Wood Hill House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Since our last inspection, some improvements had been made in regards to keeping people safe. People were supported by enough suitably qualified staff, and medicines were managed safely. People were safeguarded from the risk of abuse. Whilst accidents and incidents were recorded and monitored, improvements were required to ensure it could be evidenced lessons were learned from these. Improvements were also required about how staff recorded some incidents, to ensure these could be appropriately monitored. Records relating to managing risks had improved and were regularly updated, however further detail was needed in some care plans to guide staff. Since our last inspection major refurbishment works had been undertaken, in those areas completed, this had improved the living spaces and improved the cleanliness of the environment. At the time of our inspection people were still residing in unrenovated parts of the service, however plans were in place to move these people within the coming weeks. Improvements were still required to ensure all appropriate maintenance and safety checks were in place, and action taken to address environmental concerns.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We were unable to obtain any feedback from people regarding the learning culture in the home. Whilst staff responded appropriately to accidents and incidents, such as post monitoring following seizures, improvements were required about how the service appropriately monitored incidents for themes and trends.

We found some missing records relating to incidents of epilepsy. Whilst we found no harm to people, records required improving to ensure seizure activity could be monitored. Following accidents and incidents, such as falls, staff responded appropriately and carried out post incident well-being checks. Staff understood their responsibilities to records and report incidents.

Accidents and incidents were recorded and monitored by the management team, which included a root cause analysis. However, improvements were required to ensure records evidenced analysis of themes and trends, and action taken following incidents. For example, we found an incident relating to a person displaying behaviours of distress, which was not recorded appropriately, meaning this person’s incidents of distress could not be appropriately monitored.

The service had recently supported people to transition to new placements, this included visits from staff, choosing new furniture prior to moving and sharing photographs of potential placements. We were unable to obtain any feedback from people or relatives regarding pathways and transitions.

Staff understood their responsibilities to support people to transition between services. A staff member said, “[Name] is moving, people have been coming to see them, so they can get to know them.”

We received mixed feedback from partners who worked with the service, about how staff shared information with them. A professional said, “I haven’t had all the information I need, when I have needed it (to complete a proper assessment).” Whilst another professional said, “I have had no problems when I visit, we have meetings, and they always provide staff who know the person well to sit with us.”

The management team had supported people to move placements and had shared information with new placements via an online care planning system. However, we could not be assured this information was shared in a timely manner due to feedback we received form partners. Plans were in place to move people living at the service into newly refurbished areas of the home. However, at the time of our inspection, people were still living in unrenovated areas of the service.

We were unable to gain feedback from people or relatives about safeguarding. People were protected from the risk of abuse and unsafe harm. However, improvements were required about how the service learned lessons from incidents, to minimise risks posed to people.

Staff were trained and understood their responsibilities to keep people safe. Staff had confidence in the new management team and told us they felt comfortable to report concerns. A staff member said, “I would report any signs of abuse, the managers listen, any problems they are good. “

We saw people being treated with kindness and respect. People appeared comfortable around staff. We observed people comfortably asking for things and joking with staff.

Policies and procedures were in place to protect people from the risk of harm. Incidents were recorded and reported to external agencies where required.

We were unable to gain feedback from people or relatives about managing risks. Whilst risk management had improved since our last inspection, records required improvements, to ensure staff had up to date guidance about how to respond to emergency events.

Staff understood their responsibilities about how to manage risks posed to people. Staff had undergone safety assessments about how they respond to emergency situations, such as a choking incident, and had received appropriate training, such as moving and handling and basic life support. A staff member said, “People are safe here definitely, the training is really good. We have specialist equipment to assist people to eat.”

Daily records evidenced people received food and fluids in line with their assessed needs and we saw people being provided with specialised diets as advised by speech and language therapists (SALT’s). Appropriate equipment was in place to keep people safe. For example, falls safety equipment.

Whilst improvements had been made since our last inspection, further improvements were required to ensure care records contained enough information about how to keep people safe. For example, we found care plans relating to epilepsy and choking which contained little information about how to respond to an emergency situation. This was brought to the attention of the management team during the inspection and rectified. We also found minimal records relating to when incidents of epilepsy had occurred. Risk assessments were in place and were regularly updated.

Improvements were required to ensure people were protected from the risk of legionnaires disease, whilst some checks were in place, not all required checks had been completed and we found records which could not evidence appropriate temperature checks or shower head descaling had taken place.

Maintenance staff had recently commenced their role and had implemented a new system for daily and weekly maintenance checks. Staff told us improvements were needed to some areas of the environment. Comments included, “The walls and cupboards are chipped.” And “The environment needs changing in here (relating to a particular floor), it is clinical and not stimulating.” It was recognised by staff that building works were taking place and plans were in place to renovate all areas. One staff said, “The service is going in the right direction, better since we have the new provider, they have had lots of building works to do.”

