The Woodlands Care Home

The Woodlands is a 'care home' and supports up to 16 older people and those living with sensory impairments across two floors. People in care homes receive accommodation, nursing or personal care as a single package under one contractual agreement. At the time of our inspection one person was receiving support.

People’s experience of using this service

A number of identified improvements had been made since our last inspection. 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.

Systems and processes to assess, monitor and mitigate risk to people had been improved upon; one person living at the home was receiving the care and support they needed. Care records and risk assessments contained up to date information and staff were familiar with the level of tailored care the person needed. Clinical tools and charts were being completed; these were being used as a measure of monitoring risks which had been identified.

Significant improvements had been made to environment and exposure to risk had been mitigated. Fire safety concerns had been addressed, health and safety certificates were in place and the provider had purchased the required safety equipment that was needed to support with transfers and emergency situations.

Safe medicine procedures and arrangements were in place. Medicines were securely stored; staff received the necessary medication administration training and were having their competency levels checked.

Quality assurance measures and governance procedures had improved. The quality and safety of the service was now being monitored, assessed and improvements were being made. An experienced manager had been appointed and there was a greater level of provider oversight. New systems had been embedded, ensuring that feedback about the provision of care was regularly captured as a way of driving service improvement.

The provider was now compliant with ‘safer recruitment’ practices; there was evidence of pre-employment recruitment checks, appropriate references and the required level of identification that was needed. Staff told us they felt supported. One staff member said, “Unbelievable support and the improvements are absolutely brilliant.” Learning and development opportunities were being supported, supervision and appraisals were taking place and staff had completed all the necessary training that was expected of them.

New safeguarding measures and systems were in place. Safeguarding incidents were recorded and referrals were made to the necessary authorities in a timely manner.

The home had been refurbished since our last inspection. We observed a clean, hygienic and well-maintained environment. Improved infection prevention and control (IPC) measures and arrangements had been embedded and we were assured that people were no longer exposed to risk. IPC audits were being completed, staff had access to the appropriate PPE and COVID-19 guidelines were being followed accordingly.

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 inadequate (published 16 June 2022), we identified a number of regulatory breaches. The provider completed a number of action plans after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made, the provider was no longer in breach of regulations and the service has been rated requires improvement.

This service has been in Special Measures since 16 June 2022. 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

Why we inspected

We carried out an unannounced inspection of this service on 10 and 16 May 2022, a number of regulatory breaches of legal requirements were found in relation to need for consent, safe care and treatment, staffing, recruitment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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, well-led which contain those requirements.

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 changed from inadequate to requires improvement. This is based on the findings 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Woodlands Care Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Woodlands Care Home is a care home providing accommodation and personal care to up to 16 people. At the time of the inspection there were 11 people living in the home.

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

Risks to people had not been robustly assessed, monitored or mitigated. We could not be assured people received the care they required as their care records did not all accurately reflect their needs and risks to ensure staff knew how to support them safely. There were large gaps in the recording of care provided. There was no emergency evacuation equipment available to assist people out of the home in the event of an emergency and there was no hoist available to assist people who were supported in bed. There was no evidence that referrals were made to relevant professionals to ensure people’s needs were met and risks were minimised.

The building was not safely maintained; we identified significant fire safety risks within the home, the lift was not in working order and chemicals that posed a risk to people were not stored securely. Appropriate Infection prevention control policies and procedures (IPC) were not all in place to help reduce the risk of infections, including COVID-19. Not all parts of the home were clean and well maintained and repairs required were not addressed in a timely way. Staff had access to adequate PPE, but there was no system to ensure they were completing COVID-19 testing in line with government guidance. People’s family members were welcomed into the home safely, following current guidance regarding infection prevention and control risks.

The systems in place to monitor the quality and safety of the service were not effective and there was no evidence the provider had oversight of the service. The deputy manager was managing the day to day running of the service, with little support to ensure regulatory responsibilities were met. Ratings from the last inspection were not displayed on the provider’s website as required. The Commission had not been informed of all incidents the provider is required to notify us of. Systems were not in place to gather regular feedback from people or their relatives regarding the service provided, to enable changes and improvements to be made as necessary.

Although medication administration records were completed, medicines were not stored securely and staff who administered medicines had not had their competency checked to ensure they could manage medicines safely.

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 supported this practice. Consent to care and treatment had not been sought and recorded and applications to deprive people of their liberty had not all been managed appropriately.

People and their relatives told us they felt The Woodlands was a safe place to be and that they were well cared for. However, we found that safeguarding incidents had not all been managed appropriately, safe recruitment practices had not been adhered to for all staff, and there was no evidence that staff had completed relevant training to ensure they could safely meet people’s needs. Although staff felt well supported, there were no systems in place to ensure they received an induction, regular supervision and appraisal.

