Woodstock Dementia and Residential Care Home

Woodstock Dementia and Residential Care Home is a care home providing accommodation and personal care. At the time of the inspection 41 older people, including those living with dementia were living at the service. The service can support up to 60 people. Accommodation is set over two floors and divided into two units on the ground floor. Both units have communal lounges and dining rooms where people enjoyed activities and mealtimes together. There is secure access to a garden area.

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

People’s risks were identified but care plans and risk assessments did not always include relevant and up to date information. Where people were at risk of choking, risk assessments did not include guidance for staff on how to support people during choking episodes that was individual to them. Where people were at risk of constipation, risk assessments were not appropriately recorded and personalised to their needs.

Medicines were not managed safely. When required medicines (PRN) were not used effectively to help people at risk of constipation. PRN protocols were not in place for every PRN medicine prescribed. Where protocols were in place, they did not include step by step guidance for staff on how to administer these medicines effectively for people.

Quality assurance systems were in place, however, not effective in picking up areas of concern we found on inspection. The management team were responsive to the concerns found and since the inspection we have received updated PRN protocols and care plans with updated information.

People and their relatives told us they felt safe at the service. Staff knew how to recognise signs of abuse and where to report concerns. Staff we spoke to felt confident to raise concerns if they were to arise. Reports were made to the local authority safeguarding team when appropriate and staff had received up to date safeguarding training.

Staff were recruited safely, and enough staff were deployed to meet the needs of people living at the service. A dependency tool was used and reviewed regularly to ensure people’s needs were met. We observed during our inspection that there were plenty of staff around to respond to people. Staff were employed specifically to meet people’s social needs and plenty of activities were being carried out.

Infection control procedures were in place at the service. Staff wore masks and other personal protective equipment PPE when required as per the company policy. There were plenty of PPE stations around the service and enough stock to was available when required. When people become unwell, appropriate measures are taken to help control the spread of infection.

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 were positive about the management team. They felt supported in their roles and felt like the registered manager’s door was always open. Relatives were positive about the management and said they were always visible when visiting the service. People, staff and relatives were asked to feedback about the service, outcomes were reviewed and analysed to make improvements.

The registered manager was aware of their responsibilities under the duty of candour and knew when to send in notifications to CQC as part of their regulatory responsibility.

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 25 November 2019) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. Due to concerns found on the inspection, the service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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.

Woodstock Dementia and Residential Care Home is a care home providing accommodation and personal care to 36 older people, including those living with dementia at the time of the inspection. The service can support up to 60 people. Accommodation is set over two floors and divided into two units on the ground floor. There is secure access to a garden area.

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

People’s needs had not been individually assessed, to ensure there were enough staff on duty to meet their needs. There was a high use of agency staff to fill the vacancies of care staff whilst recruitment commenced. Agency staff did not always know people or their needs well, leaving people at times without the support they needed.

The quality assurance systems had not always been effective at identifying the shortfalls within the service. The previous registered manager had left the service and a new manager had been recruited. Statutory notifications and local authority safeguarding concerns had not consistently been submitted in line with regulatory requirements and procedures.

Potential risks posed to people had been assessed with guidance for staff to follow to reduce the risk. Staff followed people’s care plans which detailed potential risks due to specific health conditions. Incidents and accidents had not been consistently analysed and used to reduce the risk of reoccurrence.

Observation showed that permanent staff had developed trusting relationships with people where they felt comfortable in staff’s presence and approach them with any concerns they had. Staff knew what their responsibilities were in relation to keeping people safe from harm and potential abuse.

Medicines were managed safely. Medicine records were complete and staff competency to undertake the administration of medicines had been assessed. Systems were in place for the ordering, obtaining, storage and returning of people’s medicines.

Staff received the training and support they required to fulfil their role and meet people’s needs. Staff said improvements had been made since the new manager had started; proving them with structure and guidance.

People were treated dignity and respect. Permanent staff knew people well including their likes dislikes and personal histories. People’s privacy was maintained and aids were used such as a privacy screen to promote people’s dignity.

