Woodhorn Park

Woodhorn Park is a residential care home providing accommodation and personal care for up to 61 people across two floors in a purpose-built building. The service provides support to people living with dementia and those requiring support with personal care. At the time of our inspection there were 59 people using the service.

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

People were safe from the risk of abuse. Risks to people were assessed and regularly reviewed when people's needs changed. The building was well maintained, and health and safety risks were assessed.

Medicines were managed safely. The provider employed sufficient staff, staff were trained appropriately and recruited safely. Staff worked effectively with visiting professionals. Infection control measures were in place, and visiting was managed safely.

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 said staff were very caring and kind. People were supported to maintain their independence and were treated with dignity and respect.

There was a positive culture. Staff and relatives said the management team were supportive. Quality assurance checks were taking place, lessons had been learnt and improvements were made continuously.

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 March 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations 9, 10 and 17.

At our last inspection we recommended that the provider ensured they were following best practice guidance for recruitment. At this inspection we found that improvements had been made.

Why we inspected

We carried out an unannounced inspection of this service on 13 January 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, dignity and respect and good governance.

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, caring and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Woodhorn Park 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.

Woodhorn Park is a residential care home providing accommodation and personal care for up to 61 people. At the time of our inspection 58 people were resident at the home. Accommodation is available across two floors which have adapted facilities to meet people’s needs. The first floor of the home provides specialist support for people living with a dementia related condition.

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

The service was not always well-led. Systems had not always been effective in identifying issues to help drive improvements within the service. There were gaps in the records to evidence government guidance was followed in relation to testing for COVID-19.

The providers visiting policy was not in line with government guidance and placed additional restrictions on people. This had negatively impacted upon the well-being of some people. People, or where appropriate, their representative had not been involved in the decision-making process for visiting restrictions. Staff demonstrated kind and caring values and treated people with respect.

Systems were in place to safeguard people from abuse and staff understood how to escalate any concerns they had. Analysis of accidents and incidents were taking place to assess if any learning from incidents could be made. During the inspection the home manager introduced a new system for reviewing safeguarding records which included communicating outcomes to the staff team. Medicine records were not always accurately maintained.

There were enough staff deployed to meet people’s needs and systems were in place to recruit staff safely. There were some gaps in records to show candidates suitability had been robustly assessed. We have made a recommendation about this.

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 5 December 2019).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns we had received about the service. The inspection was prompted in part due to concerns received about visiting restrictions at the home which were not in line with government guidance. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the visiting arrangements, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, caring and well-led.

Enforcement and Recommendations

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 identified breaches in relation to person centred care, dignity and respect and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

We found the following examples of good practice.

¿ Systems were in place to help prevent people, staff and visitors from catching and spreading infection. A visiting suite with screen and intercom system had been built to facilitate safe visiting.

¿ There was sufficient PPE such as aprons, gloves and masks. Staff were wearing this appropriately when we visited. Staff had undertaken training in putting on and taking off PPE.

¿ The registered manager spoke very positively about the hard work and dedication staff had shown throughout the pandemic. Systems were in place to help ensure the health and wellbeing of staff were supported.

Further information is in the detailed findings below.

Woodhorn Park is a residential care home providing personal care to 58 people aged 65 and over at the time of the inspection. The service can support up to 61 people.

The home is a purpose-built facility with care supported over two floors. The upper floor of the home is designated as the ‘Memory Lane’ unit, providing help and assistance to people living with dementia or other mental health conditions.

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

People told us they felt safe when being supported by staff. The provider had dealt with any safeguarding concerns appropriately. People were protected from harm as risks had been assessed and plans put in place to mitigate these. There were enough staff to delivery care appropriately and medicines were managed safely and effectively. The home was maintained in a clean and tidy manner.

People told us their care needs had been assessed and support provided met these needs. Staff were supported to maintain good levels of knowledge and training. People said they enjoyed the food at the home and their dietary requirements were well catered for. There was good access to a range of health and social care services. 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. The environment of the home had been designed and adapted to meet people’s needs, including particular environmental adaptions for people living with memory loss.

People told us they were exceptionally well supported, and that staff worked hard to deliver care that was highly individual. Professionals praised the service highly and told us the care was of an excellent quality. A significant number of people and relatives described the care as outstanding. People were actively involved in care decisions and reviews. Staff understood about protecting people’s privacy and dignity and helping to maintain people’s independence.

Care records were well maintained and clearly identified people’s preferences and likes and dislikes. Thought had been given to people’s communication and alternative methods of displaying information. There was access to a wide range of activities and people were well supported to maintain relationships. The provider had responded appropriately to complaints. People received kind and compassionate end of life care.

People, professionals and staff all praised the registered manager highly and said she had made significant improvements at the home. A range of quality audits and checks were in place to ensure care was delivered to an appropriate level. People and staff told us they were able to input into decisions about the running of the home. The service worked in partnership with a number of other services.

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 7 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodhorn Park on our website at www.cqc.org.uk.

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 inspection took place on 25 January and 3 February 2017 and was unannounced. A previous inspection in September 2015 found three breaches of legal requirements.

