Wood Hill Lodge: Sheffield care home found to have put people "at risk of harm" says Care Quality Commission
An independent regulator found two regulations of the Health and Social Care Act to have been breached, both in multiple ways.
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A report on the findings of the inspection states: "We undertook this targeted inspection to check on specific concerns we had received about the service.
"The inspection was prompted in response to concerns received about risk management, governance, and oversight. A decision was made for us to inspect and examine those risks.
"Based on our inspection we found that some of the concerns that had been raised with us were confirmed." The CQC report adds: "Prior to this inspection, we were made aware of concerns people had about the care and support people received. Some of those concerns were confirmed during this inspection.
"The management of safety, risk and governance had not been effective. "This was a targeted inspection to check on concerns we had about risk management, oversight, and governance."
Wood Hill Lodge, run by Portland Care 4 Limited, provides accommodation, nursing and personal care for adults with physical disabilities or mental health issues, including dementia.
An unannounced three-week long inspection of the Burngreave property found that "reportable incidents" had not always been reported to the CQC "without delay" as is required, which put people at risk of harm, the report states.
Reportable incidents include injuries that shorten life expectancy, cause prolonged pain or psychological harm, or require treatment in order to prevent death, among other types of incidents but specific examples of what had gone unreported were not detailed in the report.
Safeguarding incidents were also not always reported to Sheffield City Council and the CQC, according to the report.
Staff were not always able to raise concerns through supervisions and meetings, the inspection found.
Not all staff had completed whistleblowing and safeguarding training, although the provider had made the policy available to them, and inspectors were not assured that they had the "appropriate qualifications, competence, skills, and experience to keep people safe," the CQC report states.
Care records and service records were not always accurate and reliable. This meant staff did not have clear guidance about the care required and people were exposed to unsafe care and treatment, the CQC report states.
Gaps were found in repositioning records of people at risk of pressure damage - such as when people have to be laid on a different side of their body at intervals to prevent harm - meaning it was unclear to inspectors if these needs were met, the CQC inspection report states.
Not all staff had mandatory training such as First Aid and training to support people with health conditions, such as pressure care, the report adds.
The inspection found Regulation 17 (good governance) and Regulation 12 (safe care and treatment) of the Health and Social Care Act's Registration Regulations to have been breached, according to the CQC.
The provider has completed an action plan to address all concerns and issues, and to explain what will be done to improve the standards of quality and safety, which the CQC will check, the report states.
The previous inspection, which took place under the home's previous provider in 2021, gave the service a ‘good’ rating.
No updated rating is given by the CQC after a targeted inspection such as this one, since not all key areas are assessed.
At the time of the inspection, the home had 46 residents out of a possible 99.
Portland Care said: "While our rating remains good we constantly review our processes (to include listening to recommendations on how we can improve our service) to ensure we deliver the very best care possible."