We undertook an unannounced inspection of Woodfields Residential Home on 28 January, and 3 and 4 February 2015. We last inspected the service on 15 October 2014 to look at how the provider managed medicines. At our previous inspection the provider was not meeting the law in relation to the safe management of medicines. Following our October 2015 inspection the provider sent us an action plan to tell us the improvements they were going to make.
At a previous inspection on 8 May 2013 the provider was not meeting the law in relation to the management of medicines and staffing. The provider sent us an action plan to tell us the improvements they were going to make in relation to these areas.
During this inspection we looked to see if these improvements had been made. We found that, while some areas had improved, further improvements were required.
Prior to this inspection, we had received information of concern about one person was being cared for at the service. We looked at matters relating to these concerns during the inspection.
Woodfields Residential Home provides accommodation and personal care for up to 17 older people. At the time of our inspection 13 people were living at the service.
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.
People were positive about the service they received. Most visitors were also positive about the service. One visitor raised issues which we referred to the local safeguarding authority.
Updated risk assessments were not consistently available in people’s care records. Where available updated, accurate risk assessments gave guidance to staff on how to reduce risk or harm to people when undertaking certain activities or when specialist equipment is used during their care.
The provider had not applied consistently safe recruitment practices, by ensuring that checks were carried out to show staff were of good character before they started working at the service.
We found improvements in how medicines were managed. For example, records indicated that people received the medicines they required to promote their health. However, there was still a lack of robust guidance for staff about when to administer ‘when required’ medicines, such as pain relief.
Staffing levels had increased and people told us there were enough staff to care for them. However, we observed periods of time where people in communal areas were left unattended by staff. People did not have the facility, such as call bells, to call staff to these areas should they require assistance.
Staff we spoke with knew how to keep people safe, by reporting issues of concern in the appropriate way. Staff were provided with guidance about how best to evacuate people in an emergency.
Staff demonstrated a poor understanding of people’s rights and how people were restricted. Staff gave inconsistent answers as to who was subject to restrictions in their liberties; for example, leaving the service unaccompanied. Care records showed a lack of mental capacity assessments and best interest decisions for people who staff said were not able to make certain decisions. This meant there was a risk people’s rights would not be respected.
People told us they enjoyed the food on offer at the service. However, records relating to how much food and drink people had consumed were inconsistent and contradicted each other. The records of people who were at risk of dehydration sometimes showed low fluid intakes and this had not been identified by the provider. Staff were unaware of how much fluid some people required to maintain their health. Staff demonstrated that they were aware of people’s special food requirements, such as soft diets.
People’s health was supported by appointments with external healthcare professionals, such as doctors.
People told us staff were kind and caring. Staff supported people in a compassionate way and ensured they communicated with people in the way they preferred. Staff sought to understand people’s choices and respected these. Staff promoted people’s dignity, privacy and independence.
Care plans were not always personalised in respect of people’s specific medical conditions. Staff were flexible in their approach to people’s care if their health changed. People and relatives were involved in care planning and staff listened to their opinions. People said they would feel comfortable in raising issues with staff. The provider had an effective complaints process in place.
People, most visitors and staff we spoke with were positive about the management team at the service. Staff received support from the management team in carrying out their roles.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.