor information and intelligence we receive about the service and will return to re-inspect in line with our inspection timescales. However, if any information of concern is received, we may inspect sooner.

Breaches of the regulations and enforcement:

We identified breaches regarding need for consent, safe care and treatment, safeguarding people from abuse and improper treatment, good governance and staffing.

Full information about CQC's regulatory response to the breaches found during this inspection is added to reports after any representations and appeals have been concluded.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Woodland Care Home is a ‘care home’. People in care homes receive accommodation and nursing or 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. Woodland accommodates up to 18 people in one adapted building.

Woodland Care Home is registered to provide 24 hour care and support for adults who have physical and or mental health needs. The home is a large detached property overlooking Alexandra Park in Oldham, Lancashire and is located approximately one mile from the town centre. At the time of our inspection 17 people were living at the home but two were currently in hospital.

The previous inspection had been carried out on 01 February 2017 and was a focused inspection due to concerns we had received that there was no manager in place; staff were not recruited safely; there were not enough staff to meet people's needs; there was no hot water and that the new registered provider had installed obtrusive CCTV cameras in the home which breached the confidentiality and privacy of the people who used the service. At that inspection these concerns were looked into and found to be unsubstantiated.

There was 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 2008 and associated Regulations about how the service is run.

The registered manager was on annual leave on the day of the inspection, so this was facilitated by the team leader.

There was a policy and procedure for safeguarding, staff had received training in safeguarding adults and were confident to report any poor practice they might observe. Staff had been safely recruited and there were sufficient numbers of staff to meet the needs of the people who used the service.

Safe systems were in place for the management of medicines at the service. General and individual risk assessments were in place and were regularly reviewed and updated. Health and safety records were complete and up to date.

The premises were safe and secure, with key pad locks on the doors and CCTV cameras were in place outside the home to help ensure the safety of the people who used the service. There was also an internal camera which looked into the office. We have made a recommendation about consulting CQC guidance around the use of CCTV in care homes.

Staff had a thorough induction programme and training was on-going to help keep their skills and knowledge current. We have made a recommendation about implementing a staff supervision programme.

People’s nutritional and hydration needs were addressed and the food was plentiful and nutritious. People’s health needs were clearly documented and people were supported to access health care services as required.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us staff were kind and caring. We observed staff throughout the day and saw interactions between staff and people who used the service were warm and friendly. People’s dignity and privacy were respected.

People were involved with care planning, reviews and meetings about their care delivery. Residents’ meetings were held on a regular basis and there was a service user guide with information about the service.

People were given choices in all aspects of their lives. Care plans were person-centred and included people’s goals and aspirations. Reviews of care and support were undertaken regularly.

People who used the service were supported to undertake activities both within the home and in the local community. People had advance care plans in place, setting out how they wished to be supported at the end of their lives.

There were opportunities for people who used the service and relatives to offer feedback. Some concerns had been raised around the time of a change of ownership and these had been fully investigated and appropriate responses made. Complaints were dealt with in an appropriate and timely manner.

The registered manager had sent notifications to CQC as required. Staff we spoke with told us the management were very supportive and approachable.

There were records of regular annual appraisals, but regular one to one staff supervisions were not taking place. Regular monthly staff meetings took place and offered an opportunity for staff to raise any concerns, make suggestions for improvement and discuss good practice.

There was a system of audits and quality checks in place. Accidents and incidents were monitored and reviewed to see what lessons could be learned to help improve the service.

Woodland Residential Care Home is registered to provide 24 hour care and support for up to 18 adults who have physical and or mental health needs. The home is a large detached property overlooking Alexandra Park in Oldham, Lancashire and is located approximately one mile from the town centre. At the time of our inspection 16 people were living at the home.

There was no registered manager in post. 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. The home had an assistant manager who was acting as an interim manager and we saw evidence to show that this person had begun the process of registering as the manager with the Care Quality Commission.

We saw that there were enough staff to meet the needs of the people who used the service, but one person told us that there was not a lot for them to do. We saw that the service had taken steps to employ a new member of staff to provide meaningful activities and trips out of the home for people who used the service.

Safety checks, such as reference checks, were made for the safe recruitment of staff. There were sufficient checks to ensure that new staff had the right skills knowledge and character to work with vulnerable people. The staff we spoke to knew how to protect people from abuse and there were policies and procedures in place to safeguard vulnerable adults.

We asked people if they felt the home was warm and they told us that they felt it was maintained at a comfortable temperature, one person told us that “the water is OK. It’s warm enough for me to bathe in”.

People were free to walk freely around the building. CCTV cameras outside the home ensured the safety of the people who used the service and one internal camera looked into the office to ensure data protection but was not intrusive for people who used the service.

We saw the home had a range of policies and procedures to ensure the safety and well-being of people who used the service and the staff we spoke to were familiar with these.

The people we spoke with spoke positively about the interim manager. Staff told us that the interim manager was supportive and approachable, and believed the staff worked well together. People who used the service told us that if they had an issue the interim manager would help them and address the problem.

Although the interim manager had only recently begun their duties we saw that they had taken steps to implement quality assurance checks to monitor and improve the service. They regularly communicated with the registered provider who would visit the service on a monthly basis to carry out her own audits of service delivery.

The registered provider had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.