Woodbury House

Updated 20 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors, a specialist advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Woodbury House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Woodbury House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. However, there was a newly appointed manager who was in the process of becoming a registered manager. We will refer to them in the report as “the manager”.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to the inspection we looked at all the information we had collected since the last inspection about the service including previous inspection reports and notifications the manager had sent us. A notification is information about important events which the service is required to tell us about by law. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke to the manager, the interim manager and the clinical lead. We observed interactions between staff and people living at the service and spoke to one person who uses the service. We gathered feedback from 12 staff members. We reviewed a range of records relating to the management of the service, for example records of medicine management, risk assessments, accidents and incidents, quality assurance system, and maintenance records. We looked at 18 people's care and support plans and associated records. We looked at seven staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the manager to validate evidence found. We looked at further records and evidence including quality assurance records, training data, meeting minutes, and policies and procedures. We spoke to 23 relatives about their experience of the care provided to their family members. We contacted six professionals who work with the service and received two responses.

Updated 20 May 2022

About the service

Woodbury House is a care home providing personal and nursing care to up to 45 people including people who live with dementia. At the time of our inspection 31 people were using the service.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not ensure compliance with the fundamental standards and identifying when the fundamental standards were not met.

When incidents or accidents happened, it was not always clear that it was fully investigated, and if any lessons were learnt. The provider did not ensure that clear and consistent records were kept for people who use the service and the service management. The provider did not inform us about notifiable incidents in a timely manner. Effective recruitment processes were not in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines was not always safe. Risks to people's health and wellbeing were not consistently assessed and staff did not always follow guidance to support people in the right way. Staff deployment was not always managed effectively as we observed people did not always receive timely support. People were at risk of social isolation because the provider did not ensure activities were more personalised and people had opportunities for social engagement according to their interests.

People and their families felt they were not always involved in the planning of their care. People's and relatives' feedback were sought but not always used to make improvements to the service. People were not always 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 were in place but did not support this practice. People had sufficient meals to meet their nutrition needs. Hot and cold drinks and snacks were available between meals. However, we were not assured people’s hydration needs were monitored and met in a consistent way. Relatives said they were kept informed about their relative’s health and welfare. care plans and related documents had information about people but it did not always contain information specific to people's needs and how to manage any conditions they had.

The provider had not ensured staff including agency workers were provided with appropriate training, knowledge and skills so they could do their job safely and effectively. Staff said they felt supported to do their job and could ask the home manager for help when needed.

People and relatives gave us mixed feedback about the staff and the service, but they also were positive about the staff and the care they provided. Staff upheld people's privacy and responded in a way that maintained people's dignity. However, we observed a mixture of interactions between people and staff which did not always show kind, caring and effective practice.

We have made a recommendation about the premises being suitable for people living with dementia. We have made a recommendation about the compliance with the Mental Capacity Act 2005. We have made a recommendation about compliance with the Accessible Information Standard. We have made a recommendation about gathering and acting on people’s and relatives’, and staff feedback.

There had been management changes since the last inspection, which affected the service management and the culture at the service. The new home manager was in the process of getting to know the service to ensure they could review, assess and monitor the quality of care in a consistent way.

People were safe living at the service and relatives felt their family members were kept safe. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. The management team was working with the local authority to investigate ongoing safeguarding cases.

The dedicated staff team followed procedures and practices to control the spread of infection and keep the service clean. There was an emergency plan in place to respond to unexpected events and the premises and equipment were kept clean. People were able to access healthcare professionals such as their GP. The service worked with other health and social care professionals to provide effective care for people. Relatives felt the management of the service had improved and that they could approach manager and staff with any concerns. Most of the staff felt the management was open with them and communicated what was happening at the service and with the people living there. The management team appreciated staff contributions and efforts during pandemic to ensure people received the care and support.

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 (report published 20 September 2017).

Why we inspected

This was a planned inspection based on the previous rating and a review of the information we held about this service.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to quality assurance; risk management; notification of incidents; record keeping; effective and person-centred care planning; privacy and respect, management of medicine; staff training, competence, and recruitment. We have made a recommendation about the premises being suitable for people living with dementia. We have made a recommendation about meeting the Accessible Information Standard and Mental Capacity Act legal framework. We have made a recommendation about seeking and using feedback from people, staff, others to improve the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.