People’s needs were assessed prior to an admission or stay for a period of respite. Care plans were person-centred and informed staff how the person wanted to be supported. 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 received support to maintain their nutrition and hydration with nutritionally balanced meals, snacks and drinks. People were supported to access healthcare services were appropriate for both urgent and routine healthcare. Staff worked alongside health care professionals to ensure people remained as healthy as possible.

People were given the opportunity to participate in a range of activities to meet their needs and interests. People were encouraged to maintain contact with people that mattered. People’s feedback was sought through resident meetings and surveys.

Complaints from people, relatives and others were listened to and acted on.

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 October 2018) and there were multiple breaches of regulation. At this inspection we found that some improvements had been made however, the provider was still in breach of two regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Woodstock Dementia and Residential 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. Woodstock Dementia and Residential Care Home provides support for up to 55 older people including those people living with dementia. It consists of two units and provides mainly single accommodation with some shared rooms. Accommodation is set over two floors and there is secure access to a garden area. At the time of our visit, there were 41 people who lived in the service. People had a variety of complex needs including communication difficulties, physical health needs and mobility difficulties.

There was no registered manager. 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 new manager had been employed at the service since March 2018 and told us that she had sent her completed application to us, to start the process to become the registered manager.

People gave us positive feedback about the service and told us they received safe, effective, caring, responsive care.

There were not always suitable numbers of staff deployed on shift to meet people’s assessed needs.

Staff had attended training they needed however, specialist training and regular supervision had not always been undertaken to support staff in their role.

People’s safety had not always been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified. However, not all individual risk assessments for people had been completed.

Systems to monitor the quality of care were not always effective. Potential risks were not always accurately monitored and recorded, records were not always accurate and up to date which could result in people receiving inappropriate staff support.

The provider followed safe recruitment practice. Essential documentation was in place for employed staff.

The manager demonstrated that they had a good understanding of their role and responsibilities in relation to notifying CQC about important events such as injuries, safeguarding concerns and deaths. The manager had informed CQC about Deprivation of Liberty Safeguards (DoLS) authorisations that had been approved.

People are supported to have maximum choice and control of their lives and staff do support them in the least restrictive way possible; the policies and systems in the service do support this practice. Staff had an understanding of the Mental Capacity Act and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the manager.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.

People’s care was person centred. Care plans detailed people’s important information such as their life history and personal history. However, they did not always inform staff of the care people required to meet their assessed needs.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed. Staff treated people with dignity and respect.

Most medicines had been managed, stored securely and records showed that medicines had been administered as they had been prescribed. However, improvement in the storage and record keeping for some medicines was needed.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.

Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family members received.

People’s views and experiences were sought through surveys and through meetings. People were listened to. People and their relatives knew how to raise concerns and complaints.

The premises were well maintained, clean and tidy. Decoration of the service followed good practice guidelines for supporting people who live with dementia. There were signs to direct people to different areas of the service such as to the dining area, lounge and garden area.

Management systems were in use to minimise the risks from the spread of infection and keep the service clean, although records did not always support this.

We found three 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.

We recommended that the provider reviews the pre-admission assessment process to ensure it is fit for purpose and that the provider reviews its consent forms to ensure that they are appropriately completed.

This is the first time the service has been rated Requires Improvement.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodstock Dementia and Residential Care Home on our website at www.cqc.org.uk”

Woodstock Dementia and Residential Care Home is a care home registered to provide personal care. It provides residential care for up to 55 older people including those people with a diagnosis of dementia. At the time of inspection Woodstock Dementia and Residential Care Home was providing care for 42 people.

There was 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.

At our previous inspection on 28 June 2016, the service was in breach of regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014. We found that the registered manager and staff failed to adequately implement healthcare professional’s guidance in response to people’s changing need. This was in relation to people’s nutritional needs and weight loss. At this inspection, the provider had made improvements and was no longer in breach of the regulation.

