Woody Point

About the service

Woody Point is a residential care home providing personal care to up to 6 people. The service provides support to adults with learning disabilities, autism, and mental and physical healthcare needs. At the time of our inspection there were 6 people using the service.

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

The service was not able to fully demonstrate how they were meeting the underpinning principles of right support, right care, right culture, and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.

Right Support:

People were not always cared for and supported in a secure, clean, well-equipped, well-furnished, and well-maintained environment that met their sensory and physical needs. We identified concerns that had not been fully risk assessed and mitigated against which put people at risk of harm.

There were enough staff to meet people’s needs. Staffing challenges including personnel changes, retention and recruitment had impacted on continuity of care and there were instances of people’s routines being affected. To maintain safe staffing levels the registered manager had been covering care shifts instead of overseeing the service. The provider was taking action to address this through active recruitment and had recently employed two members of staff and had plans for further senior level support.

Overall 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; but there were inconsistencies in the policies and systems in the service to support this practice. Although the outcomes for people were appropriate the management team were not always confident in reflecting shared decision making and documenting best interest decisions. We signposted the registered manager to access support in this area.

Right Care:

There was a calm and relaxed atmosphere in the service. Staff were respectful and supportive in their interactions with people. Where people required support with personal care this was provided in a discreet way and promoted people's dignity and privacy.

Right Culture:

The provider's governance arrangements did not provide assurance the service was well led. Systems and processes to oversee the safety and quality of the service were not robust and effective. They had not identified the shortfalls we found during our inspection and regulatory requirements were not always being met.

The registered manager’s responsibilities were too great and this had impacted on their oversight of the service. In addition to covering care shifts at Woody Point they supported the provider’s other managers nearby, who were new to the role. The provider’s representative were not based locally in the area and acknowledged that a more visible presence was needed to support the registered manager and had plans to address this.

The registered manager and provider’s representative were open and honest about the shortfalls at the service. They engaged with the inspection positively and demonstrated a commitment to making any necessary improvements.

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

Rating at last inspection and update

The last rating for this service was Good (published 15 March 2019).

Why we inspected

We received concerns in relation to the care people were receiving. 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.

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 Woody Point on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to Regulation 12 that ensures people have safe care and treatment at all times and Regulation 17 relating to governance arrangements in the service.

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.

We found the following examples of good practice.

The service had range of policies and individual risk assessments to manage the risks associated with COVID 19.

The service was clean however some areas were looking tired. Upgrading works were due to commence shortly.

People living in the service were enabled to maintain contacts with friends and family. Face to face visits were being undertaken in line with the government guidance and people were supported to access the community.

People had access to health care support both in person and via technology such as zoom

Woody Point provides accommodation and personal care for up to six people with a learning disability. At the time of our visit six people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

What life is like for people using this service:

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People using the service at the time of our inspection were unable to verbally communicate their views about the care they received. However, we carried out observations of how staff supported and interacted with people to gain insight into their experiences.

People who live at Woody Point have their needs met by sufficient numbers of suitably trained staff. We observed that staff were kind, caring and supportive to people.

Medicines were managed and administered safely. Additional checks had been implemented to monitor administration since changes to how the medicines were supplied by the pharmacy.

Care records were very individualised and accurately reflected people’s needs in sufficient detail, including the specific routines staff needed to follow. Risks to people were identified, monitored and managed. People were supported to live full and active lives and to engage in activities aligned to their specific interests.

People were offered a choice of meals which met their nutritional requirements. The risk of people becoming malnourished or overweight was identified, monitored and managed. People received appropriate support from staff to eat, drink and make good choices.

The quality assurance system in place to monitor the service provided to people was robust and capable of identifying areas for improvement.

The service worked well with other organisations to ensure people had joined up care. People were supported to have input from external healthcare professionals in a timely way.

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

Rating at last inspection:

At the last inspection the service was rated Good. (Report published 6 September 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 11 March 2015 the service was rated Good. At this inspection we found the service remained Good.

The service had a registered manager. 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.

