Archived: Woolton Manor Care Home

The home provides accommodation for people who require nursing or personal care. The home is registered to provide accommodate for up to 66 people. The provider closed the nursing unit in the home. The home at the time of this inspection only provided support to people who required assistance with their personal care. At the time of our inspection, there were 21 people who lived in the home. This inspection took place on 16 July 2018 and was unannounced.

There was no registered manager in post at the time of our inspection. 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 time of this inspection there had been no registered manager in post for a number of years. This was a breach of the provider’s conditions of registration with CQC.

At the last inspection in February 2018, there was an acting manager in post who was being supported to manage the home by a consultant. At this inspection another support manager had also started to work at the home to support the acting manager too. This support manager told us that they were planning to apply to CQC to be the registered manager. They said however that they were not planning to work at the home for long as they had plans to work elsewhere. Another consultant from a different organisation had also been commissioned by the provider to audit the quality and safety of the home. The consultant identified that a range of improvements still needed to be made at the home. Some of the improvements identified by the consultant corresponded with the concerns and improvements that CQC has previously identified in the provider’s last three inspections. An action plan to improve the service had been developed by the consultant and the acting manager told us that they had been given a copy of this.

At our last inspection, we found breaches of Regulations 9,10,11,12,13,17,18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this visit we followed up the breaches we identified at our previous visit. We found that the provider had not taken appropriate action to address our concerns and all of the breaches we identified previously remained. This meant people who lived at the home continued to be placed at serious risk. The rating for the service has not changed. The service remains inadequate and in special measures. This is the fourth consecutive inspection where the service has been rated inadequate with multiple breaches of the health and social care regulations.

At our last three inspections people’s needs and risks had not been properly assessed and managed. Information in relation to people’s care was confusing, contradictory and difficult to follow. At this inspection, we found that no improvements to people’s care planning and risk management had been made. People’s care plans contained some person-centred information but this information was limited. Where people had made their preferences or needs known, support had not always been provided in accordance with them. This placed people at risk of unsafe and inappropriate care.

Concerns were raised at our previous inspections with regard to the implementation of the Mental Capacity Act and people’s capacity to make specific decisions about their care. At this inspection, people’s decision making was still not appropriately supported in accordance with this legislation. This meant that people’s consent was not always lawfully obtained.

People still had no access to social or recreational activities in support of their emotional well-being and we observed that the majority of people sat all day watching the TV. This was the same as at the last three inspections, yet despite this, no effort had been made to ensure that people’s social and recreational interests were catered for. People told us there was nothing to do at the home and the place was very quiet.

At our last three inspections, records showed that people did not receive the support they required with their personal care to preserve their dignity and skin integrity. We found the same at this inspection. Records showed that people went significant periods of time without a bath or shower and for the most part only received ‘strip washes’ or ‘bed baths. We also found that some of the records in relation to these issues were untrustworthy.

The number of staff on duty was not always sufficient to meet people’s needs. We heard call bells ringing constantly and people waiting unacceptable amounts of time for staff to respond. People we spoke with told us that there were not enough staff and they often had to wait for care and support.

Staff recruitment was not robust enough to meet the regulations. We spoke with one new staff member who had moved over from another care home. They had not been recruited safely and had only received a verbal induction in the home.

Staff were polite and pleasant to people but their support was not always provided in a dignified or respectful way and staff were not always attentive to people’s well-being. We saw examples of staff asking people personal questions in public places.

The condition of the building had deteriorated since our last inspection which resulted in people being placed at risk of serious harm from unsafe premises. We also had infection control concerns as continence equipment was not cleaned safely or appropriately which placed people at risk from cross contamination.

The provider’s governance arrangements were ineffective. The managerial systems and the provider’s oversight of the service failed to identify and address all of the concerns we identified. The provider’s lack of action to address these issues both at this inspection and three previous inspections demonstrates they lack the competency and accountability to ensure the service is safe, effective, caring, responsive and well-led. This means that people continued to be placed at serious risk.

At the end of our inspection, we discussed the concerns we identified during the inspection with the acting manager and the support manager. We found they lacked understanding of the issues to be able to ensure that sustainable changes were made in the home.

The overall rating for this provider is ‘Inadequate’. It has been inadequate since 2016. This means the service will remain in ‘Special measures’ by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Woolton Manor 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 home provides accommodation for people who require nursing or personal care. The home can accommodate up to 66 people. Since our last inspection, the provider took the decision to close the nursing unit in the home. The home at the time of this inspection only provided support to people who required assistance with their personal care. At the time of our inspection, there were 25 people who lived in the home. This inspection took place on the 13 and 15 February 2018 and was unannounced.

There was no registered manager in post at the time of our inspection. 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 time of this inspection there had been no registered manager in post for a number of years. This was a breach of the provider’s conditions of registration with CQC.

At the last inspection in July 2017, there was an acting manager in post who was being supported to manage the home by a consultant. At this inspection, these managerial arrangements had not changed.

At our last inspection, we found breaches of Regulations 9,10,11,12,13,17,18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this visit we followed up the breaches we identified at our previous visit. We found that the provider had not taken appropriate action to address our concerns and all of the breaches we identified previously remained. This meant people who lived at the home continued to be placed at serious risk. The rating for the service has not changed. The service remains inadequate and in special measures.

At our last inspection people’s needs and risks had not been properly assessed and managed. Information in relation to people’s care was confusing, contradictory and difficult to follow. At this inspection, we found that no improvements to people’s care planning and risk management had been made. People’s care plans contained some person centred information but this information was limited. Where people had made their preferences or needs known, support had not always been provided in accordance with them. This placed people at risk of unsafe and inappropriate care.

Concerns were raised at the last inspection with regard to the implementation of the Mental Capacity Act and people’s capacity to make specific decisions about their care. At this inspection, people’s decision making was still not appropriately supported in accordance with this legislation. This meant that people’s consent was not always lawfully obtained.

People still had no access to social or recreational activities in support of their emotional well-being and we observed that the majority of people sat all day watching the TV. This was the same as at the last inspection, yet despite this, no effort had been made to ensure that people’s social and recreational interests were catered for. People told us there was nothing to do at the home and the place was very quiet.

At our last inspection, records showed that people did not receive the support they required with their personal care to preserve their dignity and skin integrity. We found the same at this inspection. Records showed that people went significant periods of time without a bath or shower and for the most part only received ‘strip washes’ or ‘bed baths.

The number of staff on duty was not always sufficient to meet people’s needs. We observed that one person waited over 15 minutes to be taken to the toilet. People we spoke with had mixed opinions about whether were enough staff on, some people thought there were enough to assist them but others told us they had to wait for long periods when they rang their call bell.

Staff recruitment was not always robust. Staff records showed that staff had not always received an induction into their job role or sufficient training to provide safe and effective care. Staff had received supervision from their line manager but none of the staff files we looked at showed that staff had an appraisal of staff skills and abilities to assess and monitor their competency.

Care staff had an understanding of safeguarding and the action to take should abuse be suspected but records showed they had not always identified signs of abuse correctly. Some improvements to the way safeguarding incidents were handled had been made but further improvements were required to ensure all incidents were robustly managed. This was because some safeguarding incidents were not identified, investigated or reported appropriately.

Staff were polite and pleasant to people but their support was not always provided in a dignified or respectful way and staff were not always attentive to people’s well-being. People told us the staff were kind and caring and people felt well looked after.

The provider’s governance arrangements were ineffective. The managerial systems and the provider’s oversight of the service failed to identify and address all of the concerns we identified. The provider’s lack of action to address these issues both at this inspection and two previous inspections demonstrates they lack the competency and accountability to ensure the service is safe, effective, caring, responsive and well-led. This means people continue to be placed at serious risk.

At the end of our inspection, we discussed the concerns we identified during the inspection with the acting manager. We found they too lacked accountability and the competency to implement changes to the service in order to protect people from avoidable harm.

The overall rating for this provider is ‘Inadequate’. It has been inadequate since 2016. This means the service will remain in ‘Special measures’ by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their

registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

There was no registered manager in post at the time of our inspection. 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 this service in November and December 2016, a manager was in post who was not registered with CQC. They have since left the employment of the provider and were not in post on the day of this visit. At this inspection, an acting manager was in post but they had only been at the service at short while. The acting manager was supported to manage the home by a consultant. The consultant had been brought in by the provider after our last inspection to drive up improvements.

At our last inspection, we identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated inadequate and placed in special measures. During this visit we followed up the breaches we identified at our previous visit and found that the provider had not taken appropriate action to address our concerns and make the improvements. This meant people who lived at the home continued to be placed at serious risk. The rating for the service at this inspection has therefore not changed, the service remains inadequate and in special measures.

During this inspection, we found breaches of Regulations 9,10,11,12,13,17,18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at 11 care plans and found some improvements to the way people’s care was assessed and delivered had been made but these improvements were insufficient and inconsistent. There was little evidence that people’s preferences and wishes in relation to their care had been discussed with them so person centred care could be delivered. Some of the risks in relation to people’s care had not been risk assessed and some of the risk management information was contradictory and confusing for staff to follow. This placed people at risk of receiving inappropriate or unsafe care. Records relating to the provision of care showed that improvements to people’s catheter care and wound care had been made but we found that other aspects of people’s care required improvement.

For example, records showed that people did not receive the support they required with their personal care to preserve their dignity and skin integrity. People’s ability to make decisions about their care had not been assessed in accordance with the Mental Capacity Act 2005 and the correct legal processes to deprive people of their liberty had not been followed. We found that people had no access to any social or recreational activities in support of their emotional well-being and observed that the majority of people sat all day watching the TV.

People and the relatives we spoke with told us that there were not enough staff on duty to meet their needs at all times. Some people said that they had to wait long periods of time to be assisted the toilet or for staff assistance when they rang their call bell. They told us that the care staff worked hard but that there wasn’t enough of them on duty to always meet their needs in a timely manner. Our observations of care confirmed this.

Records showed staff were recruited safely but we found that one staff member had been promoted to a senior post without any evidence that a robust recruitment process had taken place. One staff member was also disciplined for poor conduct without adequate disciplinary procedures being followed. We also found that staff had not received the training or support to do their job role effectively.

Care staff spoken with had a good knowledge of safeguarding and the action to take should abuse be suspected but the provider had not always followed the required processes to protect people from the risk of abuse. For example where potential abuse was suspected, there was no evidence that the provider’s own safeguarding policy or the Local Authority’s safeguarding procedures had been followed. This meant there was no evidence that incidents of abuse were investigated, reported and responded to appropriately.

Staff were observed to support people in a kind, caring and patient manner. We found however their ability to spend any meaningful time with people was hindered by the fact they were too busy trying to meet everyone needs. We observed that staff were unable to spend any meaningful time with people unless they were directly supporting them with their personal care. People told us that the majority of staff treated them well. We found however that the service did not always protect people’s right to privacy, dignity and confidentiality.

For instance, some people had not received a bath or shower for significant periods of time; some people’s bathrooms did not have any window blinds or coverings to protect their dignity and people’s visits to the hairdresser were undignified and de-personalised. In addition, people’s personal information was not stored confidentially and was accessible to unauthorised people.

The provider had audits in place to check the quality of the service but these were ineffective. For instance inconsistencies in people’s care planning information had not been picked up, premises issues had not been addressed and the provider’s medication audits had identified that the management of medication was unsafe.

People views about the quality of the service had not been sought and some of the people we spoke with did not know who managed the service.

This service was not well-led. At the end of our inspection, we discussed the concerns we identified during the inspection with the acting manager and the consultant. The acknowledged and accepted the concerns we had raised with regards to the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We carried out a third day of inspection on 15th December 2016. This was to check the provider was working towards an action plan they had given to us to address immediate concerns we had following the first two days of inspection. The provider was informed we would be returning but not the date on which we would do so.

Woolton Manor is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 66 people. At the time of our inspection 23 people were receiving nursing care and 33 people residential care.

The home required a registered manager. 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. The current manager had been working at the home since April 2016 but had not yet registered with CQC.

During our inspection, we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 9 Person centred care; 10 Dignity and respect; 12 Safe care and treatment; 13 Safeguarding service users from abuse; 16 Receiving and acting upon complaints, 17 Good governance and 18 Staffing, of the Health and Social Care Act 2014 Regulations.

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

The staffing in the home was insufficient to meet people’s needs. The home did not always have appropriately trained staff on duty to meet people’s specific care needs.

The care provided at the home was not always in accordance with people’s care plans placing people at risk from harm due to poor care.

Medication was not safely managed and was not always available as prescribed.

The building and equipment in it were not always fit for purpose. We found unrestricted windows and dirty equipment in the home. We also found mould in cups and jugs left lying around that a person who may be confused could come into contact with.

Complaints were not always recorded and handled appropriately and the management audits and processes in the home failed to recognise all of the concerns we identified during the inspection which meant that the home was not safely run.

On the third day of the inspection we saw that the provider had begun to take action to address some of the very serious concerns we had identified. The changes being made were new to the service and had not been fully implemented or embedded. We were therefore unable to judge whether they would be maintained and provided a consistent improvement to the service people received.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special

measures' by CQC.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will 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 we will move to close the service by adopting our proposal to vary the provider's registration to remove this location from the providers registration.

Woolton Manor is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 66 people. At the time of our inspection there were 58 people living at the home. 33 people were receiving personal care and 25 were receiving nursing care, another two other people who lived at the home had been admitted to hospital.

The home does not have a registered manager. 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. The previous registered manager left the home in February 2016. A new manager was appointed in April 2016 but has not applied to register with CQC as the manager. The name of a previous registered manager appears on this report as their application to de-register as manager of this home is currently being processed.

