Woodland House

Woodland House is a residential care home for people with learning disabilities and autism spectrum disorders, providing personal care to six people at the time of the inspection. The service can support up to six people.

The building deliberately had no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also encouraged to wear their own clothes that didn’t suggest they were care staff when coming and going with people.

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

People were safe living at the home. Staff had received training so that they knew how to protect people from harm. At the time of our site visit, we found there were enough numbers of suitably recruited staff on duty to meet people’s needs to keep people safe. People were supported by staff who knew their needs well, but had not all received training on people’s unique health conditions. Staff supported people with their medicines. Systems to prevent and control the spread of infection needed some improvement.

People were offered a choice of foods and where appropriate, received additional support with their health care needs. Staff worked with external health and social care professionals and ensured people were supported to access these services when they needed them to maintain their health and wellbeing.

People were supported to have maximum choice and control of their lives and staff. During inspection we did see that one person was restricted from using a bathroom as the door was locked. Alternative options had not been explored that are less restrictive .

People's support focused on them having as many opportunities as possible for them to gain new experiences and maintain independence.

The service was rated as Good in all five key questions at the last inspection in July 2017.

However, at this inspection, we found they key questions for Safe, Effective and Well-led were rated as requires improvement.

We also found during the inspection that there was a breach of Good governance again with systems not being in place to identify and mitigate any risks to people and failing to ensure the service was compliant with regulations. Also, the registered manager had failed to keep themselves up to date with current regulatory requirements and best practice.

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

Why we inspected

This was a planned inspection based on the previous rating.

Woodland House is a care home without nursing for up to six people who have learning disabilities or autism. At the time of the visit six people were living at the home. The home had a registered manager who was present throughout the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People, their relatives and staff told us that people were safe in the home. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice. There were safe recruitment practices and enough staff to support people well. People were protected from possible errors in relation to their medication because the arrangements for the storage, administration and recording of medication were good and there were systems for checking that medication had been administered in the correct way.

Everyone we spoke with told us that they were very happy with the care provided. People had opportunities to participate in a range of activities in the home and community, but staff respected people’s wishes when they wanted to be alone in their rooms, or not go on holidays if they preferred to stay at home. Care plans were reviewed regularly.

People told us that their relatives and friends were encouraged to visit and made welcome by staff.

Staff regularly asked people how they wanted to be supported and when necessary people were supported by those important to them to express their views. People were treated with dignity and respect.

Staff understood the needs of the people who used the service and how they liked to be supported. We saw that staff communicated well with each other.

Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills.

People were supported to have their mental and physical healthcare needs met and were encouraged to maintain a healthy lifestyle. The registered manager sought and took advice from relevant health professionals when needed, and understood their responsibilities in relation to the Mental Capacity Act.

People were provided with a good choice of food in sufficient quantities and were supported to eat meals which met their nutritional needs and suited their preferences.

The registered manager assessed and monitored the quality of care through observation and regular audits of events and practice.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodland House on our website at www.cqc.org.uk.

This inspection took place on 19 December 2016 and was unannounced. The inspection was focussed and therefore concentrated on three areas; safe, effective and well led. We had identified that the provider did not have effective systems in place to assess, monitor and mitigate the risks to health, safety and welfare of people who used the service, and that lawful authority had not been sought to deprive some people of their liberty. The provider took action and at this inspection we found some significant improvements had been made.

Woodland House is registered to provide care and support for up to six people with a learning disability. Nursing care is not provided. On the day of our inspection there were six people at the home. The registered manager was present during our inspection. 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.

During our inspection we saw that people felt comfortable with staff and moved about the home as they wished. People were supported by staff who had received training on how to protect people from abuse. Risk assessments had been completed to minimise the risk to people.

People told us and we observed that staff were kind and compassionate in the way they supported and cared for people. People were given support to make their own decisions about their individual care and support needs. We saw that staff respected people’s choices and preferences. The registered manager and staff we spoke with understood the principles of protecting the legal and civil rights of people using the service.

All the staff we spoke with said that the registered manager was supportive and approachable. The registered manager had continued to make improvements within the home and how it was run, and had developed some systems which helped to ensure the service being offered was safe and of good quality. While progress had been made in this area, formal auditing and a robust checking process had not yet begun.

