Woodham Grange

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Woodham Grange is a residential care home providing personal care to 8 people at the time of the inspection. The service is provided over 2 floors in a purpose built house.

Right Support:

Records relating to accidents and incidents, behaviour monitoring and risk assessments were lacking in oversight and detail. Handwritten medicine records also required improvement and we have made a recommendation about this. This meant people may be at risk of not receiving safe care. There was some damage to bedroom furniture within the home that may pose an infection control risk and other broken items left in the corridor. Infection control measures were in place in relation to staff duties and people were supported by staff to keep their home safe and clean. There were effective staff recruitment and selection processes in place. There were enough skilled and experienced staff who knew people well to safely meet people's needs, for example their communication needs.

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.

Right Care:

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse but records relating to risk, medicines and accidents and incidents required improvement. We also found that records relating to one person and their dietary intake were not as robust as they should be meaning they could be at risk of dehydration. The service needed to ensure recorded outcomes for people were more focused on aspirations for people and how the service demonstrated it provided meaningful choice. We saw menus only had one item and we observed people weren't asked if they wanted anything different prior to staff supporting them with eating their evening meal. The service worked well with other agencies to ensure people received ongoing health and social care support.

Right Culture:

Since the last inspection there was a new registered manager. They and staff were working to a development plan with a strong focus on improving the culture and positive outcomes for people. The service was working with two different recording systems that highlighted the gaps and inconsistency in records relating to safety. There was an action plan in place to address this and the registered manager stated they would prioritize this work. Many of the people and staff we spoke with told us they saw an improvement in the service and the culture. Relatives commented on the positive atmosphere and caring attitudes of staff.

Staff valued and acted upon people’s views but further work needed to be undertaken to show how the service was supporting people to achieve outcomes and to develop meaningful engagement and increase opportunities for people to have their say.

The service had strong links with health and social care partners and were active in the local community.

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 the service under the previous provider was good, (published on 14 February 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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.

Enforcement and Recommendations

We have identified a breach in relation to the governance of the service, risk management and record keeping.

We have made recommendations for the provider to review their records relating to medicines. We found no evidence during this inspection that people were at risk of harm from these concerns. The registered manager told us they would prioritise recording on one single system to ensure records were contemporaneous and accessible when needed.

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

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

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

Woodham Grange is a residential care home providing personal care to 8 people aged 18 and over at the time of the inspection. The service can support up to 8 people.

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

People felt safe and supported by staff who knew them extremely well. Risk assessments were in place. Staff had regard to people’s potential and aspirations rather than what may be difficult for them.

All relatives were confident in staff and their ability to keep people safe. Staffing levels were regularly reviewed and appropriate to people’s needs. The provider was recruiting new staff and a manager at the time of the inspection. In the meantime, agency staff were being used.

Incidents and accidents were documented and analysed to help identify any developing patterns. However, some accidents and their cause were not well recorded.

Staff worked well in conjunction with a range of external healthcare professionals.

Staff were well supported with a range of ongoing training, supervision and informal support.

People's needs were assessed and continually reviewed. Staff had a good understanding of people’s communication needs.

Activities were geared towards people’s interests and there was a strong person-centred culture. People’s rooms were pleasantly decorated to their tastes.

The provider had in place clear quality assurance and auditing processes. Some records required further detail.

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 20 July 2017).

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.

Woodham Grange provides care and accommodation for up to eight people with a learning disability. On the day of our inspection there were seven people using the service. The home had a spare room for people who stayed at Woodham Grange for respite care.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 previous registered manager had recently left the service. A new manager was in place who had applied to CQC to become registered.

We last inspected the service in 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

The provider had an infection prevention and control policy and procedure in place and an annual statement was produced outlining the service’s systems for the prevention and control of infection.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

Appropriate arrangements were in place for the safe administration and storage of medicines.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

Family members were generally complimentary about the standard of care at Woodham Grange.

Staff treated people with dignity and respect and helped to maintain people’s independence where possible. Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place.

Staff felt supported by the management team and were comfortable raising any concerns. The provider had appropriate auditing processes in place and people who used the service, family members and staff were regularly consulted about the quality of the service.

Some statutory notifications were submitted in a timely manner however six statutory notifications for DoLS authorisations had not been submitted to CQC. We are dealing with this matter outside the inspection process.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions, as mentioned above.

