Archived: Woodcot Lodge Care Home

Woodcot Lodge is a nursing home which is registered to offer personal and nursing care to 85 older people, some of whom live with dementia. The home had three floors, with a lift providing access to all floors. Since the focused inspection in April 2016 the provider had made the decision to close the second floor. Some people from this floor were moved to the other two floors of the home and some people were relocated in other homes. The ground floor was referred to as 'residential' and the first floor accommodated people who had a nursing need. At the time of our inspection 54 people lived at the home; three of these people were in hospital.

The home had a registered manager. 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.

There had been a history of non–compliance with the regulations at this service since September 2013, which we had continued to monitor. Due to the on-going breaches we had been following our enforcement pathway. At the focussed inspection in April 2016 we found the provider was still in breach of three regulations, which related to risk assessments, personalised care and quality assurance systems. Whilst these breaches remained we found the impact on people was low.

At this inspection we found progress had been made in all areas and the service was no longer in breach of regulations regarding safe care and treatment, person centred care and quality assurance. However one recommendation has been made and there is a continued breach of Regulation 17 regarding record keeping.

Staff understood the principle of keeping people safe and the registered manager made appropriate referrals to the local safeguarding team. Risk assessments had been completed and staff were aware of the risks facing people and how to minimise these risks. Staffing levels met the needs of people during the inspection. When staffing levels were low at short notice the registered manager was unable to fill these shortages, which meant staff were rushed.

Recruitment checks had been completed before staff started work and updated for long term staff to ensure the safety of people.

Medicines were administered and stored safely; however there had been a few recent medicine errors, which had been investigated and reported, but the errors were similar to concerns in previous inspections, We have made a recommendation regarding the policy and processes in place for when medicines have been refused by a person for a period of time.

There was a training programme and staff enjoyed the training and felt it equipped them to do their job. Staff had a good knowledge of the Mental Capacity Act (2005) which had been incorporated into people’s records. People enjoyed their meals and there was support for those who needed it. People were supported to access a range of health professionals.

People received personalised care which took into account their choices and preferences. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

People felt the staff were caring, kind and compassionate. The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the registered manager and were clear about their roles and the values of the home. Records were not always accurately maintained. There was an effective quality audit system.

We found a repeated breach in one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

With regard to previously identified concerns, we have followed our enforcement pathway which resulted in us taking proposed action to cancel the providers registration for this service. The provider made representations to us against this decision but it was not upheld, which resulted in the decision being scheduled to be heard at a first tier tribunal at a future date. However, as a result of the findings of this inspection, we have found the provider has taken appropriate action and has made improvements which we will continue to review through monitoring and inspection.

This inspection took place on 12 and 14 April 2016. Woodcot Lodge is a nursing home which offers personal and nursing care for up to 85 older people, some of whom live with dementia. The home has three floors, with a lift providing access to all floors. The second floor accommodates people living with dementia and the first floor accommodates people with nursing care needs. The ground floor is referred to as 'residential' and accommodates older people who do not fall into the other two categories. At the time of our inspection 61 people were living at the home.

The home has a registered manager. 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.

A week before the inspection the local authority safeguarding lead wrote to us, to inform us their staff had noted recent improvements in the home. The provider contacted us two days later to inform us they were closing the top floor, as they wished to focus on providing good care on the ground and first floor. They had recognised the care they were offering on the top floor was not up to the standard they expected to provide.

As a result of this information and feedback we undertook a responsive inspection to look at what the current position was and check on the progress of the previously breached regulations. This report only covers our findings in relation to our unannounced inspection on the 12 and 14 April 2016 about progress in relationship to the previous breached regulations. The previous breaches related to safe care and treatment, nutrition, person centred care, consent and good governance. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link of Woodcot Lodge on our website at www.cqc.org.uk.

We found progress had been made in all areas, but there was still room for improvement, but the impact on people was low.

Risk assessments had not been completed for all people to ensure staff were aware of the risks facing people.

People were supported in a respectful manner to ensure they received a balanced diet.

People had their mental capacity assessed and best interest decisions had been made appropriately.

All people were not receiving personalised care.

Quality assurance processes and record keeping had improved but here were still shortfalls in these areas, which had not been identified or addressed.

We found repeated breaches in three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is considering the appropriate regulatory response to the shortfalls we found during this and previous inspections. Where providers have not been meeting the fundamental standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

During this inspection we followed up on two warning notices that were served on the home on 31 July 20014. These warning notices related to our serious concerns about the care and welfare of people who used the service and the poor standard of record keeping in the home. Our inspection report relating to this is available on our website and should be read in conjunction with this one.

