1 December 2022
During an inspection looking at part of the service
Woodside Residential Care Home is providing regulated activity of accommodation and personal care to up to 40 people in one adapted building. The service is registered to provide support to people living with dementia, learning disabilities, older people, younger adults and autistic people. At the time of our inspection there were 31 people using the service.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People’s experience of using this service and what we found
Right Support: The model of care did not meet the Right Support, Right Care, Right Culture guidance. People did not benefit from an interactive and stimulating environment such as listening to music or the use of therapy lighting both specified within their care plans. People were also not supported with daily exercise and assisted to leave their room as required within their care plan.
Where appropriate, legal safeguards had been put in place and the least restrictive measures were used. We found people did have a choice about their living environment and were able to personalise their rooms.
Right Care: Peoples’ care plans were incomplete and entries were contradictory. Some clinical needs had not been identified and risks assessed. For example, people with diabetes did not have care plans in place to maintain foot care despite having poor skin integrity and sores on their feet. There were discrepancies over how foods should be pureed to mitigate the risks of choking. We found that all the food groups had been blended together into a liquid, as opposed to separately to the required consistency. Care plans lacked details of what pressure level people’s mattress should be inflated to and had not been set correctly so that it had the most comfort and support to mitigate the risk of scores. Staff did not have access to communication aides specified within people’s care plan to assist with their communication. However, we observed staff showing kindness to people and being polite and respectful whilst supporting them. Staff were able to tell us about the needs and individual preferences of people.
Right Culture: There was ineffective oversight of the service. Quality assurance processes were established and identified risks, but these were not followed up and mitigated in a consistent and timely manner. People were not always supported by staff who had been trained and assessed as competent. Staff had not completed mandatory training including in learning disabilities and autism. Whilst, people received consistent care from staff they did not always understand and support them with their basic care and specific health needs. Staff told us, “We have had a lot of agency (staff), but we tend to use the same agency, they know as much as we do about people.” Following our inspection staff told us, “Training (for staff) is ongoing” and changes had been made to how care was provided to people. A staff member told us, “We now have signs in the kitchen (to remind staff of how to puree food), we use moulds for the food, meat is separate from vegetables.” We observed staff to be kind, patient and attentive to people. Staff told us they liked their job and cared about the people. Relatives told us they felt their relatives were safe and well cared for in a home described as, “Bright, welcoming, clean and comfortable with good food.”
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 requires improvement (the report was published on 14 June 2022). Consequently, we followed up on previous breaches of legal requirements from their last inspection.
At our last inspection we recommended that improvements were required to ensure people were safe, specifically; People were appropriately assessed, care plans contained details of individuals needs and how best to support them, people were responded to in a timely and appropriate manner when seeking assistance, incidents were recorded, investigated and actions taken to improve care and medicines were managed safely.
Improvements were also required to ensure the service was well managed, specifically; Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements and continuous learning and improving care.
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
Why we inspected
The inspection was prompted in part due to concerns received about the safety of people and their dignity and care. A decision was made for us to inspect and examine those risks. As a result, we undertook an unannounced focused inspection to review the key questions of safe 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.
Enforcement and Recommendations
We have identified breaches in relation to the safe care and treatment of people, insufficient safeguarding systems and processes operating, the safe appointment of staff and overall governance systems at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
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.