Archived: Woodford Care Home

This unannounced comprehensive inspection took place on 20, 22 and 29 September 2016. The inspection was carried out by one adult social care inspector. At the last inspection of the service in August 2015, the registered provider had achieved compliance with the regulations we had found to be non-complaint during inspections carried out in February and May 2015.

There was no registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

A registered manager left the service in April 2016. A manager was recruited who began the application process to become the registered manager but they left the service in August 2016. A senior carer was then promoted and is referred to as the ‘acting manager’ throughout this report.

During this inspection, we found that the registered provider had failed to sustain the improvements we found at the last inspection of the service in August 2015.

We found multiple breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. 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 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 registered provider's registration of the service, will be inspected again within six months. The expectation is that registered 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 registered 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 registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

The infection control practices within the service increased the risk of people contracting a healthcare related infection. Staff carried soiled laundry through the home and we saw used incontinent pads left on the shelving in people’s rooms. The extractor fan in the main bathroom/toilet, which is situated off the main lounge and adjacent to the kitchen; was not working at the start of our inspection this increased the risk of air borne spoors contaminating the lounge and the kitchen.

The environment was not maintained effectively to ensure the safety and welfare of the people who used the service. Vulnerable people had access to water temperatures that could have burnt or scalded them because the registered provider had failed to ensure safe water temperatures were maintained.

Safe recruitment practices were not followed. The registered provider had failed to assure themselves that prospective staff were suitable to work with vulnerable adults because they failed to undertake Disclosure and Barring Service (DBS) checks or acquire suitable references before staff commenced working with vulnerable people autonomously.

Staff with relevant training, skills and abilities were not always deployed. We cross-referenced the staffing rotas and staff training records and saw that on numerous occasions during July, August and September 2016 staff working the night shift had not completed important training. This included dementia, infection control, health and safety, fire, first aid, food hygiene, the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS) or medication training. This exposed people to the risk of not receiving the care and support they were assessed as requiring.

Staff were not supported effectively and had not received regular supervision, appraisal or professional development.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of adults by ensuring if there are restrictions on their freedom and liberty, these are assessed by appropriately trained professionals. The registered provider had not fulfilled their responsibilities in relation to DoLS; they had failed to identify who met the criteria for DoLS and to submit applications to the supervisory body as required. This meant that people who used the service may be unlawfully restricted.

People were supported to eat and drink sufficiently to meet their needs but we found choices of meals were limited and people were not always offered alternatives if they did not want to eat the main meal options.

During the inspection, we observed a range of care and support and witnessed staff supporting people and meeting their needs in a caring way. However, we also witnessed staff not responding to people’s questions or requests in a caring way and noted that, on more than one occasion staff actions failed to maintain people’s dignity.

People’s care plans did not reflect their current level of needs and we found two people had not had a care plan created by the service. This meant staff may not be fully aware of people’s needs or the care and support they required.

The registered provider had a complaints policy that included acknowledgement, investigation and response times. The policy was made available to people who used the service.

There was no evidence that any form of auditing or quality assurance had taken place within the service between April and September 2016. The acting manager had completed tests of the emergency call bell systems in three random rooms and undertaken infection prevention and control audits on three occasions in September 2016. However, the audits failed to highlight the concerns found during our inspection and their findings were not sufficient to drive improvement within the service.

The registered provider had failed to adhere to advice and guidance provided by relevant persons such as the local fire authority and the environmental health team.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity and we observed caring and compassionate care by the staff. People told us they felt safe. People had their own care file and these contained records relating to the individual's personal support, mobility, nutrition, moving and handling, medications, challenging behaviours and mental capacity assessment. The file contained information about the way each person should be supported and cared for. Additional information included risk assessments to ensure people remained safe from harm.

Staff told us that they had completed an induction as part of their initial employment and were positive about the overall induction process. Staff were complimentary about the service and told us, 'I like working here, it's not just a job, it's like we are family.' and 'The atmosphere is so relaxing and the manager is very approachable.'

