Wood Hill House

Updated 3 July 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of a senior specialist for people with learning disabilities and autistic people, an inspector, a medicines inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Wood Hill House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Wood Hill House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post. The provider assured us additional support from the operations manager was in place in interim and the manager intended to re-submit their application for registration.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, clinical commissioning group, and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people who lived at Wood Hill House about their experience of the care provided. We met with the manager, deputy manager, and operations manager. We spoke with 10 members of staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked around the building to check environmental safety and cleanliness. We looked at written records including 3 people's care records and 2 staff files. We spoke with a visiting professional. A variety of records relating to the management of the service were also reviewed. After the inspection we continued to seek clarification from the provider to validate evidence found. This included policies and procedures, supervision and training data, and audits.

Updated 3 July 2024

About the service

Wood Hill House is a care home that provides accommodation, nursing, and personal care for adults. People living in the home had a range of care and support needs including people living with physical disabilities, mental health needs, learning disabilities, and autism. The home can accommodate up to 83 people in one purpose-built building over 4 floors. At the time of this inspection there were 13 people residing at Wood Hill House.

People’s experience of the service and what we found:

People’s medicines were not always managed safely. There were environmental safety concerns in the building which placed people at risk of harm. Safety concerns identified through risk assessment were not acted upon, therefore we could not be assured the risk had been mitigated. Plans to support people with safe evacuation in the event of a fire were not detailed and did not reflect advice from the fire and rescue service. There were policies and processes in place for managing safeguarding concerns, however we found concerns were not always identified by managers reviewing incidents. There were enough staff to meet people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider did not work in line with the Mental Capacity Act. Not all people had capacity assessments and best interest decisions where a need was identified. There were delays in applications for Deprivation of Liberty Safeguards (DoLS) authorisation. The system in place for monitoring DoLS applications, authorisation, and conditions was ineffective. A significant number of the staff team had not completed mandatory training. Staff did not have up to date training or competencies to meet complex health needs including tracheostomy, Percutaneous Endoscopic Gastrostomy (PEG), and catheter care. Not all staff had received supervisions or appraisals as per the provider’s policy.

We found care plans lacked person-centred detail. Some positive behaviour support plans had not been devised for people where there was an identified need. The service was not meeting the Accessible Information Standard. There was a lack of support for people to access meaningful activities. Managers were working to improve this, however, did not audit or have oversight of what activities were taking place.

Systems for identifying, capturing, and managing organisational risks were ineffective. The provider did not have a clear and consistent system of audit in place. The provider had not fully acted on feedback from professionals for continually evaluating and improving the service or for assessing, monitoring, and mitigating risks to the safety and welfare of people. Staff told us managers were making improvements and felt there was an open and positive culture.

We received mixed feedback from people about the care they received. There was no system in place to seek feedback from people about their care. Our observations of care provided were positive. Staff spoke passionately about the support they provide for people. There were enough staff to meet people’s needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. These principles were highlighted as not being met at the time of the last inspection and we found minimal improvements had been made to the clinical environment and lack of personalisation. Managers told us work was ongoing to reduce occupancy from 83 to 42 people. We found the size, scale, and design of the current and future premises compromise quality of care and does not facilitate person-centred care. The provider had not carried out any audit or benchmarking against right support, right care, right culture to show how the service meets the needs of people in line with this current best practice. Audits in place were not fully checking whether the service was meeting the principles within the guidance: the size, setting, and design; community participation and having the right model of care; and policies and procedures. Managers told us work was ongoing to implement an audit, however we did not receive this as part of information requested following the inspection.

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

Rating at last inspection

The last rating for the service under the previous provider was good, published on 10 July 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified breaches in relation to person centred care, need for consent, safe management of medicines, the premises, governance, and staffing. As a result of concerns found at this inspection we served Warning Notices and a Notice of Proposal. The provider submitted representations against this proposal and following review of these representations, a Notice of Decision to impose conditions was served. This was not appealed by the provider. Therefore the conditions placed on the provider's registration mean that they cannot provide regulated activities to anyone with a primary need of a learning disability and/or autism at Wood Hill House.

Follow Up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.