Woodlea Supported Accommodation

Woodlea Supported Accommodation (Woodlea) is a supported living service. This service supports up to 15 people with enduring mental health needs. There were 14 people living at the service 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.

Woodlea is a large detached house in the Chorlton area of Greater Manchester. Woodlea is situated in a residential area, close to local shops and other amenities. People living at Woodlea have their own tenancies and receive varying degrees of support from the care provider on site. People living at Woodlea were not obliged to receive care and support from this service. Tenancy agreements stipulated that people were free to choose other care providers to provide care and support.

People's experience of using this service

Improvements had been made following the previous inspection in May 2019. Staff supported people to be more independent with activities of daily living, such as shopping, preparing drinks and doing laundry. People were treated as individuals. Support was delivered according to their needs and wishes, as outlined in support plans.

At our last inspection we recommended that further consideration should be given to providing engagement in social and leisure activities on a one to one basis out in the community for people. We saw on this inspection the recommendation had been met. People participated in a range of activities. The service had introduced new ways of working during the COVID-19 pandemic so that people were better supported and entertained at Woodlea.

People could raise a concern or make a complaint in various ways and the service produced easy read formats of leaflets to help with this. The registered manager and the staff team were committed to improving the quality of care and support for people living at Woodlea and looked for ways to improve on the service provided. We received positive feedback about the quality of care and support people received and the overall management of the service. People told us they were happy with their support and were treated with respect. Relatives were also complimentary of the service and its staff.

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 27 September 2019). At this inspection we found improvements had been made. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

We carried out an announced comprehensive inspection of this service in May 2019 and made a recommendation in relation to supporting people access meaningful activities. We undertook this focused inspection to check the service had improved. This report only covers our findings in relation to the key questions previously rated requires improvement; responsive and well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to 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 Woodlea Supported Accommodation on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Woodlea is a supported living service. This service supports up to 15 people with enduring mental health needs. There were 12 people living at the service at the time of the inspection.

Woodlea is a large detached house in the Chorlton area of Greater Manchester. Woodlea is situated in a residential area, close to local shops and other amenities. People living at Woodlea have their own tenancy and receive varying degrees of support from the care provider.

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

The number of staff available during the day were sufficient to meet people’s needs whilst they remained at Woodlea. Staffing levels were not adequate to offer support to people who wished to access the community or pursue other activities if they were not able to do this independently.

At night people had access to a waking night support worker if this was required. The provider operated a 24 hour on call facility in the event of an emergency.

Medicines were being managed safely. There was good detail contained within ‘as required’ (PRN) medicine protocols and in people's medicine files.

People told us they felt safe and well cared for at Woodlea. Staff knew people well and had developed close, caring relationships. Staff were aware of their responsibilities to safeguard people.

Recruitment practices were safe and staff received the training they required for their roles.

Communal areas of the accommodation were clean.

Risks to people’s health, safety and well-being associated with their care needs were assessed and management plans were in place to ensure risks were mitigated as much as possible.

People who were independent were able to access the community and engage in meaningful leisure and social activity. There were less opportunities for people who required support from staff to do this.

People in tenancies at Woodlea were not obliged to receive care and support from this service. The tenancy stipulated that people were free to choose other care providers to provide care and support.

Care plans reflected that care was being delivered within the framework of the Mental Capacity Act 2005 and the necessary applications for Deprivation of Liberty in a Domestic Setting (DiDs) had been made where appropriate.

Audits of the service were in place and were undertaken, although these were not always used effectively to improve the quality and safety of the service.

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 18 November 2016). Since this rating was awarded the registered provider of the service has changed the service. It was previously a residential care home but now offers supported living accommodation with elements of care and support from the provider were required. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the responsive and well led sections of this full report. We made a recommendation for the provider to better engage people in more meaningful social activities in the community.

The home met the characteristics of a rating of “Good” for 3 key questions and “Requires Improvement” for 2 key questions. Our overall rating for the home after this inspection was “Requires Improvement”.

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.

Woodlea Residential Care Home is a registered service providing accommodation and support to 15 adults with mental health needs. They are also registered to provide personal care to people living outside the home but at present are not offering this service. However, the registered provider anticipates that they will in the near future as they are in the process of refurbishing some flats they have purchased in order to create a supported living service. The philosophy of the service is to maximise the potential of each resident and to develop and maintain independence.

The registered manager and has been in this role for over four years. 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.

At the time of the inspection 15 people lived at the service and we met seven of the people who used the service. They told us that they were very happy with the service and found it met their needs.

Most of the people we met had lived at the service of a number of years and some had been there for 20 years. We found that the registered provider, registered manager and staff consistently ensured people were supported to lead an independent lifestyle. We found that most of the people did not require support with personal care and led independent lifestyles.

