Woodlands Residential Home

We found the following examples of good practice.

The service was accessing the government testing scheme which assisted them to promptly identify an outbreak. The service worked with the local authority infection, prevention and control (IPC) team and other health professionals in managing the outbreak.

The home was very clean and well presented. There were PPE stations and hand sanitising points appropriately placed around the home. The provider has also invested in adaptations, including clear screening and mobile handwashing facilities, which were well placed in the home to help minimise the risk of cross infection.

There was clear and accessible infection prevention signage and clear communication with staff reinforced hygiene practices. There was a plentiful supply of personal protective equipment (PPE), such as disposable masks, gloves and aprons.

People isolating in their rooms had regular contact with staff, who wore personal protective equipment (PPE) appropriately. Staff also helped people to maintain links with their family and friends by phone and on-line.

Further information is in the detailed findings below.

The home provides care in a single, two storey building in a rural area.

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

People living at Woodlands Residential Home told us they felt safe. Risks associated with care and the environment were well managed, and there were sufficient, safely recruited staff on duty at all times. Staff who administered medicines did so safely, and there were no issues with stocks of medicines or the records relating to these.

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 systems in the service supported this practice.

Staff were well trained, caring and had good support from the registered manager. There was a very good relationship with healthcare providers such as GPs which meant people received prompt and appropriate referrals when needed. Meals served at the home were of good quality, and met people’s needs and preferences. People enjoyed the food and had choice in what was served.

People and their relatives were involved in writing and reviewing person-centred care plans which achieved good outcomes for people. Staff were knowledgeable about people’s needs and preferences, and worked to prevent people from feeling socially isolated.

There was good leadership in the home, and well-motivated staff. The registered manager used robust systems to monitor, measure and improve the quality of the service. People and staff were able to contribute ideas and suggestions, and were able to make complaints when concerns arose.

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

The last rating for this service was requires improvement (published 16 August 2018), and there were two breaches of regulations. 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Woodlands Residential 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. The care home can accommodate a maximum of 27 people in one building with two floors connected by a passenger lift. At the time of our inspection there were 18 people using the service. One person was in hospital on the day we visited.

There was a registered manager in post when we inspected. 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.

Medicines were stored appropriately, and records we looked at showed they were being administered as prescribed. We found some consistent issues with guidance for ‘as and when’ medicines and the recording of creams and lotions, however.

People told us they felt safe at the home, and we saw the environment was clean and well maintained. Work to ensure the safety of the electrical systems was in progress. There was appropriate adaptation to the premises to support people to find their way around the home, and people had access to the outside areas when they wished. However, we found some risk assessments relating to falls were not included in people’s care plans,.

Staff were recruited safely, usually deployed in sufficient numbers, and they understood how to identify and report any concerns about potential abuse. Any accidents and incidents were investigated appropriately, however we found one accident had not been reported to us as required. There were systems in place to ensure staff remained effective in their roles, including an induction based on the care certificate, regular on-going training and formal and informal conversations with the registered manager.

People told us staff were caring and respectful, and our observations supported this. People were able to meet visitors in communal areas, their rooms or quiet rooms as they wished, and we saw visitors were made welcome. Care plans were written in ways which helped staff get to know people well, and we saw evidence which concluded there was no discrimination in the service. When people or their relatives raised complaints or concerns there were appropriate processes to ensure these were addressed.

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. The registered manager had driven improvement in this area. We saw people also had good support in meeting their healthcare needs, including a weekly GP surgery held at the home.

There was good feedback about the food served at the home, including alternative choices when people wanted something not on the menu, and we saw mealtimes were supported to be relaxed and sociable. We found some improvements could be made to the records kept about what people ate and drank in order to ensure they were appropriately supported with hydration and nutrition.

People’s needs were assessed when they began to use the service, and we observed a good handover at the start of the shift, however we found care plans had not always been kept up to date when these care and support needs had changed, which meant staff did not always have access to up to date guidance. People’s wishes for end of life care were not always recorded.

There was good feedback about activities in the home, which were planned according to people’s wishes each day. There were fundraising activities to support this programme, which included trips into the community and visits by local school pupils.

