The inspection of Woodlands Lodge Care Home took place on 14 January 2019 and was unannounced. This meant the registered provider did not know we were coming.Woodlands Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Woodlands Lodge Care Home is registered to provide accommodation and personal care for up to 55 people, some of whom are living with dementia. There were 44 people living at the home at the time of our inspection.
The home is split into three different units; one of which is a locked unit, specialising in care for people living with dementia. Each unit has communal areas such as lounge and dining areas and one unit has a large sun-lounge.
The last comprehensive inspection took place in February 2018 and the service was rated as requires improvement. We identified one breach of regulation. This was because staff did not act in accordance with the requirements of the Mental Capacity Act (MCA) 2015. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions effective, responsive and well led, to at least 'good'. The action plan told us this would be completed by October 2018.
At this inspection we found some improvements had been made. Staff had been trained and were following the requirements of the MCA. Records showed, where appropriate, Deprivation of Liberty Safeguards (DoLS) applications had been made and authorised, for people living at the home. However, we found improvements were required in relation to the administration of medicines, staffing numbers and care planning. The service continues to be rated 'requires improvement.' This is the second time the service has been rated 'requires improvement.'
You can read the report from our last inspections, by selecting the 'all reports' link for ‘Woodlands Lodge Care Home’ on our website at www.cqc.org.uk.
The home had a registered manager in post. 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.
Medicine audits were not sufficiently robust and did not always identify errors and omissions on medication administration records, so we could not be assured people always had their medicines safely.
Elements of risk were identified in the care plans and plans were put in place to mitigate this risk through the care instructions. Where the level of risk was deemed to be more significant (choking for example) specific risk assessments were put in place. However, we found one instance where this was not completed in a timely manner.
In the main, there were sufficient staff on duty to meet people's assessed needs. However, there had been occasions when staffing numbers were lower than those assessed as needed. The registered manager and provider said they were monitoring this closely to prevent people being put at risk from unsafe care.
Incidents and accidents were recorded and reviewed by the registered manager to look if there were any patterns, themes or trends. This would help to prevent a re-occurrence.
People had choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice.
Staff received the training and support they needed to carry out their roles. Supervision meetings had been held on a regular basis. Staff enjoyed working at the service and said the registered manager was approachable and would listen to any ideas or concerns they had.
People were supported to make choices and staff promoted people's independence. People's communication needs were assessed and planned for. People had their privacy and dignity protected.
Newly formatted care plans were personalised and included all people's support needs and were regularly reviewed. However, only a small number of new care plans were completed. More detail was required in older care plans to provide clear guidance for staff in how to meet people's needs.
A varied range of activities were made available and we saw staff were proactive in engaging people with individual activities of their preferred choice.
People understood how to make a complaint and there were systems in place to respond to these.
The registered provider and registered manager had addressed all the areas for improvement in the previous inspection report. New issues of concern regarding medicines management, risk assessment and care planning were found and needed action. However, the governance of the service showed more in-depth monitoring of the quality of the service was being carried out by the registered manager and other senior managers.
People and their relatives were engaged in the service and felt able to approach the registered manager. Staff felt supported in their role and were involved in the service.