Woodland Nursing Home

Woodland Nursing Home is a residential care home providing personal and nursing care to up to 30 people. The service provides support to older people, some of whom are living with dementia and some require support with nursing care. At the time of our inspection there were 30 people using the service. The service is built over 4 floors. The kitchen and laundry room are on the lower floor [in the basement], and people live on the upper three floors. There is one communal lounge and dining area on the ground floor.

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

Risk assessments and care plans did not always cover people’s needs in relation to epilepsy and diabetes, and when they did, they did not always contain sufficient information. Quality assurance systems were in place, but these were not always effective, as they had failed to identify the shortfalls we found in relation to care plans and risk assessments.

There were enough staff to support people and robust staff recruitment practices were followed.

Medicines were managed in a way that was safe. Systems were in place to protect people from the

risk of abuse. Steps had been taken to ensure the physical environment was safe. Lessons were

learnt when things went wrong. The home was clean and infection control and prevention measures were in place.

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 provider was aware of their regulatory requirements and worked with other agencies to

develop best practice and share knowledge. Staff spoke positively about the management of the

service and the working atmosphere. Managers and staff were clear about their roles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires improvement (published 26 July 2019). At our last inspection we recommended that the provider review its quality assurance systems to make them more effective. At this inspection we found that quality assurance systems were still ineffective, and we have made a requirement about this.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 June 2019. At that inspection we rated the service Requires improvement and made a recommendation about their quality assurance processes. We undertook this focused inspection to check if they had made improvements. This report only covers our findings in relation to the key questions Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to the quality of risk assessments and the quality assurance and monitoring processes 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.

Safe arrangements were in place for visitors to the service. Those people visiting in a professional capacity had to demonstrate their COVID-19 vaccine status and all visitors were expected to take a lateral flow test for COVID-19 on the day of their visit. On arrival at the premises, temperature checks were done and there was a supply Personal Protective Equipment [PPE] for visitors to use at the entrance to the service. Visiting arrangements for family and friends were in line with the government guidance at the time of inspection.

There had recently been an outbreak of COVID-19 at the service and this had been managed in a safe way. People who had COVID-19 were accommodated in a separate part of the building to others and they had a designated staff team to help reduce the risk of cross-infection. Only staff employed at this location were working here, with the exception of agency staff, who had been block booked so they only worked at this service during the time of the outbreak.

All staff and people using the service had received COVID-19 vaccines and there was a routine testing schedule in place for both staff and people. Staff had undertaken recent training about infection prevention and control, which covered the use of PPE. There was a plentiful supply of PPE available at the service and staff were observed to be using it appropriately.

Policies and procedures were in place to help guide staff on good practice in relation to infection control and prevention. A monthly infection prevention and control audit was carried out by the manager. Cleaning schedules were in place to help ensure all areas of the premises were regularly cleaned. We saw the premises were visibly clean on the day of our inspection.

Woodland Nursing Home is a residential care home providing personal and nursing care to 27 people aged 65 and over at the time of the inspection. The service is registered to accommodate and support up to 30 people. The service is built over four floors. The lower floor houses the kitchen, laundry facilities and office space and people reside and receive care on the upper three floors.

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

People were not sufficiently protected from the risk of infection. Issues of concern were not always identified or dealt with in a prompt manner and we have made a recommendation that the service reviews it's quality assurance systems..

People told us they felt safe using the service and procedures were in place to safeguard people from the risk of abuse. Risk assessments were in place which set out how to support people in a way that minimised risks. Medicines were managed safely.

Assessments were carried out of people’s needs prior to their admission to the service. Staff were supported in their roles through training and supervision. People told us they liked the food and the service worked to meet people’s nutritional needs. The service worked with other agencies to meet people’s healthcare needs.

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 told us staff treated them in a caring way and we observed positive interactions between people and staff. Staff understood how to promote people’s dignity, privacy and independence. The service worked to meet people’s needs with regard to equality and diversity issues.

Care plans were in place which set out how to meet people’s needs. These were subject to regular review. People had access to a variety of social and leisure activities. Complaints procedures were in place and followed. End of life care was provided in line with people’s wishes.

Staff spoke positively about the senior staff at the service. Systems were in place for seeking the views of people who used the service. Quality assurance systems had not always identified concerns.

Rating at last inspection and update

The last rating for this service was Requires improvement (published 28 June 2018) and there were breaches of regulation in relation to statutory notifications and good goverance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Woodland Nursing Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide support with nursing and personal care to a maximum of 30 adults. At the time of inspection 23 people were using the service, many of whom were living with dementia. The service is built over four floors, with people living on the upper three floors.

The service had a registered manager in place. 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.

During this inspection we found two breaches of regulations. This was because quality assurance and monitoring systems were not always effective and the provider had failed to notify CQC about people who were subject to a Deprivation of Liberty Safeguard authorisation, even though they were legally obliged to do so. In addition, we have made four recommendations. These were related to fire safety, staffing levels, equality and diversity and the home's décor. We are still considering what our response will be to breaches of regulations.

People told us they felt safe using the service and systems were in place to help safeguard them from abuse. Risk assessments had been developed which set out how to meet people’s needs safely. Checks were carried out on prospective staff to help ensure they were suitable to work at the service. Medicines were managed safely and there were systems in place to reduce the risk of the spread of infection.

