Archived: Woodcrofts Residential Home

Woodcrofts Residential Home is a care home providing accommodation and support for up to 19 people with mental health needs. The service was supporting 15 people at the time of inspection. The building has two floors accessible via stairs and has on-site parking.

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

Gaps and shortfalls in service provision meant that people were at risk of harm. Widespread infection control issues, lack of risk management systems, and short staffing contributed to our judgment that people were not safe. People received their medications on time, and staff understood what action they would take if they felt someone was being harmed or abused, however there was not an up-to-date safeguarding policy for staff to refer to at the home.

We found no evidence staff had been trained in MCA and DoLS. Some staff were keeping a log of their own training, however the provider had no oversight of this information so it was not possible to be sure what training staff had completed.

Governance systems were not in place, and therefore not effective in highlighting areas of concern. Action was not taken when there were concerns identified with the safety of the environment. The provider has not sent us evidence these concerns have been acted upon.

People felt well-cared for and staff knew about peoples preferred care needs. However, there was not always enough staff on shift to support people and ensure the environment was clean and tidy for people to live in.

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

Some people who lived at the home accessed the community independently. People told us they liked the home and the staff and felt well looked after.

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 Inadequate (published March 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider make improvements to their practice with regards to supporting people’s dietary needs. At this inspection we found the provider had acted on this recommendation and improved their approach to supporting people with their dietary needs.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Why we inspected

We carried out an unannounced focused inspection of this service on 8 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment, staffing, safeguarding and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. We also checked whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. 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 Woodcrofts on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, governance, staffing and the need for consent.

Please see the action we have told the provider to take at the end of this 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Woodcrofts Residential Home is a care home providing accommodation and support for up to 19 people with mental health needs. The service was supporting 17 at the time of inspection. The building has two floors accessible via stairs and has on-site parking.

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

People were placed at risk from a lack of effective risk management systems. We found gaps in care plans, risk assessments and the management of infection control. We could not see any systems in place to monitor and record safeguarding concerns. People said they felt safe and well cared for. They were supported by experienced staff who knew people and their needs well.

The provider had not delivered recent training in essential areas such as medicines and infection and prevention control. We made recommendations about meeting people’s dietary requirements and mental capacity assessments.

People were supported to be as independent as possible and several people visited places such as shops and pubs without staff support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

A lack of effective governance systems meant people were placed at risk of avoidable harm and improvements were not being made where required. The provider did not complete audits, meaning opportunities to improve care were missed. There was no system for recording and monitoring incidents, meaning we were not sure whether risks and concerns were identified and acted upon. We were unsure whether the provider understood their statutory responsibilities to report issues to relevant others.

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 9 July 2019).

Why we inspected

We received concerns in relation to governance of the service, training and IPC. As a result, we undertook a focused inspection to review the key questions of safe, effective and well led.

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.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

We have found evidence that the provider needs to make improvement. Please see the relevant key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe from the risk of abuse, staff training, monitoring risk, infection prevention control, the safe management of medicine, and the overall governance of the service.

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

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.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Woodcrofts is a residential care home providing personal and nursing care to 15 people at the time of the inspection. The service can support up to 19 people. The home accommodates 19 people in one adapted building which was originally four separate houses and specialises in providing accommodation and support for people with mental health needs. There are 19 single bedrooms, with shared bathrooms and three communal lounges. The home is situated close to local amenities such as bus routes and shops.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received support from staff who had received appropriate training and support to enable them to carry out their role safely, including the management of medicines. There were enough staff to support people when they needed it. Staff knew people's identified risks well and were able to support people.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. There was a stable staff team who were knowledgeable about the people living at the service and had built trusting and meaningful relationships with them.

People were protected from abuse and the risk of abuse and staff understood their role in relation to this. People and their family members told us that the service was safe. Risks to people and others were identified and measures put in place to minimise harm.

People's care was individualised and focused on promoting their independence as well as their physical and mental well-being. Staff encouraged people to eat a well-balanced diet and make healthy eating choices.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

There was a clearly defined management structure and regular oversight and input from the registered manager who was also the provider. Staff were positive about the management of the service and told us the registered manager was very supportive and approachable. Any concerns or worries were listened to, addressed and used as opportunities to make continuous improvements to the service.

