Woodville Residential Care Home

Woodville Residential Care Home is a care home which provides personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 46 people. The service accommodates people in one building over two floors and has adapted facilities to meet people's needs. This included two lounges, one with a dining area, a separate dining room and a conservatory. An enclosed rear garden was also available that people could access.

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

The provider had made significant improvements to the home, they had shared with us an action plan which was reviewed on a weekly basis. People who used the service noted the improvements in relation to organisation and staff knowledge.

Audits and systems were now in place. These need to be continued and developed with clear oversight to ensure the improvements are sustained and embedded. Care plans had been identified by the provider as not always being up to date. A workstream was being developed to address this area.

The provider recognised their role in ensuring duty of candour and ongoing communications with people and relatives. Notifications were now being completed which enables us to monitor the service following any incidents or events.

The provider worked with health and social care partners and following external inspections any required actions were completed.

There were sufficient staff to meet people’s needs and staff had received additional training to support their role. Staff were recruited following appropriate checks to ensure they were safe to work with people. People and relatives praised the staff for their kindness and compassion in the care they provided.

Risk assessments had been reviewed and all areas of risk were now being reviewed and any concerns mitigated with equipment or advice from other professionals. People were protected from harm with staff having clear understanding of what and how to report any safeguard concerns.

Medicines were now managed safely, and ongoing audits were being used to make further improvements. Infection prevention and control was now managed to ensure people were protected from the spread of infection. Staff understood the importance of personal protective equipment and used it appropriately. Government guidance was being followed for testing, admissions and visitors.

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 Inadequate (published 7 June 2021) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 7 June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Inadequate to Good. 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 Woodville Residential Care Home on our website at www.cqc.org.uk.

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.

Woodville Residential Care Home is a care home which provides personal and nursing care to 44 people aged 65 and over at the time of the inspection. The service can support up to 46 people.

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

Risk to people were not always assessed and actions taken to mitigate the impact. Medication was not always managed safely and where mistakes had been made, management did not have oversight to make improvements.

Infection prevention and control was not well managed, and areas of the environment required attention to ensure it was kept clean and in good repair.

Staff recruitment was safe, however, there was not sufficient numbers of staff to support people’s needs. Staff were kind and committed to providing good care, however felt restricted by the lack of support, information and organisation.

The service lacked management oversight. Audits which had been completed were not always a true reflection and any areas identified where not followed up to ensure the changes or improvements were made. The provider had not ensured good oversight of the home in maintaining peoples care and safety.

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 11 January 2019)

Why we inspected

The inspection was prompted in part due to concerns received about complaints and whistle blowing about the quality of the care being provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We have found evidence that the provider needs to make improvements.

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 changed from Good to Inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodville Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety, infection prevention and control, staffing levels, medicines and good governance at this inspection.

The provider responded swiftly to our concerns and has put an action plan in place to address the concerns raised and are working with us to monitor 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.

Follow up

We will request an action plan for 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Woodville Residential 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.

Woodville Residential Care Home is registered to provide personal care and accommodation for up to 46 people. At the time of our inspection 45 people were using the service. The service accommodates people in one building over two floors and had adapted facilities to meet people’s needs. This included two lounges, one with a dining area, a separate dining room and a conservatory. An enclosed rear garden was also available that people could access.

The service 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. The registered manager was not available on the day of the inspection.

At our last inspection in September 2017 the provider had been in post at the home since August 2017 and we found that the fundamental care standards were not being fully met. This resulted in the service being rated as requires improvement. This was because the staffing levels in place at that time were not sufficient, medicines were not managed safely, social opportunities for people to participate in activities were limited and quality monitoring systems were not in place.

At this inspection improvements had been made in these areas but further improvements were needed. Quality monitoring systems were in place and this included the recording and analysis of falls. However, further improvements were needed to ensure patterns and trends were identified. This was to enable actions to be taken, to minimise risk and keep people safe. We have made a recommendation about the management of falls.

The staffing levels had increased but the deployment of staff required improvement to ensure sufficient numbers of staff were available in all areas of the home. Although improvements had been made to the social opportunities provided to people; further improvements were needed to ensure opportunities were available throughout the day to enhance people’s well-being. We have made a recommendation for the provider to review the current guidance on meaningful activities for older people.

Improvements had been made in the management of medicines. We saw these were managed safely and people received their medicines as required. Staff understood what constituted abuse or poor practice and knew how to report concerns. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Staff understood people’s care and support needs to enable them to support people in their preferred way. Staff received support from the management team and were provided with the relevant training to ensure people’s needs could be met.

Plans to respond to emergencies were in place to enable staff to support people in accordance with their needs, in an emergency situation. People had the equipment they needed to enable staff to assist them safely. The provider checked that equipment was regularly serviced to ensure it was safe to use.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People and their representatives were involved in their care to enable them to make decisions about how they wanted to receive support in their preferred way. People received a balanced diet that met their preferences and assessed needs. People were supported to access healthcare services and received coordinated support, to ensure their preferences and needs were met.

