Archived: Woodlands Care Home

This inspection found a continued breach of Regulation 12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and additional breaches, including Regulations 18 Staffing, 10 Dignity and respect and 17 Good governance were found.

There were 55 people living at Woodlands across four units during our inspection; 13 on Thornhill, 11 on Mirfield, 8 on Hopton and 23 on Calder. Each unit was self-contained with a communal lounge, dining area, bathroom and toilet facilities. Bedrooms were single rooms with en suite facilities. There was a central kitchen and laundry located on the ground floor and a hairdressing salon.

Admissions to Thornhill had been suspended by the local authority due to safeguarding concerns on this unit in relation to staffing, the role of one to one staff and the management of medicines. The registered manager was working with the local authority and clinical commissioning group to address these concerns.

The home had a registered manager in post at the time of our 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.

There was a safeguarding and whistleblowing policy in place and the registered manager and staff were able to outline the actions they would take if they had any concerns anyone was at risk of abuse or harm.

Risks to people were assessed. However, these sometimes lacked personal information and were not always up to date and therefore did not always reflect current risks.

People were not always provided with safe care and treatment. Some people were not assisted to move regularly and some people did not receive adequate assistance to meet their continence needs.

Regular checks were made to ensure the safety of the building and equipment.

Despite a dependency tool being used to help determine staff numbers, there were not always sufficient numbers of staff to meet people’s needs. Safe recruitment of staff was evident.

Medicines were stored safely but were not always administered in a safe way. This included covert medicines being crushed without advice being sought regarding the safety of this and sufficient quantities of prescribed medicines not being available.

Staff received induction and regular training. However, some staff had not received regular one to one supervision.

People were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way possible. Some nursing and care staff were unaware of which people could legally be deprived of their liberty to receive care and treatment.

People’s hydration needs were met and drinks were offered throughout the inspection. However, mealtimes on Calder were not well organised and we observed a person sat for a long period of time, awaiting their meal. Some people did not receive appropriate support to have their nutritional needs met.

People received additional support from health care professionals, in order to have their care and treatment needs met where this was appropriate.

Although some staff treated people with kindness and compassion, showing respect for their privacy and dignity, other staff did not. Some staff used derogatory terms and spoke over people to each other. Some staff failed to recognise when people’s dignity was being compromised.

Care plans were updated regularly but people or their relatives were not always involved in this.

Activities took place and attempts had been made to make these person centred.

We saw people were offered choices throughout the day. However, during our inspection, everyone living in the home was served Halal meat and the registered manager confirmed people were not consulted or given a choice regarding this.

Some care records were inaccurate and incomplete and, in some cases, records were falsified. Audits were not robust and did not identify some areas for improvement. Regular staff meetings took place and staff felt informed. Staff felt the registered manager was effective.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

It should be noted that one of the people named in this report as a manager of the service was no longer in that position 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 key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was not clean and hygienic.

There were enough staff on duty to meet the needs of the people who lived at the home however, staff did not appear to have the skills they required do this. Staff we spoke with told us they were not aware of what action they would take in the case of an emergency. They were also not clear on safeguarding procedures.

We saw people living at the home were not provided with activities on the day of our inspection. The deputy manager told us that activity staff were escorting people to appointments that day.

Is the service effective?

We looked at people's care files and saw their individual needs were assessed thoroughly. However, we saw care plans were difficult to find within the care records. They were also unclear and did not provide staff with clear guidance on how to meet people's needs.

Is the service caring?

Staff told us that due to shortages in staffing they were deployed to areas of the home they were not familiar with. This meant people were supported by staff who did not know them well. We saw people's needs were not being met because of this. We saw that care assistants from an agency were providing one to one support to some of the people living at the home. The agency staff were unable to tell us what the person's care plan said regarding care the person they were supporting required.

Is the service responsive?

We saw from the care records that people's needs had been assessed before they moved into the home. However, we saw people were not offered activities during our inspection. People were left unattended by staff for long periods of time in communal areas of the home.

Is the service well-led?

We spoke with the area manager and the deputy manager of the home. We looked at the systems in place for monitoring the quality of the service provided to people. We found that audits were being carried out on a weekly, monthly, quarterly and annual basis with action plans in place were issues were identified. However, we were unable to find clear evidence of when actions had been completed and by whom.

'The staff are very kind and they have helped me settle in here. I am no as anxious as I used to be.'

'I have a lovely room with lovely views. I like looking at the horses in the field.'

'The food is good and we are always having snacks.'

'I like the staff they are very good.'

'We have a good staff team and I enjoy working here.'

'I love coming to work here and they try to keep us working with the same people, which is good.' (agency carer)

During the inspection we spent time sitting with people and found that care and support was offered appropriately to people.

The medication system was being managed safely and people received their medication at the right times.

Our conversations with people and staff, together with observations on the day of our inspection evidenced that there were enough staff on duty.

The provider had an appropriate system in place for gathering and evaluating information about the quality of care the service provided. Records we looked at were accurate and up to date.

We observed a comfortable and relaxed atmosphere where staff took a person centred approach toward the people living at the home and treated them with respect and kindness. We saw that people were supported to follow their own routines and encouraged in their interests and preferred pastimes.

One person said "It's nice here, the staff are very good"