Archived: Woodland Grove

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. 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 at its next comprehensive inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We carried out a comprehensive inspection of Woodland Grove on 8 and 9 August 2017. This inspection was unannounced. Regulatory breaches from the November 2016 inspection were followed up as part of our inspection. At this inspection the provider had made sufficient improvements to be removed from special measures and is rated 'Requires Improvement' overall.

You can read the report for previous inspections, by selecting the 'All reports' link for 'Woodland Grove' on our website at www.cqc.org.uk

Woodland Grove provides accommodation and personal care for to up to 50 older people. Each person has a room which contains an en-suite shower room and small kitchenette. There are also four flats which have two bedrooms, which enable couples to be accommodated. At the time of this inspection there were 27 people using the service.

There was a registered manager in place at the time of our inspection; 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 provider had improved the quality monitoring systems which were used to bring about improvements to the service. Some improvements had yet to be embedded by the service.

Training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been provided to staff. DoLS aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. Staff were knowledgeable about the protection of people's rights and appropriate best interest decisions had been recorded.

Medicines were managed and stored safely. Medicine administration records were complete. We observed that medicines were administered to people as prescribed. We have made a recommendation about PRN (as required medicine) protocols.

People's needs were regularly assessed and resulting care plans provided practical guidance to staff on how people were to be supported. The care plans required further detail and improved reviews to further enhance the person centred information within the plans. People's risk assessments were not always updated to reflect necessary actions to reduce risks to people when their circumstances changed.

There were positive and caring relationships between staff and people at the service. People praised the staff that provided their care. We received positive feedback from people's relatives and visitors to the service. Staff respected people's privacy and we saw staff working with people in a kind and compassionate way when responding to their needs.

There were enough staff to meet people's care needs. Staff demonstrated a detailed knowledge of people's care and support needs. Staff had received training to support people safely and respond to their care needs. Staff were aware of the service's safeguarding and whistleblowing policy and procedures.

There was a robust staff recruitment process in operation. The recruitment process was designed to identify staff that had the ability to develop their skills to keep people safe and support their needs.

People had access to healthcare professionals when required, and records demonstrated the service had made referrals when there were concerns.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded.

The provider had made appropriate notifications to the Commission; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

Further information is in the detailed findings below.

We returned to the service in April 2016 to undertake a focused inspection to check that it was compliant with the warning notice for medicines; we found they were now compliant. There were however continued breaches in relation to safe care and treatment and good governance

At this inspection we found nine breaches of regulations. All five of the previous breaches from the last comprehensive inspection in April 2015 had been repeated. We also found four new breaches in relation to safeguarding people from abuse and improper treatment, dignity and respect, staffing arrangements and statutory notifications.

Woodland Grove provides accommodation and personal care to up to 50 older people. Each person has a room which contains an en-suite shower room and small kitchenette. There are also four flats which have two bedrooms, which enable couples to be accommodated.

At this inspection the overall rating for the service is ‘Inadequate’ it will therefore be placed into special measures. The commission is now considering the appropriate regulatory response to resolve the problems we found.

There was a registered manager in place at the time of our inspection; 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.

There were widespread and systemic failings identified during the inspection. Overall we found that quality and safety monitoring systems were not fully effective in identifying and directing the service to act upon risks to people who used the service and ensuring the quality of service provision.

The registered manager had failed to make appropriate statutory notifications; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

The registered manager had made applications for Deprivation of Liberty Safeguards (DoLS ) where they had been assessed as being required. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. However we also found that the registered manager and other senior staff within the provider management team had authorised the locking of an internal door and had failed to recognise that they were restraining people without authorisation and had seen this as an appropriate restriction.

Staff we spoke with had a variable understanding of the Mental Capacity Act 2005 and DoLS.

The registered manager had failed to report and take prompt action as required regarding adverse incidents appropriately.

Staff had not received regular meaningful supervision; the provider had not ensured that staff performance and progress was monitored effectively and that staff had an opportunity to voice their individual views. Staff training did not meet peoples’ needs.

Care plans were not person centred. Peoples’ risk assessments were incomplete and not reviewed as expected by the provider. Records used to monitor peoples’ health including nutrition and skin integrity records were not always completed. This exposed people to risks of neglect and unsafe or inappropriate care or treatment.

People had access to healthcare professionals however records demonstrated that the service had failed to make appropriate referrals when there were concerns.

The administration of people’s medicines was not in line with best practice.

We received some positive feedback about the care staff and their approach with people using the service; however we observed occasions when people’s dignity had been compromised.

Recruitment procedures were not followed appropriately.

There were enough staff to meet peoples’ basic personal care needs.

The provider had a complaints procedure and people told us they could approach staff if they had concerns.

We found nine breaches of regulations at this inspection and will be asking the provider to send us a report of the improvements they will make.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The breach relating to medicine management had been repeated from a previous inspection in April 2014. We issued a warning notice. This meant we told the provider the date they were required to meet this legal requirement.

After the inspection, the provider wrote to us to say what they would do to meet the legal requirements for the other identified breaches.

We undertook a focused inspection on 12 April 2016 to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘All reports’ link for ‘Woodland Grove’ on our website at www.cqc.org.uk

Woodland Grove is a 50 bedded home that provides accommodation for persons who require personal care. At the time of our inspection there were 31 people living in the care home.

There was no registered manager in place at the time of our inspection. The manager in charge of the home told us they had submitted an application to the Commission to become the 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.

At our focused inspection on 12 April 2016, we found that sufficient action had been taken and the provider now met the legal requirement relating to the management of medicines. We continued to find breaches relating to the care and safety of people using the service, as well as matters relating to nutrition and hydration, record keeping and the running of the home.

Risks to people were assessed, however actions were not always taken to mitigate the risks and keep people safe. Where people were at risk of malnutrition and dehydration, accurate records were not always maintained.

The provider ensured the service was responsive to providing people with personalised care. Care plans that had been recently reviewed reflected people’s individual needs, preferences and choices had been considered.

We found the provider had not ensured governance systems were robust to monitor and mitigate the risks relating to the health, safety and welfare of people. People’s records were not always accurate and completed correctly which placed them at risk of unsafe or inappropriate care.

We found three breaches of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service caring?

Staff spoke to people in a calm, caring and friendly manner. There were many positive interactions between staff and people who used the service. Staff supported those people who required assistance to eat in a caring and attentive manner.Staff respected people's privacy and dignity. They involved people in discussions and were attentive to their needs.

Is the service safe?

The environment was well maintained and free from hazards. Risks such as people falling from a height had been minimised. Systems were in place to ensure the safety of the environment.

People told us they felt safe. Staff were aware of their responsibilities to report any suspicion or allegation of abuse. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications have needed to be submitted from this home. However, only 18% of the staff had undertaken training in this area.

The home had raised a high number of safeguarding alerts. These were appropriately reported and addressed in line with local protocols.

Is the service responsive?

The manager had recognised improvements were required in aspects of the service. In order to assist this process, new admissions to the home were restricted.

The service was being developed in a more person centred way. Staff were responsive to people's choices about their daily routines. Staff helped people to take their medicines in a way which met their needs. We gained consent from a person to use their call bell. A staff member responded quickly, in a friendly manner.

The manager had requested additional funding to refurbish the environment. This had started with a new kitchen and was progressing to the dining room and people's flats.

Is the service effective?

At our last inspection in 2013, we identified shortfalls in some people's care. We will undertake a further follow up inspection after the provider's timescale for compliance.

There were clear systems in place to manage people's medicines. However, not all staff had consistently signed the medicine record to show whether people had taken or refused their medicines. There had been two medicine errors, which were being addressed within safeguarding protocols.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe management of medicines.

Is the service well led?

A new manager started at the home in January 2014. They were in the process of registering with us to become the registered manager. The manager showed they were committed to making improvements and involving people in the process. Resident and relative meetings had taken place to enable the sharing of views and suggestions. There were clear systems in place to audit service provision.

The manager sent us a clear action plan which detailed how all areas would be addressed. A voluntary restriction on admissions was put in place until standards had improved. A regional business manager was seconded to the home to support the manager with developments. There was a commitment to make improvements.

At this inspection, improvements had been made. People were relaxed and looked well cared for. Staff had received a range of training to assist them to manage people's resistance to care more effectively. A culture of person centred care was being developed.

The staffing rosters had been reviewed and changes had been made to the way staff worked. Additional staff had been recruited. This had positively impacted upon care provision and staff morale.

The laundry systems had been fully revised and new industrial machines had been installed. The area was clean, ordered and clearly managed. Attention had been given to cleaning less visible areas within the home. This included the frames of wheelchairs and underneath the seat cushions of armchairs.

Whilst improvements had been made within the home, there continued to be shortfalls with care documentation. People's care plans had been developed but care needs remained unclear. Certain health care conditions and the way in which they impacted upon people lives were not identified. There was limited information about how particular risks such as malnutrition, falling and developing a pressure ulcer were being managed.

The manager and the care manager had a clear action plan which described how they were planning to develop the service.

People told us they were happy with the service they received.

The majority of people looked well cared for, but this was not so for every one.

A new care planning system had been implemented but the information in place did not properly reflect people's needs and how they were to be met.

People generally liked the food. All meals consisted of three courses with the availability of various choices. People's risks of malnutrition had been assessed.

The home was generally clean, although less visible areas required greater attention. The laundry room was disorganised and the systems presented a risk of infection.

The manager and care manager had recognised staffing levels were inadequate and additional staff were being recruited.

Staff were well supported and able to undertake a range of training opportunities. Training provision was to be further developed.