Housing 21 - Woodridge

Housing 21 – Woodridge is an extra care scheme that was providing personal care to 26 people at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People told us they were happy with the service, felt comfortable with staff and were kept safe. Comments included, “The staff are lovely, so I do feel relaxed and safe with them” and “I feel [family member] is totally safe and well looked after.”

The registered manager understood their responsibilities about safeguarding and had additional measures in place to ensure all incidents were reported. Risks were managed safely. The provider learned from accidents and incidents. Arrangements were in place for the safe administration of medicines. The provider maintained an appropriate recruitment policy and procedure, although staffing levels were consistent.

Assessments of people’s needs were carried out before they started receiving support. Staff continued to receive regular training and supervisions as well as annual appraisals. People were supported with their nutritional needs, where required, and to access a range of health care professionals in order to maintain their health. People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People felt staff treated them with dignity and respect. Staff promoted and maintained people’s independence by encouraging them to care for themselves, where possible. People were supported to access advocacy services.

Care plans were detailed and person-centred. People’s communication needs were detailed within care records and staff knew how to communicate with them effectively. People knew how to raise any concerns and the provider had an effective complaints procedure in place.

People, relatives and staff spoke highly of the management team and were complimentary about the service. An effective quality assurance process was in place. People and relatives were regularly consulted about the quality of the service through surveys. Staff were involved in the ongoing development and improvement of the service through regular meetings.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 November 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

This service is a domiciliary care agency. It provides personal care to older people living in their own flats within the Woodridge Gardens complex.

Not everyone living at Woodridge Gardens received the regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. On the days of our inspection there were 27 people receiving personal care at the service.

The service had a registered manager in place. A registered manager is a person who has registered with 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.

We last inspected the service in April 2016 and rated the service as ‘Good’. At this inspection we found some incidents of a safeguarding nature had not been appropriately reported to the local authority safeguarding team or notified to CQC. Outcomes of the incidents were not clearly recorded. The registered manager understood their responsibilities with regard to safeguarding however confirmed these incidents had not been appropriately reported. This is the first time the service has been rated Requires improvement.

The provider had a quality assurance and auditing process in place. However, audits had not identified the need to inform the local authority safeguarding team and CQC about these incidents of a safeguarding nature.

There were sufficient numbers of staff on duty 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 vetting checks when they employed staff. Staff were suitably trained and had received supervisions.

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

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

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

People who used the service and family members were complimentary about the standard of care at the service. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

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

People were protected from social isolation and the service had good links with the local community.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

Staff said they felt supported by the management team. People and staff were regularly consulted about the quality of the service.

We found a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which relates to safeguarding service users from abuse and improper treatment, and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Woodridge is registered to provide personal care to people living in their own flats within an extra care housing complex. There are 39 flats within the scheme and at the time of the inspection there were 25 people in receipt of a care service.

At the time of our inspection the service did not have a registered manager. However, the person managing the service had applied for registration. 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.

Staff had a good understanding of safeguarding and were confident in their role of safeguarding people. Any safeguarding concerns were investigated with the outcomes recorded and practices changed where necessary to prevent reoccurrences.

People had risk assessments in place and associated care plans. Some care plans lacked sufficient detail to inform staff how to provide support to people. The housing and care manager explained they were in the process of reviewing and updating all care plans with people to provide details of how care and support was to be provided. They also told us people's personal preferences including likes and dislikes would be included.

Medicines were managed safely with people receiving their medicines appropriately. Most records were complete and up to date. A small number of gaps had been identified during weekly audits. Those were investigated by senior care workers and appropriate action was taken.

Staff were recruited in a safe and consistent manner with all necessary checks carried out. Staffing requirements were assessed in line with peoples’ needs. From staffing rotas we saw staffing levels were consistent. Agency staff were not used at the service as staff worked together to cover holidays and sickness.

Staff had up to date training in areas such as moving and handling, safeguarding, health and safety and nutrition and wellbeing. Competency assessments were carried out in relation to specific areas, including the management of medicines. Regular direct observations were carried out in between supervision sessions. Staff received annual appraisals otherwise known as ‘Valuing Individual Performance’ (VIP).

People told us staff were "nice" and they were happy with the service they received. Staff talked to people in a friendly, respectful manner and supported people whilst maintaining their dignity. People were also encouraged to be as independent as possible.