People were treated respectfully by the staff team and the practices in place enabled people to maintain their dignity. People were supported to maintain relationships with those who were important to them; such as family and friends.

People and their representatives were involved in the planning of their care. There were processes in place for people and their representatives to raise any concerns about the service provided.

People and their representatives were consulted and involved in the ongoing development of the service. Staff understood their roles and responsibilities and felt supported by the management team. The provider understood their responsibilities around registration and worked in partnership with other agencies to meet people’s needs.

Woodville Residential Care Home is registered to provide accommodation for up to 46 people who require personal care support. At the time of our inspection there were 45 people using the service. Some people that were using the service were living with dementia.

This inspection took place on the 26 September 2017. This was an unannounced inspection. Prior to this inspection we received information of concern regarding the management of medicines. Our last comprehensive unannounced inspection took place on 12 August 2015 and the provider was rated as good overall and were meeting all the regulations that we checked relating to the Health and Social Care Act 2008.

Since August 2017 the organisation Greenacres Nursing Homes Limited that owns Woodville Residential Care Home had been purchased by Prime Life. This means that the changes to registration are that of the company directors and the nominated individual. A nominated individual acts as the main point of contact with us on behalf of the organisation and carries responsibility for supervising the management of the service.

The service did not have a registered manager in post at the time of this inspection. 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 manager had been appointed under the new directors and confirmed they were in the process of applying to register with us.

People’s needs were not always met in a timely way as the staffing levels were insufficient. The limited staff numbers meant opportunities for people to receive social stimulation were limited. This had been identified by the new providers and was being addressed. We could not be assured that identified risks to people were minimised; as some information was conflicting and not updated when people’s needs changed. The medicine practices in place did not demonstrate that people always received their medicine as prescribed. Checks to monitor the support and services provided were limited. Those that had been undertaken were not always effective in analysing any themes and trends, to ensure risks to people were minimised. This had been identified by the new provider and systems were being put in place to address this.

Staff understood their responsibilities to keep people safe and checks had been completed before staff commenced employment, to ensure they were suitable to support people. The provider checked that the equipment was regularly serviced to ensure it was safe to use. Staff told us that they were supported by the management team and were provided with the relevant training to ensure people’s needs could be met.

Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions. Where people were unable to make decisions the staff supported them in their best interests. People received food and drink that met their nutritional needs and preferences and were referred to healthcare professionals to maintain their health and wellbeing.

People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us they were made to feel welcome and that staff were approachable and friendly

People and their relatives were involved in discussions about how they were cared for and supported. Complaints were responded to and the provider’s complaints policy and procedure was accessible to people. The provider had ensured that people and their representatives had been consulted regarding the changes in home ownership and the improvements planned. Plans were in place to gather people’s views through satisfaction questionnaires.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

People who used the service told us they felt safe living at the service and were able to describe what they would do if they were worried about anything. Staff had received training on keeping vulnerable people safe.

People told us that staff usually talked things over with them before and during carrying out their care. However, adequate arrangements were not in place for decisions to be made on people's behalf when they did not have the capacity to consent. We have asked the provider to tell us what they will do to meet the requirements of the law in relation to mental capacity.

Is the service effective?

Care plans provided staff with guidance in meeting most people's needs. Recorded risk assessments were in place to address risks to which people may have been exposed. However, these records were not in place for everyone. This meant that staff were not being provided with up-to-date guidance as to how they should safely manage risks for everyone. We have asked the provider to tell us what they will do to meet the requirements of the law in relation to assessing people's needs and risks they may be exposed to.

Staff had positive views on the service. One member of staff told us that, 'it's up to us to make [the service] happy and safe.'

Is the service caring?

People told us they thought that staff knew their personal wishes, interests and preferences and thought that their needs were met at the service. One person said, 'I can pretty well do as I like.' Staff told us that most activities reflected people's individual preferences.

We observed, and heard, staff interacting warmly and sensitively with people who used the service.

Is the service responsive?

People's personal records showed that staff were encouraged to take an approach to people which was centred on their individual needs. People's personal preferences and interests were identified and acted on and care and support was provided that met people's wishes.

One staff member we spoke with gave us an example of action the service had taken following a suggestion they had made. Another member of staff told us, 'If I have a problem it will be sorted.' Staff told us they felt listened to by the manager.

Is the service well-led?

The service had a quality assurance system which identified, assessed and managed risks to people's health, safety and welfare.

Staff described a sound set of values upon which the service was based. These included meeting people's needs for privacy, confidentiality and empathy and providing a clean and tidy environment.

People were provided with a comprehensive care plan that looked at what they needed and guided care workers as to how they should meet people's needs. Those who spoke with us told us they were satisfied with their care and were happy with staff who provided their care.

People said doctors and nurses visited the home when they needed them. They also confirmed visits by the chiropodist, dentist and optician.

We asked a visitor to the home if they had any concerns about any of the staff employed at the home. They told us they had no concerns and added 'staff know what to do and they do it well'.

People who spoke with us told us they were aware of care workers making daily notes about them. They also indicated they had no concerns in this area.