This inspection took place on 21 and 24 July 2015. It was unannounced. There were 20 people living at Woodville Rest Home when we inspected. People cared for were all older people who were living with dementia, some of whom could show behaviours which may challenge others. People were living with a range of care needs, including arthritis, stroke and heart conditions. Many people needed support with all of their personal care, eating and drinking and mobility needs. The registered manager reported they provided end of life care at times. No one was receiving end of life care when we inspected.
Woodville Rest Home is a large domestic-style house which has been extended. People’s bedrooms were provided over three floors, with a passenger lift in-between. Single story accommodation was provided in an extension to the rear. There were sitting/dining rooms on the ground and third floors. The sitting/dining room on the third floor was not being used because the home was not up to capacity. There was a wheelchair accessible enclosed patio/garden area to the rear. Woodville was situated in a residential street in Bexhill on Sea. The provider for the service was Pages Homes Limited who also owned another care home in the vicinity.
Woodville Rest Home had a recently appointed a registered manager. The previous registered manager left Woodville Rest Home in the Spring of 2015. The new registered manager had previously been the registered manager for Pages Homes Limited’s sister home. 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.
Woodville Rest Home was last inspected on 30 December 2014 and 2 January 2015. They were rated as inadequate at that inspection. The Care Quality Commission (CQC) issued two Warning Notices after the inspection in respect of care and welfare of people and assessing and monitoring of the quality of the services. The provider sent us an action plan which detailed when different areas would be addressed. This stated all matters would be addressed by 27 May 2015.
We found the provider had not met the Warning Notices or addressed their action plans by their due dates.
As at the last inspection, the provider was not consistently ensuring people’s care needs were assessed or met, including supporting people who were living with dementia, people who were at risk of pressure wounds and people who had continence needs. The provision of activities had increased but activities provided did not take account people’s individual diverse care and support needs.
We continued to find some people showed weight loss and were at risk of dehydration, but relevant care plans were not in place or relevant external professionals contacted. Also where people had seating and mobility needs, relevant healthcare professionals were again not contacted so people received the support and equipment they needed.
People’s privacy and dignity was not consistently respected to ensure their basic needs were met, in an appropriate way. Communal use of certain clothes continued.
As at the last inspection the provider did not have safe systems to ensure a hygienic environment to prevent risk of spread of infection. There continued to be a lack of hand washing and drying facilities in some areas. Some equipment and furnishings were not clean, including people’s easy chairs and shower seats.
People were still not protected by the provider’s systems for administration of medicines. There were unsafe systems for the storage of prescribed skin creams and a lack of information about their use. There continued to be administration of some prescribed medicines which were out of date.
At the last inspection we saw staff had not been trained in a range of areas, including the safe moving and handling of people and principals of infection control. At this inspection staff were not all trained in infection control and although staff had been trained in the safe moving and handling of people, this had not been embedded and again we observed unsafe ways of supporting people to move.
Although we had issued a Warning Notice after the last inspection about assessing and monitoring the quality of services, the provider had not identified a range of areas to ensure people were safe and areas for action were not identified and acted on. This included where people may be at risk from others or from the home environment. Differences between what people’s care plans stated and how care workers carried out care had not been identified. There was a lack of auditing of the systems for monitoring of the external cleaning contractors.
The provider did not have systems for the monitoring of informal concerns raised by people, so was not aware of some issues. However there were effective systems for formal complaints, which were being followed.
Some of the past recruitment systems had not ensured all relevant checks on prospective staff were undertaken to verify they were safe to provide care to people. The registered manager reported they would take action to ensure these matters were addressed.
However, the provider had taken action since the last inspection in a range of areas. They had invested in more equipment to support people with moving, which care workers were positive about. Plans were being developed to make the home environment more supportive for people who were living with dementia. The provider had identified many of their policies and procedures needed up-dating and development, they had contracted with an external company to do the necessary work.
The new registered manager had reviewed staff training needs and was working to ensure all staff were appropriately trained. This included making sure all staff were trained in awareness of how to support people who may be at risk of abuse, and their responsibilities under the Mental Capacity Act (MCA). Staff knew about actions to take if they thought a person was at risk of abuse and were aware of the plans to ensure they were trained in the MCA.
People and staff felt staffing levels had improved. This was partly because the provider had kept staffing at the same levels for when the home was full.
Some people were supported in the way they needed in their daily lives, including during mealtimes and when involving them in activities. Staff were consistently polite and friendly to people when they supported them.
Staff reported on the improvements in the service. They said the training provided had supported them more in their role. They felt the new registered manager was involving them more and providing an open atmosphere in which they could work to support people.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.
CQC are taking enforcement action to ensure that Pages Homes Limited provide safe and effective care.