Woodford 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

We assessed all the quality statements within the key question of safe. We found improvements had been made, however, there continued to be shortfalls and breaches of regulations. Potential risks to people’s health and welfare had not always been assessed. There was not always detailed guidance for staff to reduce and mitigate risk. There continued to be shortfalls in the recruitment process which had not been identified by the provider. Medicines had not always been managed safely. There had been improvements in staffing levels and staff training. Staff followed infection control guidelines and the service was clean. When accidents and incidents happened, they had been analysed to identify patterns and trends. Action had been taken to reduce the risk of them happening again. Safeguarding concerns had been identified and reported to the local authority for investigation.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they felt safe to raise concerns with the service. One relative said “If there is a problem it gets sorted quickly”. Another relative told us, "They are safe and I don’t worry about them."

Staff told us they felt comfortable raising concerns about people’s safety and were confident action would be taken by the registered manager. Staff said the registered manager invited openness so they felt comfortable talking about issues which provided a safe space to learn from mistakes.

The provider had systems in place to ensure learning from incidents and events. Incidents were investigated by the registered manager. The outcome was recorded and opportunities were taken to learn lessons which were documented and shared with staff.

Relatives gave positive feedback about their family member’s transition back in to the home following recent hospital stays. One relative told us their loved one was “Almost back to how he was” and another said the “Rehab is good”.

Staff were knowledgeable about people and their healthcare needs. They were able to describe people’s medical conditions and how these affected them and the care and support they needed.

We spoke with a dietician who told us they had seen improvements since the last time we visited. They said the registered manager was approachable and responsive. Referrals were made appropriately to the dietician service and staff followed advice given.

People were referred to healthcare professionals when appropriate to support safe care. There was evidence of people accessing healthcare when they needed it. Timely access to health and social care advice had improved since the last CQC visit to the service. Following healthcare visits or virtual appointments, staff had followed the advice given to promote people’s safety. These included tissue viability nurses, dieticians, GP’s, frailty nurses.

People we spoke with were happy with the care and support they received. One person told us “I feel cared for, I feel like I could ask for anything”. Relatives told us they felt their loved ones were safe at the service and they did not worry about them. One relative told us “I can relax, I know [they are] in good hands”. Another told us, "I have no safeguarding concerns".

Staff knew how to keep people safe and were aware of their responsibilities to safeguard people from abuse. They could describe different types of abuse and what they would do if faced with scenarios where people were not receiving safe care. Staff told us who they would report their concerns inside the organisation and were aware of which external organisations they could go to if they felt they were not being listened to and thought people were not safe. Staff said, “I am very confident the seniors and the manager would act if there are concerns brought to them. The manager has acted previously when issues have been raised”. “I am confident any concerns about residents would be addressed. If I raised concerns and no action was taken, I would go to CQC and I would also leave as I would not want to work in a place that didn’t care”.

We spent time observing staff interacting with people. We saw that staff treated people with kindness, understanding and offered appropriate support. There was a calm and relaxed atmosphere throughout the home.

The provider had processes in place to make sure any safeguarding concerns were clearly documented. The registered manager kept a log of concerns raised and referrals made to the local authority, either by the provider or external agencies, families or friends. The management team monitored safeguarding incidents or concerns to make sure an appropriate investigation took place in a timely manner. Safeguarding concerns were investigated and the learning from each incident documented and shared with staff.

The service supported people to remain independent and safe whilst enabling them to do the things that mattered to them. There was a drinks trolley in the lounge where people could help themselves, one relative told us that their loved one “Asks [other people] what drinks they want and gets them for them”.

Staff said people’s care records were detailed enough and clearly described the care they need to make sure they were safe. Staff told us they could access people’s records at any time on the electronic system, accessed through handheld devices. They said because they had much fewer people living at Woodford House at present, they had time to get to know people really well and find out how they liked things done and what support they needed to stay safe. “People are supported safely. We are like a family as we know people so well due to the reduced numbers”.

We observed staff being available to support people as needed with walking and mobility aids. We also observed people eating their meals independently with staff offering support where needed.

Although people were receiving improved safe care, we continued to find issues that needed further scrutiny. Specific individual risk assessments had not always been developed when known risks had been identified. One person had been admitted into the service with high and complex nursing needs 9 days before the assessment site visit. We found crucial individual risk assessments were not in place prior to our visit. These included assessing and mitigating the risks of known medical issues, and healthcare concerns including preventing further skin pressure damage, malnutrition and catheter care risks. Another person who was admitted on 17/5/2024 was assessed as being at high risk of acquiring pressure sores. An individual risk assessment to assess and mitigate against the risk to the person’s skin integrity was not implemented until 19 days after admission. It was raised by the registered manager at a nurses meeting in March 2024 that care plans were not detailed enough and reviews of care plans had recorded ‘no changes’ when clearly there had been. We found this was still the case in some areas. Regular checks to make sure people had safe care were not always recorded as being carried out at the intervals specified. One person’s records to chart when staff emptied their catheter bag to check on their fluid balance was not fully completed. Some people's records to document when they had their bowels opened, to prevent the health issues which would affect them if they became constipated, showed they may not have had their bowels opened for 5 consecutive days. Position change charts were not always completed, there were many gaps, for example, some days only 2 position changes were documented. Without accurate records of people’s crucial daily care, people were at risk of avoidable health issues and may not receive medical intervention in a timely manner.

