Background to this inspection
Updated
31 July 2019
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 Care Act 2014.
Inspection team
The Inspection team included one 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
Woodlands residential home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. An acting manager was in post and had applied to CQC to be registered.
Notice of inspection
This inspection was unannounced. The Inspection activity started on 11 July 2019 and ended on the same day.
What we did before the inspection
We used the information already known about the provider which included previous inspection reports, reports from other regulatory bodies and the providers action plans. We reviewed notifications which are important events the service are required to tell us about. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support and plan our inspections.
During the inspection
We carried out observations of the care and support people received. People were not able to verbalise their experiences, so we relied on observations to tell us if people received good outcomes of care. We spoke with a wide range of staff including the acting manager, the two assistant managers, one of whom was temporary, a member of agency staff and a permanent member of staff. We spoke with the quality coordinator, manager, area manager and the regional operations manager. We spoke with three relatives over the telephone.
We reviewed a range of records. This included two people’s care records, medication records and audits. We looked at two staff files in relation to recruitment and staff supervision. We reviewed a variety of records relating to the management of the service, including policies and procedures.
After the inspection
We requested some additional information, specifically audits which were received in a timely way. We also contacted a number of health care professionals by email and telephone and had six responses at the time of writing the report. We also spoke with one other relative.
Updated
31 July 2019
About the service
Woodlands residential care home is a service for people with a learning disability. The home can accommodate up to eight people and provides residential not nursing care. The house is a spacious bungalow with single, ground floor accommodation close to the amenities in Thetford. At the time of our inspection there were six people using the service.
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 and what we found
The service was rated requires improvement at the last comprehensive inspection and there have been a number of changes to the manager in charge. This has potentially had an impact on people using the service in terms of continuity of their care and support. The previous registered manager had recently left, and a newly appointed manager had not stayed. The provider had responded by bringing a manager and assistant manager over from another registered scheme. They had been in post for several weeks and the manager was applying for registration with CQC. We remained concerned when we were told their posts were initially for six months until a new manager could be recruited which meant further changes for the service.
Most people had limited verbal communication and benefited from clear routines and being supported by staff who knew their needs well. The service had retained a number of regular staff but have also had staff leave or planning to leave soon. Some of these staff had agreed to continue as bank staff. Agency staff were used to fill staffing voids, and most were longstanding. Staffing levels were appropriately maintained for people’s needs but the service had not had long term stability.
People using the service had a range of different and complex needs which staff were managing well with the appropriate support from other health care professionals. Some concern was expressed however that staff did not always follow support and guidance given to them specifically in relation to autism, positive behaviour and communication.
Staff were confident in the training they received which they said was needs specific, but some staff said they had not had role specific training. For example, where they had responsibility for staff supervision and other senior duties. It was the view of other professionals that not all staff had sufficient understanding of autism and sensory processing which could impact on people’s experiences of the service.
Care plans including a one- page profile, a clear health section and hospital passport. Health information was descriptive, and risks were identified and reduced whenever possible.
People were protected as far as reasonably possible from abuse because staff understood safeguarding and actions they should take to protect people. We found however there had been a number of incidents at the service which had impacted on people’s safety particularly as people were not mobile and could not move out of the way. The service was addressing this.
Most people had one to one funding and took part in sufficient levels of activity which were planned. Due to the nature of people’s disability and staffing levels some activities took careful planning and could only take place when there were enough drivers and enough staff to provide the right level of support.
People lived in an environment which was appropriate to their needs and was relaxed and stimulating. Bedrooms were personalised, and equipment was supplied around people’s needs.
Staff were observed to be patient and upbeat and supported people appropriately with their needs. Staff felt well supported and acknowledged that the service was improving.
There had been lots of audits to help determine the quality of the service and improvements necessary. Clear action plans were in place and there was good communication with families and health care professionals to help ensure people’s needs were met as fully as possible.
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.
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 14 July 2018).
The provider completed an action plan after the last inspection to show what they would do and by when to improve. This was also in response to an inspection by the Local Authority who also identified improvements were needed.
Why we inspected
This was a planned inspection based on the previous rating.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements in the key question well Led.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodlands residential home on our website at www.cqc.org.uk.