Quality and overall service delivery were monitored by an audit programme, however this had not always been effective. Issues which we have identified at this inspection were not picked up and addressed. We made a recommendation about the way in which audit activity was planned and the running of two key audits.

There was an inclusive culture in the home, and people, their relatives, and staff were able to influence decisions made about its running. The home had good links with the local community including with local councillors who attended meetings and supported the running of the home.

We identified two breaches of regulations relating to safe care and treatment and person-centred care. You can see what action we have told the provider to take at the end of the full version of this report.

At our last inspection on 22 March 2016 we rated the service as ‘requires improvement’ and identified three breaches of regulations; Dignity and Respect, Premises and Equipment and Good Governance. At this inspection we found action had been taken in relation to these breaches: locks on toilet and bathroom doors had been repaired, there was a choice of main meal, all bathrooms were in service and daily care records were more detailed.

Woodlands Residential Home provides care for up to 27 older people and people living with dementia. At the time of our inspection there were 25 people using the service. Accommodation is offered over two floors with the first floor accessed by a lift. The majority of bedrooms are single occupancy and all have en-suite facilities. The home is situated in its own grounds in a quiet, rural setting on the outskirts of Wakefield.

There was a registered manager in post. 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.

People told us they felt safe living in the home, and we saw maintenance and servicing was kept up to date. There was a programme of refurbishment in progress when we inspected. People were further protected because staff understood their responsibilities under safeguarding.

Medicines were mostly managed safely by staff with appropriate training and supervision. We identified some errors in relation to stock, recording and administration of medicines, which were brought to the attention of the registered manager.

Risks associated with people’s care and support were assessed and documented, although we found guidance for staff to follow in order to minimise those risks sometimes lacked detail.

Recruitment practices were safe, with checks made to ensure staff were not barred from working with vulnerable people. Staffing levels were generally appropriate to meet people’s needs, however we identified an issue with the numbers of staff on duty at the weekend. The registered manager agreed to review staffing levels.

There was not always a consistent approach to assessing and managing issues related to mental capacity and consent. The registered manager was correctly identifying when to apply for Deprivation of Liberty Safeguards (DoLS) and renewals, and adhering to conditions attached to any authorisations. Staff received training in the Mental Capacity Act (MCA) and DoLS, and were able to describe how they supported people to make decisions and choices. We made a recommendation relating to further improvement the provider should make.

We found staff received an effective induction and on-going training which helped them remain effective in their roles. Supervision and appraisal processes were in place, however we found the content of supervision would benefit from a greater emphasis on support rather than training.

People said they enjoyed the food served at mealtimes, and we saw there were effective systems to monitor people’s nutrition and hydration. Referrals to dietary health professionals were made as required, and we found people were supported to have good access to other health and social care professionals. We saw positive feedback provided by visiting health professionals.

People had good relationships with staff, and gave good feedback about them. Staff were knowledgeable about how to maintain people’s privacy and dignity, and respectful when giving people support. Care plans contained information about people’s likes and dislikes and ways in which they enjoyed spending their time. People and their relatives told us care was personalised to individual needs.

Care plans were regularly reviewed to ensure they reflected people’s current care and support needs, and we saw people were involved in this process. Some staff felt arrangements to update them about changes in people’s needs could be improved, and the registered manager told us they would review this.

There was an activities co-ordinator in post, and people told us they enjoyed the activities on offer at the home. We observed people participating in a range of activities on the day of our inspection. People were asked about what activities should be provided.

There were effective systems in place to manage complaints, and people told us they felt able to raise concerns with staff or the registered manager.

We received good feedback about the registered manager from people who used the service, relatives and staff. The registered manager worked at weekends to enable them to have regular contact with people’s families.

People, their relatives and staff were able to contribute to the running of the home through regular meetings and an annual survey, which was also sent to health professionals involved in people’s care.

There was a meaningful process of audit in place, and we saw actions were taken to ensure any issues identified during the audit were rectified..

Woodlands Residential Home provides care for up to 27 older people and people who live with a diagnosis of dementia. Accommodation is offered over two floors with the first floor accessed by a lift. The majority of bedrooms are single occupancy and all have en-suite facilities. The home is situated in its own grounds in a rural setting on the outskirts of Wakefield. The service was taken over by a new registered provider following the sale of the home in October 2015.