Relatives told us they were kept informed of any accidents or incidents regarding their family members and measures had been taken during the COVID -19 pandemic to facilitate people having contact with their relatives.

The provider has begun making improvements and addressing the risks identified during the inspection.

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 good (published 1 September 2018).

Why we inspected

We received concerns in relation to risk management, the safety of the building, Deprivation of Liberty Safeguards, fire safety and the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

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.

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 changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 The Woodlands Care 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 and will take further action if needed.

We have identified breaches in relation to risk management, the management of medicines, staff recruitment, training and support, consent and governance of the service at this inspection.

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 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 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 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.

We found the following examples of good practice.

The provider and registered manager had implemented appropriate procedures within the service to help minimise the spread of infection and help maintain people’s safety during the COVID-19 pandemic. Infection prevention and control (IPC) guidance was displayed around the home so everybody was aware of the procedures in place, including visitors.

Staff had received IPC training, including donning and doffing of personal protective equipment (PPE). We observed staff using PPE appropriately during the inspection and PPE stations and hand gel were available around the home.

Risks to people had been assessed and appropriate measures taken to reduce risks relating to COVID-19, that were recorded in people’s plans of care. Social distancing was encouraged and communal areas had been adapted to enable social distancing when possible. Signage was also used around the home to remind people of safe distances. Regular cleaning schedules were in place and the number of domestic staff had increased to support the additional cleaning requirements.

Staff and people living in the home underwent regular COVID-19 testing in line with government guidance and people had their temperature monitored twice daily. Staff and people in the home were also encouraged to have the COVID-19 vaccine.

Visitors were welcomed into the home following current guidance and systems had been set up to facilitate this safely. Visitors completed a lateral flow test on arrival and had their temperature monitored. A family Facebook page had been created with consent, and regular photographs posted to keep families updated when they were unable to visit.

We were assured this service was following safe infection prevention and control measures to keep people safe.

The Woodlands Residential Home provides personal care for up to 14 people; the home provides support specifically for older people and is situated in a residential area of Meols, Wirral. There is a small car park and garden available at the rear of the property. All bedrooms are single occupancy and are provided over two floors. At the time of the inspection there were 14 people living at the home.

The Woodlands Residential Home 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 Woodlands Residential Home had a registered manager who has worked at the home for a number of years. 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.

We looked at how the service managed it’s recruitment of new staff and saw that this was done well and all of the required checks were carried out before staff commenced working at the home.

We spoke with five people who lived in the home who all gave positive feedback about the home and the staff who worked in it. They told us that the staff supported people to live their lives in the way that they had chosen to do so. We saw that warm, positive relationships with people were apparent and many people described the staff as “like family.”

Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw they knew people well and how they liked to be cared for.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were kept safely with appropriate arrangements for storage in place. The improvements that we found at our previous inspection had been sustained and more improvements made.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

Care plans were person centred and driven by the people who lived who lived in the home. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. They also regularly spoke with the people who lived in the home. The provider also provided close scrutiny of the service and was a regular presence in the home providing activities for people such as mini bus outings and canal barge trips and providing support for the manager.

The Woodlands Residential Home provides personal care for up to 14 people; the home provides support specifically for older people and is situated in a residential area of Meols, Wirral. There is a small car park and garden available at the rear of the property. All bedrooms are single occupancy and are provided over two floors. At the time of the inspection there were 14 people living at the home.

A passenger lift enables access to bedrooms which are located on the first floor for people with mobility issues. On the ground floor, there is a communal lounge and a dining room for people to use.

At the time of the inspection there was a registered manager in post. The registered manager has been in post since 2013. 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 previous comprehensive inspection which took place in December, 2015 found that the service was not meeting all of the regulations which we inspected. We identified breaches in Regulation 12 ‘Safe Care and Treatment’, Regulation 14 ‘Meeting nutritional Needs’ and Regulation 17 ‘Good Governance’ of the Health and Social Care Act 2008 (Regulated Activities) 2014. These breaches related to the provision of safe and appropriate care being provided to those who lived in the home, medication management, nutritional needs and the overall management of the service.

At this inspection we found that improvements had been made in all areas but some areas required further improvement.

At this inspection we found a breach of Regulation 11 ‘Need for Consent’ of the Health and Social Care Act 2008 (Regulated Activities) 2014

The provider did not always operate in line with the principles of the Mental Capacity Act, 2005 (MCA). Mental capacity assessments were completed, the necessary Deprivation of Liberty Safeguards (DoLS) had been submitted to the local authority but there was no evidence to show any best interest decisions or meetings had taking place and the least restrictive options had been explored.