Action was taken by the service to ensure people were kept safe. Risks to people were appropriately planned for and managed.

Medicines were stored, managed and administered safely.

Staff received appropriate training and support to carry out their role effectively. Appropriate checks were carried out on prospective staff to ensure that they were of good character.

People received appropriate support to maintain healthy nutrition and hydration.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness, respect and were enabled to live as independently as possible.

The service had processes in place to gain the feedback on the quality of the care people received and this was used to inform changes where appropriate.

People received personalised care that met their individual needs and preferences. People and other appropriate professionals were actively involved in the planning of their care. People were enabled to access meaningful activities and follow their individual interests.

There was a complaints procedure in place and those involved in people’s care knew how to complain.

The registered manager promoted a culture of openness and honesty within the service. Staff and other appropriate professionals were invited to take part in discussions about shaping the future of the service.

There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below

Below is a summary of what we found during our inspection;

Is the service safe?

We found that people using the service were protected from the risks associated with the spread of infection, as appropriate measures were in place to control this risk. We found that people were cared for in a clean and hygienic environment.

We reviewed the fire safety checks undertaken by a nominated member of staff at the service. We found that these had been completed on a weekly basis, and this ensured that people would be alerted promptly if there was a fire at the service. This protected people from the risk of coming to harm in the event of a fire.

We reviewed the staff rota for the month prior to our visit. We found that in this month, there had been enough staff to meet people's needs and protect their welfare. All four people using the service required one to one care, and we found that they had received this in the month prior to our inspection. The service had in place a contingency plan to maintain the staff numbers at a safe level.

We checked to see if anyone using the service was subject to a deprivation of liberty safeguard at the time of visit, and we found that no one using the service was at the time of visit. The service had in place appropriate policies and procedures in order to protect people from having their liberty unlawfully restricted.

Is the service effective?

Care records we reviewed indicated that people's care was planned and delivered in a way which promoted their dignity and ensured their safety and welfare. These records had been reviewed and updated as needed, and we were told by staff that new updated paperwork was just being completed for each person using the service.

Is the service caring?

We found that each of the four care records we reviewed contained detailed information about the person. This included information about how they communicated, what they liked to do with their time, their past history and how staff could support them to live their life as they wished.

The service was unable to offer people the opportunity to complete satisfaction questionnaires, as they would be unable to provide responses to direct questions about their experiences. However, staff told us that they were able to tell when people were happy and when they weren't, just by observing their behaviour and interaction with others.

Is the service responsive?

People using the service had opportunities to partake in a number of different activities throughout the day and evening. All four people were supported to attend a day centre on weekdays, and there was information in their care records about what they liked doing at other times.

People's care records indicated that staff took the appropriate action in a prompt manner where concerns about a person's wellbeing or care were identified. This included seeking advice and support from healthcare professionals such as doctors, dentists and mental health professionals where needed.

Is the service well-led?

The service had a quality assurance system in place to identify shortfalls in service provision. This included a programme of audits and checks which were completed regularly to ensure the quality of the service provided to people..

People's health, safety and welfare were protected when more than one provider was involved in their care and treatment. This was because the provider worked in co-operation with others.

People using the service were protected from the risk of abuse, because the provider had appropriate policies, practices and staff training in place to identify the possibility of abuse and prevent abuse from happening.

Effective recruitment and selection processes, with appropriate checks undertaken before new staff took up their appointments, ensured that people were cared for by suitable and appropriately skilled staff. This was confirmed by the records that we saw and in our conversations with the two care staff on duty.

We met three of the four people using the service. We observed that they had good relationships with the staff.

One person showed us their bedroom, the laundry and the bathrooms. They told us that they preferred to use the bath rather than the shower. With the assistance of a staff member they told us about the television programmes that they enjoyed.

Another person told us, "I like the food," and, "I like to cook cakes." We saw that the staff offered people choices of what they wanted to eat and drink during our visit.

One person chose not to attend their day centre and this was respected.

We looked at the care records of four people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights.