Royal Mencap Society - Woodlands Residential Home Also known as Woodlands Residental Home

Woodlands residential care home is a service for people with a learning disability. The home can accommodate up to eight people and provides residential not nursing care. The house is a spacious bungalow with single, ground floor accommodation close to the amenities in Thetford. At the time of our inspection there were six people using the service.

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

The service was rated requires improvement at the last comprehensive inspection and there have been a number of changes to the manager in charge. This has potentially had an impact on people using the service in terms of continuity of their care and support. The previous registered manager had recently left, and a newly appointed manager had not stayed. The provider had responded by bringing a manager and assistant manager over from another registered scheme. They had been in post for several weeks and the manager was applying for registration with CQC. We remained concerned when we were told their posts were initially for six months until a new manager could be recruited which meant further changes for the service.

Most people had limited verbal communication and benefited from clear routines and being supported by staff who knew their needs well. The service had retained a number of regular staff but have also had staff leave or planning to leave soon. Some of these staff had agreed to continue as bank staff. Agency staff were used to fill staffing voids, and most were longstanding. Staffing levels were appropriately maintained for people’s needs but the service had not had long term stability.

People using the service had a range of different and complex needs which staff were managing well with the appropriate support from other health care professionals. Some concern was expressed however that staff did not always follow support and guidance given to them specifically in relation to autism, positive behaviour and communication.

Staff were confident in the training they received which they said was needs specific, but some staff said they had not had role specific training. For example, where they had responsibility for staff supervision and other senior duties. It was the view of other professionals that not all staff had sufficient understanding of autism and sensory processing which could impact on people’s experiences of the service.

Care plans including a one- page profile, a clear health section and hospital passport. Health information was descriptive, and risks were identified and reduced whenever possible.

People were protected as far as reasonably possible from abuse because staff understood safeguarding and actions they should take to protect people. We found however there had been a number of incidents at the service which had impacted on people’s safety particularly as people were not mobile and could not move out of the way. The service was addressing this.

Most people had one to one funding and took part in sufficient levels of activity which were planned. Due to the nature of people’s disability and staffing levels some activities took careful planning and could only take place when there were enough drivers and enough staff to provide the right level of support.

People lived in an environment which was appropriate to their needs and was relaxed and stimulating. Bedrooms were personalised, and equipment was supplied around people’s needs.

Staff were observed to be patient and upbeat and supported people appropriately with their needs. Staff felt well supported and acknowledged that the service was improving.

There had been lots of audits to help determine the quality of the service and improvements necessary. Clear action plans were in place and there was good communication with families and health care professionals to help ensure people’s needs were met as fully as possible.

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 requires improvement (published 14 July 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. This was also in response to an inspection by the Local Authority who also identified improvements were needed.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements in the key question well Led.

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

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we noted that further improvements were required.

Royal Mencap Society – Woodlands Residential Home is a residential care home that provides accommodation, care and support for up to eight young people living with a learning disability. There were eight people living at the home at the time of this inspection.

The home consisted of one large detached Bungalow. Each person had their own personalised bedroom with en-suite facilities, In addition to its eight bedrooms; the spacious property has two bathrooms, kitchen, lounge, dining room, conservatory and laundry room. The manager’s office is located within the bungalow. The home is conveniently located about fifteen minute walk to the town.

There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager had made an application to register with CQC.

There were policies and procedures in place to protect people from the risk of infections. However, there were no cleaning schedules to ensure infection control was maintained.

People had access to the community and were supported with activities. However, we found that more involvement was required to ensure people's interest and goals were supported

When care plans were updated with changes to people's support needs old documentation had not been removed.

People`s medicines were managed safely by staff who had their competencies assessed.

People felt safe living in the home and staff received appropriate training in how to keep people safe.

Staff received training and appropriate support from the managers to carry out their roles effectively.

There were enough staff employed through robust recruitment procedures to meet people`s needs effectively.

People and families where appropriate were involved in the development and review of their care and support,

People were involved in daily tasks around the home like cleaning, laundry, cooking and baking. Staff supported people to access the community.

We observed people enjoying their food and staff offered people choices.

People and staff were positive about the management of the service. There were systems in place to ensure the quality of the service was monitored and improved where required.

Royal Mencap Society - Woodlands Residential Home provides accommodation and personal care for up to eight people with a learning disability who may also have a physical disability. Each person has their own room and all of the facilities are on one level. At the time of our inspection there were eight people living in the home.

At our last inspection in January 2016, the service was in breach of two of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The use of listening devices in people's bedrooms, broadcasted to communal areas, compromised people's privacy and dignity. The principles of the Mental Capacity Act 2005 were not being followed in relation to seeking consent. After that inspection, the registered persons sent us an action plan explaining what they would do to improve. At this inspection, we found that they had taken the necessary action to comply with these regulations and were no longer in breach.

