United Response - 60 Woodland Way

United Response – 60 Woodland Way is a residential ‘care home’ providing personal care and support to up to 6 people. The service provides support to people with a learning disability and autistic people. Some people were also living with dementia or had mental health care needs. At the time of our inspection there were 6 older people living at the care home. The care home accommodates people in 1 adapted building.

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

Relatives and community health and social care professionals spoke positively about the standard of care provided at United Response – 60 Woodland Way. A relative told us, “I know my [family member] is happy living here. They [staff] look after all the people living here extremely well.” A community social care professional added, “I would not hesitate to recommend this place to any mature person with a learning disability to live.”

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 Care Quality Commission (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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

People received a service that was safe for them to live in and for staff to work. The service quality was reviewed regularly, and appropriate changes made to improve people’s care and support if required. This was in a way that suited people best. The home had well-established working partnerships that promoted people’s participation and reduced the danger of social isolation.

Right Care

Staff were appropriately recruited and trained and there were enough of them to support people to live in a safe way, whilst enjoying their lives. Risks to people and staff were assessed, monitored and reviewed. Complaints, concerns, accidents, incidents and safeguarding issues were appropriately reported, investigated and recorded. Staff were trained staff to safely administer people’s medicines.

Right culture

The home’s culture was positive, open, and honest, with leadership and management that was clearly identifiable and transparent. Staff were aware of and followed the provider’s vision and values which were clearly defined. Staff knew their responsibilities, accountability and were happy to take responsibility and report any concerns they may have.

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 good (published 12 August 2017).

Why we inspected

We undertook this inspection to check whether the service was continuing to provide a good rated service to people.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for United Response – 60 Woodland Way at www.cqc.org.uk.

Follow up

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

We found the following examples of good practice.

The service was facilitating visits to people living at the care home in accordance with current government infection prevention and control (IPC) guidance. For example, the care home was now open to visitors providing they followed the provider’s strict COVID-19 guidelines. This included ensuring all community-based health and social care professionals visiting the service were fully vaccinated against the virus, unless they had an exemption.

Alternative arrangements had been put in place to help people who had been required to self-isolate in their room remain in contact with their family and friends. For example, people’s family and friends who were unable to visit the care home in-person were encouraged to remain in regular contact with them through the use of telephone and/or video calls. The service had also facilitated ‘window visits’, which enabled family members and friends to see and speak with their loved ones from the safety of the care home’s rear garden.

Staff wore their personal protective equipment (PPE) in accordance with current (IPC) guidance. The service had adequate supplies of PPE that met current demand and foreseen outbreaks.

Staff received ongoing in-house and externally sourced IPC and PPE training during the pandemic.

The registered manager demonstrated a good understanding of the principles of isolation, cohorting and zoning, and knew which external authorities to go to for advice when there had been a COVID-19 outbreak at the care home.

The service participated in a ‘whole home’ COVID-19 testing program. This ensured everyone living, working or visiting the care home were regularly tested for COVID-19. The provider knew how to apply for COVID-19 home testing kits and had adequate supplies. The service was also meeting current requirements to ensure non-exempt staff working in the care home were fully vaccinated against COVID-19.

The care home looked and smelt clean. There was a rolling cleaning program in place for staff who were expected to routinely clean high touch surfaces, such as light switches, grab rails and door handles, at least three times during the day.

The provider operated effective monitoring systems to check staff complied with best IPC practices and were fully vaccinated against COVID-19. For example, the registered manager routinely toured the premises to check staff continued to wear their PPE correctly and the care home was kept hygienically clean. Furthermore, following a recent audit of the care home by the local authority they were assured the service met good IPC guidelines.

The service had taken adequate measures to protect people living and working at the care home assessed as being at higher risk of catching COVID-19. The provider had put adequate measures in place to mitigate the risks associated with COVID-19 related staff pressures. The service currently had its full complement of care staff.

We were assured that this service met good infection prevention and control guidelines.

During this inspection we checked that the necessary improvements had been made to address the breach. In addition to this and at the previous inspection we found that the provider did not have arrangements in place to ensure people received information in an accessible format that they were able to understand. At this inspection we checked that improvements were made to address this recommendation.

