Archived: Woodcote Hall

Woodcote Hall is registered to provide accommodation with personal care for up to a maximum of 56 people. There were 51 people living at the home at the time of our inspection, some of whom were living with dementia. There was a registered manager in post who was present during the 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.

At our last inspection we found that improvements were required. At this inspection we have found that the provider has made considerable progress but that there were still areas they needed to address in order to be rated as good overall. Following this inspection, the home continues to be rated as requires improvement.

People were supported to make decisions for themselves and where necessary best interest meetings were held however the staff were not able to locate all associated paperwork in a timely manner.

People were supported to have their personal care needs met however they did not always receive sufficient stimulation throughout the day.

People received sufficient food and drink however the meal time experience could be improved to ensure people were always given choice.

The environment had been improved and refurbishment was taking place however there was still an unpleasant odour that fluctuated during the day.

People's received their medicine from staff who had been assessed as competent to manage medicines safely.

The provider had systems in place to monitor the quality and safety of the services and was working through actions identified from the previous inspection and other audits completed in the home.

People were protected from harm or abuse by staff who knew how to recognise and report concerns. Staff were aware of the risks associated with people's needs and how to minimise these risks.

The management analysed the information to identify any trends and action required to prevent reoccurrence. The provider had safe recruitment procedures in which ensured that prospective new staff were suitable to work with people living at the home.

People were supported by sufficient numbers of staff who had the skills and knowledge to meet their individual needs. Staff received training relevant to their roles and felt supported by the registered manager.

People were supported by staff who were caring and kind. People were supported by staff who knew them well and who had access to up to date information about their needs.

People and their families were encouraged to give feedback on the quality of the service and to make suggestions for improvement. The provider had a clear complaints process and addressed concerns in a timely manner, sharing information with the local authority as necessary.

Woodcote Hall is registered to provide accommodation with personal care for up to a maximum of 56 people. There were 50 people living at the home at the time of our inspection, some of whom were living with dementia.

There was a registered manager in post who was present during the 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.

At our last inspection we found that people’s medicines were not managed safely. At this inspection we found that the provider had made significant improvements and were no longer in breach of the regulations. People received their medicines as prescribed and accurate records were maintained. Only staff who had been assessed as competent to manage medicines safely were able to administer medicines.

People’s rights were not always protected because the provider had not ensured decisions made on their behalf were in their best interests.

The provider had systems in place to monitor the quality and safety of the services. However, these had not identified all the shortfalls we had found.

The provider had not considered good practice guidance to help develop an environment that supported the independence and emotional well-being of people living with dementia.

People did not always receive care and treatment that was responsive to their needs and wishes. Staff were task led and had limited time to engage people in things they enjoyed doing.

People were protected from harm or abuse by staff who knew how to recognise and report concerns. Staff were aware of the risks associated with people’s needs and how to minimise these risks. Staff demonstrated they would take appropriate action in the event of any accidents or incidents. The management analysed the information to identify any trends and action required to prevent reoccurrence. The provider had safe recruitment procedures which ensured that prospective new staff were suitable to work with people living at the home.

People’s nutritional needs were routinely assessed monitored and reviewed. There was a choice of foods and people received the support they needed to eat and drink enough.

People were supported by staff who had the skills and knowledge to meet their individual needs. Staff received training relevant to their roles and felt well supported by the registered manager.

People were supported by staff who were caring and kind. People were supported by staff who knew them well and who had access to up to date information about their needs.

People and their families were encouraged to give feedback on the quality of the service and to make suggestions for improvement. The provider had a clear complaints process and people felt confident and able to raise any concerns with staff or management.

You can see what action we told the provider to take at the end of the full report

Woodcote Hall is registered to provide accommodation and personal care for up to 56 older people including people with dementia. On the day of the inspection there were 49 people living at the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found that medicines were not always managed safely. People were not always supported by sufficient numbers of staff. People told us they felt safe and staff were aware of their responsibilities to keep people safe from harm. Risks to people had been assessed and were managed effectively.

People were supported by staff who had received training to ensure they had the skills and knowledge to be effective in their role. People were asked for their consent before support was provided. The registered manager had assessed people’s capacity and acted appropriately to ensure people’s rights were protected. People enjoyed the food and were supported to access appropriate healthcare services when required.

People felt staff were caring and treated them with kindness. Staff knew people well and understood their life histories as well as their needs. People and their relatives felt involved in decisions about their care and support and staff acted in a way that upheld people’s dignity and privacy.

People and their relatives were involved in the planning and reviewing of their care. A range of activities were available for people to participate in, although the registered manager recognised that improvement were needed in this area. People knew how to complain if they were unhappy about any aspect of their care and support and there was a system in place to manage complaints.

People, relatives and staff told us they felt the home was well managed. The registered manager had made a number of improvements since the last inspection. The registered manager was open to receiving feedback and was looking at ways to increase feedback from people and staff. There were systems in place to monitor the quality of care being provided and the registered manager felt supported by the provider to develop and improve the service.

During this inspection we found 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.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

Safeguarding procedures had been improved so that they protected people from the potential risk of harm. Managers had reported allegations of abuse into the safe guarding of vulnerable adults procedures appropriately.

Systems to monitor the quality of the service were not effective. Medication storage systems were not being monitored well. This meant that some medications might not work properly because they were not being stored appropriately.