Systems for assessing and monitoring the quality and safety of the service were effective in identifying areas of improvement within the service. Systems were in place to gather people's views on 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 27 March 2018).

Why we inspected

The inspection was prompted due to concerns received about infection control. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well Led sections of this full report.

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

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.

At the last inspection on the 16 September 2015, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good however we changed the rating under well-led to Requires Improvement because the governance procedures did not always reflect the quality of care being delivered. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was in post at the service. The registered manager was also the registered provider of the service and was supported by a deputy manager and a senior carer. 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 registered provider had systems and processes in place to ensure that staff who worked at the service were recruited safely. People were supported by a consistent staff team, many of whom had worked at the home for a number of years. We observed there was enough staff employed to meet people’s needs.

Staff had received training in safeguarding and understood their responsibilities to protect people from harm and abuse. Staff understood the reporting procedures including how to raise concerns with their line manager as well as reporting to other organisations such as the Local Authority or CQC.

A risk screening tool was completed which assessed any risks to people's health, safety and wellbeing. Identified risks were managed in a manner that promoted both independence and safety.

Risks associated with the safety of the environment and equipment were identified and managed appropriately. Medication was stored securely and administered by staff who had received the appropriate training.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff and the registered manager maintained a clear focus on people’s autonomy to live their lives as they chose. The registered manager described the support they provided as akin to “an invisible safety net to enable people to live as independent lives as possible.”

The service operated within the principles of the Mental Capacity Act 2005 (MCA) and we saw this guidance was taken into consideration when care plans were developed. There was no Deprivation of Liberty Safeguards (DoLS) in place at the time of our inspection.

People were supported to maintain good health and the registered manager often accompanied people to routine appointments. Care records showed that staff sought the input of health and social care professionals when needed. We spoke to two visiting health professionals during our inspection who told us that staff ‘go above and beyond’ and were prompt in recognising any deterioration in health or changes to people’s support needs.

Staff had the necessary skills and knowledge to support people in the way they needed and had a good understanding of the individual needs of the people living at the home. Staff spoken with felt they received sufficient training to enable them to complete their role effectively. The registered provider’s records showed staff required refresher training in some topics and we saw that this was either in process or scheduled.

People told us they enjoyed the food served at the home. Care records showed staff had given consideration to people’s nutritional needs and diabetic diets were catered to.

Everyone we spoke with, without exception, spoke positively about the registered manager and the staff. We observed kind and natural interactions between staff and the people they supported.

People maintained their independence and chose how to spend their leisure time. People were supported to access the local community if they required it but the majority enjoyed frequent access to the local community, pubs and shops without staff assistance. This ensured that people's individuality, choice and freedom was respected and promoted.

People who used the service had experienced enduring mental health conditions which were recognised, understood and supported by staff in a highly person centred way. Records showed and feedback demonstrated that people were supported to live as independently as possible in the local community and this had improved their outcomes and minimised their use of crisis mental health services.

People had access to a complaints policy but those we spoke with told us they had no cause to make a complaint and if they needed to, they would just “knock on the office and speak to [registered manager].” The registered provider’s records showed there had been no recent complaints.

Staff we spoke with were able to describe the visions and values of the service, and felt supported by registered manager in delivering them. One staff member told us their focus was, “To promote independence whilst ensuring people are safe and happy.”

There were opportunities for people and their relatives to provide feedback regarding the home and contribute to service delivery through the use of annual surveys. People told us they could approach the registered manager or staff at any time and felt they would be listened to.

We observed people who used the service approach the registered manager with ease and a sense of familiarity. Staff spoken with told us the registered manager was ‘brilliant’, ‘supportive’ and as someone they could “approach with anything.”