60, Woodlands Way is a small care home which provides care and support for up to six people with learning disabilities. On the day of our inspection six people were living at this home.

At the time of the inspection, there was 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.

We found at this inspection the provider had made improvements to meet the breach identified at the previous inspection. People received support from staff who were appropriately trained and who received the necessary supervision and support to meet effectively people's needs. We saw staff were motivated in their work and were keen to improve their learning.

We also found at this inspection that the provider had developed information in an easy to read format that people could understand.

People also received care and support from staff who knew their needs and preferences well.

People were supported by staff who knew how to keep them safe. Risks to people's health and safety were assessed. There were good risk management plans in place. People were supported by appropriate numbers of staff. Robust staff recruitment procedures helped to keep people safe.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure people are only deprived of their liberty in a safe and correct way. There were policies in place in relation to this and appropriate applications were made by the provider to the local authorities. Staff supported people to make choices and decisions about their care wherever they had the capacity to do so.

People had varied and nutritious diets and choice of meals. They were supported to stay healthy by staff who were aware of people’s healthcare needs and through regular monitoring by healthcare professionals.

Relatives and professionals told us staff were consistently kind and caring and established positive relationships with people and their families. Staff valued people, treated them with respect and promoted their rights, choice and independence.

Comprehensive care plans were in place detailing how people wished to be supported. They had been produced jointly with relatives and where possible people using the service. Relatives told us they agreed the care plans and were fully involved in making decisions about their family member’s support.

People participated in a wide range of activities within the home and in the community and received the support they needed to help them to do this.

There was a complaints procedure in place and relatives felt confident to raise any concerns either with the staff or the registered manager if they needed to. The complaints procedure was available in different formats so that it was accessible to everyone.

We found there was an open and transparent culture in the home where staff were encouraged to share in the development of the home for the people living in it.

We found the provider had a system in place that sought feedback about the quality of the service from different people involved with the service. There were systems in place to use the feedback received to improve the service where necessary.

60, Woodlands Way is a small care home which provides care and support for up to six people with learning disabilities. At the time of this inspection there were five people living in this home.

There was a registered manager employed at the service. 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. The registered manager was on leave on the day of this inspection. We met with the deputy manager and the service manager.

Relatives of people said they felt staff were well trained. However, our findings showed that the provider had not ensured that refresher training for staff was regularly updated to ensure staff were fully up to date with good practice. Staff had also not received supervision according to the frequency identified in the provider’s policy on supervision to make sure staff were adequately supported in their day to day role. The manager agreed they needed to address these concerns.

This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we have told the provider to take at the back of this report.

All the relatives we spoke with told us staff who supported their family members were caring, polite and friendly. They told us staff respected people’s privacy and dignity and said staff listened to people. This helped people to feel they mattered. Relatives of people told us they advocated for their family members and were able to contribute to the care planning and decision process about how they wanted their care and support to be provided for people. All the care plans we looked at were personalised and contained information that assisted staff to provide care in a way that respected people’s wishes. We recommend that the provider review information provided to people, including information in their care plans, so this is provided in a more accessible format, for them to understand the information more easily and to be able to make informed decisions about their care and support.

People and their relatives told us they received safe care and support from staff who they said they were happy with. Staff received training to recognise the signs of, and to help protect people from abuse and they knew what actions to take if any concerns arose.

There were appropriate numbers of staff to support and care for the people living at 60, Woodlands Way. They knew all the people well and had a comprehensive knowledge and understanding of their personal needs, likes and dislikes. Staff recruitment processes were robust and this helped to ensure staff working in this home.

Risks for people and for staff were assessed and risk management plans were incorporated into care plans that were discussed and agreed with people and their relatives.

We found the home’s procedures for administering medicines to people were satisfactory. All the people needed assistance with their medicines and we found that staff were properly trained to do so.

The managers and staff had a good understanding of people’s capacity to make decisions about their care and documented this in people’s care files. People's care needs were recorded and reviewed regularly with staff and other relevant people such as relatives and social workers. All care plans we inspected included written consent to care. Staff had comprehensive information and guidance in care plans to deliver care the way people preferred.

