Woodlands Farmhouse

Woodlands Farmhouse is a residential care home providing personal care to up to 13 people. The service provides support to older people. At the time of our inspection there were 9 people using the service.

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

Various changes in the management of the home over the last 14 months had caused disruption to the service people received. The checks designed to ensure a high quality service had not been used or used consistently to ensure the quality of the service continued during periods of change.

Record keeping had become poor, with some records either not found or possibly not kept. Some other management systems had also been changed but not followed through or completed by managers who had then left.

People, and the service overall, would benefit from a period of management stability and a reintroduction of effective systems and structures to ensure people received high quality care and that any issues or improvements needed were identified and acted upon.

People said they liked the meals but had no real choice. Mealtime experience and menus were therefore going to be reviewed by the provider.

People said they made choices about their day to day lives. There was mixed understanding and application of the MCA by staff so people’s legal rights were not always upheld.

People were cared for by staff who required refresher training in some areas. Staff supervision also needed to be improved and sustained.

Medicine management had been improved; people’s medicines were managed safely. Regular auditing of medicines was now in place.

People needed to be better protected from the risk of infection. General cleaning of the home needed to be improved and new carpets were needed and were on order. The infection control policy needed to be reviewed to reflect current staff practice.

Staff were recruited safely. There were enough staff to keep people safe but staffing levels and times, particularly in respect of the night shift needed review to ensure people had the care they needed and had genuine choice in their care.

People said they felt safe and would talk with staff if they had any concerns. Staff knew how to report concerns and were confident people were protected from abuse or mistreatment.

Accident and incidents were recorded and reviewed. People’s care plans and risk assessments were being updated and reviewed on the on line care planning system.

People said they were happy at the home and knew they could speak to staff about any issues they had. There was a stable, caring staff team. People told us they were happy with their own rooms and the environment had been improved for them over time.

People were supported with their health care and staff said they had a good relationship with health care professionals. The service worked in partnership with other agencies to ensure they provided good care and followed good practice.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found 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 23 February 2018).

Why we inspected

The inspection was prompted in part due to concerns received about medicine administration, care planning and risk assessing, record keeping and management systems and structures. A decision was made for us to inspect and examine those risks.

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 to requires improvement following 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.

Enforcement and recommendations

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 monitor the service and will take further action if needed.

We have found 1 breach in relation to governance at this inspection. Please see the action we have told the provider to take at the end of the full version of this report. We have also made 3 recommendations relating to staffing, people’s mealtime experience and application of the MCA.

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

We found the following examples of good practice.

Most people at the home were living with dementia and were unable to talk with us about their care. However, each person appeared comfortable, happy and relaxed and interacted freely with staff.

Two people spoken with said they felt safe, well cared for and understood the need for additional protective measures due to the pandemic. One person said, “Yes [they felt safe] and [when asked about COVID-19] “All catered for, pretty good, feel well catered for.” Another person told us, “Lovely to live here. Visitors can come in. Staff do wear PPE.”

Measures were in place to prevent the spread of infection by visitors to the service. All visitors, including people’s relatives, professionals and contractors were required to have a negative COVID-19 lateral flow test prior to entering the home. New admissions were safely managed, following the current guidance.

Staff kept people and families up-to-date with the current situation through regular emails and phone calls. They facilitated visits for people in line with the current guidance.

Isolation and zoning had been used to manage the risk of infection spreading.

The premises were clean and odour free. Enhanced cleaning and disinfection of all areas of the home continued in order to reduce the risk of cross contamination.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the home. People's health was monitored carefully. This meant action could be taken immediately if anyone became unwell or received a positive test result.

There was a good supply of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. Used PPE was disposed of safely.

There was a small staff team who supported each other. The deputy manager had oversight of infection prevention and control processes. Regular infection prevention and control audits were carried out. Action was taken where shortfalls were identified.

We found the following examples of good practice.

Relatives and friends were able to visit their loved ones in a bedroom which had been adapted to provide a visiting room with a clear 'wall' partition. The bedroom area provided seating for the person living at the service and a vestibule and en-suite bathroom was used by the visitor. Visitors entered directly from the carpark and did not have to go through any other area of the service. On arrival in the carpark, visitors had a lateral flow test for Covid-19 and waited until a negative result was issued before the visit commenced. Visits were scheduled so there was sufficient time to clean the visiting area between visits.

The service had purchased a camper van at the start of the pandemic. This had been used to provide trips out for some people in a safe environment. The van had its own toilet, so people did not need to leave the van during a trip out. On one occasion where a person living at the service was nearing the end of their life, the camper van had provided short stay accommodation for two relatives. This meant they had then been able to visit their family member at short notice.

Staff had received training and were following up to date guidance in infection prevention and control, to minimise risks to people. They understood the importance of wearing appropriate PPE. There were sufficient stocks available including masks, gloves, aprons and hand sanitiser.

Regular COVID testing was carried out at the service for both staff and people living there. Staff also took people’s temperatures once a day. We discussed with the registered manager that government guidance recommends monitoring people’s temperatures twice a day. The registered manager agreed to implement a second temperature check of each person daily.

There were weekly multi-professional meetings held via social networking with professionals including specialists such as dentists, physiotherapists, dieticians as well as a GP. This has supported staff to get timely advice about particular concerns and issues.

Is the service safe?

Inspected but not rated

Further information is in the detailed findings below.

The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Woodlands Farmhouse accommodates 12 people with an additional respite bed in one adapted building. There were 10 people living in the service at the time of our inspection visit.

There was a registered manager in post but the day to day running of the service was with a care manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations.

There were systems and practices in place to protect people from situations in which they may experience abuse. Risks to people's safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, the necessary provision had been made to ensure that medicines were managed safely.

Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service to support people to stay safe and meet their needs. Background checks had been completed before care staff had been appointed.

People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong. The service recently had an outbreak of a serious infection brought into the home by a visitor, which affected everyone. So the staff were very aware of the actions they need to take to keep the chance of infection spreading to a minimum.

Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

Care staff had been supported to deliver care in line with good practice guidance. People enjoyed their meals and were supported to eat and drink enough to maintain a balanced diet.

People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations. The home was going through a refurbishment programme to improve the fabric of the building.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They were also supported to express their views and be actively involved in making decisions about their care as far as possible. Confidential information was kept private.

People received personalised care that was responsive to their needs. Care staff had promoted positive outcomes for people who lived with dementia including occasions on which they became distressed. People's concerns and complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open, inclusive and focused upon achieving good experiences for people. People benefited from there being a management framework to ensure that staff understood their responsibilities so that risks and regulatory requirements were met. The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made.

Quality checks had been completed to ensure people benefited from the service being able to quickly put problems right and to innovate so that people consistently received safe care. Good team work was promoted and staff were supported to speak out if they had any concerns about people. In addition, the manager and registered manager worked in partnership with other agencies to support the development of joined-up care.