Woodland Park

Woodland Park is a residential care home providing personal and nursing care to up to 31 people. At the time of our inspection there were 22 people using the service. The home is set close to Babbacombe Downs, the sea and local shops and services.

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

Quality assurance systems did not always effectively identify areas for improvement. Medicines audits were not effective because they did not identify where improvements were needed and who was responsible for ensuring action was taken. The provider had not identified there was not always a first aid trained member of staff on duty at night. Maintenance issues with the call bell system meant the registered manager was not able to establish how long staff were taking to answer call bells. Records relating to the care provided did not contain sufficient detail to establish what care people had received throughout the day. Some maintenance tasks had not been completed for several weeks, including weekly fire tests.

The risk of people falling or developing pressure damage were not always fully assessed or monitored, which increased the potential of people being at risk of harm. Systems did not always work effectively to ensure safeguarding concerns were appropriately recorded, reported and investigated. However, we found no evidence of harm to individuals. Staff, health professionals and people’s family members told us they felt clinical needs were well met. People’s families were reassured their relatives were safe at Woodland Park. One said, “I feel she is safe there; they look after her pretty well.” Another said, “I feel she is safe; I know all the girls, it reassures you.” People received their medicines safely, however, records were not always completed in line with best practice or the provider’s medication policy. This meant, for example, it was not clear when timed medication had been administered.

We recommended the provider review procedures to ensure medicines are administered and recorded in line with their medication policy.

We received mixed feedback regarding staffing levels. Some people and their families told us there were not enough staff, and that it could sometimes take a long time for call bells to be answered. Other people’s family members said there were enough staff, and they had no concerns. Staff told us people received safe care, and staffing levels were generally sufficient at the planned levels. Staff were recruited safely, and appropriate employment checks were made prior to staff starting work.

We recommended the provider ensure their dependency tool considered peoples individual needs to ensure safe staffing levels.

Assessments of people’s needs did not always include their personal preferences, emotional, social, cultural religious or spiritual needs. Four people who were admitted to the home in July and August 2022 had no personalised care plans in place and a fourth person had a short-term care plan in place which lacked personalised detail. Staff told us that whilst care plans did not always contain personalised information, they did know people well, endeavour to find out their individual preferences and shared this informally as a staff team. Staff had sufficient skills and experience to meet people’s needs.

People were supported to work with other health professionals and access health appointments. One relative told us how staff were working with their loved one and health professionals to alter their medication regime so the person could be better supported in the community. They told us, “They are changing it so they can open up her options, to go home with district nursing support or to a residential home.”

The culture of the service was positive, and people were supported to achieve the best outcomes for them. For example, one person had made significant improvement whist at the service and was moving on to live in the community with support. Staff felt well supported by the registered manager. One staff member told us, “[registered manager] is lovely, the biggest support, she brings so much joy and her energy’s great.” People and their families were asked for feedback about the service. Staff worked openly with other health professionals and made appropriate alerts when things went wrong. People’s families told us the registered manager was responsive when they raised concerns. One said, “When I have raised things, they have gone and sorted it out.” A second family member said, “They always tell me what’s happened, they have been amazing.”

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.

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

Rating at last inspection

The last rating for this service was good (7 May 2019).

At our last inspection we recommended the service ensure the medicines administration policy was updated in line with professional guidance, to include covert medicines administration, transcribing of changes to prescriptions and 'as required' medicines procedures. At this inspection we found the medicines administration policy had been updated.

Why we inspected

We received concerns in relation to the quality and safety of care people received, staffing levels, staff skills and experience and poor maintenance of equipment. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 Woodland Park on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding, person-centred care and 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Woodland Park is a care home with nursing, providing support to up to 27 people. At the time of the inspection there were 25 people living at the service with two other people waiting to be admitted from hospital.

The home is set close to Babbacombe Downs, the sea and local shops and services.

People’s experience of using this service:

People and their relatives spoke highly of the service they received from Woodland Park. The service had strong person-centred values and placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences.