At the last inspection we found the provider to be in breach of the regulation regarding good governance. Care plan audits, financial audits, maintenance audits and medications audits which were in place were found to be ineffective and did not evidence how safe, quality care was being measured, monitored and managed. Audits which were conducted were not robust enough, did not support a consistent approach to quality or standards of care and did not evidence how improvements were being made.

The provider was no longer in breach of this regulation but we have made a recommendation in relation to the standards of audits and their effectiveness.

We found that there was a good level of support being offered to all staff within The Woodlands Residential Home. Staff felt they were supported with their professional development; they were provided with the necessary training and skills to deliver the correct and appropriate level of care which needed to be provided and they received consistent supervisions and appraisals. It was evident that the manager operated an ‘open door’ policy and staff expressed they could seek support and guidance whenever they needed to.

Staff were familiar with the support needs of the people they were caring for. Staff could explain the different levels of support which needed to be provided, different preferences of people, specialist dietary needs and likes and dislikes of some of the people living in the home.

Accidents and incidents were routinely recorded on an internal database system. These were discussed as part of the daily handovers which took place and helped to inform the manager of any decisions which needed to be made in relation to staffing levels and lessons learnt. It was identified that there such discussions were not routinely taking pace during team meetings.

Staff morale was positive and it was evident throughout the inspection that there was good relationships between staff, people who lived in the home and relatives. People we spoke with were very positive about the leadership and management within the home and felt there was safe, kind and compassionate care being delivered.

There was a formal complaints policy in place, relatives and people living in the home knew how to make a complaint. At the time of the inspection there were no complaints being dealt with although we were shown a folder of informal complaints which had been documented and actions which had been taken to rectify any problems which had been raised.

During this inspection we found that daily, weekly, monthly and annual audits and routine checks were being completed and since the inspection we have been provided with newly devised care plan audits which will support the audit process and improve the standard of each of the care records which are in place for each person in the home.

People did feel that their privacy and dignity was respected and staff were able to provide examples of how they ensured privacy and dignity was maintained. Staff expressed there was enough staff to support the needs of the people living in the home and the manager was responsive to making necessary staffing changes when dependency needs changed.

A programme of activities was available for people living at the home to participate in. There was a dedicated activities co-ordinator in post who was responsible for the range of different activities which was being provided. The activities co-ordinator was passionate about engaging and interacting with all those who lived in the home.

There was a positive response in relation to the quality and standard of food. People's choices, preferences and dietary needs were supported and kitchen staff were aware of the specialist dietary needs of some of the people who were living in the home and how food needed to be prepared.

We reviewed five staff personnel files and recruitment was safely and effectively managed within the home. Processes demonstrated effective recruitment practices were in place. This meant that all staff who were working at the home had suitable and sufficient references and disclosure and barring system checks (DBS) were in place.

The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications. The provider ensured that the ratings from the previous inspection were on display within the home as well as being visible on the provider website, as required.

There were specific policies and procedures available to guide and support staff in their roles. Staff were aware of the such policies including the home's whistle blowing and safeguarding policy.

We looked at infection control and found that equipment was clean, in good working order and had been serviced. During a tour of the home we found the home was clean, free from offensive odours and maintenance and redecoration had been undertaken since the previous visit.

We looked at the quality assurance and found that this area had improved and people who lived at The Woodlands and their families and friends views were sought and acted upon.

On the day of the visit we spoke with four people who lived at the home, two staff, the manager and deputy and a visiting professional. People who lived at the home commented: 'I like it here', 'The staff are lovely' and 'The staff are kind.'

We spoke with six people who used the service, three relatives, two staff and three professionals involved in the service. People who used the service said: 'The staff are lovely', 'I like the food' and 'The staff are kind.'

We observed interactions between the people who used the service and staff during the day and found there was a relaxed and friendly atmosphere between them.

During a tour of the building we found it was clean and odour free. However concerns were raised regarding stained and worn carpet on the first floor and in the office and some documentation regarding the home.

We saw that although improvements had been made with regard to supervision and appraisals of the staff team, most staff had not fully completed mandatory training. This meant that staff were not fully trained to support people who lived at the home.

Policies and procedures seen were not dated or signed. Also they referred to out of date legislation. There was no policy for pressure ulcer care and prevention or staff training.

There was very little quality monitoring undertaken within the home and people who lived there were not consulted on a regular basis so that their views could be used to inform service provision. Generally records were not up to date.

We found that the home was generally clean however, the manager was not aware of the guidance for the prevention and control of infections and there was no infection control policy in place. We found that staff had not received regular supervisions or training in order to support them to carry out their role. We also found that there was a lack of quality assurance monitoring systems in place. This meant that when incidents occurred involving people's welfare, there were no mechanisms in place to prevent the same issues re-occurring.