Archived: The Woodmill

The Woodmill provides specialist neurobehavioral assessment and rehabilitation services for people with disabilities resulting from acquired brain injury. The service can accommodate 19 people. At the time of the inspection there were seven people living at the home. Some people were being assessed as part of a planned rehabilitation programme, some people stay at the service for a period of time and then move into community housing with support. The service also offers longer term residential care for people with complex needs who are unable to live in a community-based setting. The service forms part of the nationwide network of rehabilitation support services provided by The Brain Injury Rehabilitation Trust (BIRT).

The service had not accepted any new referral for the past 18 months. The regional manager explained, “We are currently reviewing the delivery models across the organisation and reviewing overall fee structures, it would seem wrong to admit to the Woodmill at this time. Therefore we would like to advise that we are not currently progressing referrals at this point in time until we are clear on the outcomes of this work, but will accept referrals onto a waiting list for future assessment.”

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

The service continued to place a very strong emphasis on person centred care. People received care and support that in many cases was life changing for them. The staff team excelled at managing people’s complex needs, including distressed behaviours by using techniques that had a positive impact on people’s well-being. One person told us proudly of the progress they had made at the service. They added, “I am doing really well now.”

The service was not risk adverse but proactive in enabling people to have control over their lives and to receive care and support which was personal to them. People were supported to try new things, such as interesting and challenging social activities, and to develop their daily living skills and confidence.

Staff ensured people’s communication opportunities were maximised. Various communication methods were used to ensure people were fully included and able to express their wishes.

People’s needs were comprehensively assessed, and rehabilitation support plans and goals were highly personalised. People were supported by the staff team to be fully involved in making decisions about their care, support and goals. They felt involved and their wishes were listened to and respected. This had led to the people feeling motivated, empowered and in control of their support.

The service continued to operate an open and inclusive management style where people were supported to influence the running of the service. There were effective systems to continually monitor the quality of the service. Evidence based practice was embedded within the culture of the service. The provider continued to seek new and imaginative solutions to meet the needs of people with acquired brain injuries.

Staff were highly motivated, skilled and enthusiastic, ensuring people’s needs were met in a person-centred way, which benefitted their rehabilitation. People were treated with dignity and respect and staff promoted their independence and helped to increase their confidence.

The service was safe. People felt safe at the service and relatives and professional expressed their confidence in the staff team. There were enough staff to support people, including those who required one to one support. Staff recruitment processes ensured people were protected from unsuitable staff. Medicines were managed safely, and people received their medicines as prescribed. The environment was safe, clean and well maintained.

People’s dietary needs and preferences were met, and they received appropriate support at meal times. Health needs were monitored, and people had accesses to a range of health professionals.

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.

There was an appropriate procedure for dealing with complaints. People, relatives and professionals were confident any concerns would be listened to and acted upon.

Rating at last inspection The last rating for this service was Outstanding (published June 2017).

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.

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

At the last inspection in November 2014, the service was meeting all requirements and the service was rated Good overall. At this inspection we found the rating remain good overall but with an improved rating of outstanding for responsive and well-led. This unannounced inspection took place on 24 and 30 March 2017.

A registered manager was in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. We had received a notification informing us the registered manager was on secondment to another part of the provider organisation, developing a new service. At the time of the inspection a registered manager from the supported housing services was managing the service as the interim manager until their return.

The care and support planned and provided was exceptionally responsive, personalised and effective. People were at the centre of their care. Their needs were comprehensively assessed and rehabilitation support plans and goals were highly personalised and drawn up with the full involvement of each person together with their family, friends and/or advocates. A person using the service said, “I have really progressed here. My concentration has improved and my moods. This has been a good place for my recovery.” One professional said, “The service is person centred and compassionate. Everybody there is very skilled…It is a gift from heaven in terms of having a specialist assessment for my client…” People were supported to learn and develop daily living skills. Comments included, “This is a good place for my recovery…” and “I am enjoying my stay. It has helped with my confidence. I feel I am improving.” People were supported to take part in innovative and challenging social activities, which developed their confidence, skills and abilities.

The service had a positive atmosphere, and an open and inclusive culture had been developed. The service continued to operate an open and inclusive management style where people were supported to influence the running of the service. There were effective systems to continually monitor the quality of the service and there were on-going plans for improving the service people received. Evidence based practice was embedded within the culture of the service and the provider was committed to seeking new and imaginative solutions to meet the needs of people using the service. For example, a comprehensive neurobehavioural assessment was completed for each person prior to admission to determine their potential for social reintegration and increased independence. The service also supported people to regain skills and confidence leading to positive discharges to more independent living and work opportunities.

People were supported by caring staff. We saw many examples of positive and supportive care being delivered, with people having opportunities to develop new skills and positive supportive relationships. Staff were very caring, paying attention to people’s health, well-being, privacy, dignity and independence.

Staff were skilled at ensuring people were safe whilst encouraging them to fulfil their potential and

achieve as much independence as possible. Positive risk taking was supported, which enabled people to experience new and interesting activities. Systems were in place to ensure people were safe in respect of safeguarding incidents, staffing levels, safety of the premises, staff recruitment, the management of medicines and infection control.

People were protected by good practice in relation to decision making. The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS); ensuring people’s rights were protected. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible.

People were promptly referred to health care professionals when needed and health care professionals expressed their full confidence in the service, telling us people’s health needs were monitored and managed well. People enjoyed varied and nutritious meals and mealtime were sociable and relaxed occasions.

The Woodmill had a highly experienced and motivated staff team, consisting of care staff, enablers and therapy staff, such as psychologists, physiotherapists, occupational therapists (OT) and speech and language therapists (SALT). Staff received training, induction and supervision to ensure they understood people’s needs and were able to work effectively and safely. Staff said they were well supported to do their job.

People we spoke with said they enjoyed life at The Woodmill. Comments included ''The staff are really good here. Sometimes I go out for coffee and to the gym. I like living here.'' Another person told us ''The staff are all brilliant, I have no complaints except about some of the food sometimes.'' We also spoke with two visiting relatives who said ''First class here'' and ''I am really pleased with the way they care for my relative. They know what they are doing and it gives you peace of mind.''

We saw care and treatment was being well planned and this included making sure people were given choice and consented to their treatment and support. Staff provided care and support in a kind and respectful way, ensuring people were given opportunities to maximise their independence. Risks had been clearly identified and plans of action were put in place to minimise any risks. We saw this was a dynamic process with staff continually monitoring and reviewing risks and people's needs changed.

The service had a robust recruitment process which ensured only suitable people were employed to work with vulnerable people using the service.

Many people stay at the home for a period of time and then move into community housing with support. However, some people live at the home on a permanent basis.

Our visit was unannounced and we spent over seven hours at the home. During this time, we spent time in communal areas to help us make a judgment about the care and support people experienced. We met with some of the people living at The Woodmill. We also spoke with staff from a range of roles within The Woodmill.

We looked at some key records, including care assessments, risk assessments and care plans. We also looked to see how the service ensured that staff were competent to manage complaints and safeguarding issues.

All the outcomes areas that we inspected were compliant. We saw that people's dignity and respect was maintained, and their health and wellbeing was assessed and care provided in a way that suited their individual needs. Staff knew their duty to report safeguarding concerns. Staffing levels helped ensure that people's individual needs were met and the atmosphere was positive and welcoming. There was a complaints system in place and we saw that concerns and complaints were addressed promptly.