People received their medicines as prescribed. We have made a recommendation the service updates their medicines management policy to ensure it is in line with current good practice and make any changes needed as a result.

People were involved in the planning and delivery of their care and this was done in a way which encouraged their independence and choice. People’s care plans contained personalised information which detailed how they wanted and needed their support to be delivered. Staff knew people and their needs well, and could tell us how people liked to be supported.

Risks to people’s health, safety and wellbeing were assessed and acted upon including for the management of health conditions. People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

People were supported by kind and caring staff. We saw staff being engaged with people and there was a positive, happy atmosphere. Staff expressed concern and compassion towards the people they were supporting, and were. Staff were provided with the training, supervision and support they needed to ensure they had the needed skills to care for people well.

There was strong leadership at the service. People and staff spoke highly of the management team and there was a positive culture at the service with people and staff feeling their voices were listened to. Where people had raised concerns, for example about the food, we saw actions were in place to address them.

There were effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. Systems ensured learning from incidents and accidents, and the registered manager and staff updated their learning via attending local forums and using training resources available to them.

More information is in the full report

Rating at last inspection: This service was last inspected on 8 and 9 February 2018. It was rated as Requires Improvement at that time in the key questions for safe and well led, with an overall rating a Requires Improvement. We saw improvements had been made since the last inspection and have rated the service as good.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received we may inspect sooner.

Woodland Park is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Woodland Park provides 24 hour nursing care, personal care and intermediate care for up to 31 older people in one adapted building. There were 23 people living at the home at the time of our inspection.

There was a registered manager in post who worked across two registered services and spent half their time at each. 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.

Risk assessment tools were used to identify common risks such as those relating to falls, skin integrity and medication. People who were at risk of developing pressure ulcers had pressure relieving equipment in place such as pressure relieving air mattresses and cushions. However, some risks to people's health and wellbeing were not always identified in people's care plans, and risk management plans were not always in place to instruct staff on how they should care for people safely.

Some risk assessments and care plans contained detailed guidance; however, records did not always show that care had been delivered as it should. For example, where people required regular repositioning, records did not demonstrate this had taken place and quality assurance systems had not identified this.

The environment was not always safe. Three exit doors at the side and rear of the property were unlocked. One door did not have a lock and opened by turning the handle from both inside and outside of the property. The door was not alarmed. This meant anyone could gain access to the home and people’s bedrooms, unnoticed and unchallenged by staff. This put people’s safety, their belongings and the security of the building at risk.

An effective robust system was not in place to assess and monitor the quality of the service. Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements.

We heard bells ringing during the inspection and these were responded to effectively. We received mixed feedback from people and their relatives in relation to staffing levels. One person told us, “I think they’re understaffed. I’ve been here hearing people ring for a while.” Another person told us, “I use my bell when I need it, and they come.” Relatives we spoke with also felt that people waited a long time for attention. However, during the inspection we saw people's needs were usually met quickly.

We looked at how medicines were managed within the home and observed how medicines were administered. During the inspection we observed administration practice that was not considered best practice nor did it follow the provider’s own medicine policy. We made a recommendation to the provider about this.

Other aspects of medicine administration, documentation and storage were managed safely.

At the last inspection in August 2016 we found improvement was needed in relation to supporting people to maintain their social activities and interests. During this inspection although there had been some improvement with the employment of an activities co-ordinator, people and their relatives felt further improvement was needed. One person said, “There is always something going on.” Other people and relatives were not so positive about the activities. One relative told us that activities seemed very few and far between. We saw there was a programme of activities which included sing-a-longs, bingo, arts and crafts, reading and movie afternoons. People were also offered one-to-one activities tailored to their interests.

Most people we spoke with told us the ‘girls’ were very kind and did their best. However, two people commented that some members of staff did not speak to them in a kind way. We brought this to the attention of the registered manager. We observed positive interactions between staff and people and staff engaged in conversation with people throughout the day. We saw staff were cheerful and friendly, and people appeared to be very comfortable with all the staff around them. People told us staff respected their privacy and dignity, promoted their independence and always gave them choices.

