Archived: Woodlands Manor Care Home Limited

Updated 1 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to follow up on the actions we asked the provider to make following the last inspection. We also checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection team consisted of three adult social care inspectors, two of whom were familiar with the service and their inspection history.

Prior to the inspection we looked at the information we had about the service. This information included the statutory notifications that the provider had sent to the CQC. A notification is information about important events which the service is required to send us by law. We also looked at information which had been shared with us regarding Woodlands Manor Care Home. We received information from three health or social care professionals prior to our inspection. We used the information they provided to guide our inspection. Since June 2018 organisational safeguarding monitoring by the local authority had ceased because sufficient improvements had been made by the service.

During the inspection we spoke with 11 people who lived at Woodlands Manor and four visitors who were with their relatives. Some people were not able to talk with us about their care, because they were living with a degree of cognitive impairment or were physically frail. Therefore, we spent periods of time during the inspection when we observed care being delivered and watched the interactions between people and the staff. This helped us to understand the experience of people who could not talk with us.

We spoke with the registered manager, the clinical lead nurse, plus seven other members of staff (qualified nurses, care staff, activities staff, catering and housekeeping staff).

We looked at five people’s care records in full and other care records in order to check out specific details. We looked at three staff recruitment files, staff duty rotas and other records relating to the management of the home. These included audits to check on the quality and safety of the service, some key policies and procedures and feedback received from people living in the home and relatives.

Updated 1 December 2018

This inspection was unannounced and took place on 18 and 19 October 2018. When we inspected the service in January 2018 we rated the service as overall Requires Improvement despite recognising that improvements had been made. There was one breach of the legal requirements. Previous to that inspection the service had been rated as Inadequate, was placed the service in special measures and enforcement action was taken.

Woodlands Manor is a care home. People in care homes receive accommodation and nursing or personal care as a 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 registered to provide accommodation and nursing care for up to 40 people, however two bedrooms that were registered as shared rooms were only used by one person. At the time of this inspection there were 30 people in residence and two people were in hospital. There were two vacant rooms and four rooms were out of use because of the building works.

An extension was being built to the right side of the building. To the left of the building the area behind the car park was being used to store pile of rubbish, empty barrels and building materials. The area was not cordoned off and was unsightly. Although we have reported on this in the last three inspection reports , the provider has not taken any action to tidy and make safe, this area. We asked an inspector from the Health and Safety Executive to visit the site and check on building site safety. Relatives who had been asked to provide feedback about Woodlands Manor had commented about the rubbish and the appalling mess.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was also the registered provider.

Why we have rated the service as Inadequate.

The management of medicines was not safe. We found gaps on the medicine administration records for several people and two people who needed pain relieving medicine had not received their medicine as prescribed. The records to show that topical creams and ointments had been applied as prescribed were poor with no staff signatures and for one this meant they had sustained pressure damage because barrier cream had not been applied. We found that the auditing of medicines was not effective.

Risk management procedures did not take a holistic view of each person and we found that where two people had serious risks to their health and well-being, the risks were not being managed to ensure the risk was eliminated or reduced.

Improvements were still required with infection control and prevention procedures. The infection control audits were ineffective and did not cover all aspects, for example bed mattresses were not checked to ensure the covers were undamaged and the foam inserts were clean. Slings and slide sheets, moving and handling equipment was still being shared between people because there was not enough to go round. We observed laundry staff not following best practice when collecting washing for laundering. Workman from the building site were seen to be accessing the kitchen area and not putting on personal protective clothing.

The provider could not demonstrate training and supervision as we were told there had been computer failure and the records had been lost. The service had changed their training provider since the last inspection and all staff were expected to complete every module of the on-line training programme. The registered manager had not arranged specific training that was talked about at the previous inspection in January 2018 and had not shared learning with the rest of the staff team following a ‘resident for the day’ exercise. This was a missed opportunity to improve staff approach, communication and attitudes.

People were not always looked after with respect and some staff did not speak nicely to them. On two occasions it was senior members of the staff team who did not talk respectfully about people and this does not demonstrate a good ‘leading by example’ means of improving staff attitudes. People’s dignity was not always maintained and we have referred to an example in the main body of the report where improvements were needed.

People may not receive person centred care which is responsive to their particular care and support needs. Concerns have been raised regarding the standard of care given to five people and this was being investigated by the safeguarding adults team in South Gloucestershire Council.

The registered manager had introduced a new quality assurance system in order to check on the quality and safety of the service. The audits we saw were did not identify any shortfalls and did not cover all aspects of the service. Many of the audits were tick-box responses and where shortfalls has been identified, there was no action plan to address the issue. The audits had not picked up the breaches of regulations we have found in this inspection.

We found that improvements were required with care records and other records related to the running of the service. This included the room folders where staff were expected to monitor food and fluid intake, repositiong and topical medicines administration where applicable. The records were not maintained accurately or consistently. Medicine records were also not accurate or complete. Incorrect forms were used to report on any accidents, falls or incidents that had occurred.

On a more positive note we received favourable comments about the meals and drinks people were served with and the activities they were able to participate in. Each person was registered with a GP and arrangements were made for them to see the GP and other healthcare professionals as and when they needed to do so.

The number of nurses and care staff on duty each shift was calculated based upon the level of care and support needs for each person who lived at Woodlands Manor at that time. This was reviewed on at least a monthly basis or whenever any changes were identified. The recruitment of new staff to the service followed safe recruitment procedures to ensure unsuitable staff were not employed.

Staff were aware of the need to gain consent from people before offering care and support. The service worked within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted to the local authority where people were unable to consent to live at Woodlands Manor. The procedures in place for assessing people’s care and support needs prior to admission to Woodlands Manor ensured any placement in the service was appropriate.

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

The service has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

On Thursday 15 November Woodlands Manor Care Home entered administration. Since that date CQC have been working with the administrator and the care management team employed by them to manage Woodlands Manor Care Home.

CQC are assured by the steps taken to ensure that people living in the home are safe and that the shortfalls identified in this inspection report are being addressed. The new care management team are voluntarily providing CQC with weekly updates on their progress in addressing the shortfalls, ensuring people are safe and how they are improving the quality of care provided at Woodlands Manor Care Home.