Archived: Woodthorpe View Care Home

At the last inspection in February 2018, we found serious concerns relating to the quality and safety of the home. The service was rated 'Inadequate' and placed into special measures. We took action to restrict new admissions to the home and we imposed conditions on the registration of the provider, which required them to submit regular action plans to us. Other enforcement action remains ongoing. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

During this inspection, we found that although some improvements had been made, further improvements were still needed to ensure the quality and safety of the home. We identified concerns in relation to risk management, consent and governance and leadership. We found three breaches of the Health and Social Care Act 2008 regulations.

There was a 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. There was also a quality manager who had been employed by the provider to improve quality of the service, they took responsibility for many aspects of the running of the home and are referred to throughout this report.

During our inspection we found the service was not consistently safe. People were not always protected from risks associated with their care and support. People were placed at risk of falls as risks were not always assessed and staff did not have access to guidance to inform their care and support. Other risk assessments were not always reviewed at the specified timescales to ensure measures continued to be appropriate and effective. Accidents and incidents were investigated, further improvements were required to ensure care plans were updated to reflect this. Safe recruitment practices were not in place. This increased the risk of people being supported by unsuitable staff.

People told us they felt safe and there were systems and processes to minimise the risk of abuse. The home was clean and hygienic and people were protected from the risk of infection. There were enough staff to meet people’s needs and ensure their safety. Overall, medicines were stored and managed safely. However, improvements were required to medicines records to ensure people were always given their medicines as prescribed.

Some improvements were required to ensure people were supported to have maximum choice and control of their lives. People had access to healthcare; however, further improvements were required to care plans to ensure people received the support they required with specific health conditions. Overall staff had enough training to enable them to meet people’s individual needs, further improvements were planned to ensure all staff had up to date training. Staff felt valued and supported.

People had enough to eat and drink, they chose what they ate and received assistance as required. There were systems in place to ensure information was shared across services when people moved between them. The building had been adapted to meet people’s physical needs, further improvements were needed to ensure the needs of people with dementia and memory loss were met by the design and decoration of the home.

People told us staff were kind and caring. Staff respected people’s privacy and treated them with dignity. People were involved in day-to-day decisions about their care and support and had access to advocacy services if they required this to help them express themselves. People were encouraged to be as independent as possible. Further work was ongoing to ensure people’s care plans fully reflected their preferences.

People were offered some opportunities to take part in social activities. However, this was limited and we received mixed feedback from people living at the home about the opportunities available to them. People were at risk of receiving inconsistent support as care plans did not all contain accurate, up to date information. Despite this people told us staff knew how to support them and we found staff had a good knowledge of people’s needs. People’s diverse needs had been identified and accommodated and people had equal access to information. People’s friends and family were welcomed into the home. There were systems to investigate and respond to concerns and complaints.

Since our last inspection there had been changes to the management team and this had had a positive impact on the safety and quality of the support provided at Woodthorpe View. However, further improvements were still needed to ensure compliance with the legal regulations. Systems to ensure the quality and safety of the service were not fully effective. There had been a failure to prioritise key areas for improvement which had resulted in people being placed at risk of inconsistent and potentially unsafe support. Sensitive personal information was not stored securely. People and staff were given the opportunity to provide feedback and make suggestions about the running of the home. The quality manager was responsive to our feedback and took swift action to address many of the issues found during our inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People’s experience of using this service: The service was not safe. People were placed at risk of harm as risks associated with their care and support and the environment were not managed safely. Opportunities to learn from accidents had been missed which meant people had been exposed to the risk of avoidable harm. People were not protected from the risk of infection. There were not enough staff employed and safe recruitment practices were not followed. Although people told us they felt safe, a lack of leadership and systems meant there was a risk safeguarding issues may not be identified or addressed.

People were supported by staff who did not have the required skills or competency to provide safe and effective support. People’s health needs were not always met and their needs were not reassessed when their health changed. Care and support was not properly planned and coordinated when people moved between services. Care was not always delivered in line with current legislation and standards. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The environment was not well maintained and this posed a risk to people’s safety.

People told us that staff were kind and caring. However, care plans lacked information about people which meant staff did not always have enough information to provide person centred care. There was an inconsistent approach to involving people in decisions about their care and support. People’s right to privacy was respected.

