Woodmarket House

Accommodation is provided on the ground and first floor with communal facilities.

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

The home had not fulfilled it's actions in regards to its environment and maintenance schedule. An action plan remained in place but there were no clear timescales for when all works would be completed.

The registered manager had continued to take steps to improve the service and ensured people received safe care.

There were systems and processes in place to identify, record and investigate incidents. This included falls management and the home had seen a noticeable decrease in falls.

The registered manager reviewed all incidents, worked with partner agencies and implemented preventative measures to keep people safe.

A new dependency tool had been introduced and staffing numbers were consistent.

The home was clean and followed infection control protocols.

People received their medicines safely as prescribed. Medicine practices were safe.

Staff understood their responsibilities to protect people from abuse and avoidable harm.

Rating at last inspection

The last rating for this service was requires improvement (report published 19 March 2020).

Why we inspected

This inspection was undertaken to follow up risks we identified at the last two inspections at Woodmarket House and action we told the provider to take. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodmarket House on our website at www.cqc.org.uk

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

The provider and the registered manager had taken steps to improve the service and ensured people received safer care. An action plan to address the warning notice carried out by CQC had been implemented. All the requirements of the warning notice had been met.

The systems and processes to identify, record and investigate incidents had been improved. The registered manager reviewed all incidents and implemented preventative measures to keep people safe.

Staffing numbers had increased and there were enough staff with the right skills to meet people’s needs. Contingency plans were in place to replace staff when they were absent from work with short notice.

Improvements had been made to the management of medicines. Stock control had improved and this meant people were not without their prescribed medicines. People had their medicines reviewed to ensure they were effective. Records were accurate and up to date.

Staff understood their responsibilities to protect people from abuse and avoidable harm. People and staff felt confident any concerns would be listened to and addressed appropriately.

The decoration and maintenance of the premises continued to require improvements. There was an action plan in place but there were no clear timescales for when the work would be completed.

People and staff had confidence in their managers and felt supported. People and staff were engaged and involved in developing the service. Changes to day to day routines were made to suit the needs of people who used the service.

Rating at last inspection

The last rating for this service was requires improvement (published November 2019) when there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 29 November 2019.

Why we inspected

This was a focused inspection based on the warning notice we served on the provider following our last inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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 care and well-led. The overall rating for the service has not changed following this focused inspection and remains requires improvement. This is because we have not assessed all areas of the key questions. The rating for the key question ‘safe’ has improved from ‘inadequate’ to ‘requires improvement’ because the provider was able to demonstrate they had become compliant with this regulation.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodmarket House on our website at www.cqc.org.uk.

Woodmarket House is a residential care home providing personal care to 38 people aged 65 and over at the time of the inspection. The service can support up to 42 people.

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

Care and support was not safe because risk was not always identified or managed effectively. Staffing numbers were not sufficient to provide the monitoring and supervision people required and there had been a number of unwitnessed falls. When people were at risk from not eating or drinking enough there was no recorded action when the amounts taken each day were not sufficient.

Staff did not have enough time to spend with people and could not always deliver care and support in the way people preferred. People had limited opportunities to follow their chosen interests and hobbies although the provider had begun to take action about this and a new activities coordinator had been employed. Staff were recruited in a safe way because the provider carried out checks and sought references from previous employers.

People mostly had their medicines managed in a safe way, records were accurate and up to date and medicines were stored in the correct way. One person did not have their medicines for a week because there was no stock available. Medicines audits had not identified the person was without their medicine and this may have caused unnecessary pain and suffering for the person.

At the time of this inspection there was an ongoing safeguarding investigation which had not been concluded. People and staff felt safeguarding concerns would be taken seriously and investigated. Staff did not always manage behaviour which may challenge in a safe way. The care plan and risk assessment for one person failed to identify the risk regarding this and the person may have received care and support which did not protect them from abuse and did not comply with consent legislation and guidance.

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.

People were not involved in planning or reviewing their care and did not always receive care and support that met their preferences.

Quality monitoring systems were not effective in identifying risk and areas requiring improvement. Some areas of the service required redecoration or refurbishment but there were no timescales in place. The registered manager did not know when this action would be taken.

People liked the meals provided but did not always receive the supervision or support they required.

Staff received induction and ongoing training and had their competency assessed. The registered manager had recently returned from long term leave and was carrying out one to one sessions for staff. This meant staff training development needs could be identified.

Daily cleaning schedules were followed. Staff had access to protective equipment designed to protect people from infection. People’s rooms were clean and fresh, but windows inside and out were grimy and smeared.

Staff had developed positive relationships with people and made visitors feel welcome. Staff protected people’s privacy and made sure information was confidential and only shared when appropriate to do so.

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care and monitoring the quality and risk at the service.

Please see the action we have told the provider to take at the end of this report.

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.

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 8 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Woodmarket House provides accommodation for up to 42 people. At the time of our inspection 41 people were living at the home. The service is on two floors accessible by stairs and a passenger lift. There are five communal lounge as well as two separate dining areas for people to use. All of the bedrooms are single occupancy. There is also access to a garden area for people to use should they choose to.

People who used the service were safe. They were supported and cared for by staff that had been recruited under recruitment procedures that ensured only staff that were suited to work at the service were employed.

People did not have concerns about their safety and staff knew how to protect them from abuse and avoidable harm. People's care plans included risk assessments of activities associated with their personal care and support routines.

The risk assessments provided information for care workers that enabled them to support people safely but without restricting their independence.

There were suitably skilled and knowledgeable staff employed. The registered manager was investigating whether they were effectively deployed to meet the needs of the people using the service.

People were supported to receive the medicines by staff who were trained in medicines management.

Medicines were stored safely and managed safely ensuring people received their medicines when they needed them. Care workers were supported through supervision and training. Relatives told us they felt staff knew what they were doing.

The registered manager understood their responsibilities under the Mental Capacity Act (MCA) 2005. Staff had awareness of the MCA and understood they could provide care and support only if a person consented to it and if the proper safeguards were put in place to protect their rights. There were people at Woodmarket House who were being cared for under Deprivation of Liberty Safeguards.

People enjoyed the food that was offered to them and were supported to maintain a healthy diet. They could choose what they ate and their preferences and requirements were known by staff.

People had access to healthcare professionals to maintain good health.

People told us they were treated with dignity and respect. The registered manager encouraged staff to become dignity champions. A Dignity Champion is someone who believes passionately that being treated with dignity is a basic human right, not an optional extra. They believe that care services must be compassionate, person centred, as well as efficient, and are willing to try to do something to achieve this.

People’s care plans were centred on their individual needs. Their care and support was based on these. People knew how to raise concerns if they felt they needed to. People were confident these would be taken seriously by the provider.

People had access to a variety of activities if they chose to take part.

The service had effective arrangements for monitoring the quality of the service. These arrangements included asking for people's feedback about the service and a range of checks and audits. The quality assurance procedures were used to identify and implement improvements to people's experience of the service.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

We found that people who lived in the home were very happy with how they were treated and that they felt welcome in the home. We saw some people were relaxing with their visitors in one of the lounges, whilst others were watching television and others were making seasonal greetings cards, with assistance from the staff.

One person who lived in the home told us, 'I do enjoy my time here.'

A family member told us, 'I am really happy with the care X is receiving there.'

We also looked at the physical surroundings within the home and found that the environment was welcoming and safe.

We saw that any comments and complaints were managed well, and in accordance with the Provider's appropriate policies and procedures.

We also reviewed how the home dealt with information and records of the people who lived at the home and of the staff members. We found that the Provider had clear polices and procedures in place. Information was used, stored and shared securely.