Woodville Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Where people’s care needs had changed, their care plans had not always been updated to reflect this change. People and relatives were not always included in the development of care plans. People’s daily care records did not always show how their risks were being managed in line with their assessed needs. For example, some gaps were found in repositioning charts for people who required regular pressure relief. This placed people at risk of harm. The provider’s dependency tool used to determine safe staffing levels were ineffective. This did not consider all relevant changes at the service. For example, when people’s needs changed, new admissions and the size of the building. We found the environment was not always safe and some risks were identified around infection prevention and control (IPC). Audits completed by the manager did not identify in-depth root cause analysis and did not always outline what actions had been taken to mitigate further risk. We found that systems in place to oversee the service were not always effective.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The manager explained there is a pre-admission policy and process in place which includes a face-to-face assessment to assess if the person’s needs can be met. The policy included a process for admissions which was introduced following identified risks. Care plans were implemented prior to a person being admitted to the care home and these were created with involvement of relatives. The manager explained they worked collaboratively with relevant professionals to ensure a smooth transition. We were told there had been some challenges, including information not always being handed over to the home. Senior staff explained they were involved in the pre-admission assessments for new admissions, and they liaised with the hospital to get all relevant information prior to the person going into the service. This was to ensure that they knew the person before the care commenced.

A relative spoke to us about their family members transition to the service. They had raised concerns initially, however the relative explained the manager was proactive in resolving the issue. The relative was satisfied with how this was managed. The relative explained other than the initial difficulties, the service had been, “Brilliant so far.” People told us about their experience of moving to the service. Overall people told us they felt safe and were happy with the move to Woodville and they received support from relevant healthcare professionals. Relatives told us that they feel the service works with healthcare professionals well and that they have a nurse practitioner visit the service regularly to undertake health checks on people.

The provider worked with local commissioners to address areas of improvement at the service, and they complied with required information requests promptly. The local authority told us that they were working with the service to undertake care reviews with people. We were told that the local commissioners were working closely with the service due to the increased number of safeguarding concerns they had received.

Prior to admission, people’s needs were assessed, and a pre-admission checklist was completed. There were systems in place to review this after admission with involvement of staff, people, and relatives. People’s care plans and risk assessments were in place prior to the person moving into the service. We found some evidence of involvement of people and their relatives within this process.

The manager understood their responsibilities in relation to safeguarding. They spoke positively about working relationships with safeguarding teams. They were able to share an example of learning from when things went wrong, for example a recent safeguarding following a visit from a healthcare professional led to increased training in report writing and documentation for staff. Staff demonstrated an understanding of safeguarding and keeping people free from abuse and discrimination. Staff were able to share how they would respond to any safeguarding concerns. Staff told us that they had received training on safeguarding.

We carried out a short observational framework for inspections (SOFI) to help us understand the experiences of people using the service who may not be able to speak with us. The SOFI showed us that people were comfortable with staff and felt able to speak with them.

People told us they felt safe at Woodville Residential Care Home, and they were supported well by the staff. One person told us they had not raised any concerns and said if they did have a problem they would speak with the manager. Another said, “I’m happy here, the carers are kind”. Relatives felt their family members were safe at Woodville Residential Care Home. A relative told us “[Family member] has settled in so well from day one, the staff are really kind with [family member]”. Relatives told us that all safeguarding concerns were resolved promptly, and they were kept informed.

People’s care plans were not always updated following incidents. This meant any changes in their needs had not been reviewed. For example, following falls or admissions to hospital. The manager completed an audit of accidents at the service. This lacked an in-depth root cause analysis and action to mitigate further risk. For example, an unknown bruise to a person's head was identified during 1 audit. There was no investigation or explanation as to why no treatment was sought in relation to this injury, or action taken to prevent further accidents. Deprivation of Liberty Safeguard (DoLS) applications were applied for and these had been followed up. Mental capacity assessments were in place.

A relative explained they had not seen their family members care plan; however, staff had consulted with them about the person’s care and support including their likes and dislikes. The relative was satisfied the staff understood and met their family member’s needs. Not everyone we spoke with was aware of their care plan, or sure if they had been involved in writing and reviewing them. However, people did confirm they had discussions with relevant staff and professionals about their support needs. Relatives told us that staff are kind and care for the people who live at Woodville Residential Care Home. One relative said, “I’m 100% confident they are safe and happy. [Family member] is loved, the staff are so kind and love [family member]”.

Staff were aware of people’s needs and risks. Daily handovers were completed to ensure they are updated on any changes to people’s needs. Staff confirmed they had time to read care plans. Staff was aware of how to find key information about a person and how to support them in line with their wishes.

People’s care plans were not reviewed regularly or as their needs changed. The manager told us care plans were in the process of being reviewed and updated. We found some examples of people’s care and support needs changing, but this not being reflected within their care plans. For example, one person had been seen by a speech and language therapist (SALT), who had made recommendations for them to have a modified diet. Their care plan had not been updated to reflect this change. Another person’s care plan guided staff to refer to the community mental health team for one person, however they had recently been discharged from this service. This placed people at risk of not having their needs safely met. People’s daily records did not always show their risks were being managed in line with their assessed needs. For example, we found gaps in repositioning records for people who needed regular pressure relief. As these people were high risk of skin breakdown, this placed them at risk of harm. Where care plans had been audited, any actions had not been assigned to staff members. This meant it was not clear who was responsible for implementing the necessary changes.

