We carried out a review of the data available to us about Woodheath Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Woodheath Care Home, you can give feedback on this service.
Woodheath Care Home is registered to provide accommodation and nursing care for up to 61 people. There were 59 people were living there at the time of the inspection, some of whom were living with dementia.
People’s experience of using this service and what we found
We made a recommendation about the management of medicines. The stock balances of medicines we checked did not all correspond with the balances recorded and records showed the temperature of one area where medicines were stored, had not been checked daily as required. However, medicines were administered by staff who had undertaken training and had their competency assessed.
Infection prevention and control policies and procedures were in place to help reduce the risk of infections, including COVID-19. The home was clean and cleaning schedules were being further developed to help minimise any risk of infections being spread. Personal Protective Equipment was available to all staff and visitors and we observed this to be worn appropriately. Staff told us they completed COVID-19 tests regularly, but the system in place to oversee this was not robust.
There were systems in place to monitor the quality and safety of the service and these were completed regularly but could be developed further to ensure they identified any areas of potential improvement. The registered manager was already aware of most areas that required improvement and was implementing measures to address these areas.
People told us they received safe care at Woodheath. Staff were aware of safeguarding and knew how to report any concerns they had. Most risks to people and the building had been assessed to maintain safety. Although staff had completed relevant training as part of their induction, not all staff were up to date with training courses considered mandatory for staff to have the knowledge and skills to support people safely.
Accidents and incidents were managed safely. Records showed that appropriate actions were taken following any accidents
There were enough staff available to meet people’s needs in a timely way. Safe recruitment procedures had been followed to help ensure staff were suitable to work in social care.
People’s friends and family were encouraged to visit the home safely in line with government guidance. Relatives told us they were always kept informed of any changes involving their family members and had been kept updated throughout the pandemic when they were unable to visit the home.
There were systems in place to gather feedback from people, such as regular meeting and surveys. This enabled people living in the home, their relatives and staff, to share their views of the service. Feedback regarding the care provided and the management of the service was positive. Staff told us they enjoyed their jobs and felt well supported by the management team.
The registered manager liaised with other health and social care professionals when required, to help ensure people's needs were met. They were aware of the responsibilities of their role and took timely action to address issues highlighted during this inspection.
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 good (published 2 April 2020).
Why we inspected
We received concerns in relation to infection prevention and control procedures within the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 remained the same at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodheath 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.
It is registered to provide accommodation for persons who require nursing or personal care to up to 61 people. At the time of this inspection there were 56 people living at the home.
We found the following examples of good practice.
•The service had procedures and protocols in place which ensured people were admitted into the service and people could visit the service safely in accordance with national guidance.
•People and their relatives were supported to understand the isolation procedures and infection prevention and control measures. The service helped to alleviate people feeling lonely, by providing access to safe supervised visiting, in accordance with national guidance, and video and telephone calls with friends and loved ones.
•Staff were supported in isolation/sickness absence by the provider. Staff support and wellbeing was considered and enhanced during the pandemic.
•Personal protective equipment (PPE) was widely available and used correctly. There was an extensive testing program in place for staff, people using the service and visitors.
•The home was clean and hygienic throughout. Areas in the home had been redesigned to enable effective social distancing.
•Staff were trained in infection prevention and control (IPC) and had frequent refresher training and guidance in COVID-19 guidelines. There were good links with the local community IPC team for guidance and support.
•There was an infection control policy, procedures and risk assessments in place. Contingency plans were in place for future service disruption, including due to infection outbreaks and winter pressures.
Woodheath Care Home is registered to provide nursing and personal care for a maximum of 61 people. The home has two units; Cherry House provided nursing and residential support and Apple House is a specialist dementia unit. At the time of the inspection 51 people were living in the home.
People’s experience of using this service and what we found
Medicines were usually administered safely and as prescribed by trained staff. We identified one issue with a product that had been administered before it had been prescribed and immediate action was taken regarding this. There were sufficient numbers of staff on duty who had been safely recruited, to meet people’s needs in a timely way. Staff were knowledgeable about safeguarding procedures and aware of actions to take in an emergency. Risks to people had been assessed and measures were in place to reduce any identified risks. Regular checks were made of the building and utilities to ensure they remained safe. The home appeared clean and well maintained and staff had access to personal protective equipment to help prevent the spread of infection.
Staff told us they felt well supported in their roles. New staff completed an induction and all staff were supported through regular supervisions, training and an annual appraisal. People received enough to eat and drink and feedback regarding the meals available was positive. Staff were knowledgeable about and met people’s specific dietary needs and preferences. The environment had been adapted to appropriately support the people living there. Systems were in place to seek and record people’s consent. 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. Applications to deprive people of their liberty had been made appropriately.
