Woodbury Manor

We found the following examples of good practice.

People were fully supported to have visitors and maintain relationships that were important to them. During the COVID pandemic, the home had adapted a spare bedroom into a cosy visiting pod with separate entrances / exits for visitors and people. At the time of the inspection visitors were making appointments to see people and were advised on appropriate PPE. Where necessary, this was provided. There was enough space in the home to allow for social distancing and people also received visitors in their rooms. There were no restrictions on visiting and the registered manager told us the appointments system worked well to ensure people were kept safe. There had been regular communication with relatives via newsletters and calls to keep them updated on government guidance around visiting.

Where the home had experienced COVID outbreaks, there were systems in place to ensure people were able to be cared for in a safe environment. There were some spare bedrooms that had been converted into a specific area for people with COVID. When there was an outbreak, staff did not work across areas to prevent cross infection. There was a separate room for staff to put on and take off PPE.

Where healthcare professionals visited, they were also screened for symptoms of COVID-19 and their most recent COVID-19 test results checked in line with government guidance.

Staff were part of the routine COVID-19 testing programme. We observed staff using appropriate PPE in line with government guidance.

Staff had received training around infection control, COVID-19 and using PPE correctly. The registered manger and organisation had supported staff through the pandemic, ensuring changes in guidance were effectively communicated using daily handovers and staff meetings.

There were safe systems in place to assess and admit new referrals. Appropriate checks and COVID tests were completed prior to a person moving in and new referrals completed a short isolation period in their rooms before mixing with other people. During this period, people were fully supported by staff.

Woodbury Manor is a residential care home providing personal care and accommodation for people aged 65 and over, some of whom may be living with dementia. The home can support up to 60 people. At the time of the inspection there were 58 people living at the home.

The home is a large detached manor house building with a large extension set in a residential area of Enfield, North London. Bedrooms are located across three floors with a large well-kept and accessible rear garden. The home had two wings, a dementia unit and a residential unit.

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

People and relatives were positive about the care and support provided at Woodbury Manor. A person told us, “Every person [staff] is approachable. It’s my home.” People were protected from harm by clear risk management strategies and staff understanding their role in safeguarding. Medicines were well managed and people told us they received their medicines on time.

People and relatives told us they felt staff were well trained and knew how to work with people as individuals. Staff received clear guidance and support through regular supervision and appraisal. People had choice around what food they wanted to eat. Specialist diets were catered for. 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 had access to a wide range of activities and were regularly consulted in what they wanted to do. People’s experience of day to day life was stimulating and people were encouraged to take part in activities that were meaningful to them. Care was planned in collaboration with people and relatives to achieve good outcomes for people. People were supported by a compassionate and well-trained staff team at the end of their lives.

There was a clear and effective management structure in place. Care was monitored through regular audits covering various aspects of the service. People, staff and relatives were involved in planning care and delivery and feedback was actively sought. There were regular residents, family and staff meetings as well as surveys to monitor the quality of care.

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

Rating at last inspection

The last rating for this service was good (published 21 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

Woodbury Manor is a residential care home that provides care and support for 60 people aged over 65, some of whom have dementia. The home does not provide nursing care. It has three wings. Cedars, which provides care and support to 22 people living with advanced dementia. Maple and Woodbury provide care and support for people who are elderly frail and may have a diagnosis of early stage dementia. At the time of the inspection the service was supporting 51 people.

There was a registered manager in place who had been in post for 11 months. The registered manager was present throughout the 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 detailed risk assessments in place that provided staff with clear guidance on what the risks were to that individual and how identified risks could be mitigated. Risk assessments were tailored to each individual. Risk assessments were reviewed and updated regularly.

There was a system in place if people were at risk of developing pressure ulcers. All people living at the home were assessed each month and appropriate referrals made if there were any concerns.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

Care plans were person centred and reflected individual’s preferences. Care plans had been signed by people. Where people were unable to sign, they had been signed by relatives.

Medicines were well managed by the home. People received their medicines on time. Medicines storage was appropriate and secure and there were regular audits of medicines.

Accidents and incidents were documented and any follow up treatment was recorded.

People were supported to ensure that they had enough to eat and drink to meet their nutritional needs. Staff were aware of specialist diets and people’s needs relating to this.

The provider had ensured that all staff employed had received appropriate checks before commencing employment.

The provider encouraged learning and development. Training was updated regularly and monitored by the manager. Staff had regular supervision and annual appraisals that helped identify training needs and improve the quality of care.

There were activities provided for people and people were involved in choosing what activities they wanted each month.

There was a complaints procedure in place which people and relatives had access to. Complaints were responded to and resolved in a timely manner.

People and their relatives felt that staff were kind and caring.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care. There was a complaints procedure as well as incident and accident reporting. Surveys were completed with people who used the service and their relatives. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

There was a clear management structure in place. People who used the service and staff were aware of the lines of accountability. This allowed for good communication and an atmosphere where staff and people felt able to appropriately challenge each other and discuss ideas that led to improvements in the quality of care.

There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people using the service, three visiting relatives and five staff supporting them and from looking at a selection of records.

Is the service safe?

Staff were recruited via a robust selection system ensuring staff had the skills required to keep people safe. The home was clean throughout and this was maintained by domestic staff, who were well-led by a supervisor.

Deprivation of Liberty Safeguards (DoLS) which applies to care homes were adhered to. On the day of our inspection we were advised the provider was in negotiations with the local authority to apply for DoLS applications for appropriate people who used the service. Staff had been trained to understand when an application should be made to deprive someone of their liberty.

Systems were in place, which ensured the home was continually reviewing safety measures. There were systems in place to make sure the manager and staff learned from events such as falls, accidents and incidents. This reduced the risk of harm to people and helped prevent such incidents in the future.

Is the service effective?

From our observations people were happy with the care which was being delivered and their needs were being met. One person told us, "The care here is excellent.” From speaking with staff and our own observations we found there was good understanding of people's care and support needs. Staff we spoke with were clear about how best to support people while maintaining their independence and dignity. Care plans we examined included assessments and reviews of people's health and care needs, as well as detailed information to ensure staff delivered care consistently to meet people's needs.

Is the service caring?

People were supported by sympathetic and patient staff, who displayed patience and gave encouragement when supporting people. Lunch was sociable and people told us they enjoyed the food served. One person told us, "the food here is good.” People were given time and supported to enjoy their meal.

Is the service responsive?

Relatives of people living at the home were updated monthly by care support staff with a review of their care plan. The home held residents' meetings and published a care home newsletter. The home had a transparent complaints policy and responded to concerns promptly. People we spoke with told us the manager was approachable and they would feel comfortable raising any concerns with her.

Is the service well-led?

The manager held regular staff meetings and used them to communicate issues related to the day to day running of the home. Staff we spoke with were clear about their roles and responsibilities and confirmed they had the opportunity to attend regular staff meetings. They said they felt supported by the manager. There were systems in place to ensure training was kept up to date for all staff.

In relation to the care provided, one person told us "I just love getting up in the morning to be in here." Care plans were under review as the provider had introduced a new format to improve the quality of recording as recommended by the local authority. There were systems in place to ensure medicines were managed safely. The provider had an effective system in place to regularly assess and monitor the quality of service that people receive. Records used within the service were appropriately maintained.

We found that some staff did not receive appropriate training to work with people who use the service. The provider had also failed to notify us of incidents of injuries and deaths in a timely fashion.