The service did not have a registered manager; however there was a manager in post who was in the process of registering with the Care Quality Commission. 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.

Staff had a good understanding of safeguarding and had undertaken regular training, however staff were unclear about the organisation’s whistle blowing policy and the protection given to staff by this.

We found that there were only two bathrooms in the home, and both of these had been out of service for a period of time at the beginning of 2016. The bathroom was functional at the time of our inspection however the shower room was still not safe and was out of service.

This was a breach of Regulation 15 Premises of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were risk assessments in place for the people who used the service. The risk assessments were generic and were not risk specific. There were no measures described to lessen the risks which had been identified.

The recruitment processes were safe and the registered provider was carrying out the necessary pre-employment checks.

We found the management of medicines was mostly safe; however we did identify one issue where a person had not been given one of their medicines as it was recorded as not in stock, when this was checked during the inspection the medicine was found to be in stock, this had not however led to any harm to the person.

Deprivation of Liberty Safeguards were in place to protect the rights of people who used the service, we saw the manager had appropriately assessed the mental capacity of the people who used the service.

There were regular meetings held with people who used the service, their relatives and staff. The meetings ensured people were kept up to date with changes which were taking place in the home.

People had access to a good range of food and drinks to meet their nutrition and hydration needs, however there was little evidence of people being given choice for the main meal of the day (lunch) despite the menu showing there was a choice offered.

There were no locks on the toilet doors on the ground floor, which meant people were at risk of being disturbed when using these facilities.

This was a breach of Regulation 10 dignity and respect of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff were kind, caring and patient in their treatment of people who used the service. There were positive relationships evident between staff and people who used the service and in peer groups in the home. Staff encouraged people to be as independent as they were able.

There was no documented consent to care being sought or gained from people who used the service or their appointed representatives.

This was a breach of Regulation 17 Good governance of the Health and Social Care Act (Regulated Activities) Regulation 2014.

The care plans which were in place had some very person centred information within them, however the way in which they were written did not give a clear picture of the care which needed to be given or how the person preferred to be supported. Care plans were regularly reviewed and information from other health professionals was included in the reviews.

There was an activity coordinator in place and people had access to a good range of activities. People had recently been given more opportunities to go out of the service which had proved to be very popular.

There was management presence within the home throughout the day, and staff told us this was always the case. Staff were clear about their roles and responsibilities.

There was a new set of processes for the auditing and oversight of the service which had newly been implemented as there had previously been no systems. There was evidence that auditing had commenced and there were clear processes to ensure the analysis of the information which was gathered and for action to be taken based on the findings.

Daily records and bathing records were very basic and did not fulfil their purpose, as they did not allow the reader to gain any insight into the events which had taken place over a period of time.

You can see what action we told the provider to take at the back of the full version of the report.

The manager and the deputy manager described what action the home had taken to address these concerns. They showed us they had introduced a 'consent policy for examination, treatment and care,' and a 'policy for decision making, consent and capacity.' We saw the policies provided staff with clear procedures to follow to ensure people received care and treatment in accordance with their wishes.

We spoke with two people who used the service to gain their views. They spoke very positively about the service and told us care staff acted in accordance with their wishes. For example, one person told us: 'The staff know what I like and know my routine, but they always check out if I want or need anything different.' Another person described how they had recently signed consent forms for some medical treatment. The person said: 'The staff always accompany me to hospital appointments. This is really good and really supportive.'

We spoke with three members of staff who told us they enjoyed working at the home. One member of staff commented; 'I really love it here.' Another said; 'This is a lovely home and I love working here.'

We spoke with a visiting health professional who told us staff at the home were always proactive in reporting and seeking specialist advice when people required it. They confirmed the staff at the home followed their clinical recommendations to meet the needs of the people in their care.

We saw records of four internal 'spot check' audits of medication which had been carried out by the manager during the past twelve months. There were also records of audits carried out annually by an external medication specialist. This showed the service had systems in place to assess and monitor the quality of the medicines management arrangements within the home.

At the time of our inspection we found the service had no clear procedures for staff to follow to ensure people received care and treatment in accordance with their wishes.