The day before our inspection we received some information of concern from a whistle blower. These concerns related to staffing levels and medicines. We looked at these concerns under the outcomes for care and welfare and records.

During the inspection we spoke with 10 staff, five people who lived in the home, three relatives and one health care professional who visited the home regularly. We also spoke with the manager, who had recently registered with the Commission to carry on the regulated activities in this home.

We looked at eight people's care plans in detail and six care plans were sampled. We also looked at other documentation including medicines records, rotas and daily notes.

Where people were unable to speak with us due to their complex needs, we used other methods to help us understand their experiences. We used the Short Observational Framework for Inspection (SOFI) over the lunch time period.

There were 54 people accommodated at the point of our inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

This is a summary of what we found-

Is the service safe?

People we spoke with told us they felt safe living at the home. When we asked one person what made them feel safe they said, 'Well, there's always someone around, you only have to ring your buzzer and they come.' Another told us, 'I feel safe as I know people and staff.' We found the service was safe because people were protected against the risks associated with inaccurate and ineffective records. We saw the home had made improvements to the record keeping, including care plans and daily records. This meant care was better planned for and delivered in a way that ensured people's welfare and safety.

Is the service caring?

Relatives and people who lived in the home told us it was a caring home. One person told us, 'Staff are lovely, nothing is too much trouble. You've only to ring your bell and they are here like a shot, no waiting around.' A relative said, 'Staff are brilliant, so caring.' Another said, 'I have no problems, all the staff are lovely. If I have a problem I can talk to the staff and they will sort it out.' We saw examples of staff supporting people in a caring way. The majority of staff were, kind, patient and polite to people. However, we noted that staff were busy, in particular at lunch time and this meant some people waited a long time for their meal.

Is the service responsive?

The home had responded to concerns raised by us and other professionals who visited the home. We saw that they had addressed the serious concerns raised in our Warning Notices. We also noted that the home responded to events as they occurred, for example when staff were off sick at short notice we saw that alternative arrangements were made. A member of staff told us, 'There have been a lot of improvements in the past couple of months, the management team have worked their socks off to get the records straight, they did need it but they have worked hard to do a great job.'

Is the service effective?

The changes made to the record keeping in the home have led to improvements in the planning and delivery of care. We saw examples of action taken when incidents occurred and care plans being updated to reflect a person's change in needs. Staff told us they were clearer on what they needed to do to carry out their role.

Is the service well led?

A member of staff told us '.I have a very good relationship with the manager, in my view she is excellent.' Another said 'I think the manager does a good job, she is approachable and friendly.' Other staff were not positive about the leadership of the home, one told us 'She is a good manager but not very approachable.' Other negative comments were made by staff however; we did not find evidence to support these views. The relatives we spoke to were very happy with the management of the home. They said they could speak to the manager if they had concerns and things got resolved quickly. We spoke with a professional who had been involved in the home and they were positive about the changes made by the management team.

During this inspection we followed up on two warning notices that were served on the home on 24 April 20014. These warning notices related to our serious concerns about the care and welfare of people using the service and staffing arrangements in the home. Our inspection report relating to this is available on our website and should be read in conjunction with this report.

We also looked at other areas where concerns had been raised with us both prior to and during the course of our inspection.

Over the three days we spoke with 13 staff, four people who lived in the home, 15 relatives and three health and social care professionals who visited the home regularly and were involved in people's care. We also spoke with the manager, the regional manager, the managing director and a member of the provider's central audit team.

We looked at 15 people's care plans, and other documentation including medicines records and daily notes. We observed the care and treatment of people on all three floors including during lunch.

There were 56 people accommodated at the time of our inspection. There was no registered manager for the home. The current manager was in the process of applying for registration with the Commission at the time of our inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service caring?

Is the service responsive?

Is the service effective?

Is the service well led?

This is a summary of what we found

Is the service safe?

We found the service was not safe because people were not protected against all the risks associated with inaccurate and ineffective records. This included care plans and medicines records. Care was not planned and delivered in a way that ensured people's welfare and safety. The home had reduced the number of agency staff that were being used by recruiting into vacant positions. Relatives and staff told us this had a positive impact on people who lived in the home. One relative said "The new staff are better" and in relation to the deployment of staff they said, "Measures they've taken are improving things." A staff member told us, "Staffing has improved massively." Staff knew how to respond to suspicions and allegations of abuse and the provider had ensured they received training in this.