People and their families did not raise any concerns with the safety of the building or the equipment used to support them. One relative told us “The building is all on one level. If people ring the bell, they get there quickly”.

Staff told us the provider maintains the premises well. They said that they can request what they need and it is supplied quickly.

We saw people mobilising safely around the home with minimal supervision. There was easy access to the grounds which surrounded the home.

Areas of concern found at the last inspection visit had now been addressed and we found the service was well maintained. The provider had processes in place to make sure the premises were safely maintained. The service was pleasant, clean and well decorated. Bathrooms were well maintained and the facilities were suitable for people living in the service, so people could have a bath or shower whatever their mobility needs were. The provider kept all equipment servicing up to date so people could be assured the equipment they needed to use were safe. These included hoists, bath chairs and lifts, weighing machines and wheelchairs. All other safety servicing was completed at required intervals such as electrics, gas and fire systems and equipment.

People and families we spoke with told us that staff were friendly and able to meet their needs. One person told us “Generally they are very good” and a relative added “Staff are professional and really want to do a good job”.

Staff told us they thought there were enough staff to meet people’s needs. Staff did raise with us they were aware the numbers of people living at the service had significantly reduced which meant they had sufficient numbers. Staff expected the staffing numbers to rise once more people were admitted to the service. Comments included, “There are adequate staff”, and “There are enough staff for the numbers of people. It would need to increase if we get more people. We have time to sit and chat with people which is very important”, also “Training is good, a mix of e-learning and face to face and this works well as we can discuss as a group and learn more. We are always doing refreshers”.

We observed throughout the day staff were attentive to people’s needs and responded quickly to requests for support. Communal areas were not left unattended and people had staff on hand when needed.

The provider had not made improvements to staff recruitment since our last inspection. New staff were not recruited safely. We looked at 3 staff recruitment records and there were gaps in employment in 2 of the records. Previous employment references given did not match the information given by 3 applicants and documents given to the provider as proof of address did not match the address they lived at. The provider made efforts to address the recruitment concerns straight away. However, the issues had not been noticed until we pointed them out. Staff had a Disclosure Barring Service check and had received an induction into the service and appropriate induction training. There were enough staff to meet people’s needs. The provider used a dependency tool to assess the numbers of staff needed based on people’s care needs. We looked at the rotas and could see there were sufficient staff to provide the levels of care people required. The provider had an in house trainer who was able to undertake some training face to face with staff, such as induction training, and refreshers.

People and their relatives told us that the home was kept clean and tidy. A relative told us there was “Good floor and room cleaning” and another told us how the standards of cleanliness had improved under new management.

Staff did not raise any issues in relation to infection control. They had enough personal protective equipment, such as gloves and aprons, to make sure they and people they provided personal care to were kept safe from the risk of infection.

The environment was clean and free from malodours. We saw staff had access to personal protective equipment (PPE) and were using it correctly.

There was plenty of PPE for staff and the service was clean and odour free. This was an improvement on the last time we visited where we found areas that needed to be cleaned more thoroughly. Domestic staff were on shift to make sure cleanliness was maintained.

Some people were aware of the medicines they were prescribed and could make decisions about them. Information such as how people liked to take their medicines, and if they had any allergies was included in the front page of their medicines record to make sure people received their medicines in the way they preferred.

The nurses and staff who were trained to give people their medicines told us they were happy with the management of medicines and confirmed they had been trained and had their competency checked.

Medicines were not always managed safely. We looked at body map records to check the siting of skin patches and staff were not following safe guidance. We looked at 3 patches, prescribed to control people’s ongoing pain, that were prescribed by a healthcare professional to be changed every 7 days. The British National Formulary (BNF) stated the skin patches should not be placed on the same area of skin within 3 weeks. The patient advisory leaflet included with the medicine stated the patch should not be sited in the same place for 3 to 4 weeks. We found staff had recorded they had placed 2 people’s skin patches on the same area every 2 weeks. Another person had a skin patch that was prescribed to be changed daily. The BNF advised the patches should not be placed in the same place for several days and the patient advisory leaflet stated 7 days should elapse before going back to the same area of skin. Staff were alternating between the 2 same sites every other day, placing the person at risk of skin irritation and their medicine not being absorbed correctly. Information for staff about people’s as and when necessary medicines, such as pain relief, or for agitation and distress was in place for staff. Staff had the guidance they needed to make sure they knew why the person was prescribed the medicine and what the safe doses to take and intervals between doses were.