Archived: Woodlands (Kent)

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

Is the service safe?

This service was not safe. Care plans lacked detail and were incomplete so staff did not have the guidance they needed to give the right support. Some risks to people had been identified but overall there was a lack of risk assessments to show staff

how to reduce potential risks. Risk assessments were incomplete or out of date. One person was recorded as having a high risk of falls but there were no risk assessments around this.

Some important and recent care records had been archived so staff could not look back to note any changes in people's needs.

People were not given their medicines when they needed them and staff did not always check that people had taken their prescribed medication. Medicines were not stored safely or correctly according to the service's policies and procedures and manufacturer's instructions.

A lack of records relating to medicine administration made it difficult for staff to look back at people's medication history. We observed that medication was not always given appropriately and that errors had been made with people's medicines.

People told us that they no longer felt safe and that they were not happy with the care they received.

There were not enough staff on duty at the service to meet people's needs or to ensure that the service was safe. People who used the service and some of their relatives told us that there were not enough staff. People told us that there were times when they had to wait for an unreasonable amount of time for staff to support them. One person we spoke with told us, "There are not enough staff; there are too many agency staff who don't know me or what I need to be done for me'.

Is the service effective?

The service was not effective. Staff were not able to respond promptly when needed due to a shortage of permanent staff and the high use of agency staff. We found that some shifts were not able to be covered by permanent or agency staff and therefore there were less staff available to respond to people when they needed assistance.

People told us that they did not receive the care and treatment they wanted or needed. A relative told us, 'Recently my relative doesn't receive the care they deserve. I have raised things with the person in charge but nothing happens. My relative told me that they've got nothing to do and nothing to look forward to'.

A person who used the service said 'The activities lady has left and there's nothing for people to do, we are just sitting around all day'.

We found that care plans and other records were out of date and incomplete or did not contain the information needed to deliver care to people who used the service effectively.

Is the service caring?

Whilst some staff was described as kind and positive comments were made about the food, overall we found that the service overall was not caring .

People who used the service told us that they were supported by kind staff and that staff showed patience and gave encouragement when supporting them. A relative we spoke to told us 'They are very patient and kind'.

People we spoke with were very positive about the food. They said that they were given choices about what they ate and if they wanted to make any special requests they could. One person said 'The food is good; I can ask for something else if I don't like what is on the menu and they'll try and sort it out for me'.

We found that the privacy and dignity of people living at the service was not always respected. For example, We found information about a person's care needs displayed on a person's outer bedroom door leading to the corridor which could be seen easily by passers-by.

Personal care was not always given to people at a time which suited them due to low staff levels. A person we spoke with in the morning told us 'I am waiting for a wash, I would like a wash at around 8am but it's usually between 9-10'. Another person's relatives told us 'It's degrading for my relative. I had to ask if they could have a shower as they haven't had one for months and months'.

Is the service responsive?

The service was not responsive. People told us that they were not happy with the service.

Some people who used the service were not getting the medical treatment they needed and there was a lack of regard for people's wound care needs. We saw from one person's care plan that they had a very high risk of developing pressure sores; there was no information on what actions should be taken to reduce this risk. We saw that where people needed referrals to other healthcare professionals, staff had not always made these as information had not been passed on to the nurse in charge of the next shift.

During the last inspection of 3rd July 2014 we highlighted non-compliance. At this inspection we found that this non-compliance had not been addressed. For example, we were told that staff supervision would commence the week after the last inspection conducted on 3rd July 2014. During this inspection, supervisions had still not commenced.

Is the service well-led?

The service was not well led. There was a lack of leadership and staff were not always sure who was in charge. The leadership was not clear to staff since the manager had been absent from the home. Staff told us they were not always clear about their roles and responsibilities.

We found that the majority of nursing staff were agency staff. One agency nurse we spoke to told us 'There is hardly any guidance to follow about the people who use this service. I just have to try and do the best I can'. They told us that although they were unfamiliar with the home they were expected to run the shift with no support.

Audits of the care plans had been completed but these audits had not picked up the shortfalls with the care plans and risk assessments. The service had not addressed previous non-compliance highlighted at the previous inspection of 3 July 2014 and we found further breaches in the regulations.

Is the service safe?

This service was not safe. Care plans lacked detail and were incomplete so staff may not have the guidance they need to give the right support.

Risks to people had been identified but there was a lack of risk assessments to show staff how to reduce potential risks.

Some important and recent care records had been archived so staff could not look back to note any changes in people's needs.

People were given their medicines when they needed them but staff did not always check that people had taken their prescribed medication. All medicines were stored safely and according to the service's policies and procedures.

A lack of records relating to medicine administration made it difficult for staff to look back at people's medication history.

People told us that they felt safe and that they were happy with the care they received but there were times when they had to wait for staff to support them.

There were not enough staff on duty at the service. One person we spoke with told us, 'There are not enough staff; I have to wait a long time if I need something'.

Is the service effective?

The service was not effective. Staff were attentive to people using the service but were not always able to respond promptly when needed.

Not all of the care plans were fully completed so they did not contain all the relevant information about people's current needs.

There was a lack of leadership and staff were not always sure who was in charge.

Is the service caring?

People who used the service told us that they were supported by kind staff and that staff showed patience and gave encouragement when supporting people. A relative we spoke to told us, 'I visit very regularly. The staff are always considerate and do the best they can'.

People were at risk of not having their personal preferences considered because care plans did not contain this information.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that most staff had a good understanding of the people's care and support needs.

People using the service were supported to attend health appointments, such as, doctors and dentists. Records showed that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

People told us that they had enough to eat and drink and that they could choose what they wanted. People with special diets were catered for.

Is the service well-led?

The service was not well led. The leadership was not clear to staff since the manager had been absent from the home.

Staff told us they were not always clear about their roles and responsibilities.

There were systems in place to ask people who used the service, relatives and staff for their views.

Audits of the care plans had been completed to assess the quality of the care being provided but these audits had not picked up the shortfalls with the care plans and risk assessments.

To help us to understand the experiences people had, we used our Short Observational Framework for Inspection (SOFI 2) tool. The SOFI tool allowed us to spend time watching what was happening in a service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences. we found that overall, people had positive experiences.

We found that people's choices and decisions about their care were respected and appropriate procedures were followed when people could not make choices or decisions for themselves. Relatives told us that they were included in the decision making process and that they were kept up to date with any changes to their relatives care.

From the documentation we looked at, we found that care plans and assessments were up to date and included people's choices and preferences. In addition, care plans included people's individual medical needs and we saw that they had been signed by the people they referred to or their representatives.