Three of the people we met needed assistance to manage their care needs and required a high level of emotional support when dealing with every aspect of day-to-day life. We saw that staff were very skilled at meeting people’s needs and reducing the distress they may experience. Staff could identify triggers that would suggest people’s mental health was deteriorating. We found that the staff’s extensive knowledge of people had enabled them to readily spot changes in people’s presentation and this had led to the staff taking prompt action to contact the person’s doctor and community psychiatric nurse.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

We saw that the care staff cooked the meals for people and encouraged them to eat a healthy diet. Some of the people were being supported to learn the skills to cook their own meals and complete the shopping.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Staff were aware of how to respect people’s privacy and dignity.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who had mental health disorders and the use of Mental Health Act 1983 (amended 2007).

Staff had also received training around the application of the Mental Capacity Act 2005. The staff we spoke with understood the requirements of this legislation. When people had capacity staff correctly did not complete capacity assessments or make best interest decisions but for those people who lacked capacity this was in place.

People and the staff we spoke with told us that there were enough staff on duty. We found that on the whole there were sufficient staff on duty to meet people’s needs. However, we discussed the impact three people’s need for constant reassurance was having. The registered provider agreed that these people would benefit from the ability to access personal assistants who could support them to use local community resources and become engaged in activities in the home. The registered provider discussed the steps they were taking to access this type of support.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the provider had an effective system in place for dealing with any complaints. We found that people felt confident that staff would respond and take action to support them.

We found that systems were in place to ensure the building was well-maintained. On the first day of our visit we noted that the extractor fan in the lounge was ineffective and pointed this out to the staff. When we visited on the second day this had been repaired and the registered manager had reviewed all the extractor fans and made sure, where necessary, these were cleaned and repaired.

Most people who used the service smoked. In light of this the home had received an exemption from the smoking regulations to provide a lounge where people could smoke. A second non-smoking lounge was provided and this was located in the basement. Although tastefully furnished and decorated we found it was not used and the three people who did not smoke sat in the dining room. Dining room seats were used in this area and we noted that for one person this was potentially exacerbating the swelling to their ankles. We discussed this with the registered provider who promptly obtained a reclining chair and also looked at how people could be encouraged to use the downstairs lounge.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the service.

The registered provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the provider had implemented these and used them to critically review the service.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

Is the service safe?

We saw people were being cared for in an environment which was safe and clean. Processes for the prevention and control of infection were in place. The numbers of items such as knives were checked twice daily. Visitors were asked to sign in and out.

The people we spoke with who used the service told us they felt safe. One person said 'They look after me well.'

We saw training records and certificates which showed staff had received training to enable them to meet the needs of the people who used the service. This meant the people who used the service were supported by staff who had the necessary skills and experience. We saw staff rotas which showed appropriate numbers of staff were on duty each shift.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. There were no authorisations restricting the freedom of anyone living at the home at the time we visited. Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one.

We saw quality assurance questionnaires had been circulated to professional visitors. One had commented 'Safeguarding issues have been dealt with appropriately.'

Is the service effective?

People's health, social and care needs were assessed with them and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly every six months and when people's needs changed.

From the training records we viewed we found staff had received training to enable them to meet the needs of the people who used the service. Discussion with staff and examination of records confirmed a programme of training was in place so all members of staff were kept up to date with current practice.

The people we spoke with told us they were happy with the care they received and said their needs were met. They spoke positively about the care they received and the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included 'I like living here' and 'The staff are very good.'

We saw the staff showed patience and gave encouragement when they were supporting people so people were able to do things at their own pace and were not rushed.

Is the service responsive?

People's needs had been assessed before they moved into the home. The records we saw confirmed people's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw documentary evidence that the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home's values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, satisfaction questionnaires had been completed by people who used the service and by professional visitors which showed people were satisfied with the service.

One person who used the service we spoke with told us 'I always have my medicines on time, the staff always supervise me and they sign the chart. I know what I am taking; the staff have gone through my file'.

We saw there were policies and procedures in place for example medications, adverse drug reactions, controlled drugs and sharps for staff to follow. The manager told us staff had read the policies.

We looked at two care files and saw evidence of people being involved in their care planning. We saw that decisions had been signed, dated and agreed by people who used the service.

We spoke with two people who used the service. They confirmed that they had been involved in the planning of their care with staff. One person told us 'I have seen my care file'. We were told by people that they were happy with their care. One person said 'I am happy, I can get up when I want, the staff are alright, they look after me'.

We observed staff completing the morning medication round. We noted that staff signed the entire MAR chart's after the medication round in the office. We asked the manager about this. We were told that this was not normal practice but a person who used the service had needed assistance from staff which had impacted on the MAR (Medication Administration Record) charts not being signed at the time of administration.

We spoke with three people who used the service. One person told us they were 'happy' in the home.

We saw evidence of a complaint and compliments policy in the home for staff to follow.

One person told us 'if a person made a complaint I would reassure them, inform the manager, speak to the relatives and I would document it'.

Additional provider visits by the owner, had been undertaken, which monitored the environment and a range of other quality indicators. Care manager questionnaires had been implemented. This meant that the provider had a more robust system in place to effectively monitor the service.