Woofferton 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

People’s risks were not always assessed effectively. Monitoring of clinical risks was not always sufficient to ensure concerns would be escalated. Mental capacity assessments were not always completed when needed which meant the provider could not be assured people were not being restricted. Staff knowledge around safeguarding required some improvement but staff were clear they would escalate safeguarding concerns to the registered manager to maintain their safety. Safeguarding referrals had not always been made when needed although immediate steps had been taken to keep people safe. Where medicines had not been administered as prescribed, medical input had not been sought to ensure this was safe for people. Accidents and incidents were recorded but there was little trend analysis which meant the provider could not be assured they always took action to reduce the risk of reoccurrence. Although people told us there were enough staff, staffing levels were not always sufficient to ensure people’s needs could be met safely during the afternoon and evenings. People told us they felt safe living in the home with the staff who supported them. Relatives told us people were safe at the home and staff were knowledgeable and kind to them. Staff knew people well and had built a positive rapport with people. Medicines were stored safely and medicines stock counts were accurate. People and relatives told us the home environment was safe. People told us staff were knowledgeable and we observed staff treating people with warmth and compassion.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were supported by staff who gave them information about how to meet their needs in a way that promoted their wellbeing positively. People felt safe and told us the staff providing care to them attributed to them feeling safe. Relatives gave us examples of where staff had supported people to understand risks to themselves and learn how to mitigate risk. For example, where one person’s nutritional intake was low and where one person’s mobility had deteriorated. People were supported to make their own choices and decisions.

Incidents and accidents were discussed informally amongst the registered manager and staff. Where there had been an incident around medicines, staff confirmed they had been spoken to about it and changes had been implemented to mitigate risk. Staff told us they were confident the registered manager would address any safety concerns and learn from them. The registered manager told us they acted on mistakes. They told us, “We are human beings so mistakes do happen but we have to make sure we do try and understand why we have made mistakes. If it keeps on happening, then we look at the patterns and try to ascertain why it's happening.”

Incidents and accidents were recorded but formal analysis of patterns and trends was minimal. Team meetings were undertaken when needed where the provider fed back any concerns and identified any learning required. However, these were not regular. Action was taken when external audits identified actions. Action was also taken to mitigate risk where safety incidents occurred. For example, where people had fallen, professional support was sought and people’s care plans were reviewed to mitigate risk to them.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe at the home. People knew who the registered manager was and told us they would speak to them if they had any concerns. People felt comfortable in sharing any concerns they may have with staff. One person told us, “If I had any concerns, I would speak to whoever was available as they're all approachable.” However, despite people and relatives telling us people were safe at the home, we found one example of where a safeguarding referral had not been submitted when it should have been. This was an incident of physical abuse between people living at the home which was shared with the local authority but not the safeguarding team. The registered manager submitted this retrospectively after this was raised during the site visit.

Staff did not know where the safeguarding policy was but told us they had undertaken safeguarding training and knew some of the types of abuse. However, the training matrix indicated not all staff had completed safeguarding training. Staff had some knowledge of safeguarding but did not always know who to report safeguarding concerns to if outside of the provider. Staff were clear they would raise safeguarding concerns to the registered manager and they were confident it would be dealt with appropriately. The registered manager told us all staff were required to undertake safeguarding training but the training matrix showed not all staff had completed it. Staff and the registered manager were not always sufficiently knowledgeable regarding their responsibilities around mental capacity and DoLS. The registered manager told us they did not undertake their own mental capacity assessments at the home. Whilst we did not find examples of people being restricted during the site visit, this placed people at risk of not having their rights around mental capacity being upheld. We observed people engage positively with staff. Staff treated people with kindness and warmth. People responded positively to staff engagement with smiles and interaction.

A safeguarding policy was in place but staff were not always aware of where they would find this. The training matrix indicated not all staff had completed safeguarding training although the ones we spoke with told us they had. Safeguarding referrals had not always been raised when needed. We found one safeguarding referral had not been made and no statutory notification submitted to CQC where there had been an incident between 2 people living at the home. We discussed this with the registered manager who stated they had not raised it as they shared with the person’s social worker so they thought this was sufficient. The registered manager immediately submitted a safeguarding referral and statutory notification in retrospect when raised during the site visit. We saw evidence of multiple statutory notifications being submitted where people had experience serious injuries and where there had been police incidents. DoLS applications had not always been made where people lacked the capacity to decide where they lived. Processes in place to ensure mental capacity assessments were completed were not robust as they had not always been completed when people had restrictions placed on them such as the use of bed sensors.

