Woodbridge House

Woodbridge House is a residential care home providing personal care to nine people with learning disabilities and autistic people at the time of the inspection. The service can support up to 10 people in one adapted building.

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

There was a lack of effective risk management in the home to ensure people’s safety, especially in relation to people at risk of constipation and choking. There was a lack of risk management, training and support strategies for staff to support people when they expressed emotional distress.

Medicines were not always managed safely and there was a lack of protocols to provide guidance to staff for the use of ‘as required’ medicines. Incidents were not always recorded and effectively reviewed. Lessons were not always learnt to prevent an incident reoccurrence and reduce risk.

There were systems in place to protect people from abuse but not all staff showed a good understanding of safeguarding practices. There were enough staff in the service to meet people’s needs. Infection prevention and control was managed safely.

There was detailed assessment and planning of some care needs people have, such as epilepsy, but this was lacking in other areas, such as behaviour support planning. Staff completed an induction and training programme and received supervision, although feedback around the frequency of this was mixed. Staff worked with other agencies to ensure people’s healthcare needs were met.

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. Best interest decisions were not completed effectively.

People’s care was not always planned in a person-centred way as there were gaps in care planning for some needs. Staff knew people well and knew their likes and dislikes. Care plans contained information about people’s preferences.

People’s communication needs were known but these were not always consistently applied in practice. For example, the lack of use of picture menus. People were not always proactively supported to do activities they enjoyed and supported effectively to maintain contact with their relatives. People and relatives could raise any concerns they had but these were not always acted on. Where known people’s wishes around their end of life care were recorded.

The provider had not ensured effective management of the service. Quality checks and audits had not identified the concerns we found at inspection. People were at risk of poor outcomes from a lack of safe and effective person-centred care. The provider had not notified CQC of all significant events. The provider engaged with people, relatives and staff to seek feedback on the service, but this had not always been effective. The provider had failed to tell us about an incident which involved the police, which they are required to do by law.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The Model of care and setting did not maximise people’s choice, control and independence. The home was registered to support a maximum of 10 people. This is larger than the current best practise guidance. The provider had not been able to reduce the impact of this to people as people did not choose who they lived with, and not everyone in the service got on well together, there were some incompatibilities.

Right care:

• Care promoted people’s dignity, privacy and human rights but was not always person-centred. Staff encouraged people to make their own choices and maintain their independence. However, people did not always receive care and support that met their needs and was not therefore always person-centred.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people lead confident, inclusive and empowered lives. Feedback from relatives was not always acted on and people and relatives were not always involved with their care planning.

People received support from a caring staff team who promoted their independence and respected their privacy and dignity. People’s equality and diversity needs were assessed.

Following the inspection, the registered manager has taken action in relation to feedback from a relative.

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

Rating at last inspection

This service was registered with us on 21 September 2020 and this is the first inspection. The last rating for the service under the previous provider was Good, published on 28 March 2020.

Why we inspected

This was a planned inspection due to the length of time the home has not being inspected since the change of provider. The service had been under the new provider since September 2020.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

Since the inspection, the provider has taken action to mitigate the risks to people around constipation, choking and management of expressions of emotional distress.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in Safe in relation to the management of risk and the safe management of medicines, in Responsive, for the failure to act on a complaint; and in Well-led the lack of management oversight of these issues and the failure to maintain accurate and complete records for each person.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.