Archived: The Woodlands

People’s experience of using this service and what we found

This was a targeted inspection that considered staffing levels. Based on our inspection of the staffing levels we found additional planning was needed each shift to ensure that the right staff were delivering the right care to the right people based on their knowledge and experience of the home.

People had their basic needs met but there were insufficient staff available to ensure that people were supported to engage in meaningful activity. People did not always receive care that was personalised, people’s individual risks and needs were not always managed by the most appropriate staff available.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was Requires Improvement (published 19 May 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the level of staffing and the ability to ensure safe staffing in the long term. The provider told us that due to the necessity for staff to be fully vaccinated against COVID-19 by the 11 November 2021, several staff would cease working on or before this date. A decision was made for us to inspect and examine those risks.

The Care Quality Commission have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at staffing under the Safe key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Woodlands is a residential care home providing personal care for up to 19 older people. Some of these people are living with dementia. At the time of the inspection, 14 people were living at the service.

People’s experience of using this service and what we found

Since our last inspection, improvements had been made to the management of risks related to people's health. Risks relating to hydration, nutrition and constipation were now managed safely. However, we identified other risks in relation to moving and handling.

Improvements had also been made to the safe management of medicines. However, further improvements were required to ensure medicines were managed safely.

Improvements had been made to risks in the environment and window restrictors now met Health and Safety Executive standards. However, we identified other areas of potential risk which we discussed with the manager. Action was taken to mitigate these risks during our inspection.

People told us they felt safe. The registered manager and staff understood their safeguarding responsibilities to protect people from avoidable harm. Staff received training in safeguarding and felt confident to raise safeguarding concerns if required.

The provider's recruitment processes did not always ensure staff were suitable for their roles in line with the requirements for employers in health and social care. There were enough staff to meet people's needs but throughout the day where people were left without sufficient observation.

People were not always encouraged or motivated to take part in activities to enhance their social and emotional wellbeing.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however the policies and systems in the service did not always support this practice.

Staff understood their responsibility to report accidents and incidents. These accidents and incidents were reviewed, and action was taken to reduce the risk of re-occurrence. Where necessary, referrals had been made to other healthcare professionals to ensure people remained well.

The provider had systems and processes in place for checking the safety and quality of the service. However, these had not always been effective. Since our last inspection, the registered manager had responded well and made sure any identified risks were being managed safely.

The registered manager understood their regulatory responsibilities and had provided us (CQC) with statutory notifications about important notifiable events and incidents that occurred in the service.

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 last rating for this service was requires improvement (published on 11 December 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We completed a responsive inspection at The Woodlands in November 2019 as we had received concerns about the management of risks related to people's health. We only looked at the areas of 'safe' and 'well led' as we wanted to be sure people were safe.

This was a planned comprehensive inspection to look at all areas of care delivery, based on the previous rating.

Enforcement

At this inspection we some found improvements had been made and the provider was no longer in breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, enough improvement had not been made and the provider was still in breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

The Woodlands is a residential care home providing personal care for up to 19 older people. Some of these people are living with dementia. At the time of the inspection, 14 people were living at the service.

People’s experience of using this service and what we found

Risk's to people's health were not always managed safely. We found risks associated with malnutrition, dehydration and constipation were not effectively managed. Environmental risks had not always been identified and assessed. We found window restrictors did not meet health and safety requirements.

People told us they felt safe. The registered manager and staff understood their safeguarding responsibilities to protect people from avoidable harm.

Medicines were not always managed safely. Systems and processes had not always ensured people received their medicines as prescribed. Where people had been prescribed medicines via a patch, we could not be confident these were being administered in line with the manufacturer’s guidelines.

The provider's recruitment processes did not always ensure staff were suitable for their roles in line with the requirements for employers in health and social care. We received mixed feedback from people, relatives and staff about how responsive staffing levels matched people’s needs.

Staff understood their responsibilities to report accidents and incidents. These accidents and incidents were reviewed, and action was taken to reduce the risk of re-occurrence.

The provider had systems and processes in place for checking the safety and quality of the service. However, these had not identified the issues we found during our inspection visit.

