Woodlands Nursing Home

Woodlands Nursing Home is a residential care home for up to 34 people who require nursing or personal care. Some people who used the service were living with a dementia type illness. There were 32 people using the service at the time of our inspection.

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

People and their relatives were positive about the quality of care people received. The feedback about the service leadership was extremely positive. There was an extensive range of quality monitoring and governance systems embedded in the service.

The service was clean, hygienic and homely. People told us staff were kind and they had a good relationship with them. People received medicines safely. People's care plans were up to date and accurately reflected their needs. People were able to receive visits from their relatives and there was a variety of activities to support their well-being.

People were supported by staff who had received the necessary training for their roles. There were sufficient staff available to support people and staff were recruited safely.

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.

The registered manager and staff had a strong ethos of person-centred care and placed people's wellbeing at the heart of their work. Quality assurance systems were embedded and monitored the service effectively to drive improvements when they were needed. Lessons learnt were used as learning opportunities to continuously develop the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 January 2022).

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.

At our last inspection we recommended that the provider reviews all aspects of training for staff at the service. At this inspection we found the provider had acted on the recommendations and implemented appropriate systems to review and monitor staff training requirements.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 01 December 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. 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 requires improvement to good. This is based on the findings at this inspection.

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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Woodlands Nursing Home is a residential care home for up to 34 people who require nursing or personal care. Some people who used the service were living with a dementia type illness. There were 16 people using the service at the time of our inspection.

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

Audits did not always identify the issues we found on inspection and needed to become embedded in the service. We identified gaps and omissions in staff training, records and processes. We have made a recommendation about staff training.

The provider was actively recruiting for staff and had implemented safe and appropriate recruitment processes, including suitable pre-employment checks. People’s medicines were managed safely although some improvements were needed for ‘when required’ medicines, variable dose medicines, and patches. People’s care plans and risk assessments had been reviewed and were up to date. Infection control procedures had improved and were now robust and in line with guidance.

We were told that the management team was helpful and approachable. Staff and relatives told us the atmosphere in the home was positive. The management team was open and honest and committed to resolving the issues we found as soon as possible. Lessons were learnt and shared with the team. Improvements had been made following our previous inspection. Communication was good and people were encouraged to give feedback. People were referred to healthcare professionals when appropriate.

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 inadequate (published 25 October 2021 and supplementary report published 4 December 2021) and there were multiple breaches of regulation. At this inspection we found some improvements had been made. However, not enough improvement had been made and the provider was still in breach of regulation.

This service has been in Special Measures since 25 October 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns, although we did identify a continued breach in relation to good governance. Please see the well-led section of this report.

You can see what action we have asked the provider to take at the end of this full report.

We also used this inspection to follow up on action we told the provider to take at the last inspection. We checked to see whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Woodlands Nursing 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in respect of 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Woodlands Nursing Home is a care home providing personal and nursing care to 20 people at the time of this inspection. The service can support up to 34 older people some of whom may be living with a dementia related condition.

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

Risks to people’s health and wellbeing were not all in place and were not well managed. Some risk assessments had not been sufficiently assessed and mitigated and placed people at risk of harm.

Medicines were not well managed, and unsafe medicine practices put people at risk.

The providers recruitment process was not robust and did not follow safe practices. The provider was in the process of trying to recruit staff and whilst this was happening, they were relying heavily on agency staff. We found the checks for using agency staff needed to be more robust.

We were not assured the service was following safe infection control guidelines in relation to COVID-19.

Records were not always fully completed consistent or in place. Audits that took place did not highlight all the concerns found on the inspection day.

Accidents and incidents were starting to be reviewed monthly for any learning outcomes. However, the staff team were not informing the manager of all events.

Staff understood safeguarding procedures and how to report concerns.

Staff felt supported by the new manager.

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

The last rating for this service was Good (published 22 April 2020)

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment. A decision was made for us to inspect and examine those risks. This inspection took place on 1 September 2021.

We inspected and found there was a concern with staff recruitment, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We carried out a focused inspection of this service on 15 September 2021. This report only covers our findings in relation to the key questions safe and well-led as we were mindful of the impact and added pressures of COVID-19 pandemic on the service.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence the provider needs to make improvement. 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 Woodlands Nursing 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing people's needs, risk management, medicines, staff recruitment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request the provider sends us their service development plan outlining 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Woodlands Nursing Home is a care home providing personal and nursing care to 25 people at the time of this inspection. The service can support up to 34 older people some of whom may be living with a dementia related condition.

The service supports permanent and short-term (respite) accommodation over three floors. The service is located in a quiet location and has a large garden and parking facilities.

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

People felt safe and that staff looked after them well. Staffing levels were continually reviewed to ensure people's needs were met. Staff knew how to safeguard people from abuse and avoidable harm. Risk management plans were in place, detailed guidance enabled staff to protect people's safety and wellbeing. Medicines were managed safely.

