Archived: Woodlands Care and Nursing Home

Woodlands Care and Nursing Home is a care home providing personal and nursing care for up to 50 people. On the day of inspection 14 people were living at the service. Some people were living with dementia and some had nursing care needs. The service is built over two floors and bedrooms are accessed by both a lift and stairs. Communal areas are spaced throughout the service.

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

Improvements were required with the governance of the service. A lack of senior oversight and leadership had impacted on the service continuing to make required improvements to reach the expected rating of Good. The provider’s inspection history demonstrates improvements have not been sustained and embedded.

A schedule of works to improve the environment had commenced, whilst COVID-19 had impacted the service, there was a lack organisation, priority and oversight of this work. Risks associated with the environment and infection prevention and control practice had increased and put people at potential risk of harm.

The provider's internal systems and processes that monitored health and safety were ineffective. Concerns and shortfalls in the fundamental care standards identified by audits and checks completed by external agencies and during this inspection had not been identified.

People’s individual risks had been assessed and planned for. Guidance for staff of how to mitigate risks were in the main up to date. Where care records needed to be updated, the manager was aware of this and was taking action. Staff were knowledgeable about people’s care needs.

Improvements were required with the storage and management of medicines to ensure best practice guidance was maintained.

The registered manager had recently resigned, some concerns were identified in the recruitment of the new manager for this position.

Sufficient staff were deployed to meet people’s individual needs and safety. People’s dependency needs were regularly assessed to determine the staffing levels required. Agency or bank nurses were used whilst permanent nurses were being recruited. These were booked in advance to ensure consistency and continuity. Recruitment checks were completed before new staff were appointed to ensure they were suitable to care for people.

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 Requires Improvement (published 23 October 2020). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last five consecutive inspections.

Why we inspected

We received concerns from the local clinical commissioning group following an audit visit at the service, where concerns were identified with infection prevention and control, and risks associated with the environment. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 coronavirus and other infection outbreaks effectively.

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 Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider had taken some immediate action following the external audit completed by the local clinical commissioning group, and further improvements were being made.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodlands Care and Nursing 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one breach in relation to governance of 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 and Nursing Home is a care home providing personal and nursing care, providing support for up to 50 people. On the day of inspection 15 people were living at the service. Some people were living with dementia and some had complex needs. The service is built over two floors and bedrooms are accessed by both a lift and stairs. Communal areas are spaced throughout the service. There have been a number of recent improvements to the building that include a new decked area off of the main lounge and improvements to a conservatory adjacent to the main dining room.

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

At our last inspection, concerns with medicines management were identified. At this inspection the administration and recording of medicines was improved. Following the last inspection, the service made improvements to infection prevention and control (IPC) procedures, the building was observed to be clean and hygienic and care staff were observed to follow national guidance as related to IPC. Risk assessments for people who exhibit behaviours that challenge was improved from the prior inspection and people were better monitored to keep them and others safe. An action plan was developed by the registered manager to address shortcomings in service delivery at the previous inspection. We determined the areas for improvement outlined in the previous inspection had been addressed.

We observed environmental improvements designed to keep people safe and improve their daily lives. Systems to monitor health and safety in the service were more robust. There was improved recording of accidents and incidents and to the home’s complaint procedure. Assessment and monitoring of risk and additional audits had been implemented. Systems and processes were improved from our last inspection, however there had not been enough progress to embed improved practices for staff, specifically around recording. We have made a recommendation to the provider regarding the need to improve their recording practices.

Policies and procedures were in place to provide guidance and expectations for staff on a variety of topics. The safeguarding and whistleblowing policies did not contain detailed instructions for staff to follow. We have made a recommendation to the provider to include practical information in these policies for staff to follow should they have a concern.

There were an adequate number of staff available to support people to remain safe and to meet their needs. The registered manager monitored staff performance to ensure they worked effectively and responded to people’s needs promptly. Staff received training relevant to their roles. Recruitment was underway to hire additional nursing staff for the service. Staff rotas were organised to ensure a good skills mix existed on all shifts. For some nurse-led tasks there was a reliance on outside health partners to assist the service. We have made a recommendation to the provider that all nurses employed by the service receive relevant training and competency checks.