We received mixed views about the food. Some people told us they really enjoyed the food and were looking forward to lunch as roast beef was on the menu. However, other comments were not so positive. People's nutritional needs were assessed and they received a choice of meals and drinks. Where people needed support to eat and drink enough to keep them healthy, staff provided assistance. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us they felt safe living at Woodland Park. One person told us, “I feel very safe here as there’s always somebody around.” People were protected from the risk of abuse because staff understood how to keep people safe. Safeguarding procedures were in place to help protect people from harm and staff understood their responsibilities to do so and to report any concerns.

We looked at recruitment processes and found that staff had been recruited safely. Staff told us they were well supported in their role and received appropriate training and professional development. Staff attended mandatory training in a range of subjects and also had the opportunity to attend other training courses to ensure staff were able to meet the specific care needs of the people who lived in the home.

Principles of the Mental Capacity Act (MCA) 2005 legislation were being followed and Deprivation of Liberty Safeguards (DoLS) applications were completed in line with current legislation. Staff showed a basic knowledge and understanding of both MCA and DoLS. Best interest decisions were being made appropriately. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People's needs and choices were assessed and their care provided in line with their wishes, preference and desired outcomes.

There were arrangements in place for staff to monitor and take action when people experienced accidents or incidents. Accidents and incidents were analysed in a way which enabled trends to be identified and action could be taken to reduce risks.

We found two breaches in 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.

We had previously inspected the service in May 2013 when we found the service was not meeting requirements in relation to records. When we checked in October 2013 we found the necessary improvements had been made and the service was compliant with all regulations. Prior to this inspection we had received information about a safeguarding matter that was being looked into by the local authority safeguarding team.

The service had a registered manager who worked across two registered services and spent half their time at each. 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.

Although staff were knowledgeable about people’s needs, we found people were at increased risk because staff did not have access to detailed, clear care plans about each individual’s care and treatment needs. Documentation about people’s care needs was fragmented. This made it difficult to see how risks were being managed as there was no clear pathway between the identification of risk through to the plan of care needed to manage the risk. Some people’s risk assessments and care plans did not contain accurate or up to date information or reflect the care they were receiving and there were gaps in some people’s records. For example, we found that records for the application of prescribed creams were not always being kept accurately. This meant the manager or nurses could not tell if people were receiving all of their prescribed medication correctly and people could be placed at risk of skin damage. However, we saw no evidence of skin damage this during the inspection.

The service had enough staff to support each person’s individual care needs. We saw staff sitting and talking to people and people being assisted unhurriedly. This indicated there were enough staff on duty to meet people’s needs.

People and their relatives told us staff were skilled to meet people’s needs and spoke positively about the care and support provided. One person told us “I’m very well looked after by the girls” One family member told us staff knew their relative’s care needs very well and commented “they are really on top of [name of relative’s] care. Staff here are wonderful really”. Staff were experienced and had the skills and knowledge to provide care for people living at the service. They undertook regular training relevant to the needs of the people they supported. Staff demonstrated awareness of safeguarding and understood their responsibility to report concerns. People were relaxed and comfortable with the staff supporting them. This indicated they felt safe.

Accidents and incidents were reported and measures were taken to reduce risks for people.

People were offered day to day choices and staff sought people’s consent for care and treatment. Mental capacity assessments were not always completed in line with the legal process set out in the Mental Capacity Act (MCA) 2005 Code of Practice. This meant people’s rights may not be fully protected.

The home arranged for people to see health care professionals according to their individual needs.

Staff worked closely with local healthcare professionals when necessary. A health professional said their experience was that staff sought advice appropriately and communicated well about people’s health needs.

