Woodlands Lodge Care Home

We found the following examples of good practice.

Good information about visiting procedures were displayed at the entrance to the home and families had been kept informed. Staff were knowledgeable about the visiting checks in place. The home had developed a ‘one-way system’ for in-house visits to minimise risk. There were alternative visiting arrangements in place such as screened visits and window visits. Staff also supported people to keep in touch with friends and families, remotely, for example by telephone and ipad.

People were supported to self-isolate, when appropriate, however the registered manager closely monitored impacts on people’s health and made safe alternative arrangements, for example, one person was more encouraged to eat in the dining area and the registered manager ensured this took place at a safe time.

Staff had been trained and regular checks took place on how they wore and disposed of PPE. There were good stocks of PPE available and this was stored correctly.

People and staff were tested regularly in line with government guidance. People and staff were supported to self-isolate as appropriate. The registered manager monitored staff test results to ensure they returned to work only when they were able to do so.

Enhanced cleaning had taken place since the start of the pandemic.

Staffing levels at the home were good. There were no issues with staff retention or recruitment.

The provider had reviewed contingency arrangements at the start of the pandemic. The registered manager said they were very well supported by the provider.

Woodlands Lodge Care Home is a residential care home providing personal care to 35 people at the time of the inspection. The service can support up to 54 people. There are three units; one of these units specialises in providing care to people living with dementia.

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

There was an open and inclusive culture within the home. There was a governance framework in place however this was limited to the last 10 months. Not all audits had identified the issues we found.

We have made a recommendation about the checks and audits in the home.

Plans were in place to engage and involve people and relatives in the service. People had been asked about the new visual menu that had been put in place. The service carried out reviews to consider improvements and the manager is involved in other research to improve the service.

People were receiving medicines when they should. However, protocols for 'as and when' medication and body maps were not always used consistently. Risks were assessed and people supported safely, although one person did not have their up-to-date risks assessed. People were protected from infection by good use of personal protective equipment. However, access to handwashing facilities in some toilets was restricted. Systems and processes safeguarded people from abuse and the risk of harm. People’s needs were reviewed regularly and used to inform staffing levels. Lessons learnt were considered after incidents.

Some staff had not received all the training the provider had identified they needed to do their job. Staff were supported through supervisions and appraisals. People’s rooms were personalised and some dementia signage was in place. People’s needs and choices were assessed and considered. People were offered a good choice of food and their support needs were known. Staff were vigilant about people’s health needs and sought appropriate access to professional advice. Staff worked alongside health professionals. Consent to care was sought appropriately. 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 were treated with kindness and compassion by staff. People were supported to express their views and decisions. People’s privacy and dignity was respected.

People’s social histories were known and people received activities, although these were limited. Staff knew people well and supported people with person-centred care. Complaints and concerns were monitored and responded to. People were asked about their end of life care and received care as they wished.

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 requires improvement (published 4 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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.

Woodlands Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Woodlands Lodge Care Home is registered to provide accommodation and personal care for up to 55 people, some of whom are living with dementia. There were 44 people living at the home at the time of our inspection.

The home is split into three different units; one of which is a locked unit, specialising in care for people living with dementia. Each unit has communal areas such as lounge and dining areas and one unit has a large sun-lounge.

The last comprehensive inspection took place in February 2018 and the service was rated as requires improvement. We identified one breach of regulation. This was because staff did not act in accordance with the requirements of the Mental Capacity Act (MCA) 2015. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions effective, responsive and well led, to at least 'good'. The action plan told us this would be completed by October 2018.

At this inspection we found some improvements had been made. Staff had been trained and were following the requirements of the MCA. Records showed, where appropriate, Deprivation of Liberty Safeguards (DoLS) applications had been made and authorised, for people living at the home. However, we found improvements were required in relation to the administration of medicines, staffing numbers and care planning. The service continues to be rated 'requires improvement.' This is the second time the service has been rated 'requires improvement.'

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Woodlands Lodge Care Home’ on our website at www.cqc.org.uk.

The home had a registered manager in post. 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.

Medicine audits were not sufficiently robust and did not always identify errors and omissions on medication administration records, so we could not be assured people always had their medicines safely.

