Archived: Woodland Care Home

Updated 4 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We carried out a comprehensive inspection of this service on 29 January 2018 and 5 February 2018. One adult social care inspector and one expert by experience visited the service for an unannounced inspection on 29 January 2018. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. In this case, the expert by experience had experience of working or caring for people with a mental health condition. One adult social care inspector returned for an announced visit on 5 February 2018.

Woodlands care home is registered to accommodate 15 people. At the time of inspection there were 13 people using the service who were supported by the registered manager, deputy manager, eight care staff, one chef and one domestic member of staff. The service provided support to working age adults and older people with a mental health condition or learning disability.

Before our inspection we reviewed all the information we held about the service. We examined the notifications received by the CQC. Notifications are changes, events or incidents that the provider is legally obliged to send us within the required timescales. We spoke with Durham local authority contracts and commissioning team, Health Watch, and Durham fire service. We used this feedback as part of our inspection planning process.

The provider was asked to complete a Provider Information Return (PIR). This is a document wherein the provider is required to give some key information about the service, what the service does well, the challenges it faces and any improvements they plan to make. This document had been completed and we used this information to inform our inspection.

During the inspection we spoke with seven people. We also spoke with the provider, deputy manager, five care staff and the chef. The registered manager answered questions via email.

We reviewed three care records in detail and the supplementary records (medicines administration records, hospital passports and dietary records) of a further four people. We reviewed two recruitment and induction records and six supervision and appraisal records. We reviewed the training summary records for all staff. We also reviewed records relating to the day to day running of the service.

We looked around the service and went into some people's bedrooms (with their permission) and visited the communal areas. We carried out observations of practice.

Updated 4 April 2018

This inspection took place on 29 January 2018 which was unannounced. This meant the provider, registered manager, staff and people using the service did not know that we would be carrying out an inspection of the service. We returned for a second day of inspection on 5 February 2018 which was announced because we needed access to records in the registered manager’s office.

Woodlands care 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.

Woodlands care is an established building which has been adapted to become a care home. People had their own room with access to three communal areas and an outside courtyard. The service can accommodate up to 15 working age adults and older people living with a mental health condition or learning disability who require personal care. It is not registered to provide nursing care. At the time of the inspection, there were 13 people using the service.

The registered manager has been registered with the Care Quality Commission since 1 October 2010. 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.

At the last inspection of the service on 30 July 2016. We rated the service to be Requires Improvement. We asked the provider to make improvements to become a Good rated service.

At that inspection, we found that people did not always receive care and support in line with their individual needs, wishes and preferences. Staff knowledge of fortified diets for people with diabetes was limited. As a result staff did not provide the support for people with diabetes which was outlined in the care plans. Bi-monthly meetings with people were not person-centred and goal orientated as stated in the providers Philosophy of Care Policy and Statement of Purpose. People did not have the opportunity to be involved in activities of daily living, such as the preparation and cooking of food. There were no funds in place for activities and as a result, the provision of activities was limited. People were encouraged to attend events in the community; however this was because they were free rather than centred around people’s preferences.

We also identified that an ineffective auditing system was in place. The provider did not carry out their own quality monitoring of the service. This meant that areas for improvement had not been identified. The refurbishment plan lacked detail and we found that improvements were not made in a timely manner.

At this inspection, we found the required improvements had not taken place.

Safeguarding alerts had been made when needed, however risks had not been fully assessed and care plans updated as a result. There was no evidence of procedures in place to ensure lessons had been learned. Risk assessments for behaviours which challenge were not in place and care plans did not contain the detail needed to provide safe care and support. Medicines were not safely managed.

Robust procedures were not in place for staff at night to ensure they remained safe from behaviours which challenge. Ineffective procedures were in place to cover staff absence. This meant the deputy manager worked additional hours, six days per week and was on-call every night.

Unsafe water temperatures were in place, increasing the risk of potential harm to people and staff. Doors to equipment such as the gas boiler and electrical switches, which needed to be locked for safety and prevent misuse, had been left open. All areas of the service needed to be cleaned. No colour coding system was in place for cleaning equipment

The registered manager and deputy manager had not received supervision or appraisal. Training for all staff was not up to date. Some training had been undertaken by the registered manager but they did not hold appropriate training qualifications to complete this, which meant the training received by staff was not valid. This included moving and handling, infection control and food hygiene.

People who needed a specialist diet because of diabetes or high cholesterol did not receive one. People were not involved in menu planning and menus did not reflect their choices. Consistent choices are mealtimes were not provided. All aspects of the service needed updating. This included paintwork and plasterwork, torn furniture and mattresses, broken furniture and worn flooring.

People are 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 do support this practice. Staff did work in line with the Mental Capacity Act 2005. However staff knowledge on the Mental Capacity Act 2005 was limited.

People told us they were happy at the service and received good care from staff who knew them well. However minutes of staff meetings and feedback from surveys showed some staff were unkind to people. In feedback respondents thought some staff could be more compassionate to people and treat people the same. No evidence was available to show that thorough action had been taken to address this.

Some staff practices meant that people’s privacy and dignity was not always protected. Records did not show if people were routinely involved in planning and reviewing their own care. Staff did support people to maintain meaningful relationships.

People did not have access to regular meaningful activities. There was no evidence of innovation or use of technology to encourage people to participate in activities. Staff missed opportunities to provide activities to people at the service and in the community.

Care records lacked detail about how to provider person-centred care to people. We identified records did not reflect current needs. There were gaps in many of the records looked at. There were no systems in place to archive records.

People were aware of how to make a complaint and told us they would speak with staff or the deputy manager if they needed to. However, in meeting minutes and surveys people had raised concerns and there were no robust measures in place which showed these concerns had been listened to and action taken to resolve them.

The provider and registered manager did not have adequate oversight of the service. An ineffective auditing system was in place. Information from meeting minutes and surveys did not result in action plans and had not been used to drive improvement at the service.

People and staff told us the provider and registered manager were not visible and were no responsive to them when concerns were raised about their care or aspects relating to the service. There was no evidence to show the service was integrated in the local community and no evidence to show how equality and diversity was embedded into the service or what the goals for these were for the next year.

No improvements to the service have been made since the last inspection. There was evidence of further deterioration at this inspection. Robust systems and adequate oversight had not been put in place to support the service to provide and deliver a good service to people.

Registered managers and providers are required to notify the Commission of specific events which take place at the service without delay. When notifications were submitted, some were sent late. Some incidents such as police incidents or safeguarding incidents had not been reported to the Commission. This will be dealt with outside of inspection.

We found seven breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity, safe care and treatment, meeting nutritional needs, the premises, good governance and staffing. We identified one breach of the Care Quality Commission (Registration) Regulations 2009 in relation to submitting notifications.

“The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”

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