Pre-admission assessments were undertaken which looked at people’s care support needs. Staff were supported through regular training and supervision and new staff undertook an induction training programme on commencing work at the service. People told us they enjoyed the food and we saw they were offered choices about what they ate. People were able to access health care professionals and the service kept family members informed of any health issues.

People said they were treated in a kind and caring manner by staff. Care plans set out how to support people in a dignified manner. Staff had a good understand of how to promote people’s dignity, privacy and independence.

Care plans for people set out how to support them in a personalised manner relevant to the individual. Activities were offered and people told us they valued and enjoyed them. Systems were in place for dealing with complaints and people told us they knew how to make complaint if needed. Care plans included information about supporting people with end of life care.

Staff spoke positively about the registered manager and systems were in place for seeking the views of people who used the service and their relatives.

Woodland Nursing Home is registered to accommodate up to 30 people who require nursing and residential care. At the time of the inspection, there were 27 people using the service and two people were admitted to a hospital.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found staff had the knowledge and experience to care for people who needed nursing care. People and relatives spoke positively about the staff by saying that they were kind and caring. We found staff had received training in adult safeguarding and were knew their duties to ensure people were protected from abuse.

We found that systems were in place to respond to people’s needs. Each person had a personalised care plan that was regularly reviewed and provided guidance for staff how to support them. This included referring people and helping them access to appropriate healthcare when needed. We recommended people’s risk assessments should include risks associated with keeping bedroom open or closed.

Staff told us they were supported by the registered manager. They told us they could approach the registered manager to ask for support and that they found her very helpful. We noted that staff had supervision with their line managers and had attended team meetings. Staff told us they had training opportunities and had attended various courses including the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty safeguards (DoLS). This showed that people were supported by staff that had been trained to provide quality care.

The registered manager undertook regular audits to check the quality and safety of the service. We found that the registered manager attended meetings with the other managers of care homes owned by the provider. We also noted monthly audits and reports were sent to the Head Office to enable the provider to advise and support the registered manger.

People and staff had the opportunity to influence the quality of service by sharing their views through informal feedback and survey questionnaires. We noted that the provider had a complaints procedure and people and their relatives were aware of how to make complaints if they were not satisfied with the service. This enabled the registered manager to review and develop the service.

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 want to see evidence supporting our summary please read our full report.

Is the service safe?

Risk assessments had been completed for each person using the service to identify potential risks such as falls or pressure sores. Staff we spoke with knew how to respond if a person using the service became unwell and we saw evidence they had received training to provide safe care. Accidents and incidents were reported and recorded. Appropriately trained staff were observed to safely administer and manage medicines. Medicines were stored and when no longer required disposed of safely. There were effective recruitment procedures in place and relevant checks were undertaken before staff were employed.

Is the service effective?

People's health and care needs were assessed with their involvement where possible. Care plans had been developed and these reflected the level and type of support each person required to be safe and receive appropriate care to meet their needs and preferences. People's mental capacity to make informed choices had been assessed and we saw relatives had been involved to ensure their best interests were considered. Relatives we spoke with felt people were safe and care was provided in accordance with people's wishes.

Is the service caring?

We observed people using the service had their privacy and dignity respected and staff sought people's agreement before providing care. We spoke with people and their relatives. Relatives told us they were always contacted if staff had a concern about a person using the service. One person using the service said, 'I'm very lucky really. They do everything for me. I have my own things in my own room and can go and rest when I wish.'

People had been involved in the planning of their care and supported by their relatives to identify their preferences and what was important to them. People's cultural needs had been respected by ensuring they were able to choose appropriate clothing and diet. Staff demonstrated a good understanding of each person's needs and how to effectively communicate with them including being able to speak to people in their own language.

Is the service responsive?

There was a system in place to respond to and handle complaints. People were invited to be involved and make decisions about their activities but their wishes were respected when they did not wish to participate. There was evidence to show the service worked effectively with other health care professionals such as general practitioners to ensure people received care they had needed. We observed peoples wishes about aspects of their care and daily activities were respected and responded to appropriately.

Is the service well led?

The registered manager had completed audits of various aspects of the service to ensure the quality of service was maintained and improvements could be identified. There were satisfaction surveys undertaken to obtain feedback about the service and suggestions had been responded to appropriately. People using the service had also been supported by their families to participate in meetings to obtain their opinion of the service.

We saw that people were asked about their choices and staff sought their consent before providing support. The care plans showed that people's health and social care needs were identified and appropriate care was delivered to meet these needs.

All the people using the service and their relatives were happy with the care provided. One person said, 'I couldn't fault them in anyway, I think they are angels.' Another person told us, 'the staff are brilliant. They always have a smile on their face.'

We found people received care and treatment in a clean environment. There were effective systems in place to reduce the risk of infection. Staff were able to describe the infection control policy to us and provided evidence to show that checks were carried out regularly.

Staff were qualified, skilled and had the relevant experienced to meet people's needs. They all received appropriate support and training. However staff told us they often felt their job was task orientated and they would like to be able to spend more quality time with the residents.

There were quality monitoring processes in place. The people using the service and their representatives were asked for their opinion of the home through regular meetings and a yearly survey.