The registered manager understood their regulatory responsibilities and had provided us (CQC) with statutory notifications about important notifiable events and incidents that occurred in the service,

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published on 4 July 2017).

Why we inspected

The inspection was prompted in part due to concerns received about risk management and nutrition and hydration. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Woodlands on our website at www.cqc.org.uk.

Enforcement

We have identified breaches of the regulations in relation to safe care and treatment at this inspection. The provider had not done all that was reasonably practicable to mitigate risks to the health and safety of the people using the service. We also identified a breach of good governance at this inspection. The provider did not have effective systems and processes in place to assess, monitor and improve the quality and safety of people using the service. Identified risks were not continually monitored.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

The Woodlands is a residential home which provides care to older people including some people who are living with dementia. The Woodlands is registered to provide care for up to 19 people. At the time of our inspection there were 18 people living at the home.

The Woodlands was last inspected in April 2015 and was rated as ‘Good’.

There was a registered manager at the home. 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.

Staff received training that helped them to meet people’s individual needs, and they effectively used their skills, knowledge and experience to support people and develop caring and trusted relationships.

Staff supported and encouraged people to make individual choices in how they lived their lives. For people who lacked capacity to make certain decisions, staff prompted and offered people choices which were made in their best interests.

Relatives felt involved in care decisions and were complimentary about the support staff and the registered manager provided to their family members and in some cases, to them, especially when they needed support at difficult times. People were referred to other healthcare professionals when required to ensure their health and wellbeing was maintained.

People were involved in hobbies and leisure activities and activity co-ordinators arranged activities to help keep people motivated and stimulated.

People had meals and drinks that met their individual requirements and people said they enjoyed the choices of foods provided.

People told us they felt safe living at The Woodlands and staff knew how to safeguard people from the risk of abuse or poor practice. Staff knew what actions to take if they had any concerns for people's wellbeing. The registered manager knew what action to take if concerns regarding people’s safety were brought to their attention.

People’s medicines were administered by trained and competent staff. The staff team were becoming more confident in using a new electronic medicines system which helped them ensure people received their medicines safely and as prescribed.

The staff team had been at the home for some time and were complimentary of the home, the registered manager and the provider. All staff said they enjoyed working there and worked well as a team.

The provider had quality monitoring processes which included audits and checks on care records, infection control, fire safety and accidents and incidents. We found improvements were needed because these systems did not always identify and demonstrate what improvements and actions had been taken. When checks were delegated to others, there was no follow up to ensure they were completed to the provider’s expectations and standards.

We looked at the care records for two people who lived at the home. People that we spoke with were very satisfied with the care they had received. One person said: 'There is no place like your own home but I am happy here as I could be'.

We found consent had been obtained from people before care and treatment had been provided. Staff we spoke with told us they respected people's individual choices and decisions.

We found people received care and support as planned according to their needs. Staff understood people's individual needs and how to give the support that they required.

People were cared for in a safe and clean environment and were able to access all parts of the home and garden.

We found that the provider had an effective system in place that monitored the quality of service that people received.

People received information on how to make a complaint if they were not happy with the service. We found that the provider had received complaints and had dealt with them to people's satisfaction.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Some of the people who lived at The Woodlands were unable to express their views verbally, so we spent time observing how staff supported them. We were however able to speak with four people who used the service, four relatives, one visiting professional, two members of care staff and the manager.

People who used the service and their representative told us they had been involved in their care planning or that of their relative. We saw consent to care and treatment information had been included in people's electronic care plans. We spoke with two relatives to confirm the consent to care and treatment had been explained to them.

We saw people's electronic care files contained up to date information and these had been regularly reviewed.

People and their relative told us they felt safe at The Woodlands. They said the 'Staff are very good and kind.'

We looked at training records and we found care staff had received up to date training in key elements such as safeguarding vulnerable people. We found that staff had been given the opportunity to meet with their manager on a regular basis.

Systems were in place to monitor the quality of care and people who used the service told us they were given the opportunity to be involved in the running of the care home.