People did not consistently receive personalised care that met their needs. People were not provided with opportunity for meaningful activity. There was a risk that complaints and concerns may not be identified or addressed.

The provider had no oversight of the home and there was no management team in place. Consequently, there had been a failure to identify and address serious issues with the safety and quality of the service at Woodthorpe View. Systems to monitor and improve the quality of the service were not effective. Where audits had identified areas for improvement action had not been taken to address issues. The provider had not implemented learning from serious incidents. Failings in leadership and governance placed people at risk of harm.

Rating at last inspection: Requires Improvement (Report published on 15 August 2018). This service has been rated as Requires Improvement, or Inadequate, at our last four inspections. This demonstrates a failure to make and sustain improvements to the quality and safety of the service.

Why we inspected: This inspection was conducted due to concerns we received about the safety and quality of the service provided at Woodthorpe View Care Home.

Enforcement: You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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.

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.

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

Following our inspection on 6 February, 1 March and 8 March 2017 the service was rated ‘Inadequate’ and placed into special measures. The provider sent us an action plan outlining how they would improve. During our last inspection on 27 July 2017 the service was rated as ‘Requires Improvement’ as further improvements were needed. The provider told us they would complete their action plan by the end of August 2017 and a new audit system would be introduced. During this inspection we found that actions had not been fully implemented and identified additional concerns in relation to people’s safety and the governance of the service.

The service had a registered manager in place at the time of our inspection who was also the registered provider. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not always protected from risks associated with the premises, the improper use of equipment or from risks associated with their care and support. People could not be assured that the management and storage of medicines was safe. Not all staff were aware of the action which should be taken when accidents occurred. People told us they did not have to wait for support from staff but improvements were required to ensure that staffing levels were determined by people’s needs. The service appeared clean but we were not assured that sufficient action was taken to ensure that robust infection control procedures were in place. People felt safe and were supported by staff who knew what action to take if they suspected abuse.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service do not support this practice. People were supported by staff who had received training relevant to their role although some staff felt that the quality of training required improvement. People were complimentary about the food at the service but we saw people did not always get the supervision they required to ensure their safety. People had access to health professionals, however, information in care plans about the support people required to maintain good health was not always clear. The premises was suitable for the needs of the people living at the service, however, information was not readily available in the event people needed to move between services.

People told us that staff at Woodthorpe View Care home were kind and caring. Our observations supported what people had told us. Information about independent advocacy was not made clearly available to people and not everyone living at the service felt they were involved in decisions about their care. People were supported to maintain the privacy and dignity by staff however people’s care records were not stored securely.

People were at risk of receiving inconsistent support which was not always personalised to their needs. People’s care plans did not always contain information about how staff should support them in line with their preferences at the end of their life. People were supported to take part in limited activities and social opportunities. People felt confident to make a complaint or raise concerns about the care and support they were provided with.

The service was not well led. Systems in place to monitor and improve the quality and safety of the service were not effective and this placed people at risk of harm. There was poor oversight of the service which meant that areas for improvement were not identified or acted upon. People were provided with opportunities to provide feedback on the service they received. Staff expressed mixed views on whether the management structure at the service was conducive to driving improvement.

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 of 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 this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The home was last inspected on 6 February, 1 and 8 March 2017 and was rated ‘inadequate’ overall. We placed the home in to ‘special measures’ and the provider sent us an action plan outlining how they would improve. We undertook this inspection to check if improvements had been made. We found that enough improvements had been made to take the home out of ‘special measures’ and the quality and safety of care people received had improved. However there were still some improvements required so that the provider could ensure themselves that people received a service which consistently met their individual needs.

The home had a registered manager in place at the time of our inspection who was also the registered provider. 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.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily lives and care needs were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support however not all staff had undertaken the training the provider identified that they required. Plans were in place for further staff training.

People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions. However care plans did not always contain personalised information which told staff how they preferred to be supported.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a home where staff listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

People were involved in giving their views on how the home was run. However the systems in place for monitoring the quality and safety of service people received required time to be implemented, embedded and sustained. We found a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The home was last inspected in June 2016 and was rated ‘Good’. Due to concerns raised by the local authority safeguarding team in relation to the management of falls within the home, this inspection was brought forward.

