Archived: Woodview

Woodview is a residential care home providing personal and nursing care to 48 older people, younger adults and people living with a dementia type illness. The service can support up to 60 people. The service is divided into two units. ‘Woodview’ provides care to older people or people living with a dementia type illness and ‘Greenwood’ provides care for younger adults with physical disabilities and longer-term medical conditions.

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

Governance systems and processes were in place. However, these were not always operated effectively. This meant risks and shortfalls were not always identified and addressed.

Risk management was poor. Risks were not identified, assessed or managed well. Meaning people experienced poor outcomes and increased risk of harm.

Care plans did not always contain person centred information. Some care plans contained conflicting information about how to support the person to ensure their assessed needs could be met. We found when reviews took place, any changes to people needs could not be easily located and the care plan was not updated.

Accidents and incidents were recorded by staff. However, reviews and action taken as a result of accident and incidents was not always effective. This meant people were experiencing recurrent accidents and incidents of the same nature.

Medicines management was not always operated effectively. People did not always receive their medicines as prescribed; ‘As and when’ medicines did not always have information for staff about when these should be administered.

There was not always enough staff to meet the needs of people. There was a high dependency on agency staff, increasing the risk of inconsistent care. Safe recruitment systems were in place to ensure staff were suitable to work with people.

Infection control measures were in place and a housekeeping team completed daily cleaning tasks. However, malodours were present, and some areas of the home required repairs and refurbishment. This meant whilst cleaning was completed, the effectiveness of cleaning could not be maintained.

Activities were in place; however further work was need from the provider to ensure these were meaningful and the electronic system for recording activities was reflective of people engagement and involvement of activities.

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.

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 (published 3 April 2020)

Why we inspected

We received concerns in relation to the management of medicine, risk management, leadership and governance. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodview on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, medicines management, learning lessons, person centred care, leadership and governance at this inspection.

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 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.

We found the following examples of good practice.

¿ There was clear information and guidance on managing COVID-19 visible to staff, residents and any visitors coming into the service. Visitors were screened before entry and, where applicable, COVID-19 vaccination status was confirmed.

¿ There were abundant personal protective equipment (PPE) supplies in place at various key areas in the service to ensure safe infection prevention and control practices were undertaken.

¿There was a cleaning programme in place and the service was visibly clean and well maintained.

¿ The provider had ensured staff were skilled in infection prevention and control (IPC) practices. This included up to date training on infection control and 'Donning and Doffing', (how to put on and remove) PPE.

¿There was a testing programme in place for staff and people living in the service. This was to ensure any staff or people who had contracted COVID-19 and were asymptomatic, were identified in a timely way.

¿ Staff promoted and practised safe social distancing throughout the home as far as was reasonably practical. Clear systems were in place to shield and isolate people should outbreaks occur.

¿ The provider had robust systems in place to ensure that effective IPC practices were carried out with senior management oversite.

¿ The provider had assessed the impact on residents of how PPE may cause fear and anxiety and had taken steps to support people through this positively.

¿ Staff spoken to during our inspection told us they felt assured by the steps taken by the provider to promote good IPC.

Woodview is a residential care home providing personal and nursing care to 57 older people, younger adults and people living with a dementia type illness. The service can support up to 60 people. The service is divided into two units. ‘Woodview’ provides care to older people or people living with a dementia type illness and ‘Greenwood’ provides care for younger adults with physical disabilities and longer-term medical conditions.

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

Staff were caring, thoughtful and attentive. The staff team were motivated and enthusiastic in their roles. Staff clearly knew the people they were caring for. People and relatives consistently told us staff were kind and caring and they were treated well.

People were given the opportunity to express their views regularly and were encouraged to make decisions about their care. Staff were knowledgeable about how to maintain privacy and dignity.

People were receiving care that was responsive to their needs. Care plans captured peoples wishes, and care was delivered by staff who understood the needs of the people they were supporting.

The activities team were providing an exceptionally wide range of activities which people had chosen for themselves. People were engaged and encouraged to take part in activities, people who chose to spend time in their rooms were not left out. Innovative and thoughtful ideas to provide a wide variety of activities and pursuits mean that people had the opportunity to try new things.

People were protected from abuse by staff who were knowledgeable about how to recognise and report abuse. The provider had a safeguarding policy which staff were aware of.

Systems were in place to ensure people were protected from avoidable harm. Processes for the administration and storage of medicines were operated effectively.

Staffing levels met the needs of people living in the service. Staff were recruited safely and in line with current regulations. Accidents and incidents were recorded and analysed.

People’s needs were assessed prior to admission to the service. People and relatives told us their needs were met well.

People told us they enjoyed the food and drink on offer.

Staff told us they received the training they needed to do their job well and were supported in their roles. Nursing staff were supported to maintain their professional registration.

People received the support they needed to access healthcare services.

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.

The registered manager developed an open and inclusive culture within the service. Staff were consistently positive about the support they received to carry out their roles.

The registered manager and the team were clear about their roles and what they needed to do to achieve regulatory compliance. Governance systems were operated effectively.

Clinical governance in the service was good. People, their relatives and staff were regularly consulted and asked for feedback in relation to the delivery of care in the service.

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 (published 9 August 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Woodview is registered to provide accommodation and nursing and personal care for up to 63 older people, younger adults or people living with a dementia type illness. There were 56 people living at the service on the day of our inspection. The service is divided into two units. "Woodview" provides care to older people or people living with a dementia type illness and "Greenwood" provides care for younger adults with physical disabilities or long term medical conditions.

There was a registered manager in post at the time of our inspection, although they were not present on the day of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Four people at the time of our inspection had their freedom restricted under a DoLS authorisation.

