The inspection took place on 7 and 13 September 2016 and was unannounced.Woodside House provides accommodation and care to a maximum of 56 people. The majority of people receiving care and support are older people and some people using the service may be living with dementia. The service is registered to support people both with their personal care and nursing care if they need this. At the time of our inspection, there were 53 people living in the home. People who are living with dementia are largely supported within the Memory Lane unit of the home.
There was a registered manager in post who was present for the second of our inspection visits. 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 service needed to make improvements to people's safety. There was inconsistent information about how drinks needed to be thickened to minimise the risks of choking for specific individuals and in one case the required thickener had not been used at all when a person was given a drink, presenting a serious concern for a person's safety. We ensured that action was taken immediately to rectify this and so that the registered persons could ensure the person was not exposed to serious and avoidable harm.
People were also exposed to risks from inappropriate storage of some toiletry products, creams and thickeners. This presented concerns that the products could cause harm by being swallowed, used inappropriately or contaminated. Staff used some products well beyond their expiry dates, presenting a risk they would not be safe and effective to use. Staff were using some creams and thickener, labelled as issued for others and which could therefore present confusion about the correct usage and management. Systems for assessing, monitoring and improving the service and for mitigating risks had not identified the concerns we found. Between our inspection visits, the registered persons told us they had taken action to improve. However, we were concerned that we have raised such issues in previous inspections and but again found similar failings. We could not therefore be confident in improvements would be sustained.
Staff understood the importance of reporting any concerns that people may be at risk of harm or abuse. They were recruited in a way which ensured proper checks were made, so contributing to protecting people from the risk of harm. There were enough staff on duty who were competent to meet people's needs safely, but they were not always well organised in the way that they supported people. This included during lunch time. Although people had a choice of enough to eat and drink, the mealtime lacked a calm, pleasant and conducive atmosphere for people to enjoy their meals. Some people did not receive consistent and sustained support from one staff member sitting with them throughout their meal to offer support and encouragement.
Staff understood the importance of seeking consent from people to deliver their care. They recognised how their individual approach could help people feel comfortable with receiving care and secure their cooperation. They were aware of the importance of acting in people's best interests where people were not able to give specific consent. People could be supported by their family members who knew them well, to make decisions and choices about their care if they found this difficult.
Where people's freedom may be restricted because of their lack of awareness of personal safety, the registered manager sought appropriate authorisation. This contributed to protecting people's rights and freedoms.
People had access to support and advice from health professionals to promote their physical and mental wellbeing. For example, staff arranged for people to see their GP, falls prevention team and dietician where necessary.
Staff understood people's individual preferences, likes and dislikes. These were clearly documented within people's plans of care so that staff knew what action to take to deliver care focused on individual need. Care records were kept up under review if people's needs changed. Staff responded to people warmly and compassionately when they were supporting people with their care. However, there were instances when people's privacy and dignity was compromised. In one case, we asked staff to intervene straight away because of the person's lack of dignity.
People had opportunities to express their views about the service, as did their relatives and staff. There were meetings to ensure information was shared with them about any developments in the service, as well as to ask what they would like to see happening within it. There was also a system for receiving and investigating concerns or complaints in a formal way so that people could have these addressed.
We found two breaches of regulations. One of these related to improvements needed to the safety of the service and the way risks were assessed and minimised as far as practicable. The other was because the systems in place for identifying where improvements were needed, and for sustaining these when necessary, were not working well. You can see what action we told the provider to take at the back of the full version of this report.