There were clear policies and procedures in place. Safe and appropriate moving and handling practices were followed within the service.

Is the service effective?

People who used the service engaged with their support worker on an individual basis to discuss their likes, dislikes and care and support needs. Staff completed daily records which monitored a person's care and wellbeing and included their daily living activities.

During our inspection we saw a hairdresser visiting and people were supported to use this facility. We observed four people who had used the hairdressing service and one said, 'We have all had our hair done, don't we look nice. It makes you feel better when your hair is nice.'

We spoke with members of staff and found they understood the process for making health care support appointments on behalf of people who used the service.

Is the service caring?

People's care was planned and delivered in a way that was intended to ensure their safety and welfare. We saw that people had risk assessments in place which covered areas such as: weight monitoring, bed rails, pressure relief, falls and moving and handling.

We saw that care plans had been checked on a monthly basis by the manager and they also contained a signature from the person who used the service to say they had read and agreed with their care plan.

We spoke with visiting relatives and they told us, 'The care is wonderful and mum is really safe here. If we had a problem with the service they would know about it straight away', 'I know mum is looked after well which is important to us and the staff are so good to people' and 'I chose this home for mum because the residents always sit together. I think the manager has done a lot for this place, she is passionate about the care.'

Is the service responsive?

We spoke with the manager about the arrangements for activities in order that people who used the service felt involved and stimulated. The manager told us that they did not have a full time activities co-ordinator and that care staff were responsible for in house activities. Theses consisted of ball games, reminiscence, skittles, 'play your card right', movement to music and bowling. We observed people who used the service reminiscing over old photographs with staff.

We spoke with a visiting health care professional and they told us, 'The staff are open and friendly and they are always asking for advice on matters when I attend most days of the week.'

People we spoke with told us they felt able to complain and they were sure issues would be addressed. People were therefore assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service had an effective quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. We spoke with the manager about the arrangements for monitoring the quality of the service. They told us that they had completed a quality assurance survey in March 2014 and records we looked at confirmed this.

We spoke with staff and comments included, 'The service runs really well, on most days but we can have days where we are much busier than normal but these are managed and staff work well as a team' and 'I love everything about the service. It is really easy to approach the manager, seniors and other staff. We play a part in the success of the home. We are a great team.'

We saw that policies and procedures were in place to give staff clear direction and understanding about how to manage various situations.

We looked at maintenance records provided to us by the manager. These included safety and electrical tests around the service that ensured the safety and welfare of people was protected.

We found that information was available for staff which told them how the person preferred to be cared for. People who used the service told us the staff were very caring, comments included, 'The girls are very kind', 'The staff are really good they can't do enough for you.' Relatives told us, 'The staff are marvellous they are really caring', 'I chose this home for my mum because it's like one big family' and 'The staff put their heart and soul into caring for my mum.'

The home was clean and tidy and free from any mal-odours. However the furnishings in both the bedrooms and communal areas were looking worn and in need of replacement.

People had a say about how the home is run. People who used the service told us, 'I can go to the manager if I have any problems and she will sort it.' Relatives told us, 'The manager is approachable and I can go to her if I have any problems' and 'We can talk to any of the staff they are all really approachable.'

A relative told us 'The carers are really good, you couldn't get better anywhere, and the carers are really good to them.'

Another relative said 'I am very happy with the care of my wife, the staff are very nice and they keep me informed.'

We found that where staff had identified any issues with a person's nutrition such as their intake had reduced, there was evidence that they had sought medical advice and had commenced monitoring records.

A relative said 'My wife is eating well and has put weight on since being here.'

Staff told us they had received training and were knowledgeable about what constituted abuse and how they would report any signs of abuse.

We saw that safe handling of medicines training had been completed.

A person who used the service told us, 'There are enough carers about and they are very good. They answer the bell straight away.'

A staff member said that they received regular training and confirmed they had completed administering medication, health and safety and moving and handling in the last 12 months.