We inspected Woodend Nursing and Residential Centre on 17 and 18 November 2015. The first day of the inspection was unannounced.
Woodend Nursing and Residential Centre provides nursing and residential care for up to 79 older people. At the time of our inspection there were 62 people living in the home. People are supported over four floors. The basement floor provides single sex residential accommodation. The ground floor provides accommodation to people requiring either nursing or residential care. The first floor provides support to people living with dementia and the top floor provides both nursing and residential care, although most people had higher dependency nursing needs at the time we inspected. Each floor has a communal lounge/dining room and a small kitchen for making snacks and hot drinks. The kitchen and laundry room are situated in the basement and the home is accessible by a lift and stairs to all floors.
The service is required to have a 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The overall rating for this service is ‘Requires Improvement.’ However, we are placing the service in ‘Special Measures.’ We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in Special Measures.
There had been no registered manager in post at Woodend Nursing and Residential Centre since January 2015. Since that time two further managers had been employed and then left the service. The current manager had been in post for six weeks and was in the process of applying to be the registered manager. Concerns relating to practice at Woodend Nursing and Residential Centre had led to a joint intervention by the Local Authority and Clinical Commissioning Group at the end of October 2015 whereby a 28 day suspension of admissions to the home had been agreed and a Service Improvement Plan imposed. At the time of our inspection officers from the Local Authority and Clinical Commissioning Group were working with the current home manager to ensure the improvements they had identified were being made. Since the inspection an extension to the suspension of admissions until 24 December 2015 had been agreed.
Our last inspection took place on 29, 30 January and 3 February 2015. At that time we rated the service as inadequate as there were breaches of the regulations relating to safeguarding people, the need for consent, person-centred care, good governance and the regulation which requires services to notify the Care Quality Commission (CQC) of certain types of incidents. We asked for and received an action plan telling us how they intended to make the improvements that were required.
The action plan was not comprehensive in terms of the breaches we had identified and whilst the provider had followed the plan to rectify some breaches, during this inspection we found other breaches had not been addressed fully. This failure meant a further breach of the regulation relating to good governance.
Medication administration records were not always completed properly or updated when changes were made, not all ‘as required’ medications had instructions for staff, some MAR charts were not easy to read and creams and lotions were not dated upon opening.
Assessments for people who might lack mental capacity were not consistent or comprehensive and staff lacked knowledge and understanding of the Deprivation of Liberty Safeguards. This was a finding from the last inspection and constituted an ongoing breach of the regulation relating to need for consent.
People and their relatives, where relevant, were not involved in the planning of their care to ensure their needs and wishes were considered. This was a finding from the last inspection and constituted an ongoing breach of the regulation relating to person-centred care.
Assessments and care plans were not comprehensive and had not been evaluated and reviewed monthly according to the home’s policy. This was a finding from the last inspection and constituted an ongoing breach of the regulation relating to person-centred care.
There was a lack of meaningful activities available for people living at the home for promoting and encouraging people’s involvement and enabling them to retain their independence.
There was a history of management changes at the home which resulted in poor leadership and governance of the service provided.
The provider had again failed to implement effective systems to monitor the safety and quality of the service so that people received a safe and effective service. This was a finding from the last inspection and constituted an ongoing breach of the regulation relating to good governance.
We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.
People, their relatives and staff told us that there were not enough staff to support all the people as they needed, especially at busy times. Our observations during the inspection supported this. The current manager was recruiting staff for a new twilight shift on one of the floors.
Systems were in place to ensure people being deprived of their liberty were done so lawfully, ensuring their rights were protected.
We identified issues with the fire safety systems in place at the home. Fire drills were not taking place and regular checks of equipment had not been carried out in accordance with the home’s policy. There was also outstanding action on the fire risk assessment. We raised this with the current manager who took immediate steps to address the issues.
People told us that they felt safe at the service. We saw that improvements had been made to the way safeguarding issues were recorded, investigated and reported and staff had received recent safeguarding training.
Staff were recruited safely; all the correct checks and documentation was in place. This included agency staff used by the home.
The home was clean and tidy and actions raised by a recent Infection Control Audit had been put in place.
Staff had received a comprehensive programme of training and had recently received supervision. A plan for ongoing supervision had been put in place to support staff in their work.
People enjoyed the food served at the home and we saw that a choice of meals was offered; kitchen staff were knowledgeable about people’s nutritional needs and preferences and had been trained appropriately.
People had access to a range of healthcare professionals; the service supported people to meet their holistic healthcare needs.
People and their relatives told us that the staff were caring and promoted their dignity and privacy. Interactions we observed between people and staff were mainly positive and people could exercise a choice over their daily routines.
Information on advocacy was available to people and their relatives and feedback on the end of life care from relatives was good.
A system had been put in place by the current manager for reporting and responding to complaints. We saw that all the relevant documentation was available and complete.