Below is a summary of what we found. The summary is based on our observations during the inspection, observing how people using the service were supported, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service had very complex physical and learning disability support needs. Not all were able to communicate verbally. However, we observed people to be comfortable in the presence of the staff team. We saw that staff used various and effective communication techniques to communicate with people. We saw and observed lots of positive interactions with staff and people who used the service.

We saw the provider had a rigorous training programme in place for staff. The staff training and observations helped to ensure people living in the home were appropriately supported and protected from harm.

People who lived in the home had regular assessments carried out and an annual review with their care managers. This ensured peoples care and support needs were current, effective, safe and protected their rights.

Is the service effective?

We saw people who used the service and other professionals were involved with the planning of their care and the level of assistance they wanted wherever possible.

People's care plans were individual and person centred, detailing individuals likes and dislikes, preferences and religious beliefs.

People who lived at the home were given access to specialist health care professionals including, occupational therapists , opticians, and physiotherapist's to help ensure their wider health needs were being met.

Is the service caring?

People who received help with personal care were treated kindly and with respect. People smiled a lot were seemed happy and relaxed with the care staff and we saw their preferences being taken into account. For example, what they wanted to do during the day, and where they wanted to go to on holiday. Two people had just returned from a week's holiday in Kielder Forrest. Others were planning a holiday to Blackpool.

Is the service responsive?

People who used the service, their family, friends and other professionals who worked with them were regularly asked for their views on the way the service was run. Responses to surveys were analysed and used to enable the manager to make changes to the service where needed.

Is the service well lead?

The staff working at the home told us they felt supported in their roles and were happy with the level of training they received. Staff were confident that any concerns or complaints they may have would be dealt with quickly, appropriately and in confidence.

Our inspection of June 2013 we found people's care plans did not fully reflect their current care needs. This was because some plans had not been completed or updated on a regular basis to keep people safe. Following this inspection we asked the provider to send us an action plan detailing how improvements would be made. The action plan we received told us there were procedures in place to review all people's care and support plans. Where possible, people who used the service and their representatives had been involved with the review, planning and decision making of their care and support needs.

During this inspection we looked at three people's care records in detail. We found people's health and care needs had been fully assessed. We saw specialist dietary, mobility and equipment needs had been identified in care plans when required. We found people's current care and support needs were reflected in their care plans and these were evaluated and updated each month or more frequently where necessary.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people.

The home was in the process of recruiting a registered manager at the time of the inspection and was temporarily filling the post with senior staff at the home.

We found the home to be clean and tidy and the people living there appeared happy and content.

People living at Woodham Grange had their own way to communicate, which staff had recorded on care records; for example facial expressions, or gestures. At lunch time we saw staff supporting people using these techniques and also helping people to remain as independent as possible.

We found that staff were using older care records and some risk assessments had not been reviewed for over a year.

We spoke to two relatives at the visit and one relative said, 'I cannot find a fault, staff are good'. They also said, 'They are regularly taken out on the bus and have a better social life than me'. 'They' meaning the person living in the home.

We found appropriate arrangements in place to manage people's medicines.

We looked at staff records at the home and found that staff were suitably qualified, skilled and experienced to be able to care and support people living at Woodham Grange.

We found complaints procedures in place at the home and when we asked relatives if they knew how to complain they said, 'I would speak to the manager or Durham county council'.

Pre admission assessments were carried out for all prospective people who were considering using the service. On the day of our inspection the home had one vacancy.

Health and personal care plans seen were recorded to a good standard and health care records were fully completed.

Staff were observed to have respect for people's privacy.

We saw there were a range of activities organised by staff, including regular trips out of the home and indoor activities.

The home had a detailed adult protection procedure. Systems were in place for the reporting concerns and abuse.

The home was well maintained. Some areas of the home had recently been redecorated and a maintenance plan was in operation.

The area manager and a director of the company told us a minimum of four staff would continue to be in place across the day.

A staff training plan was in place, which identified how staff would be trained to the required levels. Staff received formal supervision sessions and an annual appraisal.

Health and Safety systems were in place and the manager said all the equipment including alarm systems and nurse call systems had been checked by approved contractors.