About the service Woodcote Hall is a residential care home providing personal and nursing care to 46 people at the time of our inspection. The service can support up to 56 people over the age of 18 years.
Woodcote Hall is a large building set in a rural location. The home has mainly single rooms, but a number of shared rooms are available. The home supports a high number of people living with dementia and mental health conditions.
People’s experience of using this service and what we found
Known risks to people's health had not always been assessed and planned for and people were not always kept safe from the risk of avoidable harm. Where incidents had happened, lessons had not been learnt because the provider’s procedures were not followed. People’s prescribed topical medicines were not always stored safely.
The provider had made improvements since our previous inspection in reducing the risk of cross infection within the home. However, some further improvement was needed in this area to ensure risks of cross infection were prevented.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The systems in the home were not used effectively. People’s ability to make their own decisions had been poorly assessed. However, the provider was aware and was taking steps to address this.
The completion of staff training needed improvement to ensure staff had the skills and knowledge to support people’s specific health conditions. The provider had started to work in partnership with a range of other health professionals and agencies to ensure people’s needs were able to be met. Referrals to health care professionals were not always made in a timely way to maintain people's health and wellbeing.
Work was ongoing in updating people’s care plans to ensure they met people’s needs. People did not have end of life plans in place, so their wishes may not be known about how they wanted to be cared for at the end of their lives.
Governance arrangements had failed to ensure risk was safely managed, or that people’s rights were promoted when making decisions about their care or that their care records were accurate, legible and met their specific needs. The provider had placed other managers from within their organisation to take over the day to day management of the home.
People were supported by sufficient numbers of staff who had been recruited safely. Visitors were screened for symptoms of COVID-19 before entering the home. Visits had recommenced following the changes in Government guidelines to enable people to see their loved ones. The home environment was clean. Domestic staff had designated areas they cleaned throughout their shift. People and staff had access to COVID-19 testing.
People were supported by staff in a way that was caring, friendly and kind. Our observations showed staff knew people living at the home well and they shared positive interactions with them.
People were able to engage and be involved in social and leisure activities in the communal areas of the home. Complaints were responded to in line with the provider’s policy.
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 provider changed the legal entity of Woodcote Hall in April 2019. No changes were made to the corporate provider of the home. The last comprehensive inspection rating for the service before their change of legal entity was requires improvement (published 18/01/2019).
Our previous inspection of Woodcote Hall was a focused inspection on 20 and 26 April 2021. We inspected but did not rate the service. The provider was in breach of regulations relating to managing people’s safety, consent and the governance of the home.
Following our previous inspection on 20 and 26 April 2021, we served the provider and registered manager with a warning notice for regulation 12 and regulation 17. We serve a warning notice to tell the registered persons they were not complying with a condition of registration or a regulation. We told the registered persons we required them to be compliant by 7 June 2021. Because this inspection took place on 26 May 2021, we did not inspect the service against the warning notice. We will return at a later date to confirm compliance with the warning notice.
The provider completed an action plan after the previous inspection to show what they would do and by when to improve.
At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations. However, we acknowledge the short timeframe between the previous inspection and this one. The provider’s improvements to the service were yet to be fully implemented and embedded in the culture and practice.
Why we inspected
This inspection was prompted in part due to an incident at the home and the management of that incident. We also received ongoing concerns from the local authority about failure to identify risks to people’s health and the management of the home. A decision was made for us to inspect and examine those risks by completing a comprehensive inspection.
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.
We have found evidence that the provider needs to make improvements. Please see the full report.
The provider has taken action to mitigate risk within the home.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified ongoing breaches in relation to the management of risk, consent and the governance of the service.
Please see the action we have told the provider to take at the end of this report.
Follow up
The provider has already sent to us an action plan detailing what they will do to improve the standards of quality and safety. We will return to the home to ensure they have complied with enforcement actions taken by us in serving two Warning Notices on the provider. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.