Is the service caring?

Relatives and people who lived in the home told us it was a caring home. One said 'Staff are wonderful.' Another said 'I have no problems, all the staff are lovely. If I have a problem I can talk to the staff and they will sort it out.' We saw examples of staff supporting people in a caring way. However, we also saw examples of how staff treated people in a way that lacked empathy and understanding. For example, staff who did not not respond to a person who constantly called out.

Is the service responsive?

The home had responded to concerns raised by us and other health and social care professionals who visited the home. We found the management team willing to work with us to improve the service. For example, to improve staffing numbers and ensuring staff were aware of their responsibilities in relation to safeguarding. Improvements were still needed to people's care planning records to enable staff to provide the appropriate care and treatment and respond to their changing needs.

Is the service effective?

The systems used to monitor and audit the home were not always effective. For example, the monitoring and auditing of care plans did not ensure that all care plans were accurate and up to date. Care planning documentation was not effective in ensuring that staff knew what care and treatment was required for each person. For example in relation to food and fluid intake. The records did not detail people's individual needs, for example in relation to pressure area care, to ensure they received safe and appropriate care and treatment.

Is the service well led?

Staff and relatives told us they had noted the improvements in the home since the new management team came into post. Whilst there were still areas of non-compliance and serious concerns raised at this inspection, the manager acknowledged this and was prepared to work with us to ensure improvements were made. One member of staff commented on the new management team. They said there had been, "Improvement in meeting needs. Running a lot better." We saw that the home had a range of auditing systems in place, however they had not been fully effective in ensuring compliance.

We spoke to nine members of staff, including nurses, care staff and an activities coordinator. We also had discussions with the regional manager who was in the home that day.

Views were mixed about the home with the majority of relatives we spoke to being happy with the care in the home. However, we saw comments in people's notes from relatives which showed those people were not always happy with the care of their loved ones. Many relatives spend long hours at the home, assisting their loved ones with meal times and personal care. Some commented to us that they did this because they felt if they didn't "It wouldn't get done".

We noted that in the main staff were cheerful and caring towards people. We saw staff encouraging a group to get involved in an activity.

We received some positive comments from relatives such as 'He's settled and seems quite contented; he's really blossomed.' Another said, 'The staff are very nice and kind, although I'm not sure there are quite enough of them.'

Another relative commented about their father, 'He had a fall here at Christmas and it's knocked him back a bit. I've been pushing them to get his eyes tested and also his dentures need attention since he lost all the weight but the response hasn't been very fast.'

We found that although improvements had been made to staffing levels the service was still non compliant with the warning notice we served.

Prior to this inspection we received concerning information from a whistle blower that staffing levels were low and no improvements had been made since our last inspection.

We visited on 5 December 2013 to check if they were compliant. During this inspection we reviewed the care records of eight people using the service, spoke to six care staff, two registered nurses, the deputy manager and a visiting manager and senior member of staff from another home belonging to this provider. The care staff and registered nurses we spoke to will be referred to as "Staff" throughout this report as they do not wish to be identified.

On the day of our visit the deputy manager told us she was in charge as the registered manager had resigned and left. There were 73 people being accommodated at the time of our visit.

During our inspection we spoke to 10 relatives and four people living in the home about their views. We met and chatted with other people living in the home and observed the care of some people who were unable to verbally give us their views.

The views of people living in the home and their relatives were mixed. In general people said the staff were good and "Worked hard". The majority of relatives said that staffing levels were too low and there were often not enough staff on duty to meet people's needs.

Staff told us they were stressed and exhausted due to low staffing levels. They told us they were regularly understaffed and people were going off sick and leaving due to the working conditions. The majority of staff said they loved their job and cared about the people living in the home. Some said they found it difficult to do their job to the standard they would want to due to low staffing levels.

We found that the staffng levels were not adequate to meet the needs of people. Even when the home had their planned level of staffing numbers, we found evidence that people's needs were not being met. This meant that the home had not complied with the regulation.

People we spoke with were positive about the care and support that they or their relative received. We found members of staff had all received training in dementia care and were enthusiastic and engaged positively with people. One relative told us how their parent 'was treated like royalty here.' Another told us that whenever they had concerns, these were positively resolved. We spoke with one relative who had recently had concerns and they were raised with the registered manager who subsequently resolved them.

During our inspection, we saw one to one and small group activities being undertaken. We found members of staff encouraged people to participate.