Woodview (Active Prospects)

Woodview (Active Prospects) is a care home for up to nine people with learning disabilities. It is arranged on one floor with individual bedrooms and shared living and dining areas.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support (RRS) and other best practice guidance. While the service was slightly larger than RRS suggests, supporting nine people, the arrangement of the home, and the way people were supported aligned with the values that underpin RRS. 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

People received highly personalised care from skilled staff who knew their individual needs and how to meet them. People were supported through a comprehensive assessment and transition period when they moved to Woodview which ensured they had positive experiences at the home.

Care plans were highly detailed and reflected people’s skills, abilities and communication styles. People’s independence was promoted. People’s goals were reviewed and monitored to help ensure people were being supported to their achieve personal outcomes.

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 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.

People were kept safe from avoidable harm and abuse by staff who were knowledgeable about safeguarding them from harm. Staff received the training and support they needed to perform their roles. People were involved in the recruitment of staff, and systems ensured only suitable staff were employed.

The leadership of the service was unique and distinctive. The registered manager inspired staff and people to achieve positive outcomes. The provider worked to ensure people, staff, relatives and the public were truly involved in the development of the service and for the wider benefit of people with learning disabilities.

The opportunities for people to be involved in developing and shaping the service were unique and distinctive. The provider recognised and valued the achievements of people and their staff.

The values and culture of the provider were embedded and shared across the organisation; they focussed on genuinely empowering people to take control over their lives.

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 January 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.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out a previous inspection of this service on 1 October 2014 where we found the service was meeting the requirements in the areas we looked at.

This inspection took place on 22 November 2016 and was unannounced. At the time of our inspection there were eight people living in Woodview. People had a range of needs, with some people living with complex epilepsy, autism, physical and learning disabilities. Seven people in the home required the use of a wheelchair.

In the months prior to our inspection a new manager had started at the home and had registered with the CQC. Since the registered manager had started they had made a number of improvements relating to increasing people’s involvement in their care.

Staff treated people with kindness and respect. During our inspection we saw positive and caring interactions between people and staff. We found staff had caring attitudes towards people and spoke highly of them, their personalities and qualities within their care plans. Staff spent time with people individually and knew people’s needs, preferences, likes and dislikes. Staff understood people’s preferred communication methods and used these to involve people in their care and support them to make choices.

People were protected from risks relating to their health, mobility, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

Staff knew how to recognise possible signs of abuse which also helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report concerns. Safeguarding information and contact numbers for the relevant bodies were accessible. Staff told us they felt comfortable raising concerns. Recruitment procedures were in place to ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were vulnerable. Staffing numbers at Woodview were sufficient to meet people’s needs and provide them with individual support and time to take part in their chosen activities.

Staff had the competencies and information they required in order to meet people’s needs. There was a new schedule in place to ensure staff had supervision and appraisal regularly. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

People were supported to have enough to eat and drink in ways that met their needs and preferences. People were supported to make choices about what they wanted to eat and encouraged to help prepare meals where they were able. Where people required specific foods or food textures, these were provided by staff who understood people’s needs.

There was open and effective management at Woodview. The registered manager led by example to ensure best practice was followed. People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were effective systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

We carried out this follow up inspection to check the provider had taken action to ensure people who used the service were receiving appropriate care from staff who felt supported. We also checked people's care plans and general records had been updated. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

As most of the people who lived at Woodview were unable to communicate verbally we were unable to obtain their views. However, we observed interaction between staff and people, spoke with staff and relatives, as well as the registered manager.

We found staff related to people in a kind and caring manner. We observed people being given choice and encouraged to be independent.

Staff told us they felt things had really improved over the last few months. Staff felt more supported and told us, 'We are made to feel part of a team now.'

The registered manager showed us all care plans had been updated and they were introducing a new way of staff recording daily interactions with people.

As part of our inspection we spoke with eleven staff (which included the manager and deputy manager), head office and one care professional. We also spoke with four relatives of people who lived in the house and reviewed the care plans. We were unable to speak at length with any of the people who used the service because of their complex needs, so we used observation to inform our judgements.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We noted that the provider had ensured that where people lacked capacity to give their consent a mental capacity assessment had been carried out. We also noted that 'best interest' meetings were held in relation to some of the restraints that had been put in place.

We saw that staff had received training in safeguarding vulnerable adults. All of the relatives we spoke with told us that they felt their family member was safe at Woodview. One relative told us, 'Yes, I feel they are safe.'

Is the service effective?

It was evident from our observations and from speaking to staff that they had a clear understanding of people's needs. The relatives we spoke with told us that they felt staff knew their family member well. One relative told us, 'They know my relative's needs better than I do.' However, we noted that staff did not always follow guidance that had been included in the care plans.

Is the service caring?

We saw that people were supported to do things, such as have their lunch or take part in an activity. One relative told us, 'The staff seem very caring and very nice.' However, we had some concerns that staff did not interact with people who used the service in a meaningful way.

Is the service responsive?

People who used the service had a keyworker who reviewed the needs of the person. The relatives that we spoke with told us they felt involved in these reviews. However, we saw when we looked at the care plans that they had not been reviewed as regularly as they should. We also found that information was missing.

Is the service well-led?

We saw that the provider carried out a stakeholder's satisfaction survey in order to gain the views from relatives with regards to the quality of the care and support the service provided.

We received mixed feedback from staff when we asked them if they felt supported. We heard that Woodview had a lot of staffing issues which, although being addressed by the manager, were causing some concerns by staff who worked there. Staff also told us that they did not feel supported by the provider.

One person recognised us from the previous inspection and greeted us by name, telling us they had been alright. They talked about different activities they were doing. They told us they could have a drink or a snack anytime they wanted and would tell a staff member if they wanted something different.

Another person showed us they had hurt themselves and were going to the doctor. When they returned they showed us that the injury had been treated properly.

We concluded that people's rights were not always upheld, as people's capacity to make decisions had not been assessed under the Mental Capacity Act and yet they were all being subjected to restrictions of liberty that had not been assessed as needed.

We reported that although people were offered food they like and had plenty of carbohydrates and calories, the provider should note that there was a lack of evidence of variety and nutrition, especially vegetables and fruit. At a future random inspection, where the menu could be slightly poorer due to its variation, without this additional information full compliance under this standard may not be able to be maintained.

We found that people were not always protected against the risks associated with unsafe or unsuitable premises, because staff were leaving cupboards open that contained hazardous items that were required to be kept locked, and this posed a risk to people.

We saw that people were protected against the risks of unsafe or inappropriate care and treatment because records could be located promptly when needed, were kept confidentially and securely, for appropriate period of time and then destroyed securely.

A person who lives at the home told us that the staff were nice and treated them well, and they liked the home and their rooms.

Another person told us they felt safe at the home and if they were worried about anyone they would tell a member of staff they named.

One person showed us activities they were involved in and another person showed us their room and how they had personalised it with items they liked to collect.

We found that comments and complaints that people made were responded to appropriately.