Our inspection of people’s care files indicated they had regular and appropriate access to all the relevant health care professionals such as GPs and hospitals. Staff demonstrated taking care of people’s health was important.

The home had a complaints policy and procedure that relatives of people all knew about. They all told us that they had not needed to make a complaint as they were happy with the service offered to their family members. Relatives and staff said they felt confident they could raise concerns with the registered manager and staff. We reviewed the home’s complaints records and we saw the provider responded to concerns and complaints and learnt from the issues raised.

There were systems in place to monitor the care provided and people's views and opinions were sought regularly. Suggestions for change were listened to and actions taken to improve the service provided.

We considered our inspection findings to answer 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?

Was the service safe?

People who use the services were treated with respect and dignity by the staff. They told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. These assessments had been carried out for the three people whose files we looked at. Staff had been trained to understand when an application should be made and the process for submitting an application. This meant that people were safeguarded as required.

Recruitment practice was safe and thorough. The manager ensured there were sufficient staff on duty who were appropriately qualified to meet the care needs of people who used the service. This helped to ensure that people's needs were met.

Was the service effective?

People's health and care needs were assessed with them and their relatives or advocates and they were involved in their care and support planning. We inspected three people's care files. They included essential information about the person, needs and risk assessment information, service delivery plans, a 'my plan', records of health care appointments, a 'my health care booklet' as well as records of keyworker meetings.

Staff received training and supervision to ensure they were able to meet the specific needs of people using the service.

Was the service caring?

People who use the service were supported by kind and attentive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting the people using the services. The relatives of people we talked with said that staff treated people well and respected their privacy. One person said, "The staff are excellent, they work really well with XXX. They are gentle and helpful", and another person told us, "the staff at the home could not be better, they are caring and compassionate and they do their best with our relative'.

Relatives of people who use the service told us they were kept very well informed and they were able to discuss relevant issues and make decisions about care being provided. We saw from reading the minutes of meetings that meeting the wishes and preferences of people where appropriate was the main priority. This reflected the caring environment that we found on the day of the inspection.

Was the service responsive?

We found at this inspection that there were regular reviews of people's care that involved all the appropriate people. People told us that they were kept fully informed and one person said, 'If there was anything we needed to know we'd talk to the manager and they'd get back to us with an answer'. Another person told us, 'We attend regular reviews of their care and we find staff are very helpful and responsive'.

All the people we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and although no complaints had been made since the last inspection staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw that the service worked well with other agencies and services to make sure that people were supported in a co-ordinated way. It was clear that the main objective was to support people in relation to maintaining and developing their independence.

The views of people who use the service, their representatives and staff were listened to by the manager. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

Due to their needs, some people we met were unable to share direct views about their care. We therefore used a number of different methods to gather evidence of people's experiences. These included observing care practices; interactions with staff and reviewing records. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

During our inspection we met with all five people who use the service and observed how staff supported and cared for individuals. We saw that the deputy manager and staff respected people's privacy and dignity, and took account of what people expressed and said in relation to the way their care and support was provided.

People who were able to communicate with us said they were happy with the service and liked living at the home. We saw that people were supported to undertake a range of activities in the community and had varied and individual routines. For example during our inspection we observed two members of staff supporting people to venture out to local shops and cafes that they liked to visit.

People had consented to their care and treatment. Where people did not have the capacity to consent, decisions would be made in their best interest and with people's representatives fully involved. We observed that people using the service had choice and control over the support they received and were involved in making decisions about their daily lives.

People we met told us staff that worked at the home were always kind and caring, and listened to what they had to say. During our inspection we saw staff always treated people with respect and dignity. We read the comments the relatives of some of the people who use the service had written about the home, which were all positive. A relative wrote in one stakeholder satisfaction they had completed 'we have only the highest praise for our relatives carers'.

During our inspection we saw staff encouraged the people they supported to make informed choices about how they lived their lives. For example, people were always encouraged to choose the food they ate and the social activities they engaged in every day. We also saw people, so far as they were willing to do so, were appropriately supported to maintain their independence and encouraged to do as much for themselves as they could.