This inspection took place on 6 February, 1 and 8 March 2017. The first inspection visit was unannounced, with the second announced to ensure the provider had sufficient time to meet with us. The third visit was unannounced to check whether actions the provider assured us they would take after our second visit had been taken. Due to the seriousness of concerns found during our first visit we held a meeting with the provider. During the meeting we shared our concerns with them and requested that immediate actions were taken to ensure people’s safety. At the time of our third visit some of the actions they had assured us they would take had not been completed.

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.

The service had a registered manager (who is also the provider) in place 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. We will refer to this person as the ‘provider’ throughout the report.

The provider did not have sufficient systems and processes in place to assure themselves that people received safe and good quality care that met their needs. We found risks associated with people’s care were not always identified and managed well to make sure people were protected from the risk of harm. Learning was not taken from previous incidents to reduce the risk of similar incidents from occurring again and actions were not taken to drive improvement at the home.

Assessments of people’s care and support needs were not always undertaken prior to people coming to live at the home. People’s care records were not always detailed and personalised to give staff guidance on how people preferred to receive their care and how they care needs were to be met. We could not be sure that the provider had taken action to ensure people’s wishes and preferences were identified, listened to and considered when delivering care. People were not always supported to maintain good health as referrals to healthcare services were not always made when people’s needs changed. For example, we saw that referrals had not been made to GPs or the Falls Team when people had fallen.

Medicines were not managed and administered safely in line with current guidance.

The provider and staff did not understand the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments were not undertaken for people who might need them and people were restricted of their freedom without the necessary legal authority to do so. However, people who were able to were supported to make decisions about their care and support.

People were supported by individual care workers who had undertaken training to have the skills needed to provide safe care and support, however processes to ensure people received care that met their care needs were not in place. People were supported to maintain their nutrition and had a choice at meal times.

People who were able to express their wishes lived in a home where staff listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to participate in activities they enjoyed.

People were involved in giving their views on how the service was run however we could not determine how this information was used to drive improvement at the home.

Accommodation for up to 28 people is provided in the home over two floors. The service is designed to meet the needs of older people and there were 18 people using the service at the time of our inspection.

A registered manager was in post and she was available during the 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 previous inspection on 23 June 2015, we asked the provider to take action to make improvements to the area of premises and equipment. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in this area and the regulation had been complied with.

Staff knew how to identify and respond to potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices and safe medicines practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink and external professionals were involved in people’s care as appropriate. However, the adaptation, design and decoration of the service could be improved to support people living with dementia.

Staff were kind and knew people well. People were involved in decisions about their care. Advocacy information was made available to people. People were treated with dignity and respect. People’s privacy was respected and staff encouraged people to be as independent as possible.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken. The registered manager was aware of their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

We did not speak with people using the service at this inspection. We have based our findings on documentation that we inspected and discussions with staff.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive and was notifying the CQC of all incidents that it was required to do so by law.

We saw that the service had made improvements following our last inspection in October 2013.

We spoke with five people using the service. People were happy with the care they received and felt safe. Two people told us that they felt more activities could be offered by the service.

People told us that the building was clean. They told us staff looked after their medication, they had no concerns regarding medication and they got it on time.

Four people felt that there were enough staff to meet their needs. One person told us that they felt there were sometimes not enough staff, for example, when they wanted to go to the toilet in the afternoon. People told us they would be comfortable raising concerns with management.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. However, we also found that people's care and treatment was not fully planned and delivered in a way that ensured people's safety and welfare.

We found that the provider had not taken appropriate action in relation to a safeguarding issue and effective infection control practices were not always being followed.

We found that people were not fully protected against the risks associated with medicines because the provider did not have all appropriate arrangements in place to manage medicines. However, we found that there were sufficient staff to meet people needs.

We found that the provider still did not have an effective system to regularly assess and monitor the quality of service that people receive and was still not notifying the CQC of all incidents that it was required to do so by law. We also found that records were not fit for purpose.

We looked at the care plans and records of four people who used the service. We found people's needs were assessed and care was planned and delivered in line with their individual plan.

We found medication to be handled appropriately and to be safely stored and administered. However, we found an anomaly with one person's medication records which was responded to appropriately on the day of our visit.

Staff received appropriate professional development and staff we spoke with demonstrated a good understanding of the needs of people using the service and how their care should be provided.

The provider did not have an effective quality assurance system and had not notified the Care Quality Commission about incidents that it was required to do so by law.