Woodbridge Lodge Residential Home

Woodbridge Lodge Residential Home is a residential care home providing personal care to up to 32 people. The service provides support to older people, some living with dementia. The service is provided in one adapted building over three floors. At the time of our inspection there were 28 people using the service.

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

The registered manager had retired 11 days before our inspection visit. The provider had advertised for a new manager and the service was being managed by the provider’s operations manager and other members of the provider’s operations management team.

The service was working with stakeholders, were in the process of improving the service and had an action plan in place. However, not all of these improvements were fully implemented and embedded in practice.

The governance systems were not robust enough to support the provider and management team to independently identify shortfalls and address them. Improvements were being made in this area.

The systems in place to assess and mitigate risk were not always robust enough to keep people safe from abuse and avoidable harm. People were not always receiving their medicines as prescribed. We found bed linen was not always clean and hygienic. We were assured by the operations team these shortfalls were being addressed.

Staff had been recruited safely and the provider had a system in place to calculate the numbers of staff needed to meet people's needs. We received mixed views from staff and relatives relating to the staffing numbers in the service. Improvements were being made in the deployment of staff around the service to be present to support and make checks on people on all floors.

The provider had risk assessments and policies relating to the COVID-19 pandemic. People were supported to have visitors. 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.

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 12 December 2019).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of skin care and diabetes. This inspection examined those risks.

We received concerns in relation to pressure ulcer management, staffing, records, safe care and treatment and the overall governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance 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.

Woodbridge Lodge Residential Home is a care home, without nursing and can accommodate up to 32 people in one adapted building, providing personal care and some people were living with dementia. At the time of inspection, there were 29 people living at the service

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

Systems supported people to stay safe and reduce the risks to them. Staff knew how to recognise signs of abuse and what action to take to keep people safe. There was enough staff to support people safely and the service had safe recruitment procedures and processes in place. People received their medicines as they were prescribed. The registered manager had installed audits on cleaning activities and staff training on infection control, Staff informed us that the team meetings were an opportunity to share information and learnt lessons to develop the service.

Each person had a care plan which had been delivered from the initial assessment of the needs and included their choices of how they wished care to be delivered. People were supported to maintain their health and had support to access health care services when they needed to. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Food served at the service was well presented and took account of people’s choices.

Staff were caring, and we saw kind interactions with people at the home. The activities team at the service ensured people had a variety of things to do during the day if they so wished. People’s care was personalised and documented clearly in care plans. There was an established complaints system which people and their relatives informed us they knew about and would not hesitate to complain should the need arise.

People, relatives and staff spoke positively about the culture of the home and said it was well managed. The registered manager arranged quality assurance audits and surveys to gather information regarding how they could further develop the service.

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 7 February 2019) and there was a breach of Regulation 12: Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements 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.

At the last inspection on 13 October 2017, the service was rated Requires Improvement. We had not found any breaches in regulation, but had concerns about care planning and risk assessments for matters such as falls prevention and the environment and the use of the stairs. We had also concerns about management oversight as this was inconsistent and there was a lack of registered manager. The new electronic care planning system had not been effectively introduced. At this inspection we found there had been developments with improvements made in some areas, but other matters had not consistently been maintained and therefore we have continued to rate the service as Requires Improvement.

There was a lack of safe systems and management oversight. There were concerns in relation to several safety issues. Windows above ground floor not having restricted opening, there was not an effective system in place to ensure when a person required a sling that an assessment was carried out by a competent person, oversight of controlled medicines and infection control systems being monitored and suitable equipment in the form of a sluice and systems understood by all. This lack of systematic oversight of these safety issues placed people and staff at potential risk that was avoidable. We have made a breach in relation to Regulation 12.

There had been improvements made with the embedding of the electronic care system. We found staff to be more competent and confident with the system. A registered manager was in place and feedback about them was positive. However, when they were absent feedback was that communication was not consistently effective within the service.

People spoke highly of the service offered and felt appropriately cared for. People experienced good care with on-going monitoring of health needs and access to health services. Visiting health professionals told us that the service was caring and met the needs of people who lived there. There was varied, needs led social stimulation that people were happy with. People were supported to have maximum choice and control of their lives. People liked the variety and quality of food on offer.

