Woodstock Nursing Home

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

We found improvements had been made to the provider’s recruitment processes. Safe employment and recruitment checks were now being completed. Medicines were not always managed safely; however, we were assured as the provider took action to resolve this at the time of the assessment. Staff knew how to report safeguarding concerns and managers worked with external agencies to address safeguarding issues. Staff told us there were insufficient staff to fully meet people’s needs although the provider used a dependency assessment tool to help them determine what staffing numbers were required. The service had experienced a period of poor staff retention and they used agency staff to supplement the staffing numbers. We were informed the care home was actively recruiting new staff. Our observations showed the staff available did not always have the experience and skills required to effectively support the needs of those being admitted. We received mixed feedback from relatives regarding the staffing levels. Most relatives considered their family member to be safe at Woodstock Nursing Home. Where there had been safety concerns the service worked with external agencies and professionals to address these concerns.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The majority of people’s relatives told us staff took action to safeguard their relative from harm or abuse. They told us staff were open and transparent with them, informing them about incidents or accidents involving their relative. One relative had been present when an incident took place involving their family member. They told us they had received an apology, been informed of the investigation and the subsequent lessons learnt. Other comments from relatives included, “[My Relative] is consistently not very nice to people because of their dementia and can be violent towards staff and other residents. I’ve not seen a risk assessment for [relative], but they [staff] do try to keep [relative] away from other residents and they do a good job in controlling [relative]. I take my hat off to Woodstock for having [relative].” and “Yes, they ring me and tell me there’s nothing to worry about and then tell me what’s happened and where.” However, another relative told us their family member had sustained injuries and the care staff had been unable to provide them with satisfactory explanations as to the cause of these. Therefore, a meeting had been organised, between external professionals, the registered manager and themselves, to investigate the concerns further.

The service's permanent staff told us they had completed safeguarding training. They knew what constituted abuse, and they knew how to report concerns of a safeguarding nature. The registered manager discussed how they investigated concerns and engaged with external professionals when concerns of a safeguarding nature were raised.

We observed staff monitoring people who experienced behaviour which, in some incidents had, caused harm to themselves or others. We observed staff, in the course of their work, remaining alert to potential behaviour which could be of an abusive nature. One person, who lived with dementia, gently slapped another person who lived with dementia on the arm, this was in response to the person’s loud and persistent vocal noises. Staff immediately and appropriately intervened to reduce the risk of further escalation between the people involved.

The provider had processes in place to investigate and learn from incidents and accidents, including those which were of a safeguarding nature. The investigation findings into 1 incident had been shared with us. The provider had used a route cause analysis process to help identify the wider failings which had led to the incident and what processes and practices needed to be addressed to prevent reoccurrence. This resulted in further training for staff and changes to how staff worked together when completing certain tasks, which we observed during this assessment. The provider had processes in place to monitor the reporting and management of incidents and accidents. This ensured, where appropriate, the service reported these to external agencies who also have responsibilities to safeguard people from abuse and harm. There were processes in place to record and monitor injuries, such as bruises and skin tears, so any patterns or trends in these, could be identified and explored as part of the process of identifying potential abuse or poor practice.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s relatives had mixed views on whether they felt there were enough staff to support people’s needs. A relative said, “When I go there’s always enough staff and I go at lots of different times. Since Covid they have more agency staff.” Another relative said, “Yes, I visit at different times but always enough staff.” However, other relatives said, “Sometimes it is a bit sparse at the weekends.” and “No, I don’t think there are enough, but I’ve been told that according to the staffing algorithm there are. I feel the staff are under pressure.” Relatives also had mixed views when asked if they felt staff had the skills and knowledge to support their relatives. Comments included, “Yes, I would have said so from what I see.”, “Yes, on the whole, but I think there is a lack of continuity sometimes because they have to use some supply staff who need to be given more direction.” and “Yes, I think they do but staff turnover is high which makes it harder to build a relationship with [person].”