The service was undergoing major refurbishments to areas of the home. Appropriate risk assessments were in place to manage risks posed to people whilst this was ongoing. There was also a separate entrance used for external contactors, to ensure people were not placed at risk when entering or exiting the building. In areas which had undergone refurbishments this had improved the living spaces on offer, and included a kitchenette, en suite, living and bedroom areas. At the time of our inspection people were residing in unrenovated part of the service.

Maintenance logs were in place, however records did not always evidence action was taken to address concerns found during routine checks. For example, it was identified some lights were not working and this was not included in the maintenance log or recorded as work being undertaken. Fire safety systems were being reviewed at the time of our inspection, including replacing fire doors during renovations, however these required embedding into practice. Records did not evidence action had been taken to address all fire safety requirements, as advised by the fire service and identified on a fire risk assessment. Following the inspection, we spoke with the fire service who assured us they were planning to undertake a full inspection in the coming months and the provider had planned dates to conduct fire marshall training for staff. People had Personal Emergency Evacuation Plans (PEEPS) in place, which details people’s evacuation needs in the event of a fire, and an emergency grab bag was available in the event of emergencies. Staff had also undertaken fire training and meetings had been held to discuss fire safety procedures.

People were supported by enough suitably trained staff. Where people required 1:1 support this was provided, and partners told us there was enough staff.

Staff told us there were enough staff to meet people's needs and they had received appropriate training and development to carry out their roles. A staff member said, “The staffing is ok, we are familiar with people here now. People are safe living here.” And another staff member said, “There are enough staff, we have a good team now, it is really good. We all get on, everyone here works hard.”

During our inspection we observed people being supported by enough staff and people having their needs met. Daily records also showed people had their day to needs met. Where people refused care tasks, records evidenced staff had offered these and recorded refusals.

Staffing rota’s confirmed enough staff were provided each day, including a registered nurse. We found some discrepancies in staff recruitment records, such as missing references and application forms. However, the majority of these were historical and the management team had conducted an audit of these records to identify gaps. Some improvements were needed to ensure where staff had missing references, risk assessments were in place. This was brought to the attention of the manager on the day of inspection and implemented following the inspection visit. Disclosure and Barring Service (DBS) and Nursing and Midwifery Council (NMC) checks had recently been undertaken to ensure staff were suitable to support vulnerable people.

Whilst the overall cleanliness of the service had improved, at the time of our inspection people were still living in unrenovated parts of the service. In this area we observed some furniture which could pose an infection control risk. Plans were in place to move people to newly decorated parts of the home within the next few weeks. Partners told us people were clean and well kempt.

Staff told understood their roles and were trained about how to protect people from the risk of infection. Managers conducted daily walk rounds, which included a check of infection control measures.

Improvements had been made to the overall cleanliness of the service. Personal Protective Equipment (PPE) stations were now in place and staff were seen to be wearing PPE where required. In some areas of the building, which had not yet been renovated, we found ripped and stained furniture which could pose an infection risk.

An internal Infection Prevention and Control (IPC) audit was used by the service, and plans were in place to implement a recognised best practice tool in the future. We found items stored appropriately, including Control of Substances Hazardous to Health (COSHH) items. Food was appropriately prepared and stored.

During the inspection we reviewed recent medicines related records. We found that no missed doses of medicines were noted, and all medicines were found to be in stock. Most of the medicine stock levels were correct, but some discrepancies were found. The manager assured us these were going to be investigated and stocks amended accordingly. Choking risk assessments were completed to ensure people were safe when taking their medicines. These were regularly updated in case of any changes to the person’s needs. Care plans were in place for people with complex needs, for example: epilepsy. They also had a section on how people liked to take their medicines. This ensured staff could look after residents in a personalised way.

We saw evidence of monthly audits taking place and medicines competencies were completed annually, or more often if required. Staff told us that they didn’t have any issues with the pharmacy service or any problems with medicines being unavailable or out of stock. Where creams were prescribed for people, it wasn’t always clear when these had been administered. Creams were prescribed on the electronic records system; however, staff also had to manually write when these had been given on separate online care notes, including where on the body they had been applied. If staff forgot to add this into the care notes, it could suggest that the regular creams had not been applied. This was acknowledged by the home managers as a flaw in documenting information.

The clinic room where medicines were kept was neat and tidy. Extra stock was kept in a cupboard separate from the current stock being used in the drug trolley. ‘Date opened’ stickers were added to liquid medicines, to ensure they were being used within their expiry dates. People that were prescribed ‘as and when required’ (PRN) medicines, did not always have accurate protocols in place. These were not always person-centred and some protocols did not have the correct prescribed doses of medicine included on them. One person received the wrong dose of Paracetamol, as the PRN protocol did not match the current prescription. Although this wasn’t a high-risk event, it showed how important it is for all records to match. The home showed evidence these had been reviewed since our visit. PRN doses didn’t appear to be over-used, and doses were documented when given.