We noted that the registered provider’s documentation was not always reflective of the quality of the care being delivered at the service. We identified that some governance procedures to assess and monitor the quality of the home were not documented. We did not receive a Provider Information Return from the service and identified one incident which had not been notified to us in accordance with our statutory requirements. The registered manager was clearly very 'hands on' in their approach and took an active role in the daily lives of all the people using the service but admitted this sometimes meant that paperwork was not always completed most effectively. The registered manager acknowledged this as an area for further development.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

Staff had received training in safeguarding and felt confident in being able to maintain people's safety. Staff were confident they would be listened to by the provider and supported with reporting procedures to safeguard people living at the service. They told us they would not hesitate to report any concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The staff had a good knowledge base regarding these safeguards. Staff had access to appropriate policies and procedures including guidance on the Mental Capacity Act. These policies are necessary to ensure the protection of vulnerable people who may lack the ability to consent on various issues.

One staff member told us that staff worked hard to provide a service which maintained people's safety and well-being whilst allowing them to live a life of their choice. They said that "staff provided an invisible safety net".

Is the service effective?

We spoke with ten people who lived in Woodcrofts and they told us they were happy with the care that had been provided and they felt their needs were being met. We observed the support being provided and saw examples of good communication and interaction by staff. Staff discussed the individual needs of people they supported. Staff described the support they provided on a day to day basis including daily choices and they were knowledgeable about people's needs and requests. People told us they were supported to pursue hobbies and interests and live a fulfilling life.

Is the service caring?

The interactions between staff and people who lived in the home were excellent. Conversations were all interspersed with gentle humour and mutual respect was observed at all times. Comments received were all positive and included, "staff are very good and help me a lot", "staff never let me down", "the staff provide very good care" and "they are always around, always helpful, if you need any help they always assist". Observations of staff interactions with people who used the service evidenced that they did this with confidence and skill and good humour and in a relaxed and positive manner.

We saw that the staff were skilled in supporting people whilst encouraging them to maintain their independence. Staff discussed the individual needs of people they supported. Staff described the support they provided on a day to day basis including daily choices and they were knowledgeable about people's needs and requests.

Is the service responsive?

People living at the service had a detailed care plan in place to help to show how their needs would be met while living at Woodcrofts. These records were detailed and showed that people's choices and diverse needs were identified and care plans were regularly reviewed. People told us that they were able to discuss arrangements made for their care and they said that they were happy and content with the manner in which their care and support was provided. Feedback from people's relatives also confirmed that people were pleased with the services provided. One relative told us that they felt the home provided just the right amount of care to enable people to live a life of their choice.

Is the service well-led?

The provider had distributed surveys to people using the service and relatives to obtain their feedback. Positive summary reports had been produced and were available for viewing by any person living or visiting the service. People who lived in the home told us that they had regular residents meetings where they discussed the running of the home and made any suggestions as to how it could be improved upon.

There was a selection of in house audits carried out by the manager with checks on various areas within the service including; pharmacy audits; accidents; weight loss; safeguard referrals; records and health and safety. They showed on-going checks by the manager offering evidence of compliance and actions taken to show good practices in supporting people who lived, visited or worked in the home.

We met most people living at Woodcrofts residential home. They advised us they were happy living at the service. They told us that: "There are books to read and games. I've just bought a new television"; "you can please yourself what you do, which I am quite happy with"; "I've got everything I need in my room"; "I think it's lovely here"; the staff help me like with writing a letter"; "I don't want activities, I like to go to town to the shops" and "I'm quite content with the way things are." People were positive about the staff saying: "I like all the staff they are nice people" and "staff are ok."

The service organised monthly meetings for people living at Woodcrofts residential home. Minutes showed information about a lot of topics discussed at these meetings such as: activities; request for bingo; request for toast in the evenings; refurbishment; baths and hoovering. Regular engagement and feedback offered ways for people using the service to provide their opinions and helped influence the development of the service.

Some of the people we spoke with told us there wasn't much to do in the day time. Care files showed no evidence of support or consultation with the individual regarding how their social needs would be met.

Most staff records could not demonstrate whether they had received training in various necessary subjects such as safeguarding; mental health needs; challenging behaviour; food hygiene; medications; fire training and health and safety. The manager/provider advised they would review all staff training needs to ensure that all staff received mandatory training and supervision necessary for their work.

As part of this review we spoke with the provider who advised they had taken steps to recruit a manager for the service. However for the last year the provider had been carrying out the role of the manager but they had not applied to be registered with the 'Care Quality Commission.' The provider was aware of the legal requirement to have a registered manager at the service.