Woodham Lodge

About the service

Woodham Lodge is a residential care home providing support to 6 people at the time of the inspection. The service can support up to 6 people. The service comprises of one purpose-built bungalow.

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

Care plans and monitoring records were not always in place for people to support them with their physical health needs.

The service didn't support people to have the maximum possible choice, control to be independent over their own lives. Aspects of peoples lives such as sharing a bedroom were not recorded or discussed as part of a decision-making process.

We have made a recommendation regarding recording decision making.

People were encouraged to set targets and achieve goals in some areas of life for example, planning a holiday and building relationships and contact with family members. However, this wasn’t consistent.

The service didn't always support people in a safe, clean, well equipped, well-furnished, and well-maintained environment. Due to a kitchen refurbishment people were exposed to unplanned risks as well as infection prevention and control issues. Regular fire drills were recorded as taking place however, there were some issues with people’s personal evacuation plans as the kitchen refurbishment disruptions hadn’t accounted for these risks.

Medicines were managed and administered safely. However, cleanliness of storage needed to be improved. Records and systems to monitor medicines were in place. Staffs’ competencies to administer medicines was checked. People were supported with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right care

The service acted to protect people from poor care. Staff knew how to report any concerns to the appropriate places. Staff had training on how to recognise and report abuse.

The service had enough staff to meet people's needs and keep them safe. However, some staff training was not up to date or completed.

We have made a recommendation about staff training.

People were supported by person centred practices; however, some support plans were more personalised than others and this wasn’t consistent. People were encouraged to take positive risks. Risk assessments were in place for most people. However, there were some gaps.

We have made a recommendation about care plans.

Right culture

People were supported to lead inclusive and empowered lives and make choices with the support of advocates where needed. However, some choices were not documented appropriately. The quality assurance processes in place were not always effective in identifying and addressing shortfalls in a timely manner.

Safe recruitment processes were followed. People and those important to them, were involved in planning their support. The service enabled people where appropriate to work with staff to develop the service. Staff felt supported by the manager.

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

Rating at the last inspection and update

The last rating for the service was good, published on 1 November 2017.

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to the length of time since the previous inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodham Lodge on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to assessing and managing risks, premises, records, infection control, safe care and treatment, and manager oversight at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The home 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. The registered manager was not present for the inspection.

Woodham Lodge is registered to provide care and support for a maximum number of six people who have learning disabilities and / or physical disabilities. At the time of the inspection there were six people who used the service.

People were protected by the services approach to safeguarding and whistle blowing. There were systems and processes in place to protect people from the risk of harm. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained. Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. This meant staff had the guidance they needed to help people to remain safe

There were sufficient staff on duty during the day to meet the needs of people who used the service. Night staffing levels had changed to one waking night staff member and one sleeping night staff member who alternated each week between Woodham Lodge and one of the providers other services which was on the same plot of land. The sleeping staff member was shared across both services and woken if people needed support. We have asked the provider for additional information about the current staffing arrangements on night duty and will follow this up outside of the inspection process.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

Staff had received induction training and shadowed other more experienced staff when they were first recruited. Staff had the knowledge and skills to support people who used the service. The majority of staff training was up to date and where there were gaps this training had been organised.

Staff had an understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and acted in the best interest of people they supported, however at the time of the inspection, processes had not been followed to formally record this. Information was supplied to us after the inspection to confirm that staff at the service had completed this process.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were kind, caring, and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs.

People’s independence was encouraged. Activities, outings, holidays and social occasions were organised for people who used the service. People’s needs were assessed and their care needs planned in a person centred way.

The provider had a system in place for responding to people’s concerns and complaints. Relatives told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the home had an open, inclusive and positive culture.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions, as mentioned above.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service had very complex physical and learning disability support needs. Not all were able to communicate verbally. However, we observed people to be comfortable in the presence of the staff team. We saw that staff used various and effective communication techniques to communicate with people. We saw and observed lots of positive interactions with staff and people who used the service.

We saw the provider had a rigorous training programme in place for staff. The staff training and observations helped to ensure people living in the home were appropriately supported and protected from harm.

People who lived in the home had regular assessments carried out and an annual review with their care managers. This ensured peoples care and support needs were current, effective, safe and protected their rights.

The senior support worker told us the provider used a dependency tool to work out how many staff were required on duty each day. This meant people who used the service received the correct level of care and support. When we spoke with the three support workers, they told us there was always enough staff on duty each day to meet people's needs.

Is the service effective?

We saw people who used the service and other professionals were involved with the planning of their care and the level of assistance they wanted wherever possible.

People's care plans were individual and person centred, detailing individuals likes and dislikes, preferences and religious beliefs.

People who lived at the home were given access to specialist health care professionals including, dentists, opticians, and chiropodists to help ensure their wider health needs were being met.

Is the service caring?

People who received help with personal care were treated kindly and with respect. People smiled a lot were happy with the care staff and we saw their preferences being taken into account. For example, what they wanted to do during the day, and where they wanted to go on holiday. Two people had just returned from a weeks holiday in Bridlington and two people were out shopping with staff to purchase new clothes.

Is the service responsive?

People who used the service, their family, friends and other professional who worked with them were regularly asked for their views on the way the service was run. Responses to surveys were analysed and used to enable the manager to make changes to the service where needed.

Is the service well lead?

The staff working at the home told us they felt supported in their roles and were happy with the level of training they received. Staff were confident that any concerns or complaints they may have would be dealt with quickly, appropriately and in confidence.

At the time of our inspection, the manager was on holiday.

We spoke to everyone living at the home during the visit, although most found it difficult to express their experiences of living there. One person said, 'It's ok". The same person then smiled.

We found the home had a very friendly atmosphere. It was very clean and tidy and the people living there looked happy and content.

We spoke to two relatives at the inspection visit and one relative said, 'We are welcomed and kept informed'. Another relative said, 'From a care prospective I would highly recommend'. The same relative said, 'The d'cor could do with a lick of paint, but that is being seen to'.

We found appropriate arrangements in place to manage people's medicines.

We were unable to check staff records as the manager was on holiday and held the key to the locked cupboard in which they were held. However we were able to check electronic training records including a training matrix which confirmed regular training occurred.

We saw a complaints book in the reception area along with the complaints policy.

We asked one person what they would do if they did not like something or did not want to do something. They indicated that they would tell the staff. One relative we spoke to confirmed that they knew how to complain and said. 'I have never had to complain as they listen and change things that might not be working'.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

All people who used the service had lived together since the home opened 21 years ago. The relationships between staff and the people who lived there were good and personal support was provided in a way that promoted and protected their privacy and dignity.

The standard of the accommodation, d'cor and furniture and fittings were very good and provided a clean and comfortable place to live.

There was a stable and competent staff team who had the training, skills and experience to meet the specific needs of the people who lived there.

The health and safety of the people who lived in the home was taken seriously, and the proper checks and tests of safety equipment were in place.