People told us staff were kind and caring and treated them with respect. Their feedback was sought regularly through meetings and satisfaction surveys. It was clear that changes were made based on the feedback provided and these changes were displayed on the “You said, we did” board. People told us they felt involved and had choices about how they spent their day. People were supported to be as independent as they could be and felt that staff maintained their dignity and privacy when providing care. Confidential records regarding people’s care were stored securely to protect people’s privacy.
Individualised plans of care were in place, which included information about people’s needs and their preferences. Most care plans provided detailed and up to date information and the plans had all been reviewed regularly. People’s friends and relatives could visit the home at any time and told us they were always made welcome. There was a range of activities available to people, both within the home and in the local community. There was a complaints policy in place and people knew how to raise any concerns they had, although every person we spoke with told us they had no reason to complain. People had the opportunity to discuss their end of life care wishes and staff had undertaken training to support people effectively at this time.
Feedback regarding the management and quality of service people received was positive. Relatives feedback reflected the high standard of care provided. Staff told us they were well supported by the management team and that the registered manager was, “Very open and approachable.” A range of policies and procedures were in place to help guide staff in their roles. There were effective systems in place to monitor the quality and safety of the service on a regular basis. When areas of improvement were identified actions were taken to address them.
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 good. (Published 29 September 2017).
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.
The home is required to have a 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 manager had been registered with CQC since June 2017 and was in attendance at the time of the inspection.
We spoke with the registered manager and they were open and honest and told us that they were committed to delivering a quality service. People we spoke with told us they felt safe at the home. They had no worries or concerns. People’s relatives also told us they felt people were safe.
People who lived at the home were protected from the risk of abuse because staff had undertaken safeguarding training, to recognise and respond to potential signs of abuse. Staff had a good understanding of what safeguarding meant and how to report it. The home had policies and procedures in place to guide staff.
The Mental Capacity Act 2005 and the associated Deprivation of Liberties Safeguards legislation had been adhered to in the home. The provider told us that some people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We found that in applying for these safeguards, people’s’ legal right to consent to and be involved in any decision making had been respected.
Staff were recruited safely and registered nurses had the appropriate checks regarding their registration with the Nursing and Midwifery Council. We saw evidence that staff had been supervised regularly. Regular staff meetings were held as well as relatives’ meetings. Relatives we spoke with said that communication with the home was good.
Each person living in the home had a plan of care and risk assessments in place. These were specific to them and were regularly reviewed. Care plans showed that people's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary.
The staff knew the people they were supporting and the care they needed. We observed staff to be kind, patient and respectful. People told us that staff ensured their dignity was protected and people were called by their preferred names.
The home had quality assurance processes including audits and satisfaction questionnaires. People’s care records were maintained to a good standard.
We saw records to show that infection control standards in the home were monitored and managed appropriately. The home was clean, safe and well maintained. The provider had an infection control policy to minimise the spread of infection and all staff had attended infection control training.
People who lived at the home and relatives we spoke with said they would know how to make a complaint. None of them had any complaints. The complaints procedure was clearly visible at the entrance of each unit.
We issued the provider with a warning notice in relation to the breaches. A warning notice is an enforcement action used by the Care Quality Commission to direct a provider to improve their service to meet requirements of a specific regulation within a set time period. We gave the provider until the 01 March 2016 to meet their legal requirements in relation to assessment and mitigation of risk.
We undertook a focused inspection on the 30 March 2016 to check that they had met the requirements of the warning notice and their plan in order to meet the legal requirements in relation to the breaches described above. This report only covers our findings in relation to
these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Woodheath Care Home’ on our website at www.cqc.org.uk’
Woodheath Care Home is registered to provide nursing and personal care for a maximum of 59 people. This consists of two units, these are Apple House which is provides residential care and has capacity for nineteen people and Cherry House which is nursing care and has capacity for 42 people, five of these beds are for Intermediate Medical Care.
The home had a manager in place who was in attendance during our inspection but is not yet registered. 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 saw improvements had been made to care plans and risk assessments, medication processes and quality assurance processes.
We undertook this comprehensive inspection on 16 June 2015. Woodheath Care Home is registered to provide accommodation and nursing or personal care for up to 61 people. This includes a purpose-built unit, known as Apple House, for 19 people who have dementia. At the time we visited there were 15 people living in Apple House, and 32 people living in Cherry House.
The service had a 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.
Records showed that safeguarding adults concerns had been referred to the appropriate authorities and the home had investigated if requested to do so. Training records showed that staff had received training in safeguarding adults. The home had a whistle-blowing policy and staff had been provided with information on this via their staff handbook.
There were enough qualified and experienced staff to meet people’s needs and the manager advised us that if the number of people living at the home increased then staffing numbers would be increased.