People were not always protected from avoidable harm because not all risks had been identified. Staff were aware of the signs of abuse and knew how to escalate their concerns. There were sufficient staff on duty to keep people safe and meet their care needs. People received their medicine safely from staff that were competent to do so. However, some protocols were not in place for the safe administration of "as required" medicines. People were cared for in clean environment.

People received effective care from skilled and knowledgeable staff who received training to meet most people’s care needs. Some staff lacked the skills to care for people when they became anxious or distressed. Staff had received appropriate training, and understood the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and where able people were asked for their consent to care. People were not involved in planning their menus and their feedback on their choice of food was not actioned. People were supported to access their GP, dentist and other appropriate healthcare professional when needed.

People were cared for with kindness and compassion by committed and caring staff. Staff involved people and their families in decisions about their care. People were cared for by staff who respected their privacy and dignity.

People received care that was personal to their individual needs. Staff supported people to engage in meaningful activities and pastimes of their choice, both in and outside the service.

The registered manager has been absent for some time and staff were concerned about the lack of visible leadership and support. There were systems in place to monitor the quality of the service, but these systems did not always identify areas for improvement.

At the time of our inspection the home was without a registered manager. We spoke with the acting manager who told us they had submitted their application for registration to become a registered manager. We observed they had arrangements in place to provide leadership and support in the interim period.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service caring?

We saw where people were able that they were involved in their home. One person told how proud they felt when they had recently been involved in staff interviews for the recruitment of new staff. They said, 'I asked them about their interests and what they wanted to do and explained the home to them.' This person also told us they had attended a staff meeting on 18 July 2014. They said, 'It was of mutual benefit, I gave them the resident experience, I would do it again.'

We found staff did not always refer to people in a person centred way. For example, we heard one member of care staff say, 'I've done the feeds.' We asked this member of staff to explain what they meant by this. They said, 'I've fed people who need help eating.' This meant people were not always treated with consideration and respect.

Is the service responsive?

We looked at nine care files and saw that people had their care needs assessed and care planned prior to admission to the service. We saw as a person's care needs changed this was recorded in their care files. This meant staff had accurate information on the person's care and treatment needs.

We spoke with four members of care staff who told us how they would respond to a person in an emergency situation such as when a person had a sudden collapse. We found that most staff had been trained in first aid and new how to keep a person safe until assistance arrived.

We observed that staff used different communication tools to communicate with people who were unable or had difficulty communicating verbally. This helped people to communicate their needs.

There were several lengthy delays in answering the call bells during our visit. The manager spoke with senior staff and requested that care staff answered call bells in a timely manner. However, we noted that this did not improve the time it took staff to answer the call bells.

Is the service safe?

The provider had policies and procedures in relation to safeguarding vulnerable adults. Care staff told us that they were unsure if there was a policy for safeguarding and would not know where to find the policy. Care staff were unsure about the training they had received and actions to take if a person was at risk of abuse.

We looked at several areas of the home including people's self-contained flats and shared areas such as bathrooms and shower rooms. We found the provider did not always maintain an appropriate standard of cleanliness and hygiene.

The unit managers for Woodview and Greenwood had been identified as infection control leads and were involved in the local authority infection control link nurse network. The network provides the link nurses with up to date guidance on infection control practices to be shared with other staff.

We found that there was little evidence that audits of the quality of service provided to people had been undertaken prior to the new manager coming into post in April 2014. The manager had introduced a programme of audit. However, not all of the completed audits had an action plan in place to ensure that any shortfalls identified had been addressed.

Is the service effective?

We spoke with a relative who told us their relative had improved since moving into the service. They said, 'They are brilliant with her, proactive with her. Their physical and mental health wellbeing has improved.'

We found that staff were supported to undertake nationally recognised diploma level qualifications in adult health and social care to ensure that they had the skills and knowledge to support people.

Is the service well led?

Staff told us the service was well led. One staff member said, 'There's been lots of changes to the management, XX [manager] is very new. We have the unit managers, thoroughly compassionate and strong, we can turn to them for advice.' Another member of staff said, 'It's a good place to work, we keep the service users happy and morale is good. We get positive feedback from residents and their relatives. We're a good team.'

We spoke with two relatives about their views. We observed the support staff gave to people who used the service. We also looked at records, including care files of six people and carried out a tour of both units.

We found people gave consent to their care and where people lacked capacity to do so the provider had acted in accordance with legal requirements.

We asked people who used the service what they thought of the food that was provided for them. One person told us, "The food is good, there is always a choice of two hot meals at lunchtime and one for vegetarians as well.'

We found there were sufficient skilled and experienced staff to support people who used the service and saw the building was clean, safe and effectively maintained. A person told us, "I like the fact I have an en suite room, it is so convenient.'

We found the service to be well led.

We reviewed all the information that the provider had sent us, visited the premises and talked with the registered manager.

We saw that the provider had taken the appropriate measures to meet the essential standards of care for people who used the service provided at Woodview.

Prior to our visit we reviewed all the information we had received about the service. During the visit we spoke with four people who used the service. We spoke with one relative of a person who had used the service. We also spoke with five members of the staff team, the registered manager and the regional manager who was visiting on the day of our inspection. We also looked at some of the records held in the service including the care files for four people.

People who used the service were supported to make their own decisions where they were able to do so. We saw staff asking people for their views and preferences. One person told us about various community resources they used.

We observed people contributing towards everyday tasks including being supported in preparing breakfasts and beverages.

The building was clean, odour free and had recently been re-carpeted throughout.

We identified concerns regarding a shortage of equipment used to assist people in mobilising.