Staff told us that they had the training and support to carry out their roles effectively and confidently. Staff spoke highly of the management who they said were approachable and made positive changes when needed. Staff were happy and positive. People looked happy. On the second day of our visit there was a degree of calm and several visitors were seen on both days.

There were sufficient numbers of staff to meet people needs. People were able to develop caring and meaningful relationships with staff. People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required.

Medicines were generally safely managed using an electronic system. The registered manager had quality assurance processes in place that were fed up to and monitored by the provider. There was a culture of learning from listening to people and positively learning from events so similar incidents were not repeated. The registered manager was supported appropriately by the providers management system and resources being available to them.

At the last inspection we reported that an incident was subject to a criminal investigation. The previous criminal investigation has been concluded and no action has been taken.

Further information is in the detailed findings below.

Our previous inspection in December 2016 had identified a breach of Regulations 9 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans contained generic statements which were not always correct and quality monitoring and auditing processes required improvement. At this inspection we found that the provider was in the process of implementing a new care planning system. Care plans were now more person centred but still lacked some detail about people’s care requirements. Quality monitoring had improved with regular audits. However, the implementation of the new care planning system meant that some action had not taken place. Sufficient action had taken place to improve the care plans and quality monitoring at the service, which meant they were no longer in breach of the regulation. However, they still needed to make improvements.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk from the environment. This inspection examined those risks.

The service provides care and support for up to 32 people. At the time of our inspection there were 21 people living in the service some of whom were living with dementia.

The service is required as a condition of registration to have a registered manager. On the day of our inspection there was not a registered manager in post. 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. The service had a manager in place who was undertaking the registration process.

Since our previous inspection the service had introduced a new computer based care planning system. Care staff used hand held smart phones to access care plans and input information about the care provided. At this inspection the new system was being used by staff but full details had not been transferred to the new care plans. This meant that care plans did not always contain the detail required. However, staff knew people well and were able to provide the care and support needed. The manager was working to get all the care plans up to date.

Staff knew how to respond to any suspected abuse. People’s care plans contained risk assessments but these did not always contain sufficient detail about the action to be taken to mitigate the risk to ensure staff knew how to support people safely.

There were sufficient staff to meet people’s needs. They were appropriately trained to support people with their care needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to be as independent as they were able.

There were effective policies and procedures for managing people’s medicines. People received their medicine as prescribed. The provider was introducing a computer tablet based system for the management of medicines.

People were supported to have sufficient to eat and drink. A choice of food and was offered and specific diets, such as gluten free, were catered for. People’s fluid intake was monitored when required.

Staff were caring and kind and treated people and each other with respect. People's right to privacy was maintained by the actions and care given by staff members. The service had recently employed two activities co-ordinators who were developing activities to meet people’s preferences.

The service provides care and support for up to 32 people and is located close to Woodbridge town centre. On the day of our inspection there were 20 people living in the service. Some people were living with dementia.

The service did not have a manager registered with the Care Quality Commission but the person managing the service had applied to register. 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.

People told us they felt safe living in the service. They however had mixed views as to whether there were sufficient staff. Staff told us that staffing levels had improved since our last inspection. Staff were allocated particular tasks throughout the day which could lead to a task based approach to care as opposed to a person centred approach.

Care plans were not always person centred. They contained generic statements which did not always relate to the individual. They also contained inaccuracies which could put people at risk of receiving inappropriate care and support.

People received support with their meals. The lunch time meal in the dining room was a pleasant experience with people supported to enjoy their meal. However, this experience was not replicated for those who chose to eat in their bedroom. Fluids were not appropriately monitored to ensure people did not become dehydrated.

People were supported to maintain their independence and do as much as possible for themselves. However, they were not supported with hobbies, interests and activities. People living with dementia were not always supported to lead meaningful lives.

Staff received training and support and were aware of their responsibilities with regard to reporting safeguarding incidents and the application of the Mental Capacity Act 2005. However, the reporting of safeguarding incidents was not always effective. We were also concerned that staff did not always demonstrate effective support for people living with dementia.

There were procedures in place to ensure people’s medicines were managed safely. However, we found improvements were required in the monitoring of medicines prescribed to be taken as required.