A registered manager was 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 the previous inspection we found that risks to the health and safety of people who used the service had not always been assessed and mitigated. At this inspection we found improvements in this area. Individual risks to people were assessed and reviewed regularly. Checks on the safety of the premises and equipment were also carried out and staff demonstrated an awareness of maintaining a safe environment as they worked.

The premises were clean and staff were aware of procedures to follow to prevent the spread of infection. Suitable personal protective equipment such as gloves and aprons were readily available, and cleaning chemicals were safely stored.

There were mixed views about the number of staff on duty. The registered manager was staffing the service in line with the dependency assessment rating tool used by the provider, although she had identified certain times of the day that could be very busy and had requested additional staff hours. We found that staffing on the ground floor, up to and including the lunch time period was insufficient to consistently meet the demands of people in a timely manner. Immediately following our inspection additional staff hours were agreed and an additional staff member was deployed without delay to support this busy period. Due to the concerns raised about staffing we made a recommendation that staffing remains under review.

Medicines were managed safely. There were suitable procedures in place for the ordering, receipt, storage and administration of medicines. Staff competency to administer medicines safely was assessed on a regular basis, and medicine audits were carried out internally and by the dispensing pharmacy.

Safeguarding policies and procedures were in place, and staff were aware of what to do in the event of concerns of a safeguarding nature. Suitable staff recruitment procedures were in place which helped to protect people from abuse.

At the last inspection we found that support provided at mealtimes was not always person centred. At this inspection, we found that improvements had been made in this area. Staff supported people to make choices by providing written menus and visual aids. The individual needs and preferences of people were supported including people receiving meals in their bedroom. Nutritional risks were assessed and appropriate advice sought for people at risk of malnutrition.

Staff received regular training considered mandatory by the provider. Clear records of training were maintained. Additional specialist training related to people's individual psychological and physical needs was also provided. Staff received regular supervision and annual appraisal, and told us they felt well supported.

At the last inspection, we found that improvements had been made to the environment in the Memory Lane unit, for people living with dementia. At this inspection, we found that there had been further improvements with more planned. People's bedrooms were personalised and homely.

The service was operating within the principles of the Mental Capacity Act (2005) (MCA). MCA care plans were in place, and decisions taken in people's best interests were appropriately recorded.

The health needs of people were met. Visiting professionals told us they were asked to see people in a timely manner, and that staff acted upon the advice they gave. Records showed a variety of health professionals visited people on a regular basis.

Staff were observed to be kind, caring, attentive and respectful in their communication with people. They knew people well and could describe the care people needed to help them to feel safe and relaxed. A number of people and visitors commented on the warm and welcoming atmosphere in the home, and the friendly and helpful approach of staff.

At the last inspection, we found that care plans were not always followed by staff. At this inspection, we found that person centred care plans were in place which were up to date and regularly reviewed. We saw no evidence of these being contradicted. People and relatives were involved in the care planning process where possible.

A range of activities were available. These were well organised and catered for varying needs, interests and level of ability. People were supported to make choices and to remain as independent as possible.

At the last inspection, we found that not all aspects of the service were well led, as some of the issues we identified had not been picked up through routine audits by the registered manager. At this inspection, we found that systems to monitor the quality and safety of the premises had improved. There were feedback mechanisms in place to obtain the views of people, relatives and staff. There were good links locally with people having the opportunity for trips into the community, and planned events in the home involving the local community.

Notifications of events the provider is obliged to notify us of, were sent to CQC in line with legal requirements.

We talked to two visitors and three people.

We found people of varied needs and abilities were all involved in making decisions about their care as far as they were able. Their representatives were also involved, where possible and appropriate. People's independence and community involvement was promoted. One person said, "I like it here, I think it is quite settled, it is working out well, I am getting to know them and they are getting to know me."

We found the provider acted in accordance with people's wishes and the legal requirements regarding people's consent to care and treatment. People's care needs were assessed and care was planned and reviewed regularly. Care was delivered safely and in line with the care plans and people were happy with their care. One person said, "This is a nice home, the staff are good, there are activities and we have a car that is used to take people out for short trips."

We found the provider had taken steps to raise staff awareness about abuse of vulnerable people, to encourage staff to report concerns and prevent abuse occurring.

We found that the record keeping ensured people had their care delivered safely and maintained confidentiality.

People told us they enjoyed the food. One person commented, 'The food is brilliant, it reminds me of when I was younger.' Another person said, 'The food is lovely and we always have plenty to eat and drink. We can have a full breakfast." We found that people were provided with a choice of suitable and nutritious food and drink.

People and relatives, who we spoke with, told us that they were happy with the care provided. One relative said, 'The place is very good, the staff are obliging, they have arranged for a walking aid so mum is more independent now, they pick up on when a doctor is needed, or an optician or chiropodist, there are trips out and things to do, we are delighted with the care Mum gets.' We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people's complaints were fully investigated and there were enough staff to meet people's needs. We found that some people's records were not up to date or held securely.