Archived: Woodlands Retirement Residence

Woodlands Retirement Residence is a residential care home providing personal care to 18 people aged 65 and over many of whom live with dementia at the time of the inspection. The service can support up to 19 people.

The care home accommodates people in one adapted building over two floors. Both floors of the home were accessible via a lift.

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

We found some areas of people’s care experience which could be improved further. For example, people were not always informed what meal they were receiving. In addition, there were periods of time where people did not receive meaningful engagement or opportunity for activities.

Improvements had been made in the monitoring systems in place at the service. However, we found that these had not consistently been utilised and had not identified some of the areas of improvement we identified at this inspection. Further time was needed to ensure these new systems were embedded.

People were supported by staff who understood how to recognise and escalate safeguarding concerns should they have any. Peoples’ medicines were in the most part given safely and staff had received training around the administration of medicines.

People were supported by staff who had received sufficient training for their roles. Staff had been recruited safely and received an induction and supervision.

People had the risks associated with their care managed well and steps were put in place to mitigate these. People received access to healthcare to support their individual needs.

There were parts of infection control practice that needed improving. We observed two staff not wearing face masks and some staff not wearing face masks appropriately. The provider has informed us they have taken action to address this practice.

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.

Staff enjoyed supporting the people at the home and we saw that staff engagement with people was caring and kind.

People had a care plan that reflected their individual needs and which was reviewed to ensure it remained current.

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 21 December 2020). However, the service was placed in special measures as they had been rated ‘Inadequate’ for two consecutive inspections in one key question. We found that there was a breach of Regulation 17. Following this inspection we met with the provider and carried out monthly meetings to monitor and support improvement in the service.

This service has been in Special Measures since 21 December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

At this inspection improvements had been made although these needed to be sustained and embedded and as such the provider was still in breach of regulation 17.

Why we inspected

This was a planned inspection based on the previous rating and to see if the required improvements had been made. This inspection was also prompted in part due to concerns received about people having choices in their care, people not being supported safely with manual handling and people having routines for when they had drinks and food. A decision was made for us to inspect and examine those risks.

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.

Whilst we found the service had made improvements we have found evidence that the provider needs to make further improvements. Please see the safe, caring and well led sections of this full report.

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.

This inspection has identified a continued breach relating to monitoring systems at the service. We will continue to monitor the improvement within the service through existing conditions we have placed on the providers registration. This includes sending us monthly reports of action the provider has taken to monitor and make improvements within the service.

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.

Woodlands Retirement Residence is a residential care home providing personal care to 17 people aged 65 and over who may also be living with dementia. The service can support up to 19 people. The care home accommodates people in one adapted building which is set out over two floors. There is access to the second floor via a lift.

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

People had not received a service that was well-led. We found significant shortfalls in the systems in place to monitor the quality of the service.

Since our last inspection, the service had made improvements to how people’s risks were assessed and in ensuring there was guidance available for staff to evacuate people safely in the event of a fire.

People received support from staff who understood how to recognise and escalate safeguarding concerns. Whilst staff had received training around the administration of medicines, we found some systems around the administration of medicines required improvement.

We identified that further improvement was needed around the monitoring of staff recruitment and in the monitoring of staffing levels at the home.

Whilst we found many instances where people had been supported to have maximum choice and control of their lives, we also identified areas which required further improvement. Staff did not always support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We have made a recommendation about accessing information and resources to support people living with dementia.

Staff supported people to access healthcare appointments. People were offered a choice of meals that met their needs.

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 overall and inadequate in well led (published 22 February 2020) and there were two breaches of regulation in relation to the safety of peoples care and in the monitoring of the service. We carried out enforcement activity to place conditions on the provider’s registration to support them to improve in this area. These conditions remain in place.

At this inspection sufficient improvement had not been made in the governance of the service and the provider was still in breach of regulation 17 (Good Governance).

The last rating for this service was requires improvement (published 22 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about medicine management, restrictive practices and people being involved in choices in their care. 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, effective 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

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the well led 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 Woodlands Retirement Residence 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.

This inspection has identified a continued breach in relation to monitoring systems at the service. We will continue to monitor the improvement within the service through existing conditions we have placed on the providers registration. This includes sending us monthly reports of action the provider has taken to monitor and make improvements within the service.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

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 request reports to be sent to us on a monthly basis to monitor the planned improvements. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

We found that risk assessments did not contain adequate information to keep people safe. We also found that some Personal Evacuation Emergency Plans (PEEPs) did not give staff members clear instructions to follow in the event of a fire to keep people safe. The PEEPs contained no instructions for staff members to follow whilst supporting people who were unable to moblise downstairs or who required hoisting.

We found audits undertaken had not identified issues with risk assessments and medication records.

We also found some people who lacked capacity did not have best interest meetings regarding decision about their care and support.

People felt comfortable in the company of staff who supported them. Any concerns or worries were listened and responded to and used as opportunities to improve. Staff were aware of the risks to people and how to manage those risks.

Staff were aware of people's life histories and individual preferences. They used this information to develop positive, meaningful relationships with people. Staff were very knowledgeable about people’s changing needs and people and their relatives confirmed that changing needs were addressed.

