Background to this inspection
Updated
7 March 2020
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. This was a targeted inspection to check on specific concerns we had about staff levels and skills, and management of the home.
Inspection team
The inspection was completed by one inspector.
Service and service type
Woodlands Neurological Rehabilitation 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 service had a manager registered with the Care Quality Commission. 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service, two relatives and one visitor about their experience of the care provided. We spoke with twelve members of staff including the regional director, registered manager, two nurses, three care practitioners, the clinical governance lead and occupational therapist.
We reviewed the staffing structure and planned recruitment, three staff files, and the training matrix. We looked at minutes of meetings, governance reports and the induction process.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at action plans and training data.
Updated
7 March 2020
Woodlands Neurological Rehabilitation Centre is a residential care home providing personal and nursing care for up to 27 people who require long term care or rehabilitation. There were 24 people using the service at the time of the inspection.
Woodlands Neurological Rehabilitation Centre accommodates people in one adapted building, all facilities are on one level. It is located on the outskirts of York.
People’s experience of using this service and what we found
People were encouraged to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. However, the service had locked doors on day one of the inspection due to risk. Following discussion with the management team this was changed. A further full review of risk, people's capacity, DoLS and best interests was undertaken and the doors to the gardens were unlocked from nine am until early evening.
We recommend this continues to be reviewed to ensure people's liberty is not restricted.
The newly appointed management team had undertaken a full review of the service. Following this, changes had recently been made to the way staff were deployed. This had caused anxiety for some people using the service and some staff. This was being addressed.
We found not all people’s care records had not been reviewed or updated as their needs changed. The management team knew there were some shortfalls with people’s records and a full review and re-write of care records was taking place by the multi-disciplinary team (The consultant, nursing staff, occupational therapist, physiotherapist, speech and language therapists and psychologist). We were informed on the second day of the inspection this work had been completed.
Medicine management was generally robust. However the use of prescribed thickeners was not recorded and ‘as required’ medicine protocols required improving. These issues were immediately addressed and were in place for the second day of the inspection.
Staff undertook induction and training to develop or maintain their skills. The management team were aware supervision for staff was not up to date this was addressed, eight staff received supervision before the second day of the inspection.
On day one of the inspection we received mixed feedback about the food and protected mealtimes were not in place, this was re-instated. A new head chef was appointed, they had liaised with people about their preferences and dietary needs and new menus were being created.
People were supported by kind, caring, compassionate staff and their privacy and dignity was maintained.
People's needs were fully assessed prior to their admission into the service. People were cared for by a multi-disciplinary team of staff. People’s care records were created and reviewed by the multi-disciplinary team and detailed their goals and aspirations. Wherever possible, people were encouraged to achieve their goals, with the support of staff. Multi-disciplinary team meetings and reviews were held to maximise people’s living skills which promoted their independence.
Quality assurance checks and audits were in place and these continued to be strengthened. Priorities for improving the service had been identified by the provider.
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 21 December 2018).
Why we inspected
The inspection was prompted in part due to concerns about how the service was being managed, concerns about staffing levels, skill mix, safety for people using the service and medicine management. A decision was made for us to inspect and examine those risks.
The inspection was prompted in part by notification of a specific incident. Following which a person using the service had been admitted to hospital and died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.
The information CQC received about the incident indicated concerns about unsafe medicines management. This inspection examined those risks.
We found the provider has taken action to mitigate the risks and this has been effective. We found no evidence during this inspection that people were at risk of harm from this concern.