Redwood House

We found the following examples of good practice.

Staff were checking people’s temperatures daily to see if people had COVID-19 symptoms. The registered manager made sure staff had daily COVID-19 tests. Staff promoted social distancing when possible and amongst themselves.

Staff wore personal protective equipment (PPE) correctly. The registered manager completed a weekly PPE stock check to ensure they had enough for the staff and people in the home. The staff had received face to face training on PPE and infection prevention and control (IPC).

People were supported to go out and to also see their relatives in a safe way.

The home looked clean and there were no malodours. There was enough staff who supported people in a calm and kind way. The registered manager completed regular checks to promote good IPC practices by staff.

People’s experience of living at this home:

People told us that they liked living at Redwood House and liked some of the staff who supported them. One person talked about wishing their bedroom looked better. Another person said they were bored at weekends. Other people spoke positively about going out with staff and told us what they did. People and their relatives spoke positively about the registered manager.

Not everyone had a robust risk assessment and care plan for staff to follow in order to meet their needs and understand the risks which they faced.

Accidents and incidents were not always reviewed to ensure action had been taken to mitigate further risks. A person had had an accident and hurt themselves but a safe process had not been followed with accompanying records to ensure they were safe. No review of this incident had taken place.

People were supported to access health care services and attend routine appointments when they needed this support. Plans were put in place when the registered manager had identified when a person may not be well and in need of some input from a health professional. Although people received their medicines as the GP prescribed some safe processes were not always followed to promote people’s safety in this area.

People had enough to eat and drink, but they were not being fully involved in the planning of meals. People were not offered drinks and snacks during the day. Healthy options were not promoted or offered to people. A person’s cultural diet needs were not always being promoted and followed by staff.

The people at the home told us about the healthy activities they participated in. These included going to the gym to support their aims of being a healthy weight. However, some people’s plans relating to this lacked information, and healthy lifestyles were not encouraged when people were in the home.

People and staff worked out goals for the year but these were not developed further. There was no meaningful review of these and plans were not always made to try and achieve them. People spoke about their interests but there were limited attempts or plans made to help people explore these interests. Staff were not aware of what was available locally to inspire or fulfil people’s interests. People’s records lacked detail about these interests.

The staff were polite but task focused. They did not spend time chatting or engaging with people.

Although the home was clean it looked tired and uncared for. Basic maintenance and up keep was not taking place. The provider was not promoting the service as people’s own home. There was limited stimulation and accessible information in the home and in people’s rooms.

The registered manager and provider’s audits were not always effective at identifying short falls, enabling lessons to be learnt and improvements to be made. There was a lack of insight and a poor culture of promoting people’s rights and giving them the best of opportunities.

The home had not been fully developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy. Further work was needed to fully meet these values.

As a result of these findings we concluded that the service needed to make improvements and it has been rated as Requires Improvement overall with breaches of the Health and Social Care Act 2008.

Rating at last inspection: This home was rated Good overall in March 2016.

Why we inspected: This was a scheduled inspection based on a previous rating.

Follow up: We have requested an action plan from the provider which we will review. We will return to the home to check improvements have been made and sustained.

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

Redwood House provides accommodation and support to up to seven people with a learning disability. At the time of the inspection there were six people living at the home.

The service has 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.

People were happy living at the home. They were treated with compassion, respect and dignity. The service had a 'Dignity Champion'. People were encouraged to maintain their independence as far as was possible. People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from risk of possible harm.

Medicines were administered safely and people were supported to access other healthcare professionals to maintain their health and well-being. People were assisted to maintain their interests, hobbies and religions. They were aware of the provider’s complaints system and information about this and other aspects of the service was available in an easy read format. Staff were always available if people wished to raise concerns informally. People were encouraged to contribute to the development of the service and to develop links with the local community.

The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely. Staff had received regular supervision and had been effectively trained to meet people’s individual needs. They understood and complied with the requirements of the Mental Capacity Act 2005 (MCA). They were caring and promoted people’s privacy and dignity. Staff were encouraged to contribute to the development of the service, aware of their roles and responsibilities and understood the provider’s visions and values.

The provider had quality monitoring processes in place and these had been used effectively to drive continuous improvements. People had no concerns about how care was provided or how the service was managed. There was good communication between the manager and staff, and this meant that they were able to deal quickly with any issues that arose.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

People had been cared for in an environment that was safe because the home had been well maintained. There were enough well trained staff to meet the needs of people who lived at the home. People's care plans reflected their individual needs and risks and they were regularly reviewed. The staff had daily hand overs to ensure good safe care.

Is the service effective?

From observations and from speaking with staff, they demonstrated that they had a good understanding of people's care and support needs. One person who used the service said, 'I am happy.' We saw care plans that supported people's needs, for example we saw one person with complex needs and spoke with a professional who was visiting the home to support them. They said, 'Because of the support from the provider and the service user's family, we were able to get extra funding. This meant extra hours to support the service user's needs. This has made a big difference to [the person].'

Is the service caring?

People were supported by kind attentive staff who were caring. We saw that staff provided appropriate levels of care and support in a kind, patient and respectful way. Staff we spoke with told us, 'It is about giving choice and respecting people's wishes.' Another told us, 'On a daily basis we ask people if they need our support and respect people's decisions.'

Is the service responsive?

All people had pre-assessments to ensure the home could meet their needs. Care plans were regularly reviewed and people's needs were assessed and documented, all care plans we saw had a named key worker. There were lots of activities for people and support from staff.

Is the service well led?

Staff had a good understanding of their roles within the home and quality assurance processes were in place, for example risk management was documented in peoples care plans.

Staff were well led by their manager, this included daily hand overs, training, supervision and support. Staff we spoke with confirmed they felt supported and understood their role.

You can see our judgements on the front page of this report.

People appeared calm and relaxed in the home environment and with the intervention they were offered by staff. One person said, "I like it here.' We found that staff were respectful in their approach to people and treated them with dignity and respect.

We reviewed three care records to establish whether the provider engaged effectively with other professionals to ensure that people's full care needs were met.

During the inspection, we also reviewed the medication systems in place to ensure that the storage and administration was safe and appropriate.

We inspected the premises to check they were safe and appropriate for the people living at Redwood House. We also looked at the training records for the home and observed that staff training was generally up to date which ensured that staff had the appropriate skills and knowledge to provide care for the people they supported.

We observed the quality assurance processes within the home and noted that there were appropriate systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met. There was a relaxed atmosphere in the home, and staff were friendly and polite in their approach and interacted confidently with people.

We noted that people were encouraged to express their views and were involved in planning their care and making decisions about their support and how they spent their time. One person told us "The thing I enjoy most is going out with my friend who is a volunteer". They also talked about the range of activities and entertainment that was available to them.

Within the care files we saw that care documentation had been signed by the individual to confirm their involvement and agreement with their particular care needs. Some people also took an active role in writing daily diaries about their experiences.