This unannounced inspection took place on 27 and 28 October 2014. Woodland View provides accommodation and nursing care for up to 60 people who are living with dementia and have complex needs. The home is level access and consists of four individual ‘cottages’ linked by corridors.
We last inspected this service in July 2013 and found that it was meeting the requirements of the regulations we inspected at that time.
During our visit we spoke directly with four people who lived at Woodland View and with three relatives. We also spoke with three nurses, seven support workers, two clinical educators, an activities coordinator, a member of the housekeeping staff, the site operational manager, the overall operations manager and the 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.
Our inspection identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
People’s safety was being compromised in a number of areas. This included how people were monitored and how they sought assistance when in their bedrooms. We also found that medicines were not safely recorded and monitored. Whilst the registered manager had reassessed the number of staff needed to meet people’s needs and was in the process of recruiting to these positions, our review of records identified that staffing levels were frequently below those assessed as required.
Our review of accident and incident records did not provide an accurate record of the concerns observed during our inspection. Similarly, we found gaps within people’s care plans which meant that people may not be protected against the risks of unsafe or inappropriate care and treatment. Care plans contained detailed risk assessments about people’s behaviour, however, risk assessment for other areas of care were less detailed or absent.
Most staff had received safeguarding training and were aware of the possible indicators of abuse and how to report these. Appropriate systems were in place to safeguard and manage people‘s finances. An effective recruitment process was in place.
Whilst there were sufficient staff to support people to eat, we found that the overall meal time experience was not positive and was at times unsafe. Overall, the support observed was task centred with little or no interaction between people and the staff supporting them.
Staff were not always following the Mental Capacity Act (MCA) 2005 for people who lacked capacity to make particular decisions. For example, staff demonstrated varied degrees of knowledge and records provided evidence that the staff were not always making decisions in line with the MCA Code of Practice.
Woodland View had submitted Mental Capacity Act Deprivation of Liberty Safeguards applications for each person living at the home. The safeguards are part of the MCA and aim to ensure that people are looked after in a way which does not inappropriately restrict their freedom.
Staff received supervisions less frequently than the provider’s 6-8 weekly timescale but were not concerned by this. They said that senior members of staff were approachable and felt able to go to them should they need any support or guidance. Staff received a variety of mandatory and other training courses and plans were in place to address any training shortfalls.
Woodland View was in the process of a programme of re-decoration and improvement to make the environment more dementia friendly. Specialist architects had been involved and people, their relatives and staff had been involved in choosing the new décor. Dementia friendly signs to orientate people and pictures to prompt memories and conversations had been ordered.
Whilst relatives were positive about the way in which people were cared for, our observations did not always correspond with these views. We observed some positive and caring interaction but overall found that care was task centred with little interaction with people and few examples of people being offered choice. ‘This is Me', books were in place for some people to provide staff with information about people, their preferences and the things which were important to them. We saw little evidence of this information being used. For example, two staff did not know the surnames of the people they were supporting and the records for one person did not reflect their preferred name.
We observed some good practice about end of life care and the plans the registered manager had to further develop staff practice and support relatives.
Activity coordinators were in place; however, we saw few activities or opportunities to engage people who were less active and found that interactions and engagement were often prompted by people and not members of staff.
We identified a number of shortfalls in various aspects of the service and asked about how the provider monitored the quality of the care provided. We were told that the operations manager conducted audits of the service and requested copies of these. Copies of these audits were requested during and following our inspection but were not provided. The provider later forwarded some documents relating to monitoring the quality of the service. A comprehensive process to monitor the quality of care was not in place.
The registered manager had been in place since November 2013. We received mixed reactions from staff about management and leadership within the service. The registered manager had clear goals for the service and had made a number of changes since being in post. He was aware that some staff were resistant to the changes and plans for the home and had introduced a weekly ‘open door’ session to enable him to address any concerns directly with staff.