Elements of risk were identified in the care plans and plans were put in place to mitigate this risk through the care instructions. Where the level of risk was deemed to be more significant (choking for example) specific risk assessments were put in place. However, we found one instance where this was not completed in a timely manner.

In the main, there were sufficient staff on duty to meet people's assessed needs. However, there had been occasions when staffing numbers were lower than those assessed as needed. The registered manager and provider said they were monitoring this closely to prevent people being put at risk from unsafe care.

Incidents and accidents were recorded and reviewed by the registered manager to look if there were any patterns, themes or trends. This would help to prevent a re-occurrence.

People had choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice.

Staff received the training and support they needed to carry out their roles. Supervision meetings had been held on a regular basis. Staff enjoyed working at the service and said the registered manager was approachable and would listen to any ideas or concerns they had.

People were supported to make choices and staff promoted people's independence. People's communication needs were assessed and planned for. People had their privacy and dignity protected.

Newly formatted care plans were personalised and included all people's support needs and were regularly reviewed. However, only a small number of new care plans were completed. More detail was required in older care plans to provide clear guidance for staff in how to meet people's needs.

A varied range of activities were made available and we saw staff were proactive in engaging people with individual activities of their preferred choice.

People understood how to make a complaint and there were systems in place to respond to these.

The registered provider and registered manager had addressed all the areas for improvement in the previous inspection report. New issues of concern regarding medicines management, risk assessment and care planning were found and needed action. However, the governance of the service showed more in-depth monitoring of the quality of the service was being carried out by the registered manager and other senior managers.

People and their relatives were engaged in the service and felt able to approach the registered manager. Staff felt supported in their role and were involved in the service.

Woodlands Lodge Care Home is registered to provide accommodation and personal care for up to 55 people, some of whom are living with dementia. There were 48 people living at the home at the time of our inspection. The home is split into three different units; one of which is a locked unit, specialising in care for people living with dementia. Each unit has communal areas such as lounge and dining areas and one unit has a large sun-lounge.

Woodlands Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home had previously been inspected during January 2016 and was rated good in all of our five key questions at that time.

The home had a registered manager in post. 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 at Woodlands Lodge Care Home. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely and there were sufficient numbers of staff deployed to meet people’s needs. Staff told us they felt supported and we saw evidence staff had received induction, training and ongoing supervision. The registered manager had identified improved methods of training were required and was working towards implementing these.

Risks to people had been assessed and measures were in place to reduce risks. However, the quality of risk assessments was variable. Some moving and handling plans lacked detail to provide staff with sufficient information for staff to safely assist people to move. The registered manager had already identified this and work was continuing to improve these.

The building was well maintained and regular safety checks took place. The environment, particularly for people living with dementia, had recently improved.

Staff responded appropriately to emergency situations. Accidents and incidents were analysed and lessons were learned and shared.

Medicines were managed, stored and administered safely and appropriately, by staff who had been trained, and assessed as competent, to do so.

Our observations showed people were supported to have choice and control of their lives and we observed staff supported people in the least restrictive way possible. However, the principles of the Mental Capacity Act had not been followed. We identified a breach of regulation in this area.

People received appropriate support in order to have their nutritional and hydration needs met.

People told us staff were caring and we observed staff to be kind and considerate. We observed people’s privacy and dignity was respected. People were encouraged to maintain links with their family and community. People’s diverse needs were considered.

The quality of care records was variable and we found the registered manager was working to improve these. People told us they could make their own choices in relation to their daily lives.

There was a complaints policy in place and we found the registered manager had responded to complaints appropriately and in line with policy.

Staff told us they felt supported and people and their relatives spoke positively about the registered manager. Meetings such as staff meetings and residents’ and relatives’ meetings were held regularly. Regular audits and quality assurance checks took place, to help improvements to continue at the home.

We found a breach of regulation in relation to Consent. You can see what action we told the provider to take at the back of the full version of the report.

The inspection included reviewing training and supervision records and speaking with the manager and four members of staff.

We found that staff had received relevant training and supervision in order to develop and improve their skills.