Staff files for six people who had differing roles in the home showed that the required checks were carried out before new staff started working at the home to ensure that they were suitable to work with people who may be vulnerable.
We walked all around both of the buildings and found that in general the premises were clean and adequately maintained and improvements to the environment had continued. Maintenance certificates confirmed that services and equipment were tested and serviced as required. Disposable aprons and gloves were available for the staff and sluices and hand-washing facilities had been improved.
We found that people’s medicines were stored appropriately and medication administration record sheets we looked at had been fully completed and had no missed signatures.
Staff told us that they had received the training they needed to carry out their role effectively. We looked at records of staff training which confirmed this. We saw that new care staff had all commenced working towards the nationally recognised care certificate.
The manager and relevant staff had undertaken training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw that applications for DoLS authorisations had been made to the local authority for some of the people living at the home, however we did not find records to show how people’s capacity to make their own decisions had been assessed.
The care plans we looked at contained a series of assessments of the person's health and personal care needs. These included assessments of the person's risk of falls, risk of pressure sores and nutritional needs. We saw that these had been updated regularly. Where an assessment showed the person required support a care plan was in place providing details of how to provide this support.
Information about how to make a complaint was clearly displayed within the home for visitors and the people living there to access. The manager maintained records of any complaints that had been received and the action taken.
The Commission have identified a specific concern regarding the application of the Manager to become registered and, whilst this does not immediately impact on the service, the Commission are currently following enforcement processes in light of this concern.
Is the service safe?
We looked at the way the service protected people from abuse. We spoke with six members of staff about their understanding of safeguarding. We found that while staff understood the principles of safeguarding, responses on how this would be handled differed. Staff told us that they had received training in safeguarding awareness and this was confirmed through the viewing of training records. Staff understood the idea of whistleblowing with some being clear about where they could raise concerns about care practice if needed. Other people were not sure about how they could raise concerns to external agencies.
We were informed by the provider and by the manager that none of the staff working in the home, including the manager, handled any money belonging to people who lived at the home.
We walked all around both of the buildings and found that in general the premises were adequately maintained and improvements to the environment had continued. We identified some issues that required improvement we discussed these with the manager. The manager was able to show us certificates to verify that testing and servicing of all utilities and equipment including gas, electrical circuits, fire equipment, hoists, and the passenger lift were up to date.
We spoke to staff about training and they confirmed that they had completed mandatory health and safety training as well as training linked to the needs of people who used the service.
Is the service effective?
People we spoke with told us:
'The food is good, the girls are good and the nurses are good, what more could I want?'
'They can't do enough for you here, they are really good, all of them.'
'We have nothing to worry about here.'
'We get well looked after.'
The care staff we spoke with were able to demonstrate their knowledge of people's individual needs. Equipment was provided to meet people's needs including profiling beds, different types of pressure relieving mattresses, moving and handling equipment and mobility aids.
Care plans recorded an assessment of the person's needs before they went to the home and after they had arrived. Each person had plans for how their care should be provided, and risk assessments for any identified risks to their health, safety or well-being. There was also evidence of input from the person's GP and other health care professionals including the falls team, district nurses, psychiatric nurses and continence service. Care staff completed charts to record people's food and fluid intake, repositioning, and personal care.
Is the service caring?
All of the people we spoke with praised the staff and described them as kind and caring. They told us:
'They are all very good girls.'
'All of the staff are nice, they are gentle people.'
We observed that staff had a good rapport with the people who lived at the home and treated them with respect when providing care, for example when using moving and handling equipment.
Is the service responsive?
One of the people we spoke with had a relative visiting. They told us that any concerns they had raised had been dealt with to their satisfaction.
We looked at the way the provider supported staff to perform their respective roles. We found that while supervision had been undertaken, the records did not appear to have any records of the views of the person being supervised. We looked at minutes of staff meetings. These were held regularly and this was confirmed by the staff team. Minutes appeared to have little recorded involvement of the staff team.
The manager told us that residents /relatives meetings took place every six months and she had met with the families of more than half of the people who lived at the home during June 2014. A satisfaction survey was sent out every three months and we were able to look at forms that had been completed in April 2014. People had generally expressed satisfaction with the service provided. We did not see any evidence that the views of professional visitors to the home had been sought.
Is the service well led?
The directors visited at least monthly and carried out quality assurance checks.
The manager had considerable previous experience and been in post for two years. We looked at the staff rotas which showed that the home had a full complement of registered nurses including a deputy manager, and there was a minimum of one nurse on duty at all times. Team leaders and senior care assistants led the staff team on the dementia care unit.
An audit folder recorded monthly audits of care plans, accidents, medicines, pressure sores and infections. A detailed complaints procedure was displayed in the home and this gave information about who people could contact if they wished to make a complaint or raise a concern.