People told us they felt well cared for by staff who treated them with respect and dignity and encouraged them to maintain relationships and keep their independence for as long as possible.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to management at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

More information is in Detailed Findings below.

Rating at last inspection:

The last rating for this service was requires improvement (published 22 March 2019) with one breach of regulation. We found that not, enough improvement had not been made and the provider was still in breach of regulations. At this inspection the service is rated as requires improvement. Previously this service has been rated requires improvement for the last four consecutive inspections.

We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected:

The inspection was prompted in part due to concerns received about the management of people with pressure sores. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well led 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 Woodlands Retirement Home on our website at www.cqc.org.uk.

Enforcement:

We have identified a breach in relation to safe care and treatment and good governance at this inspection. The provider responded to the concerns on the day of the inspection.

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.

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

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

At the last inspection in June 2018, we judged that improvements were required in delivering a safe, effective, caring, responsive and well-led service. We found the provider continued to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service. In addition, the registered provider was failing to comply with Regulations 9 (Person centred care), 10 (Dignity and respect), 11 (Need for consent), and 13 (Safeguarding service users from abuse and improper treatment).

After our inspection in June 2018 we met with the provider to stress the level of concerns we had about the service. We imposed a condition on their registration, (a condition is one of our enforcement powers). This required them to be compliant with regulation 17 related to governance and effective systems to monitor the quality and safety of the service. As part of this condition, the provider has been required to submit monthly reports to us at the Commission so that we can monitor their progress in improving the key questions ‘Safe, Effective, Caring, Responsive and Well-Led' to at least good.

We also placed the provider in 'special measures' because the management of the service was inadequate at the February 2018 and June 2018 inspections. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, we inspect the service again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

This inspection on 31st December 2018 and 2nd January 2019, was conducted to assess if there has been improvement.

At this inspection we saw action had been taken to address all the areas of concern, but some improvements were still needed and those made needed to be sustained.

Risks to people’s safety had been identified and plans were in place and followed by staff to support people safely. Staff had been provided with training in how to protect people from abuse and the process for reporting any concerns was now accessible to staff. Staff recruitment had improved with checks on the required documentation made. People received their medicines as prescribed and the arrangements for administering, storing and checking people’s medicines had improved. Staffing levels had improved to meet people’s needs but these levels had not been maintained across all shifts. The provider was recruiting to fill staff vacancies and needs to ensure the required levels of staff are consistently in place. Equipment and supplies to the service were checked and maintained safely. However, further improvement was needed on acting on fire safety within the environment.

At the last inspection we found people's capacity was not always assessed and considered when decisions were made. At this inspection we found the provider was applying for authorisations where people lacked capacity and needed their liberty restricted for their safety. People enjoyed the meals provided although promoting choices around cooked breakfasts for people unable to make a choice needed further improvement. People were supported to drink enough and risks of dehydration were monitored but needed review. There had been some changes made to improve signage and privacy within the premises. People were supported with their healthcare needs. The provider had a schedule in place to provide staff with the training and support they needed.

People described staff as caring and we saw staff attended to people in a caring manner. Since the last inspection the provider had addressed issues related to people's privacy, dignity and confidentiality. They had ensured care records were secured and confidentiality addressed. Privacy screens were in use to protect people’s dignity in shared rooms.

Since the last inspection people had been involved in planning and reviewing their care to identify their preferences. We saw staff understood and responded to people’s needs. People had access to indoor activities; opportunities to follow their own interests such as accessing the local community needed improvement. People knew how to make a complaint.

There were improvements in the systems used to check on the quality and safety of the service. However, there was still some inconsistency in how these were applied. The provider did not have a clear management structure or team in place in which the responsibilities and roles were clear. Whilst they had acted to address many of the concerns we highlighted in our previous report, they still needed to demonstrate they could sustain improvements made. The provider was continuing to work to an action plan which was being monitored by the local commissioning team for progress. Feedback from the commissioning team showed progress was being made. The provider was continuing to share appropriate information with CQC in monthly progress reports as required as part of the condition on their registration. We have advised them more specific information is required which they were addressing. At this inspection we found more work is needed to improve the management and oversight of the service. We found that whilst the provider had implemented audits these were not fully effective in identifying shortfalls and demonstrating action to rectify. We judged the provider continued to be in breach and that the conditions on their registration remain to allow further time to sustain and continue with the improvements.

At the last unannounced comprehensive inspection in February 2018, we judged that improvements were required in delivering a safe, effective, caring, responsive and well-led service. We found the provider continued to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service. In addition the registered provider was failing to comply with Regulations 9 (Person centred care), 10 (Dignity and respect), 11 (Need for consent), 13 (Safeguarding service users from abuse and improper treatment) and 18 (Staffing) . After our inspection in February 2018 we served Warning Notices to the registered provider which required them to be compliant with these regulations by 6 April 2018. A Warning Notice is one of our enforcement powers. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions ‘is the service safe, effective, caring, responsive and well-led service’ to at least good.