We observed people not being able to access drinks which were made available to them, as these were out of reach. Some people who had drinks had been left to go cold. However, we found no indicators that people were dehydrated. The SOFI we completed showed people had access to their specialist aids or assistive equipment. People who were mobile wore appropriate footwear. Staff supported people to sit and stand where appropriate.

During our onsite visit, we identified some infection prevention control (IPC) and trip hazards around the service. This placed people at risk of injury or infection. We found that not all areas within the service were maintained to a high standard, for example scuffed walls and doors, worn carpets and stains on walls and ceilings. This placed people at risks such as infection as they did not allow for effective cleaning.

The manager was aware of improvements which were required to the environment. They explained audits had identified this. However, there was no action plan in place to address improvements with the environment.

Moving and handling risk assessments were in place to support staff in using specialist equipment to support people safely. However, these were not always regularly reviewed to ensure they remained accurate. Health and safety audits were completed monthly. These failed to adequately identify issues seen on site by the inspection team. This meant we could not be assured this audit was effectively identifying and addressing improvements on the environment.

On the whole, relatives we spoke with felt the environment was safe, but some areas could do with attention, such as new seating rather than cloth seats. People we spoke with raised some concerns about their environment. This included a broken tap and broken TV aerial. Some people told us they did not have access to a call bell for staff and had to shout for help if needed. Some felt areas within the home were not always cleaned to a high standard. However, some relatives we spoke with felt that issues were resolved promptly, and they were satisfied with how any concerns had been rectified.

The provider had a dependency tool in place which was ineffective in identifying safe staffing levels at the service. This did not take into consideration new admissions, changes in people’s needs, and the size of the building. There was no associated guidance to support the manager in completing dependency assessments for individuals which were used to input into the overall dependency tool used to calculate staffing numbers. As there was no guidance, and care plans reviewed were seen to be out of date we could not be assured this system was an effective method of calculating staffing levels at the service. This placed people at risk of not having their needs met promptly due to insufficient staffing levels. We identified gaps in staff training and not all staff had suitable training to complete key tasks for their role and not all staff had completed mandatory moving and handling training. This placed people at risk of unsafe care. Call bell audits were conducted which calculated the numbers of call bells each month. This did not analyse themes and trends or identify how improvements could be made.

We received mixed feedback from people using the service about staffing levels. One person told us staff were quick to respond to their needs if it was not a busy time. Another said, “No not really and there’s less at weekends, we’re always being told, there’s minimum staff and sometimes if feels like there’s no-one around at night’’. One person said, “Sometimes it’s difficult to get someone to come, especially in the afternoon.” A relative we spoke with said they had not noted any issues with staffing and felt staff had bonded well with their family member. Relatives felt that staff received appropriate training to support their family member safely.

During our onsite assessment we observed call bells were alarming regularly which were not always responded to promptly. The SOFI we completed showed us that staff did not always have time to engage with people. Communal lounges were not always supervised. We observed one person moving another person unsafely in wheelchairs. This was addressed by a staff member; however, this placed this person at risk of harm.

Staff did not always feel there were enough staff to support people safely. One staff explained the dependency assessment used to calculate staffing levels was not accurate. Staff told us they had fed back their concerns around staffing levels, but no changes had been made. Staff did not feel they had time to spend with people. However, staff were positive about the training provided. The provider had a quality monitoring advisor who provided support and training to the staff on site. They were able to provide bespoke training at the manager’s request. They were available as and when needed. Staff fed back positively about the support of the quality monitoring advisor. Staff confirmed learning disability and autism training was carried out. Staff had access to an online portal for e-learning, but a mix of face-to-face training and online training was provided.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Overall people received their medicines. However, medicines were not always given in line with prescriber instructions. As and when required medicine (PRN) protocols did not always provide sufficient guidance to support staff in administering. For example, referring to needed for 'pain' but limited details on how to identify a person is in pain. Staff did not always record reasons for administering PRN medicine. We did not find any evidence people had been harmed, however failure to identify these issues meant we could not be fully assured by the provider’s governance systems in relation to medicines or staff competence. Medicines audits were completed monthly with action plans in place. These did not always identify relevant actions.

Most people were satisfied with how their medicines were managed and they were supported to take them by staff. However, another person felt ‘as and when’ medicines were not always provided when asked. This left them feeling pain. Two people fed back they were unsure whether their medicines were in stock, we checked and confirmed they were. Relatives told us that their family members received their medicines as prescribed, and they were kept informed of any changes.

Senior staff who were trained in administering medicines were able to explain the process in the event of making a medicines error. The manager had overall responsibility for medicines within the service, however they had support from the provider’s medicines manager. Medicines competencies were completed 6 monthly, and the manager understood the process in the event of a medicines error.