People’s clinical risks were not always monitored adequately which placed them at risk of not having clinical risks escalated. For example, there were no systems in place to ensure concerns were escalated for people's continence needs and no protocols for managing people's diabetic needs. Whilst we did not find any examples where people had come to harm as a result of this, this did place people at risk. People and relatives told us staff supported people to manage and mitigate risk to themselves. Where one person was mobilising independently but they were placing themselves at risk, this was discussed with the person. One person told us, “When they got me back walking again, they said I mustn't walk without someone with me so that still applies.” People were supported to engage in activities with the support of an activities co-ordinator who gave them options and choice.

Staff were aware of risks to people regarding their mobility and were able to tell us about some risks related to specific health risks. However, we found risk assessments were not always in place when needed for some clinical risks which meant staff did not have guidance around how to manage these risks to people. The registered manager told us they involved people in risk assessments. For example, the registered manager explained that they ask for people’s consent to use pressure mats when they are admitted to the home until they are able to assess their falls risk. This is then adapted to suit people’s needs and with their consent. The registered manager told us risk assessments were reviewed regularly dependent upon each person’s needs and risks. The registered manager told us they communicated changes in people’s risks verbally to staff and risk assessments were updated. Staff understood the need to mitigate risk to people but sometimes this was risk averse and did not always promote people's autonomy. For example, staff told us they supported people with their personal care needs before meal times to try to avoid them needing support during meals when staffing levels were low.

People were supported by staff who responded in a timely way to risk. Staff intervened when needed to manage people’s risks. Where staff were required to intervene, they did this with warmth and compassion. We saw one person sit on a chair that may have placed them at risk of falls. Staff immediately guided them to a supported chair that was appropriate to meet their needs. We also observed staff giving a person a hot drink which they placed within reach of them but reminded them it was hot and to put it in a place of safety on their tray. CCTV was in use at the home and people and relatives had been asked for their consent.

Where restrictions were in place such as for the use of bed sensors and CCTV, no mental capacity assessments had been completed with people who required them. However, risk assessments did include a question about whether the person had consented and relatives did tell us they had been asked about the use of bed sensors and CCTV. Risk assessments were brief and did not always guide staff how to mitigate risk. However, staff knew people well in respect to most risks and managed risk to them safely. However, processes to ensure risk assessments had been completed for all pertinent risks were not robust enough which meant people did not always have risk assessments in place when needed. For example, where one person had diabetes, there was no risk assessment in place and where people had risks related to their continence, there were no risk assessments in place. Risk management was sometimes risk averse such as all people being asked to consent to a bed sensor on admission. However, the provider took appropriate steps to adapt to people’s personalised risks after a period of assessment.

People told us they felt safe when being supported with their mobility and relatives confirmed people were supported safely. One relative told us, “Staff always support them safely when using equipment.” Relatives told us the environment appeared dated but it was homely and safe. People’s personal emergency evacuation plans were not always up to date with their current needs which meant they may not receive the right support in the event of an emergency.

The home was clean and free of clutter. Equipment was stored safely and did not cause an obstruction for people enabling them to move round the home freely. Fall sensor mats were in place and on. We observed a fire safety door that was not shut but this was closed immediately when raised and when we returned to the upstairs floor, all fire safety doors were shut. The medicines cabinet was locked safely and could not be accessed by people living at the home.

Personal Emergency Evacuation Plans were not always up to date to reflect people’s current needs which may have placed people at risk of harm. The provider was unable to evidence an in date legionella test certificate. However, they immediately followed this up and were awaiting test results. All other environmental certificates were up to date and compliant and we saw evidence of action being taken when needed to ensure compliance. Where actions had not yet been completed in respect to fire safety, this was done immediately and the provider sent us evidence the work had been completed and the home was fire safety compliant. Window restrictors were in place to maintain people's safety. Fire drills were undertaken and actions taken where needed to mitigate future risk to people.

People told us there were enough staff to meet their needs safely. People told us staff responded quickly when they pressed their call bells and they did not feel like they had to wait for the care they needed. One person told us, “I think there are enough staff. They don't take long to come to me when I press my buzzer.” Another person told us, “If you need anything, all you do is press the call button and they are there within 5 minutes, shall we say as a round figure. I very rarely feel at risk." Relatives told us there were sufficient staff to meet people’s needs and they did not see their relatives waiting for care. However, despite the positive feedback received from people and relatives, staffing levels during the afternoon and at night were not always sufficient to meet people’s needs safely. For example, some people's care plans showed they needed assistance of 2 staff to meet their night needs but there was only one waking night staff member and one staff member sleeping over who were available to support at night