People's capacity to make specific decisions about their care and treatment was assessed properly and, if they were not able to make the decision, their best interests were taken into account. In relation to listening devices, there was better assessment of people's awareness of risks associated with epilepsy and work with a professional to consider essential aspects of people's safety. They were only used for short periods when they were essential and receivers were not used within communal areas. The service was looking at further developments in technology to see if there were alternatives that would further improve the way people were supported.

There was a registered manager 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We noted that, during the course of 2016, the registered manager for this home was seconded elsewhere to another of the provider's services. Another manager was allocated to oversee the service but not registered in respect of it. When the registered manager returned to the home, the deputy manager was seconded elsewhere, again to oversee another of the provider's services. This meant that management of the service had not been entirely consistent. Staff were looking forward to a period of more stability and continuity following the registered manager's return to the service, together with the assistant service manager.

Most systems for monitoring the quality and safety of the service were working well. However, monitoring systems associated with the management of medicines had not been sustained during 2016. Processes for monitoring the management of medicines were not robust enough. Thorough checks were not made regularly to ensure that concerns about medicines were identified and followed up promptly. The provider's quality assurance processes had not addressed this issue to ensure improvements were made.

We found that medicines were not always managed safely and in a way that ensured people received them in the way the prescriber intended. Creams or lotions for external use were not always used as their prescriptions showed they should be. These products were not always dated when they were opened so that staff could be sure they remained free from contamination, safe and effective to use.

There were enough staff who were competent to support people safely and robust recruitment processes contributed to protecting people from the risk of harm or abuse from staff who were not suitable to work in care. Staff understood their responsibilities to report if they had any concerns that people were at risk of harm or abuse and how to go about this. They also understood the risks to which people were exposed in their daily lives and had guidance about promoting each person's safety.

People had access to enough food and drink. Where there were concerns about this aspect of people's welfare, staff followed them up. They also ensured that they sought advice from health professionals to help promote people's health and wellbeing.

Staff had developed warm and caring relationships with people living in the home and treated people with respect for their dignity and privacy. They understood how people communicated and the things that they liked to do so they could support people to live full lives. Staff spoke with enthusiasm about their work and their commitment to the people living at Woodlands.

Most people needed support from either staff or their relatives to raise concerns or complaints. Relatives were confident that the management team would listen to any issues they did raise and take action to make improvements where these were needed. People's relatives and staff were confident in how they were able to express their views about the way the service was running. They valued the approachability of the management team.

You can see what action we told the provider to take at the back of the full version of the report.

Royal Mencap Society Woodlands Residential Home is registered to provide accommodation and personal care for up to eight people who are living with learning and physical disabilities. At the time of our inspection there were eight people living at the home.

There was a registered manager in place. 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 an understanding of abuse and safeguarding procedures. They were aware of how to report abuse as well as an awareness of how to report safeguarding concerns outside of the service. Staff undertook safeguarding training providing them with knowledge to protect people from the risk of harm.

The provider had a robust recruitment procedure in place. People were supported by staff who had only been employed after the provider had carried out checks. Staff were well trained and supported by the registered manager. There were sufficient numbers of staff to meet people’s needs safely.

Risks were identified through a range of comprehensive individual risk assessments to help keep people safe. Care plans were up to date, person centred and detailed in order that staff could support people in the way that they liked to be supported.

People’s health, care and nutritional needs were effectively met. People were provided with a varied and balanced diet. Staff referred people appropriately to healthcare professionals in a timely manner when their support needs indicated that additional input was required.

The Care Quality Commission is required to monitor the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had some knowledge of the MCA and DoLS. The principles of the MCA had not always been followed when decisions had been made on behalf of people who could not make them for themselves.

The registered manager demonstrated good leadership and was very knowledgeable about the people being supported at the service. Effective systems were in place to monitor the quality and safety of the care provided to people, action plans were in place where necessary. Staff were well supported by the registered manager.

We found the home was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations and decision making. We saw that people were offered daily activities that stimulated and interested them.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

Relatives told us that people living in the home received the care and support they needed and that staff were excellent.

Medication was administered and recorded accurately. We found that the room that the medication was stored in was too hot and that there was a risk that medication was not stored safely. We saw that the provider was taking action to correct this situation.

Adequate numbers of staff members were provided to ensure that the care and support needs of each person were met.

Relatives told us that they had no complaints and that their wishes were listened to and adhered to. We found that there was a complaints system in place that met the needs of people living in and visiting the home.