The culture of the home was warm and friendly and people told us they felt safe and were supported by kind and caring staff. One person said, “They [the staff] are all wonderful and very kind to us” and another said “We have a lot of fun here and I am happy”. We observed staff being kind and respectful to people, as well as sharing jokes and general conversation. Staff told us they enjoyed working at the home and they received a great deal of satisfaction from caring for people. One said, “I enjoy making them laugh, sharing their problems and being part of their last years. I want to make it as dignified and important a time as the rest of their lives”.

We looked at how people were supported to follow their interests and take part in social activities. People who were able to engage in formal activities told us they enjoyed what was provided, but would like to do more. Some people said they felt bored and some relatives told us they had noticed a reduction in the number of activities available. There were no specific activity plans in place to guide staff about how to support people’s social needs and maintain their individual interests. This meant people who found it difficult to engage or preferred to remain in their room through choice or health reasons could be at risk of social isolation. We spoke with the registered manager about this who said staff had time to chat to people in their rooms. However, feedback from people and staff did not support that this always happened. The registered manager told us they were in the process of recruiting a new activities coordinator and developing this aspect of the service. We have made a recommendation about the provider seeking advice and guidance about supporting people at risk of social isolation with engagement in meaningful activity and stimulation.

People were involved in developing and reviewing their care plans assisted by staff, relatives or others who knew them well. Staff knew people well and cared for them as individuals. They were aware of what mattered to people, about people’s lives their families and their interests. People were encouraged and supported to maintain relationships with their relatives and friends and to make new friendships within the home. Visiting times were not restricted and relatives and friends were welcome at any time.

People were supported to maintain their health through good nutrition. People told us they enjoyed the meals provided by the home, describing them as “tremendous” and “very satisfactory”. They said they could have drinks and snacks whenever they wished and always had a good level of choice. People’s nutritional needs and food preferences were recorded in their care records and in the kitchen so that the chef had easy access to this information. We saw people being assisted with their meals at breakfast and lunchtime. Staff sat beside each person who required support and helped them to enjoy their meal at their pace.

The provider had a complaints policy. People and relatives said they could to speak to staff or registered manager about any problems and felt confident they would be listened to. The service was working with families and the local authority to resolve two complaints at the time of our visit.

People, relatives and staff were confident in the leadership of the registered manager. One person said “I could tell [registered manager’s name] anything. I like her. She keeps everything on track”. Staff said they received a good level of support through supervision and could ask for guidance or support whenever they wanted.

There was a clear management structure within the home. The registered manager worked across two locations and spent half their time at each home. They also held additional responsibilities in relation to providing quality monitoring of another home in the Woodland Healthcare group. They told us they were well supported by the deputy manager and by the director of Woodland Healthcare, but were very busy working across both homes. They told us they believed the service would benefit from full time management support and were in the process of seeking a suitably skilled and competent manager to assist with the running of the home.

The provider had a range of quality monitoring arrangements in place to monitor care and plan ongoing improvements. This included audits, surveys and regular health and safety checks. These checks were not fully effective as they had not recognised the issues we found during our inspection. The registered manager understood their responsibilities in relation to their registration with the Care Quality Commission (CQC) and was aware of their responsibility to their duty of candour. The duty of candour places requirements on providers to act in an open and transparent way in relation to providing care and treatment to people.

We identified breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

People told us they were happy with the care they received. Comments included "the staff know how I like things to be done" and "I'm very happy here". Some people who lived in the home had dementia and when we spoke with them they were not always able to tell us about their experiences. During our visit we observed good interactions between care workers and people who lived in the home. We spoke with care workers who were able to tell us how they met people's care needs.

We found that care workers were receiving appropriate training and professional development so they could carry out their job role effectively. Care workers knew how to report concerns to ensure people were protected from the risk of harm.

The home had a comprehensive quality assurance system to assess and monitor the quality of the service. People told us "there's nothing to complain about' and 'I've no complaints".

Records were not always maintained to evidence what was happening in the home. Care plans did not contain up to date and accurate information.

We found that some items in the first aid boxes had passed their expiry date. The registered manager took action to remedy this.