During the inspection we spoke individually with 10 of the people living at the home and with four of their relatives. We also held a meeting which was attended by a further four people who lived at the home and three of their relatives. We visited six people who were being looked after in their bedrooms but we were not able to communicate with them in a meaningful way.

We spoke individually with 14 members of staff and held a meeting with a further 4 members of staff one of whom we had spoken with individually, these staff held different roles within the home. In addition we spoke with two visiting health professionals.

We examined a variety of records relating to people living at the home and the staff team. We also looked at systems for checking the quality and safety of the service.

People felt safe living at the home. Staff had received training in safeguarding adults and knew how to report any concerns that they had. However safeguarding concerns were not always dealt with in line with local authority procedures.

The views of people using the service had not always been obtained and / or acted upon to improve the quality of the service they received.

People said they had always received their medication and were given pain relief when they needed it. Support was provided to people with their personal care but not always in the way they would prefer. People told us they did not have the opportunity to have a bath or shower as often as they would like.

People received the support they needed with their healthcare and had their legal rights protected where they lacked capacity to consent to treatment. Their care needs were assessed and clear guidance was in place for staff to meet the person’s needs.

A choice of meals was always available and people had plenty to eat and drink but did not always enjoy the food provided.

A number of changes had recently occurred in the home including a high turnover of staff and a lack of activities. People living there felt this had impacted on their quality of life.

People liked the regular staff team and were satisfied with the care they provided. Sufficient staff worked at the home but a high staff turnover and use of agency staff had impacted on the experiences of people living there and staff working there who felt that at times there were insufficient staff available who knew people’s care needs well.

Robust procedures were in place for recruiting new staff.

Staff had received training in recent months and felt that this was sufficient to meet their needs. However training records were incomplete and it was not possible to establish whether staff had undertaken more specialist training related to their role.. A process for supervision of staff had been put into place but was not yet embedded. Some staff felt unsupported whilst working at the home and that staff morale was low. Other members of staff felt supported and welcomed some of the changes being introduced.

It was unclear who managed the home when the manager was absent and we found that people living there, their relatives and staff had different opinions as to who was in charge of the home on a daily basis in the manager’s absence.

During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The people living at Woolton Manor told us that they had always felt safe living there. They had confidence that any concerns they had would be taken seriously and acted upon by senior staff.

People's health and personal care needs had been identified and were being met by the home.

There were enough staff on duty to meet the needs of the people living at the home. Prior to employment, recruitment checks had been carried out on staff to help ensure they were suitable to work with people who may be vulnerable.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place.

Is the service effective?

People living at Woolton Manor told us they had received the support they needed with their care and welfare needs. They told us that staff ensured they received any pain relief they needed on time and obtained healthcare advice for them when needed.

Staff had received training to meet the needs of the people living at the home.

Is the service caring?

The people living at Woolton Manor told us that they liked and had confidence in the staff team. One person told us, 'They are polite, helpful. They don't shout.' Another person commented 'Very good. I couldn't get better.'

We observed that staff took time to speak with people and provide reassurance if they were upset or agitated. We also observed that people had received support to maintain their appearance.

Is the service responsive?

People's needs had been assessed before they moved into the home. This enabled staff to plan they support they would need.

Regular monitoring of people's health had taken place and care records reflected the support people needed. When required referrals had been made to other healthcare professionals.

Is the service well-led?

Staff told us that they felt supported by senior staff at the home. The people living at Woolton Manor told us that they had confidence in senior staff. However systems for checking the quality of the service were not effective. No formal system was in place for obtaining the views of people living at there. Some equipment checks were out of date and no audit of the environment had been undertaken recently.

People told us they felt safe living at the home and we found that people were able to express themselves freely and openly. People told us they would tell someone if they had any concerns about the way they were treated. Staff were knowledgeable about the different types of abuse and indicators of abuse and they knew the procedures they needed to follow if they had a safeguarding concern.

We found that medication was properly stored and had been signed for correctly.

We found that people had all the equipment they needed to help with their comfort, mobility and independence and we found it was suitable and safe for peoples to use.

Staff told us that they had gone through strict checks before they started work at the home and we found that they were suitably experienced and qualified to do their job.

A complaints procedure was available at the home and people told us they had been given information about how to complain. People said they were confident about complaining if they needed to.

We spoke with seven residents about their medicines and the care they received.

None of the residents we spoke with raised any concerns about the way their medicines were handled and all were very positive about living in the home.

One person who was looking after their own medicines told us they wanted to do this and they said care workers checked on them regularly to help make sure they were managing them properly.

Another person told us they were 'happy with the care' they received.

One person said 'I feel safe, all very good'