There was a vision and strategy to progress the care and support offer for people. Staff felt the management of the home was heading in a positive direction and thought the registered manager was approachable and would respond to any concerns. The registered manager had increased audits and checks throughout the service, however all actions resulting from these were not followed through. We have made a recommendation to the provider to ensure that all actions resulting from audits and checks are completed.

The registered manager engaged people to help design their personal spaces and considered their individual needs in this process. There was evidence of partnership working with partner agencies. In response to the coronavirus pandemic plans had been developed to create safer spaces for people, a safer workplace for staff and a visiting process for relatives and professionals.

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) At the last inspection the service was rated Requires Improvement (report published 22 April 2020). 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 had made improvements in behavioural management, medicines management and IPC practice and was no longer in breach of Regulation 12: Safe care and treatment. There was sufficient progress to resolve a breach of Regulation 15: Premises and Equipment. Sufficient improvement had been made to remove the breach of Regulation 17: Good Governance.

The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. 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 coronavirus and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 20 February 2020. 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 safe care and treatment, their premises and equipment and good governance.

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 of 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. 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 and Nursing Home on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements and have made recommendations. Please see the Safe and Well-Led sections of the full report.

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.

Woodlands Care and Nursing Home is a care home that was providing personal and nursing care for up to 50 adults and older people with a range of health needs such as dementia and physical disability and provides palliative care. At the time of the inspection 30 people were in residence.

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

Since our last inspection, the provider had made some improvements to the medicines system, but there was further work and closer monitoring required to ensure people were provided with medicines safely. We found that infection control could be improved and cleaning schedules made more detailed to ensure staff were fully aware how all areas of the home were cleaned thoroughly and were hygienic. There was work required to ensure people’s safety and all the required changes in the 2018 electrical report had not been carried out.

The complaint procedure was not used effectively. Though people were encouraged to complain if they wished to, the current procedure needed to be updated and local authority contact details added. Monitoring of complaints made to staff was not completed thoroughly and a complaint remained uninvestigated.

The provider’s governance system was still not fully implemented. Further action was needed to improve the monitoring, consistency in the leadership and quality of care and support.

People told us they felt safe at the service. Some risks to people’s health, safety and welfare were assessed, managed and monitored to protect people from avoidable harm. People were mostly supported to take their medicines safely and people’s healthcare needs were met promptly.

There were enough staff to meet people’s needs and the registered manager continued to monitor staff to ensure they worked effectively and responded to people’s needs promptly. 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 procedures developed by the service supported this practice. People were provided with a choice of meals that met their dietary and cultural requirements and were supported by staff to eat as required. People were supported by staff who had undertaken training in topics such as safeguarding and health and safety procedures. Staff were knowledgeable about people’s needs and had their competency assessed.

People’s equality and diversity was respected, and their privacy and dignity maintained. People had developed and maintained positive relationships with staff, and family and friends. People’s cultural and religious needs were identified and supported.

People’s rights and choices were promoted, and they were protected from discrimination. People were cared for by kind and caring staff. People’s privacy and dignity was protected, and their independence was promoted by staff. People’s wishes as to their end of life care were identified, planned for and respected.

People and relatives were involved in aspects of care planning where appropriate. People, and where appropriate their relatives, were encouraged to contribute to care reviews. People had opportunities to take part in organised activities and outings. People received visitors and maintained contact with family and friends. People, their relatives and staff had opportunities to give feedback and influence service development.

Rating at last inspection and update

At the last inspection the service was rated Requires Improvement (report published 3 April 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 had made some limited improvements in medicines but remained in breach of Regulations 12: Safe care and treatment. There had also been some improvements in Regulation 17: Good governance, though further improvement was needed to ensure people received safe care through an effective monitoring process. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

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

Why we inspected

This was a planned inspection based on the rating of the service at the last inspection. At this inspection the domains of safe, effective, responsive and well led were rated as requires improvement.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

Woodlands Care and Nursing 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.

Woodlands Care and Nursing Home provides accommodation for up to 50 older people, this included people with nursing care needs and some people living with dementia. At the time of the inspection there were 27 people living there.

The service did not have a registered manager. The previous registered manager was no longer working in the service; however their name remains on this report until they are de-registered. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The provider had appointed a new manager who was planning to apply to the Commission for registration.