The management team had made improvements since our last inspection in developing a more open and honest culture. Regular meetings were held with people and staff to encourage participation in the development of the service. However, there were continued shortfalls in the quality assurance processes.

Our previous inspection of 23 June 2015 had rated the service as Requires Improvement in the areas of Effective and Responsive. This inspection found that improvement had not taken place and a number of requirements of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were being breached.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service provides care and support for up to 32 people and is located central to Woodbridge town. On the day of our inspection there were 30 people living in the service. Some people living in the service were living with dementia.

The registered manager of the service had left the service the week prior to our 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. The provider had put arrangements in place to cover the management of the service while a new manager was recruited. This included cover by three different people all of whom had responsibilities elsewhere within the organisation that would continue.

Risks to people living in the service were not appropriately managed. Appropriate risk assessments were not always completed. Where they were, staff were not aware of the actions put in place to minimise the risk therefore these were not always followed. Appropriate manual handling practices were not always followed.

There were not sufficient staff to support people with their assessed care and support needs. This resulted in people waiting long periods for their care and support or not receiving the care and support they required. Staff regularly stayed over their contracted hours to provide care and support.

Effective infection control processes were not in place. Poor infection control procedures were observed during the inspection. Infection control audits were not used to improve processes.

The service did not demonstrate an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) appropriately. Where people who required a referral to the appropriate authority this had not always been carried out and other referrals had been made inappropriately.

Staff did not always receive effective supervision and training. They did not demonstrate the skills required to provide effective care. We observed poor manual handling practices, poor infection control procedures and poor communication with people. We did observe some good interactions although these appeared to be because of the character of the individual rather than training and support they received from the service.

People had mixed views on the quality of the food provided. The lunch meal was not relaxed and enjoyable. People demonstrated challenging behaviour during the meal that was not addressed by staff. People did not always receive the support they needed to eat their meal. People’s dietary intake was not effectively monitored.

People were able to express their views at residents and relatives meetings. However, people did not always feel listened or believe their concerns would be acted upon.

People did not always receive personalised care that was responsive to their needs. Care plans were not reviewed regularly to ensure they reflected people’s changing needs. People did not always feel involved in their care planning.

The management appeared disconnected from what was happening in the service with a lack of cohesive leadership. The Provider Information Return (PIR) sent to us before the inspection gave examples of what the service was doing. We did not see these demonstrated during our inspection.

Monitoring and auditing was not effective and did not drive improvement. Action plans were not put in place where audits had identified deficiencies.

Medicines were managed safely and appropriately. People received their medicines when they required them. People were safeguarded against the risk of abuse as the staff were trained to recognise abuse. This was supported by appropriate safeguarding and whistleblowing policies.

You can see what action we told the provider to take at the back of the full version of the report.

We observed that the staff were attentive to people's needs, that they respected people's privacy and dignity and sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

People told us that they were well cared for and liked living there. One person told us, 'They (staff) are all very good.' Another person told us, 'I always find staff are great.' A person's relative told us, "This is a home. They are just so kind. (Relative) is really happy here."

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights. We found that the provider had effective recruitment processes in place.

We found that the provider had taken reasonable steps to ensure that the premises were safe and suitable for people to live in.

We found that the provider had good quality assurance processes in place to continually monitor the service delivery and ensure that the service was well managed. We found that the service was well led.

We found continued shortfalls in the provider's record keeping in terms of people's plans of care.

People's needs were assessed, care and treatment was not always planned and delivered in line with their individual care plan. Individual needs relating to visual impairment, symptoms of dementia, pain management and sleep patterns were not always well established in people's care plans. There was an activity programme for both internal and external functions. The programme generally met individual people's needs . All attendees names were documented in an activity diary and activities were planned on a rotational basis to suit individual needs.

People we spoke with during the visit told us that the staff were kind and helped them with their daily activities of living. One person stated, "The staff are wonderful." Safeguarding policies and practices were well established and staff received appropriate training to ensure that they are up to date with their safeguarding practices. Staffing levels were appropriate to meet the needs of the people who used the service.

The provider used a system of audits to ensure that standards were maintained. Regular surveys of people who used the service helped to identify areas for improvement, survey respondents were positive about the service.