Woodland House is a care home without nursing for up to six people who have learning disabilities. At the time of the visit six people were using the service. The home had a registered manager who was present during the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People, their relatives and staff told us they felt people were safe in the home. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice. People were protected from possible errors in relation to their medication because the arrangements for the storage, administration and recording of medication were good and there were systems for checking that medication had been administered to people in the correct way.

People’s relatives told us that they were very happy with the care provided. People had opportunities to participate in a range of activities in the home and community, but staff respected people’s wishes when they wanted to be alone in their rooms.

People’s relatives and friends were encouraged to visit and made welcome by staff. Staff regularly asked people how they wanted to be supported and when necessary people were supported by those important to them to express their views. People were treated with dignity and respect.

Staff understood the needs of the people who used the service and how they liked to be supported. We saw that staff communicated well with each other. Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills.

The registered manager did not have a good understanding of the principals of the Mental Capacity Act (2005), and associated guidance in respect of making best interest decisions on behalf of people. They had not applied for authorisations to deprive people of their liberty.

People were supported to have their healthcare needs met and were encouraged to maintain a healthy lifestyle. The registered manager sought and took advice from relevant health professionals when needed. People were provided with a good choice of food in sufficient quantities and were supported to eat meals which they enjoyed.

The registered manager did not have effective systems in place to monitor and checked that the service was safe and compliant with the regulations and continually improving. Management of records related to aspects of the management and operation of the home were not being maintained as expected.

You can see what action we told the provider to take at the end of this report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Woodland House had policies and procedures in place for the assessment of people under the Mental Capacity Act and Deprivation of Liberty safeguards. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve.

People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual support plans in relation to activities of daily living. Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support the people living at Woodland House. We found that medication was stored, administered and recorded appropriately and people's needs were reviewed as required.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved in writing their plans of care. Staff spoke with pride about the progress that individual people had made whilst they had been living at Woodland House. People who lived in the service were able to describe specific benefits to their health and wellbeing.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were supported to be as independent as possible. People who used the service were invited to complete an annual survey. Where shortfalls or concerns were raised, there was an opportunity for these to be addressed. All the people we spoke with were happy living at Woodland House. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People were regularly involved in a range of activities inside and outside the service. The home supported people to take part in local activities within the local community which included visiting local places of interest, shopping and going on holiday. People knew how to make a complaint if they were unhappy and people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything. Staff worked in partnership with health professionals who visited Woodland House on a regular basis to monitor the progress and provide support for people who lived there.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. Records seen by us showed that any identified shortfalls were addressed promptly and as a result the service was constantly improving. Staff were supported to undertake training. Relatives and health professionals we talked to spoke highly of the commitment of the manager and staff team in the way that they provided the service for the people who lived at Woodland House.

We found the home to be clean, homely and comfortable. Care was provided in an environment that was safe, accessible and adequately maintained.

People were complimentary about the care staff who supported them. Comments included, 'It's good here, I like the staff' and 'We go on holidays to Devon and have a great time.'

From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support. We spoke to relatives of people who lived at the home and they were equally complimentary about the staff and the care being provided. We concluded that there were enough qualified, skilled and experienced staff on duty to meet people's needs.

We examined care plans and found that people's needs were properly assessed and that care and support was planned and delivered in line with their individual care plans. People who used services had also given their consent to the care and support they received.

People who use services and those acting on their behalf could be confident that their comments and complaints were listened to and dealt with effectively.

People told us, 'I like it here' and 'I like the staff.'

Relatives of people using the service also made complimentary comments. Comments made included, 'He is very happy there' and 'We are very happy with everything, our relative has really improved since he started living there.'

The community nurse who visits Woodland House every two weeks told us, 'They provide an excellent service, I have no concerns about it.'

Our inspection confirmed much of the feedback we had received. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare.

Our observations and conversations with people using the service confirmed that the staff were attentive, polite and that the management team were approachable and responsive to suggestions and feedback. It was clear that the staff had a good knowledge of all of the people who they cared for and were familiar with their preferences and health conditions.

We saw that people were safe and their health and welfare needs were being met because there were sufficient numbers of staff available to support them and that they were protected from the risk of abuse.