Wood Hill Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Whilst improvements had been made to managing people’s safety, some further improvements were required to ensure people were protected from the risk of unsafe harm. We identified two breaches of the legal regulations in relation to medicines management and infection control practices. Improvements had been made to the cleanliness of the environment, however further improvements were required to ensure all areas were effectively clean and the risk of cross contamination was effectively managed. Medicines systems had improved, however further improvements were required to ensure medicines were safely administered and stored. At our last inspection we identified concerns relating to managing risks, enough improvement had been made and the provider was no longer in breach of regulations relating to risk management. Risk assessments were more robust, and staff were provided with training and guidance about how to manage risks and respond to emergency situations. However, some improvements were required to ensure records relating to risks contained all relevant information. The overall learning culture had improved, and systems were in place to monitor accidents and incidents. The provider had systems in place to protect people from the risk of abuse, whilst most people told us they felt safe living at the service, some people told us they felt uncomfortable around their peers. People were supported by enough staff and staff had received training to enable them to safely carry out their roles. The environment had improved, refurbishments had been undertaken in several areas of the service and plans were in place to continue refurbishments and make the service a nicer place for people to live. Environmental safety checks were in place, this included checks of equipment, however we found radiators which were not covered. This was raised during the inspection and steps were taken to address this concern.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst new systems were in place to monitor accidents and incidents, monitoring systems required strengthening to ensure it could be evidenced that risks were identified and actioned in a timely manner. Where people had experienced an accident or an incident, appropriate action was taken. For example, where a person had accidentally fallen, referrals were made to external healthcare professionals, to ensure this person could undergo an assessment of their needs.

Staff were aware of their responsibilities to learn from accidents and incidents. One staff said, “We have drills [to enable staff practice in emergency situations]” and another staff said, “We discuss accidents and incidents in daily handovers, this allows concerns to be escalated.” The management team told us they had introduced ‘lessons learned’ systems, which had improved how the service responded to incidents. During our inspection it was fed back to the management team that some records required improvements, to evidence what action was taken, the management team assured us they would put an action plan in place.

Monthly governance meetings were in place, and these explored any accidents, incidents or safety concerns within the service. Themes and trends were identified, and a falls analysis was in place. This was being further strengthened by monitoring staff's whereabouts during incidents. Improvements were required to ensure an action plan was formulated following this analysis, which evidenced when actions had been undertaken and in what timeframe they had been completed.

Pre admission assessments were in place for people. Records evidenced people received support from external professionals to meet their healthcare needs, including regular G.P ward rounds. People and relatives told us they had access to healthcare professionals and staff would contact external services if required. One person said, “The Dr comes, and I can talk to them if I need to.” Another person said, “I had a physiotherapist who came and showed me some exercises.”

Nursing staff completed admission and discharge records and staff told us they were provided with information about people's needs before they were admitted to the service. The provider was working closely with the local authority and commissioners to make continuous improvements to the safety and quality of the service.

We received some positive feedback from partners about how the service worked with them and had made improvements to maintain safe systems of care. However, we received some negative feedback from a professional who told us they often had to wait for long periods for staff to provide information to them.

Any healthcare concerns, admissions, discharges and hospital stays were discussed at daily flash meetings. Online care planning systems were in place, which allowed the service to share information with external professionals as appropriate. However, these processes were not always effective in ensuring the service shared information in a timely manner.

Most people told us they felt safe living at the service. One person said, “I am safe, it is nice here, no one isn’t nice.” A relative said, “I can see [relative] is looked after, it is like home from home, I have peace of mind because I know they are safe.” However, some people told us they felt uncomfortable at times due to the behaviours displayed by other people living at the service. People had access to their own rooms which could be locked, however this required exploring by the provider, to ensure all people living at the service felt safe and comfortable. Staff worked in line with the principles of the Mental Capacity Act. People's capacity was assessed and where required people had Deprivation of Liberty Safeguarding authorisations in place.

Staff were trained and understood their roles and responsibilities in relation to safeguarding people. Staff told us they felt able to report concerns and understood where they could escalate concerns if they needed to. One staff said, “The managers listen to any concerns about people.” Another staff said, “It is safe for people living here, when I have reported things, I was listened to and things were taken seriously by the manager, action was taken.”

We observed staff providing support to people in a respectful, safe and dignified way. People told us staff treated them well. Staff gained consent from people, and we saw care being provided to people in line with their preferences. For example, one person with communication difficulties indicated they did not like a song which was playing, staff recognised this and changed the music.

Systems were in place to protect people from the risk of unsafe harm. Safeguarding concerns were recorded, investigated and monitored. The management team reported notifiable incidents to external agencies, such as CQC and the local authority.

Improvements had been made and people had detailed risk assessments and care plans in place. However, we found some care plans containing conflicting or missing information. For example, 1 person’s records did not have enough information relating to how staff used slings to move them, and 1 person’s records contained conflicting information relating to pressure care. This was a recording concern, we found people had received care and support in line with their needs.

Where people displayed emotional distress, care plans were in place and detailed people's triggers, presentation and ways staff support people to aid calming. The provider had recently provided training to specific staff, to provide the staff team with Positive Behavioural Support (PBS) training. Some staff were awaiting this training, this was planned for the near future to ensure all staff had the knowledge and skills to safely deal with incidents. Staff told us they had access to peoples records and had received training in the use of equipment. One staff said, “I read peoples care plans and follow the guidance, I have had training to use all the equipment on the units.”

Guidance was readily available to staff on each unit regarding appropriate food and fluid, people had access to fluids in communal areas and their own rooms. Management and kitchen staff were involved in daily meetings to discuss any risks. Staff had their competencies assessed in the use of fluid thickener; however we found an incident where fluid measurements were incorrect for the amount of thickener used. We observed people being moved safely.

Staff completed daily records of peoples care and recorded any incidents relating to risks. Where people required a specialist diet, this was provided in line with Speech and Language Therapy (SALT) guidance and where people required repositioning this was carried out in line with their assessed needs, to reduce their risk of developing pressure wounds. Specific risk assessments and associated care plans were in place for people at risk of choking and people managing diabetes. These were detailed and provided guidance to staff in the event of an emergency. Daily flash meetings involved checks of people's food and fluid, these required further improvement to ensure actions were logged when concerns were identified.

Whilst improvements had been made to the quality and safety of the environment, further improvements were required. For example, radiators were not covered, this could pose a risk of burns to people. This was brought to the attention of the manager at the time of the inspection and action was being taken to address this. People and relatives told us the environment had improved. A relative said, “They have replaced [relative’s] floor and toilet, and it is much better.” Another relative said, “The environment is much better now, they have had it all painted, before there was broken furniture but that has been replaced.”

Staff told us new equipment and furnishings had been replaced and they were provided with the appropriate equipment to carry out their roles safely. One staff said, “It is much safer now, since we had our last CQC inspection.” However, another staff told us of continuing concerns in relation to the tumble dyer. This is covered in the infection control section of this report.

Several areas had undergone refurbishment and new furniture and chairs had been provided. Some bedroom areas required repainting, this was recognised by the provider and refurbishment plans were ongoing. Some flooring was observed to be lifted in areas and required replacing.

Maintenance checks of equipment and the environment were in place, such as slings, bedrails and lifting equipment checks. Appropriate risk assessments and regular maintenance was in place to manage fire safety and risks related to legionnaires disease.

Most people and relatives told us there was enough staff and staff were trained and knowledgeable. One person said, “The staff know what they are doing.” A relative said, “There is enough staff here.” Another relative said, “Staff know what they are doing, they know [relative] well and what they need.” People told us staff responded to call bells and checked on them regularly.

Staff had received training in various mandatory and specialist subjects, to provide them with the knowledge to carry out their roles. Staff told us there were enough staff to meet peoples needs. One staff said, “Staffing levels have improved and there is no change in levels over the weekend.”

We observed enough staff to meet people's needs and where people required 1:1 support this was provided. Dependency tools were used to calculate staffing numbers and records evidenced enough staff were in place.

Staff were recruited safely, and all pre-employment checks were in place. Regular checks were in place to ensure clinical staff were registered with the nursing professional body. Staff received supervisions which covered key areas, such as person centred care, choking risk and medicines management. Reactive supervisions were also in place, to focus on any staff performance concerns and nursing staff received clinical supervisions, which covered the Nursing and Midwifery Council’s (NMC) code of conduct.

We could not be assured people were protected from the risk of infections due to ineffective processes and our observation during the inspection. People and relatives told us the cleanliness of the service had improved. Comments included, “It is clean, they come and clean my room as often as possible.” However, some people told us there were issues with their laundry, this concern was also raised via a complaint to the service and in a previous relatives meeting. The tumble dryer was broken, and people’s clothes were being dried at a neighbouring service, meaning peoples clothes were often mixed up, putting people at risk of cross contamination. Following our inspection, we were assured the tumble dryer had been fixed.

The provider was made aware by the NHS IPC team, they were required to replace some sluice cleaning equipment as it did not meet appropriate standards. This was still not resolved at the time of our inspection. However, work had commenced to rectify this and the management team informed us following the inspection work was taking place and the correct equipment had been fitted. Staff were trained in relation to preventing the spread of infections and had their competency assessed in regards to donning and doffing of PPE.

Improvements had been made in relation to infection, prevention, and control (IPC), such as increased daily checks and domestic staff hours. PPE was stored appropriately and there were no malodours throughout the service. However, some IPC issues identified at our last inspection remained. We found bed bumpers which required cleaning, a visibly dirty shower floor, continence equipment stored incorrectly and a kitchen worktop with bare wood exposed, meaning it could not effectively be cleaned.

Audit tools were being used, cleaning schedules were in place and management daily walk rounds were in place to check day to day infection control measures, however these were not effective in recognising issues found during our inspection.

When people were prescribed medicines to be taken ‘when required’ or with a choice of dose the guidance to support the safe administration was not person centred. This meant staff did not have enough information to tell them when someone may need the medicine or how much to give. Some people needed to be given their medicines covertly, hidden in food or drink. The information from a pharmacist to explain how to give each medicine safely was not always followed which meant they may not have received the full dose of their medicine. Medicines that needed to be given at specific times in relation to other medicines or food were not given safely because the medicines may not be effective.

The service completed audits; however, they had not identified the concerns highlighted during this assessment.

Since our last inspection improvements had been made in the safe management of medicines. Medicines were all in stock in adequate doses to ensure that no doses were missed, they were accurately accounted for and given as prescribed. When transdermal patches for pain were applied, they were not rotated in accordance with the manufacturer’s directions putting people at risk of skin irritation and altered absorption of the medicine in the patch. Creams were not always applied as prescribed, placing peoples skin integrity at risk. Some people needed their drinks thickened to a prescribed thickness, the records showed they had not been thickened to the correct consistency. Placing them at risk choking and aspirating.