At this inspection we found the required improvements had not all been made since February 2018. Some of the improvements we had identified as required at our previous comprehensive inspection in February 2018 were on-going or had not been made and the provider remained in breach of several regulations. Despite previous inspections identifying shortfalls in governance systems, we found that insufficient progress or improvement had not been made to the systems and processes to audit and improve the quality of care provided at Woodlands Retirement Residence and to meet the Regulations. We are considering what further action to take.

There was a registered manager in post who was present throughout 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.

Risks had not always been assessed to keep people safe and protected. There was insufficient guidance available for staff to ensure that people’s conditions were managed appropriately to protect people from potential risks. Most staff knew how to protect people from abuse. Staff recruitment was not robust. People received their medicines as prescribed but the management of medicines was not effective.

People’s capacity was not always assessed and considered when decisions needed to be made to ensure their rights were protected in line with legislation. The registered provider had not ensured that the staff team knew which people were subject to a Deprivation of Liberty Safeguards (DoLS). People had access to a variety of food and drink to maintain good health. People were supported when necessary to access a range of health care professionals. Health care records did not contain sufficient information and guidance for staff to follow. People felt staff had the skills and experience to care for and support them, but staff did not always receive the training they needed to support people effectively and in-line with current guidance.

People were supported by staff who they described as kind and caring. However, we saw instances when people’s privacy, dignity and confidentiality were compromised.

People told us they were given choices about some aspects of their care. However, it was not always clear how people were involved in planning and reviewing their care. People's care records did not always contain an accurate and up to date account of their needs and how these were being met. People were provided with activities they enjoyed but had limited opportunities to access the outside or local amenities. People knew how to raise concerns but information was not available in different formats.

The management of the service was inadequate as the provider did not carry out robust checks to ensure that care was being delivered safely and effectively. The provider had not taken sufficient action to address many of the concerns we highlighted in our previous report. The delivery of high quality care is not assured by the leadership and governance in place.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

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.

We found that the provider was not meeting all of the requirements of the law. We found multiple breaches in regulations. 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.

Woodlands Retirement residence is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates 19 people in one building. At the time of the service 17 people were using the service.

There was a registered manager 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.

The registered manager had not responded and improved the quality of care following our previous inspection and feedback. There was a culture of keeping people safe by restricting their freedom to be independent.

The registered manager did not always follow policies and guidance to ensure people were receiving care that met their individual needs. Staff did not always feel the registered manager was approachable and staff or people were not involved in the running of the home

Risks to people were assessed and lesson learned however actions taken to reduce the risks were restricting people's freedom. There were still insufficient numbers of care staff to maintain people's safety. The registered manager had not recognised and responded to potential safeguarding injuries.

The principles of the Mental Capacity Act 2005 were not being followed to ensure that people were consenting to their care at the service.

People's needs had been assessed however staff did not always have the information they needed to care for people effectively. Staff received training and supervision however they did not feel supported by the registered manager.

The environment was well maintained and nicely presented however consideration to supporting people living with dementia required further action.

People were not always treated with dignity and respect and their right to privacy was not always upheld. People were not always involved in making decisions about their care and support.

People were not all receiving care that was person centred and that met their individual preferences.

People's medicines were safely stored and administered and the infection control procedures in place prevented the spread of infection.

People's nutritional needs were met and they had access to a range of health care agencies when their needs changed or they became unwell.

There was a complaints procedure and people felt able to complain.

People's end of life wishes were noted and when necessary they were cared for to ensure a comfortable and pain free death.

Woodlands Retirement Residence is registered to provide accommodation and support for 19 people who have conditions related to old age and /or dementia. On the day of our inspection there were 17 people living at the home. There was a registered manager in post who was also the 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 told us they felt safe living in the home. Staff were able to explain the actions they would take to keep people safe from harm, but had not received the appropriate safeguarding training. People were able to receive medicines for pain relief when needed, but the medicines were not always being administered safely. The provider did not have a dependency tool in place to be able to identify and demonstrate they had sufficient staff to meet people’s assessed needs.

While staff had received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards, further training was still needed as they were unable to explain how people who lacked capacity their human rights would be protected. Staff were not able to access a good level of support by way of regular supervisions or staff meetings.

While the majority of staff showed that they were caring and kind, it was important that this was demonstrated at all times as we observed a member of staff shouting at a person. The environment of the home was warm and welcoming.

We found that people were encouraged at the point of receiving support from staff to make choices and decisions as to how staff supported them. People’s privacy and dignity was not always being respected.

We found that while there was an assessment and care planning processes in place there was not sufficient information being gathered to ensure people’s needs were met appropriately. We found that while reviews were taking place they were not happening on a consistent basis and there was no evidence to show that people were involved in the process.

We found that the provider was unable to show how people were able to socialise or take part in activities that interested them. Information about people’s interest and hobbies was not being gathered to enable them to take part in things they like to do. The provider had a complaints procedure in place but there was no process for logging complaints.

The provider carried out spot checks and audits on the service however these were not sufficiently effective enough to identify areas for improvement.

The provider used quality assurance surveys to gather some views on the service. However it was unclear how people who lived with dementia shared their views and how any identified actions were discussed as part of making the required improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.