Woodlands Care Home

Woodlands Care Home is a residential care home providing accommodation and personal care up to 56 people. The service provides support to people living with dementia and mental health. At the time of our inspection there were 42 people using the service.

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

The provider had not made sufficient improvement since the last inspection. Governance systems had not always identified the areas we found at this inspection. We identified continued concerns with care plans, risk management, and staff skills and competency.

People did not always receive their medicines in line with the prescribers’ instructions. Risks to people were not always managed and learning from accident and incidents had not identified themes or training needs off staff.

The environment was clean and tidy, but some furniture still required replacing to ensure it could be effectively cleaned.

People’s rooms were personalised, and people had a choice of communal and outdoor spaces to spend their time.

People were supported to access health care appointments. The mealtime experience was pleasant, and people told us they were happy with the food and choice available to them. The kitchen team were passionate about providing good quality food.

People were happy with the care and support they received. We received consistent positive feedback about the kind and caring nature of staff.

Staff felt supported by the management team and there was good staff morale at the service.

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 08 July 2019)

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 the provider remained in breach of regulations.

Why we inspected

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

We carried out an unannounced comprehensive inspection of this service on 18 July 2019. Breaches of legal requirements were found. 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, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained 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 Woodlands Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management, medicines, and governance plain at this inspection.

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.

Woodlands Care Home is a residential care home providing personal care to 42 people including people with dementia and mental health at the time of the inspection. The service can support up to 56 people.

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

People were at increased risk of harm, because accurate and up to date records of care and support had not always been maintained to ensure staff had access to person centred information to provide people with safe care and support.

People were at risk from not receiving high-quality person-centred care and support because governance and performance management was not always reliable and effective to ensure assessed risks were managed safely.

Staff had not been assessed or training evaluated to ensure they remained competent and trained to provide people with safe care and support in all situations according to people’s individual needs.

Oversight of infection control practices failed to record, and action changes required to ensure two people’s rooms remained free from unpleasant odours.

Accidents and incidents, including safeguarding concerns, were recorded. However, care plans had not always been updated to reduce the events happening again.

People were supported to enjoy activities and interests of their choosing.

People received good support to maintain a healthy balanced diet and, where appropriate, the provider worked closely with other health professionals to support people with their health and wellbeing.

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.

The registered provider worked within the principles of the Mental Capacity Act 2005 and was in the process of updating records to ensure people’s capacity to consent was clearly recorded.

Staff ensured people received their medicines safely as prescribed.

People were supported by kind and caring staff, but the organisation and leadership of the service adversely effected the overall quality of the care people received.

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 (published 17 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staff competence, record keeping, and a lack of management oversight to ensure people always received safe care and support. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well led sections of this full report. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have identified breaches in regulation 12 (Safe Care and Treatment) and regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because systems were either not in place or robust enough to demonstrate the service was effectively managed. This placed people at risk of harm.

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

Woodlands 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.

The home is situated in Driffield in the East Riding of Yorkshire. There are 46 bedrooms for single occupancy (15 with toilet and wash hand basin facilities) and four bedrooms for double occupancy with wash hand basin facilities. Bathrooms and toilets were shared. The first floor was accessible to everybody using a staircase or a lift.

Woodlands Care Home provides accommodation for up to 54 people some of whom may be living with dementia. At the time of this inspection there were 41 people living at the home and receiving a service.

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.

People told us they felt safe living at the home and staff understood how to recognise and report any signs of abuse. There were effective systems in place to manage any safeguarding concerns and these were reviewed, with actions implemented to keep people safe.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Care workers understood their responsibilities under the MCA and were actively promoting people's independence. The manager and care workers understood Deprivation of Liberty Safeguards. They had made appropriate referrals to the relevant authorities to ensure people's rights were protected. Assessments of associated risks were carried out to ensure any care and support activities were safe and with minimal restrictions.

Assessments were carried out around the home environment including any equipment used, to ensure it was safe for everybody. Where any concerns were highlighted action plans were implemented and reviewed for their effectiveness.

Care workers were supported to complete training, learning and development that enabled them to fulfil the requirements of their role and meet people's individual needs and support their preferences.

People were assessed and supported to take their medicines safely as prescribed. Systems and processes in place ensured people’s medicines were managed and administered safely by staff who had been checked as competent and who followed national best practice.

The provider had systems and process in place to ensure staff were appropriately recruited into the service. Staff received appropriate induction, supervision, support and training to acquire and update their skills to meet people’s individual needs and fulfil their roles.

We observed there were enough staff on duty to meet people’s needs. People confirmed they received care and support from regular care workers who they knew.

The provider completed a range of checks on the systems and processes in place to ensure they were fit for the purpose: to maintain and improve the service. We saw this included oversight of accidents and incidents, complaints and concerns, and other audits and maintenance checks.

People received information in a format they could understand and were supported to communicate their needs, and these were recorded to ensure peoples’ needs were met.

The provider included people or their representatives in discussions regarding their health and wellbeing. Any positive behaviour support plans were evaluated and included input by appropriate health professionals for effectiveness.

People were supported to maintain a healthy and balanced diet. Care plans contained details of people's preferences and any specific dietary needs, they had, for example, whether they were diabetic, had any allergies or religious needs.

Care workers had a good understanding of people's needs and were kind and caring. They understood the importance of respecting people's dignity and upholding their right to privacy.

There was information available on how to express concerns and complaints. People were encouraged and supported to raise their concerns and processes were in place to ensure these were responded to.

The provider employed an activities coordinator. The registered manager was reviewing their input to improve the support people received to enjoy meaningful activities and avoid social isolation.

The registered manager understood their responsibilities as part of their registration with the CQC and had informed the CQC of significant events in a timely way.

There was a defined staffing structure and all staff understood their responsibilities and when to escalate any concerns.

Everybody spoke positively about the new registered manager and the improvements brought about by the new ownership of the home.