Most people told us they felt safe. We saw that people were free to go about their daily routine. One person told us, 'The care is really good'.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

Most, but not all, of the people who lived in the home told us they were happy with the care they received. They made comments such as, 'Staff very good' and 'I only have to press the buzzer and they come' and 'As soon as I buzz, they're there'.

Many of the care records had been reviewed since our last inspection. These generally confirmed people's needs and preferences had been recorded and care and support had been provided in accordance with their wishes. However, we did find examples of records that contradicted what staff told us or showed that they had not been followed correctly.

People and their relatives were involved in the assessment of their needs. However, one person's relatives told us they had advised the staff how their relative liked to be cared for but this advice had not been followed.

We found that there were plans in place for staff to receive the support and training that enabled them to meet the needs of the people living in the home. This program had been started but had not been completed at the time of this inspection.

Is the service caring?

People were cared for and supported by staff who showed a clear understanding of their needs. We saw that staff showed patience and gave encouragement when they supported people. Some people told us this was not always how they were treated. For example one person told us that they were rushed by some of the staff.

At lunch time we saw that staff assisted people with their meals in a friendly and caring manner. This made the mealtime a pleasant and relaxed experience for them.

Is the service responsive?

We saw that the care files indicated that people's care had been reviewed recently. However, we found that some issues had not been fully checked. An example of this was the food preferences for one person whose dietary needs were important to them both culturally and medically. Another example involved the monitoring of someone's bowels and the need to seek medical attention at a certain point.

Is the service well led?

A new manager had recently been appointed and was in the process of applying to be registered with us. Improvements had been made in a number of areas. Staff told us they were very supportive of the new manager and were confident that the improvements would continue. One person said, 'Things are starting to change - improving'.

We identified further improvements as being necessary. The reviewing process carried out by the provider to ensure that any necessary changes were identified was not fully effective.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

Safeguarding procedures were not robust and did not protect people from the risk of potential harm. Managers had not reported potential allegations of abuse into the safe guarding of vulnerable adults procedures.

Systems to monitor the quality of the service were not in place. Accidents and incidents were not being monitored well. This meant that managers and staff did not learn from these events to improve the quality of service people received.

Managers could not show that they had carried out a needs analysis and risk assessment as the basis for deciding sufficient staffing levels. We could not determine there were sufficient staff on duty at the time of our inspection.

Is the service effective?

Most people we spoke with told us that staff treated them kindly and that their individual needs were met. One person told us they had not had the opportunity to discuss their needs and was helped to bed later than they would like to go.

Although staff had an understanding of people's needs they appeared rushed during our inspection. Call bells were unanswered for longer than five minutes.

Staff told us there had been a high turnover of managers at the service and they did not receive effective support from managers. This meant that staff did not feel there was clear management direction and support for them.

Is the service caring?

People were supported by staff who demonstrated a clear understanding of their needs. We saw that some care workers showed patience and gave encouragement when supporting people, some did not. For example some staff spoke to people when assisting them to eat their lunch. Others did not communicate with the person they were assisting.

We observed that people were treated with respect and dignity by the staff on duty. One relative told us that some staff spoke abruptly to their relative and they did not always receive adequate health care.

Is the service responsive?

We saw the service had carried out an annual survey. The responses were generally positive although the response rate was very low.

Incidents were not always responded to promptly and policies had not been followed. This placed people at risk of not receiving appropriate health care when they required it.

The provider employed an activities co-ordinator they were not present during the two days of our inspection. We did not observe any activities during their absence.

Is the service well-led?

There had not been a registered manager at the home since November 2013. Two managers had been appointed since November 2013 but neither had stayed in post. This had impacted on staff morale. Staff did not feel the service was being well led. At the time of our inspection the home was being managed by an area manager who had been at the home approximately two weeks.

We could see that there had been management systems in place but these had lapsed. For example the monitoring of accidents and incidents to establish if any themes/patterns were apparent, a system to assess and monitor that there were sufficient numbers of staff, with the right competencies, skills and knowledge to meet people's needs was not available.

We found that the poor arrangements for the record keeping and the administration of medicines could affect the health and welfare of people using the service.

Everyone we spoke with told us they were satisfied with their care. Care plans were well written, clear and contained detailed information about people's individual needs. This meant staff understood how people preferred their care to be delivered.

People told us that they enjoyed the meals at the home and there was a choice at mealtimes.

On a tour of the home we saw that the environment was clean and tidy.

We found shortfalls in poor record keeping and the administration of medicines that could affect the health and welfare of people living in the home.

The home had developed an action plan in relation to the recent concerns raised. We could see progress had been made in addressing issues. The area manager, who was present during our inspection, acknowledged that there were still areas to be addressed. They continued to support the manager and staff to address the outstanding issues.

People were involved in making decisions about their care and support.

Staff met people's care and support needs in ways that they preferred. People were treated with dignity and respect. People were moved using suitable equipment and requests were responded to in a timely manner. Some people told us that they occasionally had to wait for assistance.

Assessments and plans were available but some information was missing and care staff said they did not have time to read them.

People enjoyed a range of activities both within the home and outside to places of interest.

Everyone told us that they enjoyed the meals on offer. There was a choice and drinks were served throughout the day. People did not always know that they could request drinks and snacks when they wanted.

People were protected because staff were overall confident to recognise and report abuse.

People were supported by staff that had numerous training opportunities. Some staff felt that the quality of the training could be improved.

The home ensured that people's views were considered and listened to and the complaints procedure was given to people on admission.