People were supported with their dietary needs. Appropriate referrals were being made to medical professionals when required. People had dietary risk assessments that were specific to their needs. People were being referred to relevant professionals and staff were following guidance given and this was documented in people’s records

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Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

The principles of the Mental Capacity Act 2005 (MCA) were adhered to for more complex decisions. People's mental capacity was being assessed appropriately and meetings took place to make decisions on people's behalf and in their best interests, when they were unable to do so.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People told us they were very satisfied with the care staff and the support they provided.

There were effective processes in place to reduce the risk of people experiencing skin breakdown.

Woodstock Residential and Dementia Care Home is located on the outskirts of Sittingbourne in a quiet residential area. It provides residential care for up to 55 older people including those people with a diagnosis of dementia. It consists of two units and provides mainly single accommodation with some shared rooms. Accommodation is set over two floors and there is secure access to a garden area. At the time of our visit, there were 44 people who lived in the home. People had a variety of complex needs including communication difficulties, physical health needs and mobility difficulties.

There was a registered manager at the home. 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’s care plans contained information about their personal preferences and focussed on individual needs. However, people’s care plans had not been updated with up to date information about their changing needs and staff had not effectively responded to one person’s needs based on a healthcare professional’s guidance.

People were protected against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as physical disabilities, falls and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of staff to meet people’s needs. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Staff were recruited using procedures designed to protect people from unsuitable staff. Safe recruitment processes were in place. Staff files contained all of the information required under Schedule 3 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Safe medicines management processes were in place and people received their medicines as prescribed.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

Systems were in place to enable the registered manager to assess, monitor and improve the quality and safety of the service.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The chef prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and that staff supported people with health care appointments and visits from health care professionals.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

During this inspection, we found a breach of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

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

Is the service safe?

The daughter of a person who lived at the home said 'I know my mum is safe there, I have no concerns for her, I know the staff will take care of her'. A person also told us they felt safe and well cared for at the home.

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse, and the correct steps to take if they were concerned that abuse had taken place.

The staff had received training and understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People had an individual care plan which set out their care needs. People we spoke with told us they had been involved in developing ?the plan of their care needs. One person said, 'They involve me in what is going on at the home, the staff are like my family'. A relative told us 'They asked me things about my mum that went in her care plan, they said it helps them to care for mum better'.

People had access to a range of health care professionals some of which visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented 'The staff here are great, they have good sense of humour and they look after me well', and "The staff are lovely and look after me well', the staff are kind and nothing is too much trouble'

We saw that regular reviews were undertaken with the people who used the service and/or, their relatives. They did this to make sure the care being provided matched people care needs and was being delivered to meet people wishes and preferences.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We saw that the home had a complaint system in place and there were copies of complaint procedure displayed around the home. A relative commented 'When I did have a little problem it was sorted out straight away, so I know that if I was unhappy I could trust them to put it right'.

Is the service well-led?

The service has a quality assurance system, that included asking people who lived in the home from their views. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff spoken with were clear about their roles and responsibilities. Staff had a good understanding of the quality assurance processes were in place. This helped to ensure that people received a good quality service at all times. Staff also said that they felt supported by the manager and the deputy manager. Staff said that they felt they could talk to them about any concerns they had and they would be listened to.

We observed that staff treated people with dignity and respect. Staff were polite and interacted well with people. Staff understood the needs of the people who lived in the home and supported them in line with the guidance in their care plans.

We spoke with some of the people who lived in the home. They told us were pleased with the way they were cared for. Comments included, 'I am happy here and feel well cared for and I have no concerns'. 'They have a lot to put up with but they are so good, I don't know what I would do without them' and 'Look how well they look after us, I have no complaints'.

Staff understood the importance about asking people for their consent before any care and treatment was given.

People were provided with appropriate care and support that met their needs and promoted their wellbeing.

People were safeguarded because staff were trained and there were appropriate procedures in place.

People received the medication they needed at the time they needed it.

Staffing levels generally met the needs of the people who lived in the home.

There were systems in place to ensure the smooth running of the home.

We have made some comments which the provider may find useful to note.