When we visited Woodheath on 24 September 2013, we were concerned that only four regular nurses were employed to cover day and night duties. On 30 December we found that the deputy manager and three other nurses were employed on day duty. This meant that there were always two nurses on duty in a morning and the deputy manager told us that this had made a significant difference in making sure that care records were kept up to date and that people's nursing needs were met.
When we visited Woodheath on 24 September 2013 we found that the home's complaints procedure did not give enough information to people and we were not able to see how many complaints had been received or how complaints had been responded to. Since then, the manager had updated the complaints procedure and a complaints register had been put in place; however records lacked detail to show how issues arising from complaints had been addressed.
Practical moving and handling training was being provided for all staff to ensure that they knew how to transfer people safely. We observed that Care plans contained brief biographic details, assessments of people's care needs, plans for how their care should be provided, and risk assessments for any identified risks to their health, safety or well-being. There was also evidence of input from the person's GP and other health care professionals as needed.
New staff had completed application forms in full and Disclosure and Barring disclosures were in place, however an employer reference was not always in place and records did not show that nurses' registrations were always checked.
There were enough staff on duty to meet people's needs, however we were concerned that only four regular nurses were employed to cover day and night duties.
A new complaints procedure written by the manager after our visit gave people details of how to make a complaint. Complaints records did not show how many complaints had been received or how they had been addressed.
When we visited on 27 February 2013 some people told us that they had been part of care plan reviews. Care plans were being rewritten and approximately half were completed. Two observations carried out by an inspector found that staff treated people with respect, for example people were asked what they wanted to have for lunch and where they preferred to sit. Staff explained what they were doing when using a hoist. We considered that the staffing levels were sufficient to meet the needs of the number and dependency levels of the people who were living there at the time. Staff were following a programme of training and individual staff supervision meetings had started.
Staff meetings had been held and a meeting for residents and their families. The manager had developed monitoring and auditing systems and had used various methods of finding out people's views of the service.
Two people told us that they did not always receive the support they needed at mealtimes and we observed that people did not always receive their medication on time. The care plans for people living in the main house had not been well maintained which meant that staff did not have information about the care people should receive. Improvements were needed to the ordering, storage, administration and recording of medicines.
There were not always enough qualified, skilled and experienced staff to meet people's needs and not all staff had received the training and support they needed to deliver care and treatment safely and to an appropriate standard.
The new manager had been reviewing all areas of the service and introducing auditing systems. She had identified improvements needed to the environment and redecorating was going on when we visited. During our visit we identified some health and safety issues that were brought to the attention of the manager.
People spoken with during our visit to the service told us they were happy with the care and support offered. Both people who used the service and members' of the staff team spoken with felt Woodheath was a 'happy home where you can have a good laugh'.
Records and discussions with the Registered Manager indicated peoples' likes and dislikes were taken into account when care and support was being planned.
We were told that a small number of people liked to spend most of their time in their bedrooms and have their meals brought to them. One person spoken said confirmed this was their choice and said they did not fell isolated as staff 'dropped in' for a chat and to see how they were.
During our visit we observed members of the staff team responding quickly to people who were experiencing difficulties. The support provided was sensitive and encouraged them to carry on with the task they had been trying to complete.
Overall people told us they were happy with the activities offered and felt the home was open to suggestions about new ones.
We observed that people who used the service received care and support in a timely manner that met their needs.
We observed the lunch time meal being served we noted for those people who needed support to eat they had to wait. This meant that on occasions people may have had cold meals. However we observed that care workers supported people to eat their meals in a respectful and sensitive manner.
Wirral local authority contracts and commissioning team told us they had no current concerns about the care and support being offered to people who lived at Woodheath.
Overall the people we spoke with were satisfied with the care and support offered to them. However some people made comments that indicated they were not fully involved in their care. Some comments made were;
"Staff are okay, some are really nice, other don't care quiet as much".
"It's a lovely friendly place".
'I enjoy the quizzes and days out".
"None from the home came to see me before I came here".
"I've not been asked to read a care plan".
'The girls are lovely'.
'All the staff are very approachable'.
'I get looked after well here'.
'I have not been asked what my needs are, but they are really nice girls and I'm sure all I'd have to do is ask".
Wirral Local Involvement Networks (LINks) carried out a visit in March 2011 and raised no issues of concern.
Relatives told us they were happy with the care and support being offered to their parent and felt the staff team kept them well informed.
We observed some care workers offering people in the lounge areas respectful and sensitive support.
We observed nursing and care workers not offering verbal or physical reassurance to a person who was distressed.
We spoke to people living in the home who told us they got their medications regularly. Those who could request medications such as painkillers told us that if they asked for them they were made available.
People spoken with during our visit offered the following comments:
'I can ask for my medicines'.
'No, no one said that I could do my own tablets I thought they had to do it'.