People knew how to raise concerns and felt confident they could complain to the housing and care manager if they were not happy with the care they received. Records showed the service had received one complaint in the last 12 months which related to the grounds. We saw the complaint was investigated and the housing and care manager took appropriate action to resolve the issue.

The service communicated with people using a variety of methods such as tenant meetings and newsletters which the housing and care manager created and delivered to each person's flat. Newsletters contained information in relation to the service, staff, activities and any other significant information relevant to people.

The housing and care manager operated an open door policy. During the inspection we saw staff entering the manager's office to discuss various issues.

Staff met on a regular basis to discuss the service, any changes in service provision, people and potential developments. Staff completed recorded handover's twice a day to update staff who were starting their shift about any specific information about people including if people were unwell or any appointments required with health professionals.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary describes what we found and what people using the service, their relatives and the staff told us.

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

Is the service caring?

People said the care workers who supported them were 'kind and friendly'. We saw that care workers were aware of people's individual needs and preferences.

The people we spoke with said they were 'satisfied' with the care provided at the scheme. One person told us, 'They help me with my meals. I can manage most other things myself, but they are always very helpful.'

The comments from healthcare professionals and other visitors included,'staff are very caring' and 'staff's attitude towards people seems genuinely caring and warm'.

Discussions with people and the records we looked at showed that people had been involved in agreeing their care service. We found people's individual preferences for care and support had been taken into account.

Is the service responsive?

People were asked for their views on a regular basis. People told us they felt comfortable about discussing any issues or requests to change their care package.

People's care plans were individually designed around the times and support tasks that each person needed. People told us that they always received their planned visits. Some people commented that the service did not respond quickly to calls that were outside of their planned visit, for example if they were in the communal lounge. The service acknowledged that people may have to wait if staff were already on a planned call to another person using the service, but that all calls were responded to.

People and visitors told us they knew how to raise any issues. People said they would feel 'comfortable' about making any comments. One person told us, 'I would tell them in the office if I wasn't happy with something.'

Visiting healthcare professionals told us that the staff were responsive to people's changes in needs. One healthcare professional told us, 'My client's needs have increased so they changed the care package to support her with this. It means they provide more support so she can stay in her own flat.'

Is the service safe?

People told us they felt 'comfortable' with the agency staff and they felt 'safe' at this scheme. People were provided with clear, written information about how to raise any concerns or complaints.

Before anyone received a care service their needs were assessed by senior staff. The assessments included each person's care needs, their medication, moving and assisting needs, and the safety of their home environment. This meant any risks to people's safety were identified and assessed to ensure that appropriate care and support was provided to keep them safe.

The scheme made sure there was sufficient staff to carry out all the planned visits to meet people's needs. There were also contingency arrangements to cover any gaps or emergencies.

The provider and senior staff understood people's rights to make their own decisions, in line with the Mental Capacity Act 2005.

Is the service effective?

Each person had an individual care plan which set out their specific care needs. People told us they were included in agreements about their care. People had copies of their own care plans and assessments in their apartments.

A healthcare professional told us, 'The service always gets in touch straight away if there any changes in my client's needs. They always contact medical professionals if they are concerned about her health.'

Another healthcare professional commented, 'They look after my client really well. They support her to keep living an independent lifestyle even though she has very complex needs.'

Is the service well-led?

The scheme had a registered manager who managed the daily care service. The registered manager was leaving the week after this inspection visit and the provider wrote to us to tell us how senior managers would support the scheme until a new manager could be appointed.

The provider was a national organisation that had a system to assure the quality of the service it provided. A quality assurance manager visited the scheme to check whether it could be improved.

People and staff felt they were regularly involved and were consulted about the service. The scheme used monthly satisfaction questionnaires to get the views of people who used the service.

We looked at the medication administration records (called MARs) for six people who received support with their medication from the service. We saw that there were gaps and anomalies with medication records that had not been identified at the monthly checks of MARs records. For example, we saw one person had not received a prescribed medication for three dosage times and the medicine was still in their medication box.

People had many positive comments to make about the care they received. Their comments included, 'I get the support I need, and I do everything else myself' and 'staff are lovely and very kind.' A regular visitor to the scheme told us, 'It seems to be a good service. I visit a few people and they say the staff are very caring.'

The provider had a good system for managing the training needs of care staff. This meant staff received all the required training before they started work and there was refresher training provided when this was needed.

The provider had a clear system for checking the quality and safety of the service, and this included asking people for their views. Records were accurate and securely stored.