Woodrow Cottage

About the service

Woodrow Cottage is a residential care home providing personal care to 7 people at the time of the inspection. The service can support up to 8 people. Personal care was being provided by a separate agency to one person living in the annex. This started the week of the inspection.

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

Right Support: Care plans contained sufficient detail for staff to support people to lead the lives they wanted. However, there were some inconsistencies which meant there was a risk of support not being provided in a person-centred way. Medicines records were not always accurately completed. Staff knew people well and we observed positive interactions.

We have made a recommendation in relation to medicine recording.

People living in the main house 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; the policies and systems in the service supported this practice. This had not always been the experience of the person living in the annex.

Right Care:

Care was mostly person centred for people living in the main house. The person living in the annex had not always received care promoting their dignity and human rights. There were some instances of inappropriate language but staff had been open to learning when this was raised. Improvements were planned in care planning to promote independence and set longer term goals.

Right Culture:

There were some instances where language and care planning did not always support people to lead inclusive and empowered lives. The provider was working with the local authority in order to improve the service. Changes had been made by the local authority to the staffing for the annex as the person living there had not been receiving a service in line with the values and attitudes they should expect. Relatives and professional were positive about the changes being made in the service.

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 this service was requires improvement (published 21 September 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service. It was also prompted in part due to concerns received about the care provided to a person living in the annex.

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.

Due to changes made within the service by the local authority shortly before the inspection, we found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring, responsive and well led sections of this full report.

We have found evidence that the provider needs to make improvements. Please see the relevant key question sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodrow Cottage on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to governance and auditing systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Woodrow Cottage is care home registered to provide personal care for up to eight people who may be autistic or be living with a learning disability. At the time of our inspection eight people were using the service.

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

We could not be assured the provider had suitable numbers of appropriately skilled, qualified and experienced staff deployed to meet people’s needs at all times.

The provider had governance systems in place to help identify areas for improvement. However, feedback suggested leadership were not always receptive or responsive to concerns raised. Staff raised concerns about the culture within the senior management team.

Staff were trained effectively in how to identify possible abuse and were confident the registered manager would investigate any concerns.

Care plans and risk assessments were in place to assist staff on how best to support people.

People were supported safely to manage their medicines.

The provider had effective measures in place to reduce the possibility or spread of infection.

The provider had effective recruitment procedures in place.

Staff told us, and records demonstrated people were supported to access support from external organisations such as support from GP’s and other professionals.

Follow Up

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

Why we inspected

We received concerns in relation to staffing, leadership and culture. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We previously carried out an unannounced comprehensive inspection of this service on 9 May 2019 and the report was published on 18 July 2019.

The overall rating for the service has deteriorated from good to requires improvement. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodrow Cottage on our website at www.cqc.org.uk

Woodrow Cottage is a residential care home providing personal care and support for up to eight adults who have learning disabilities and / or autism. At the time of the inspection eight people were living at the home.

The home is based on three floors which are connected by stairs. On the ground floor there are communal areas and access to a garden. On the second and third floor there are single occupancy bedrooms. There is a separate annex located at the front of the home which has accommodation for one person.

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.

People’s experience of using this service:

The provider and staff put each person at the heart of the service. Their approach to each individual had been effective in reducing people’s behaviours that challenged and supporting people to continue to live active lives. A relative told us there was “An ethos of building a service around the individual’s needs, individual personalities and behaviours”. Another person’s relative said that, as a family, “The support we (also) got was way over and above”.

The provider sought out best practice to improve the lives of people using the service. The service had taken innovative steps to meet people’s information and communication needs.

People’s needs were assessed and care and support plans were person-centred and reviewed.

People were supported to maintain their mental and physical health and the service had good relationships with external professionals. The service was responsive to people’s needs and staff listened to what they said. Any concerns or complaints were dealt with appropriately.

Staff were friendly and caring and treated people with respect. Relatives comments included, “Amazing care”; and “There is always a nice atmosphere”. Staff demonstrated a good knowledge of people’s individual needs and preferences regarding their support. People were empowered to be involved in making decisions about their care and support and how the service was run.

There were systems and processes in place to protect people from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team. People’s medicines were stored and well managed to ensure their safe and proper use.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills.

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; the policies and systems in the service supported this practice.

There was an open, inclusive culture and ethos within the service, which empowered people and promoted positive outcomes. The registered manager and staff engaged well with people using the service, their relatives, and external stakeholders. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.

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.

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 this service was good (published 14 October 2016).

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.

There was a registered manager at the home. 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 provider notified CQC about significant events that happened in the care home and had acted in line with regulatory requirements.

People felt safe living at Woodrow Cottage. People appeared relaxed and comfortable in their home environment. Family’s members told us that their relatives were happy living at the home.

Risks relating to individuals were managed safely. Staff were knowledgeable about following care plans that identified risks and actions required to ensure people were safe. The registered manager and provider analysed Incidents to identify causes and triggers, putting measures put in place to reduce risk and likelihood of reoccurrence.

People were supported to maintain their health and wellbeing. Medicines were managed safely. Staff knowledge around Storage and safe administration was robust and effective. People were encouraged to maintain a healthy, balanced diet with access to healthcare services when needed.

There were suitable numbers of staff employed who had the right skills, training and support to work effectively with people. There was a clear management structure in place. Staff felt supported and motivated to improve service provided and were clear about their roles and responsibilities. Staff were knowledgeable about safeguarding and were confident in taking appropriate action to keep people safe if they had concerns.

People received personalised care and support and had access to a range of meaningful activities tailored to their individual interests. Staff demonstrated a good awareness of people’s individual needs and responded effectively when their needs changed. Peoples were involved in their care planning and the service was developing ways to support effective communication for people who did not communicate verbally.

Staff followed legislation designed to protect people’s rights and freedoms. People were cared for with kindness and compassion by staff that were enthusiastic and motivated to improve the lives of the people they worked with.

The service had an open and transparent culture. Families were welcomed and were kept informed about changes to people’s health and wellbeing. The registered manager sought feedback from people, families and professionals in order to make improvements to the service. Staff were confident in raising concerns to the registered manager and were knowledgeable about the provider’s whistleblowing policy if they had further concerns. There was a prominently displayed complaints policy in place which staff and families were confident in using.

Auditing and quality assurances processes carried out by the registered manager and provider resulted in improvements being made to the service. The environment had been adapted to ensure it was suitable for people living with autism and further adaptations were planned.