The provider’s quality assurance systems had not been effective in learning lessons and ensuring timely improvements were made within the service. People’s care was not always fully assessed and not all their needs were responded to, including how risks were managed. People’s care records did not always reflect how they needed to be supported. People felt there were sufficient staff available to provide their care and support, however the staffing arrangements did not allow for staff to be involved with meaningful activities with people.

Medicines were not managed safely. Safe systems were not in place to ensure medicines were suitably administered and stored. Infection control practices were adhered to by most staff, but we observed people did not have an opportunity to wash their hands before meals and people did not use individual slings when being supported to move. Staff had received training to develop and maintain their skills and knowledge; however, we found this had not always enabled them to provide care under best practice guidelines.

People felt that the staff were kind and caring. However, dignity was not always promoted in relation to personal care and ensuring people received the care they needed to be safe and well.

People enjoyed a variety of food and drink. Improvements had been made with how this was monitored. People were supported by staff who were recruited safely.

Where people had provided information about how they would like to be cared for at the end of their life, this was recorded. Staff felt they supported people at the end of their life with compassion and care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People made decisions about their care and staff helped them to understand the information they needed to make any decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests. Where people’s liberty was restricted, this had been done lawfully to safeguard them.

People and staff were positive about the recently appointed manager and how the service was currently managed. People had access to a range or health care service to keep well. People felt any complaint or concern would be responded to.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager at this service. 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. At our last inspection in February 2015 the provider was in breach of Regulation 12 Safe care and treatment. At this inspection we found they had met this breach. However this took the intervention of a senior manager from the provider to recognise and meet this breach.

During our inspection visit we observed that staff were friendly and approachable. However they did not spend time with people other than to meet their basic needs. At times staff walked through the communal areas without speaking or acknowledging people.

People’s physical and mental health was promoted. Some staff were trained to care for people living with dementia. Medicines were stored appropriately and were administered and recorded as prescribed. However the process of administering medicines took too long and this delay could impact on time sensitive medicines.

There was a process in the service to ensure the Mental Capacity Act and the Deprivation of Liberty was used to protect people. However we found that the registered manager did not fully understand this and made some unnecessary referrals to the Local Authority.

We saw staff ensured people were comfortable. However people’s dignity was not always promoted when they were been assisted to move using a hoist. Some people’s clothing had risen up and this left them in an undignified position they could not control themselves.

People were offered choices at meal times and were seen to enjoy their food. Although some people who struggled with eating they were not offered support. When people were offered a snack staff made the choice for them rather than taking time and allowing people the choice. There were two dining rooms and there was a marked difference between both. In one the dining experience was promoted and the other lunch was served in a haphazard manner.

Most staff were caring and communicated well with people, however some staff focused on the task they were carrying out rather than on people. Some staff spoke over people’s heads. Most staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes.

Staff understood how to keep people safe, however if they had concerns they were not always aware of who to contact outside the service to address this. Assisting people to move using a hoist was not always carried out in a safe manner as people did not have individual slings bases on their weight and size. This put them at risk of an accident or injury as the sling needs to fit people correctly to keep them safe.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time.

Records we looked at were not always easy to follow and although they contained good information they were not always personalised. They did not always included decisions people had made about their care including their likes, dislikes and personal preferences.

Staff were well supported and had regular meeting with their line manager to ensure they had the training and information to care for people.

The service was not always well managed. The management of the service lacked structure. The registered manager was not always able to recognise areas of the service that required input to ensure good outcomes for people and staff. There was no clear leadership and the deployment of staff and responsibilities was not always clear. There were sufficient staff on duty however they were not effectively deployed and this meant people were left unattended at times and had to wait for their needs and wishes to be met.

During the inspection we observed and spoke with people who used the service, a relative and staff. One person we spoke with told us, "I'm having a good time". Another said, "The food is lovely here and the staff are really nice". We found most people received the support, care and treatment they needed.

People who used the service received a sufficient and nutritious diet, and where they needed support they were provided with appropriate assistance. We observed people make choices about food and drink, and we saw that staff were responsive to people's requests.

We saw that medication prescribed for people who used the service was securely stored and safely administered. People were protected from the risks associated with medicines because effective systems were in place to manage medicines at the home.

We noted that improvements in some areas of the home were required to ensure people's exposure to the risks associated with cross infection were not compromised. Poor levels of maintenance meant some areas of the service were not clean.