The registered manager told us they were looking to recruit new care and housekeeping staff, including an activities coordinator. Staff told us they were aware of the recruitment campaign. The registered manager told us the provider had just increased the allocated hours for care and housekeeping because the numbers of people in the service had increased. The registered manager told us they were looking at which part of the day would best benefit from the additional care hours. Staff told us their concerns about staff numbers verses the complexity of people’s needs had been discussed with the registered manager. A member of staff said, “We struggle to get people up and ready by lunch time, there is no time for meaningful time spent with people, we are rushing. Personally, I'm disappointed as I want to give quality care to everyone equally and I cannot do that, people are very dependent.” Both the registered manager and a regional manager told us a dependency assessment tool was used to help determine staffing numbers and this was reviewed weekly. The regional manager said, “She [registered manager] knows who is dependent and who is independent.” and they said, "I would never allow the home to be unsafe.” A member of staff told us staff had been unable to attend local training initiatives due to the staffing situation. The regional manager told us the registered manager had requested training for staff in positive behaviour management and several staff had attended this in March of this year. The regional manager confirmed the provider currently did not have arrangements in place to provide their nurses with the support they may need when revalidating their registration with the Nursing and Midwifery Council (NMC). However, they told us, the need for this had been recognised and there were plans to introduce this.

We observed staff supporting the needs of the service by completing additional tasks, for example, care staff helping with housekeeping tasks. We saw more experienced care staff prompting and supporting less experienced or unfamiliar care staff to meet people’s needs. For example, we saw a permanent staff member working with an agency staff member to safely move people using a sling and hoist. We observed a member of staff supporting 1 person who was at risk of choking to eat safely because they knew what food and drink this person should have. We saw that 1 staff member was always allocated to remain in the communal areas so the risk of falls falls and altercations between people could be reduced. We observed staff completing tasks to keep people safe, but we also observed staff had little time to spend with people outside of completing a care task. When there were opportunities for meaningful engagement with people, for example when staff supervised the communal areas, some staff lacked the necessary experience and skill to positively engage with people. One person, who was expressing boredom and who was becoming increasingly distressed, was given a piece of paper with a word search on it. The person said, “What does that mean, I can’t even read it.” There was no attempt to organise getting the person’s glasses or change the activity to support more meaningful engagement.

The registered manager, with the support of the regional manager, worked to staff the service in accordance with the provider’s dependency and staffing tool. The tool was reviewed weekly by the registered manager. The provider had arrangements in place to supplement their staffing requirements with agency care staff where needed and until they were fully recruited. The provider had processes in place to recruit staff safely. We reviewed 4 staff recruitment files which showed checks had been completed with the Disclosure and Barring Service (DBS), references had been sought and received and staffs’ employment histories including any gaps in these had been explored before staff started work.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

During the time of our assessment, it was found some people did not have their medicines administered as prescribed, this was due to the medicines not being in stock in the care home. A GP had confirmed there had been no lasting impact on people who had not received their medicines and during the assessment, action was taken by the provider to address this. During the assessment we were aware of staff taking action to support a person who was experiencing discomfort. The person, who lived with dementia, was unable to verbally describe their discomfort, but staff suspected they were in pain. Therefore, a nurse administered a pain relief medicine, which had been prescribed to be used in such a situation. People’s relatives had positive views about the support given to their relatives with their medicines. Comments included, “Yes, they give [person] their tablets but sometimes [person] doesn’t take them as [person] doesn’t know what they are. They’ve discussed crushing [person’s] tablets with the GP, and they are going to do this now and put in [person’s] food.” and “Yes, [person] needs constant support with their medication and to be told to take them.” Another relative told us staff let them know when they needed to buy more of the supplement their relative needed but could no longer be prescribed by the GP.

Staff were trained in medicines administration and had competency assessments were completed. Staff told us they worked with clinical healthcare professionals so people's medicines were reviewed periodically. At the time of the assessment, staff told us about changes, which had previously been made to medicine processes to try and improve how medicines were ordered. However, they said these changes had not been effective in resolving the ordering issues. Staff told us the service used to have a stock of over-the-counter medicines, but these had been removed but they were not sure why.

Medicines policies were in place although staff had not fully followed the provider’s policy and national guidance, for ordering medicines. The provider’s policy for over-the-counter medicines was not implemented in Woodstock Nursing Home at the beginning of the assessment. Regular medicine audits were completed by staff, but these would not have identified the scope of the issues regarding the medicine ordering. During the assessment, the regional manager acted immediately to reinstate over-the-counter medicines, and another provider representative was on site investigating the incidents where people had not received their medicines. At the time of the assessment processes were reviewed and altered to ensure people’s prescribed medicines were in stock when they needed to be administered. There was a process in place to report and investigate medicine-related incidents. The provider’s representative shared the findings of their investigation with us. This showed there had been a full investigation, it explained the actions taken, and lessons learned with further recommendations, to prevent recurrence. Some people were prescribed medicines to be administered on a when-required basis. Guidance in the form of written protocols (known as PRN protocols) were in place but these were not person-centred. These were to be reviewed by the staff following the assessment. Medicines including controlled drugs were stored securely and at appropriate temperatures.