Staff told us they did not always think there were enough staff on the afternoon and night shift. They told us they did not think this impacted on meeting people’s needs safely but it was difficult to manage if one person was up at night as there was only one member of waking night staff to support them. Staff also told us it was difficult on the afternoon shift as there were only 2 staff members and one also had to prepare the evening meal. Staff did not always think they had enough time to support people with activities as much as they would like. One staff member told us, “I do think there are enough staff to support people safely. I just don't think there are enough staff always to support with activities.” The registered manager told us they thought staffing levels were sufficient and people were supported safely. The registered manager told us agency staff were currently being used at night time but they ensured they employed staff who had worked at the home before so they knew people and processes well. Staff told us they had received sufficient training to make them feel competent to support people safely. Staff told us they had supervisions, but they could be infrequent. However, staff felt comfortable in approaching the registered manager if they needed to discuss anything outside of supervision. The registered manager confirmed supervisions were undertaken 2/3 monthly but were held more often if required or if staff wished to discuss anything with them.

Staff were responsive to people’s needs. People did not have to wait long for support and staff engagement with people was positive. However, staff did not always have the time to interact and engage in prolonged communication and activities with people other than when the activities co-ordinator was present. People were supported by competent staff who knew them well and understood how to meet their needs safely.

People were supported by staff who were generally recruited safely. References were sought prior to employment and Disclosure and Barring Service (DBS) checks were undertaken prior to employment. However, the provider did not keep copies of job interview records. The provider told us they would amend the recruitment process and ensure they kept interview records going forward. Systems in place to determine staffing levels weren’t always sufficient to ensure people weren’t at risk. For example, at night there was only 1 waking night and 1 staff member sleep in. However, some people required assistance of two for transfers out of bed which meant people may have been placed at risk in the event they needed support during the night. People were only supported by 2 staff during the afternoon who also needed to prepare tea which meant people may be left at risk in the event someone needed their personal care needs met during meal times. However, despite this people told us this did not impact them and they considered their needs to be met safely. The supervision matrix showed evidence of staff supervision but this was not always frequent.

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.

People told us they received their medicines as needed. One person told us, “The staff help me with medicines. There's a couple of times when I have to take them in the morning and night. I do get the medicines I need. I'm very well looked after here.” Another person told us, "They never forget the medication, they are strict on that. If there is a time for medication, you have to have it at that specific time and they give it you then.” Despite positive feedback from people, we found some examples where people had not received their medicines as prescribed. The provider explained the rationale to us but had not checked this with a medical professional before deciding when to administer these medicines. The registered manager checked this once we raised this and people’s prescriptions were changed by the GP surgery who confirmed there had been no impact on them. However, failing to seek a professional opinion prior to nto following people's prescriptions placed people at risk of harm from medicine misadministration.

Staff told us senior carers administered medicines and they were required to be fully trained before they could administer medicines. The registered manager told us, “Only staff who are medicines trained administer medicines and they are all seniors. Even the non-seniors do the training as sometimes they have to countersign for medicines even if they don't administer them themselves.” The registered manager told us they undertook supervisions regarding medicines and do competency checks with staff to ensure medicines are being administered safely. The registered manager told us they investigated medicines errors to ascertain what had occurred and addressed any concerns with the staff members involved. The registered manager acknowledged that protocols in place for 'when required' medicines were not presently kept in a place accessible to staff but immediately addressed this. The registered manager also confirmed that the reason for administering PRN medicines was not recorded but put a system in place immediately to address this. The registered manager confirmed they had not sought professional medical opinion before adjusting people’s medicines administration for some medicines. This was followed up with the GP surgery following the site visit who confirmed these changes had no impact on people and all prescriptions were changed accordingly.

Protocols for when to administer 'when required' medicines had been completed but were kept in the office and not accessible to staff. The registered manager told us they would immediately put these in people’s care files and with their medicine administration record (MAR). Processes in place to escalate concerns around medicines prescriptions were not always effective. For example, where the provider had made the decision to administer medicines differently to people's prescriptions, despite their rationale being potentially reasonable, they had failed to discuss this with the GP to ensure this action was safe. The registered manager followed this up following the site visit and the GP surgery confirmed there had been no impact on people and changed all of the prescriptions accordingly. Medicines were stored safely. Fridge temperatures were recorded and were consistent. Medicines competency checks were undertaken with staff when needed to ensure medicines were being administered safely. Medicines audits were undertaken but did not always identify where there had been oversights. For example, where protocols were not available to guide staff when to administer 'when required' medicines and where medicines were not being administered as prescribed and GP input had not been sought.