Staff received regular training, supervision and support from management to deliver effective care. Regular meetings and handovers between shifts ensured staff were aware of people's changing needs. People felt supported and that staff had the skills and experience to support them.

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 's dietary requirements were regularly reviewed, and advice sought from health professionals when needed. Staff patiently supported people to eat and drink, when possible people were supported to do this independently.

Staff and management were caring and kind. They respected people's privacy and dignity at all times.

Staff delivered person-centred care tailored to each person’s needs. Communication care plans were in place and included alternative formats such as large print depending on people’s preferences. Staff knew about people's life histories, interests and hobbies. A variety of activities had been scheduled taking into consideration people’s hobbies, interests and suggestions. People’s religious needs and beliefs had been considered and accommodated. People's wishes for end of life care had been explored and documented.

People knew the registered manager and they had an ‘open minded’ approach. People and their relatives felt listened to and happy discussing complaints with any of the staff. Systems in place to monitor the quality of the service were effective in driving continuous improvements. The culture within the service was open and honest and staff felt their input to improving people’s experiences was valued.

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

Rating at last inspection

The last rating for this service was good (published 26 July 2017).

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.

The manager was not available on the first day of inspection and we could not access specific documents we wished to inspect so we returned on another day to complete the inspection.

Our last inspection of the service was carried out on 24 November 2015 and we rated the service as Good overall with a recommendation being made in the well-led section about ensuring there was a good management team in place. At this inspection we found the provider had acted on the recommendation and staff were supported by a robust management team.

Woodlands Nursing Home is registered to provide care and support for 34 people, some of whom were living with dementia. The service provides permanent and short term (respite) accommodation. The service is located in a countryside setting with grounds around the building and disabled access into the building. At the time of our inspection there were 33 people using the service.

The service provided communal space and bedroom accommodation over three floors. There were two units – Poppy unit supported people with nursing needs and Buttercup supported people living with dementia.

The provider is required to have a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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. At the time of our inspection, the service did have a registered manager. We have referred to them as ‘the manager’ throughout this report.

People told us they felt safe and were well cared for. The provider followed robust recruitment checks, to employ suitable people. There were sufficient staff employed to assist people in a timely way. Medicine management practices were being reviewed by the manager and action was taken to ensure medicines were given safely and as prescribed by people’s GPs.

Staff had completed relevant training. We found that the care staff received regular supervision and yearly appraisals, to fulfil their roles effectively.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the district nursing team and speech and language therapists.

People had access to adequate food and drinks and we found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals.

People were treated with respect and dignity by the staff. People and relatives said staff were caring and they were happy with the care they received and had been included in planning and agreeing the care provided.

People had access to a range of low key activities which they enjoyed. However, the frequency of these depended on the availability of the care staff to carry these out.

People and relatives knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with.

People told us that the service was well managed and organised. People and staff were asked for their views and their suggestions were used to continuously improve the service.

When we inspected in March 2014 we found that the provider had carried out repairs and refurbishment to several areas of the home, and those identified issues in the previous report had been fully addressed.

The home was now in a better condition.

We found that nutrition was monitored and food and drink was available at all times. People told us they were able to choose what they wished to eat and kitchen staff knew peoples nutritional needs well. Staff knowledge of safeguarding procedures was reasonable and reporting mechanisms were used appropriately.

We found that there were some improvements needed to the environment to ensure that the building was maintained in an appropriate state. This was particularly the case with sluice areas which required immediate improvement.

Appropriate procedures were followed when recruiting staff and the induction programme followed enabled staff to complete appropriate training and shadowing prior to working alone. There was a quality assurance system in place which was undergoing improvement at the time of our visit. There needed to be some improvement in the ways the service gathered feedback from residents and staff about the service.

We asked the provider to submit an action plan and we then revisited in January 2013 to check that they had taken these actions.

We found that the provider had renewed and refurbished all of the areas of the home we had previously identified. This included ensuite toilets and bathrooms, and communal bathrooms. It also included equipment which had been replaced or refurbished.

We saw that cleaning schedules had been put in place and there had been an increase in the amount of hours domestic staff were employed for. This all resulted in an improvement in the general cleanliness of the service.

There were a range of activities available for people and we observed that people were not bored or passive, but were engaged with staff, each other and the activities and environment. One person told us 'I feel safe. I am still independent even though I am living in the home'.

Staff were observed to be encouraging and motivating people, and were treating people with dignity and respect. Staff were given various training opportunities and were able to discuss their needs with the manager and senior staff.

Audits and surveys were carried out on a regular basis. Staff and relatives meetings were held to allow people to have a role in the running and ongoing improvement of the service. One person told us 'They have asked me about what activities I might like on several occasions'. Another told us 'We always get lots of choices'.

Infection control procedures were followed in some areas, but bathrooms, toilets, and toileting equipment needed updating and replacing in many cases to minimise the risk of infection.