Archived: Woodbury House

In this report the name of a registered manager appears who was not in post or managing the regulatory activities at this location at the time of the inspection. This is in addition to the name of the registered manager who was managing these activities. These names appear because they were both registered managers on the CQC register for this service. We have written to the provider to ensure actions are taken to remove the name of the registered manager who is no longer in post.

We observed how staff supported people, and looked at documents including care plans and management reports. We considered all the evidence we had gathered under the outcomes we inspected, which related to respecting and involving people, provision of care and welfare, the suitability of the premises, supporting workers and monitoring and assessing the quality of the service. We used the information to answer the five key questions; is the service caring, responsive, safe, effective and well led. This is a summary of what we found.

Is the service caring?

We observed staff were caring, kind, patient and respectful when interacting with people. One person told us 'I like the staff. They get me up, then I have breakfast, read my paper and have lunch'. They were satisfied with the care provided.

A relative told us 'When X first arrived they supported us as a family. We were upset and they [staff] looked after us. They are great'. We saw people often welcomed staff interaction with a smile or greeting, and responded positively with staff. People and staff joked together. Staff had time for meaningful interaction. This indicated to us that people enjoyed the attention they received from staff, and felt comfortable with them.

One nurse stated that the 'close knit and happy workforce' was reflected in the care of the people they supported. 'They [staff] are caring, they have empathy for people. They act well towards them, they are respectful. They make people content with where there are. Families tell me how happy they are with how people have settled following such a big move [into the service]'.

Is the service responsive?

We found the service was responsive to people's needs. One care worker told us 'I always listen to people. I put myself in their position, and ask myself how I would feel about that. I try to look at things from their perspective'.

Relatives told us staff were responsive to their concerns, and made time to keep them informed and updated. One nurse explained that part of their duty was to liaise with families to ensure communication was promoted.

People's care plans were checked monthly or as changes were identified. This ensured that people received the care appropriate to their needs and wellbeing. Effective communication between staff, such as daily meetings, ensured all staff were aware of actions required to take to promote people's health.

Is the service safe?

One person told us 'I like the staff, they look after me'. Documentation ensured all staff were aware of issues that may affect people's or others' health or wellbeing. We noted staff recorded the actions they took to reduce the risk of harm. For example, we saw daily food and fluid charts for those at risk of malnutrition, and the use of pressure relieving mattresses to reduce the risk of developing pressure sores.

Staff were aware of when to refer health issues to the GP or other health professionals, and relatives told us that staff effectively managed people's health and wellbeing. We saw records demonstrated appropriate actions had been taken to monitor wounds and pressure sores and promote healing. Staff were aware of risks that may affect people's health status, such as deteriorating mental health. Monthly checks assessed people's level of risk, and records indicated that staff took steps to promote actions to resolve or reduce identified risks.

The building was well maintained, clean and clutter-free. At the time of our inspection the two passenger lifts were not working, which restricted people's access between floors. Staff had created a communal lounge on the top floor for people who would usually attend communal activities on the ground floor. Fire evacuation plans did not include the use of lifts. This meant people were supported to maintain activities and interactions safely, and the environment did not place people at risk of harm.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The manager was aware of when an application should be made, and how to do so. They demonstrated that they were aware of the recent case law in relation to DoLs, and were taking actions to progress applications in a timely manner for those people affected.

Is the service effective?

Relatives told us they felt their comments were sought and listened to. There were effective communication strategies in place to support people and their relatives, such as monthly information sharing, and resident and relative meetings. The registered manager described actions taken to resolve one concern raised regarding the laundry service. This demonstrated that they listened to people's concerns and took effective actions to resolve these to people's satisfaction.

We saw records demonstrated that staff understood people's current health status. They understood when people required the support or intervention of health professionals such as the GP or dietician. Documents demonstrated that appropriate guidance was sought when issues had been identified, and staff followed the guidance provided.

Staff were trained to provide care and support safely and effectively. We saw records that demonstrated staff received regular refresher training as required. The registered manager and other senior staff ensured that learning from training was reflected in the care provided for people. Regular staff meetings provided a forum in which concerns could be raised. Individual supervision and appraisal meetings meant each staff member's development and skills could be reviewed. This meant people were supported by a skilled and effective workforce.

Is the service well led?

We found the service to be well led. People told us they liked the staff, and relatives told us they felt welcomed and supported by the staff. One relative told us 'X has come alive' since being cared for by the service.

The manager displayed strong leadership qualities. They understood the importance of empowering and valuing staff, and supported the staff team through encouragement and feedback. Many staff spoke passionately about their roles.

One member of staff told us 'We try to prevent things from going wrong, but if they do we learn from the incident to create a better service'. We saw the registered manager had a system of audits and checks in place to monitor the quality of service provision. Information was shared appropriately with all staff to ensure communication of issues and actions required was understood across the service.

The provider carried out monthly quality audits to monitor that policies and procedures were followed. Provider management meetings promoted learning across the services they oversaw.

We observed the staff providing good individualised care to people in the home and encouraging them to take part in activities. Care plans and associated documents contained the information necessary for staff to provide support in the way people wished. The home liaised well with external healthcare agencies to ensure that people's health needs were met.

The home had appropriate arrangements in place to respond to safeguarding concerns. Where such issues had arisen, they had been responded to positively and the manager had notified relevant people.

The provider had appropriate recruitment checks in place to confirm the identity and quality of new staff.

The provider and manager had systems in place to monitor the operation of the home and the quality of record keeping. The views of people in the home and their relatives, about the quality of care, had been sought.