Archived: Woodlands Cottage

Woodlands Cottage is a residential care home providing personal care for up to four people who have learning or physical disabilities. There were two people living at the service at the time of our inspection.

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

At the previous inspection we made a recommendation to the provider around improvements to the infection and prevention control processes. At this inspection we found processes had improved and staff were following correct procedures for the use of PPE when caring for people.

People received safe care. There were systems in place to safeguard people from harm or abuse. Risk assessments were in place to support people during their care. Staff had received training on safeguarding matters.

There were arrangements in place to ensure people received their medicines safely and when required. Staff undertook training in the safe management of medicines and regularly had their competencies assessed.

The service followed safe recruitment practices. Staffing numbers were not always in line with identified care needs. Some people needed two staff to support them at times. This left the home short to support or observe other people at the home. We spoke with the Area Manager about this. We have made a recommendation the provider review staff and cover arrangements at the home.

Records were up to date but were spread across several different files. We found it difficult to find certain documents or cross reference information because of the system. The Area Manager was looking to address this matter. Quality assurance systems were in place to monitor the quality of care and support people received. The service worked in partnership with other health and social care professionals to meet people's needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. People were supported, as far as possible to make decision about their care or had access to independent advocates. Staff had a good understanding of the support people needed and how they could assist people to live the best lives possible.

Right support:

• Model of care and setting maximises people’s choice, control and

independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human

rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people

using services lead confident, inclusive and empowered lives

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 23 March 2021).

Why we inspected

We received concerns in relation to the safeguarding of people living in the home. We also followed up on previous concerns relating to infection control at the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We have found the provider has taken the necessary steps to improve.

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.

Woodlands Cottage is a residential care home providing personal care to up to four people who have learning and physical disabilities. There were three people living at the service at the time of our inspection.

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

We reviewed the provider's infection and prevention control processes and found, whilst there were protocols and procedures in place, further action was required to ensure the risk of the spread of infection was being managed robustly.

We have recommended the provider ensures the systems for the management of infection prevention and control are embedded in the service to ensure correct practices are followed.

People received safe care. There were systems in place to safeguard people from harm or abuse. Risk assessments were in place to support people to be as independent as possible. Staff were aware of their responsibility to keep people safe and were confident that any concerns raised would be acted upon by the manager.

There were arrangements in place to ensure people received their medicines safely and when required. Staff undertook training in the safe management of medicines and regularly had their competencies assessed to ensure they were following the correct practices.

There were enough staff to meet people’s care needs. The service followed safe recruitment practices.

Quality assurance systems were in place to monitor the quality of care and support people received. When people had accidents or incidents these were recorded, and actions taken to minimise the risk of reoccurrence.

The service worked in partnership with other health and social care professionals to meet people’s needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Care provided was person centred, focusing on people’s wants and wishes. People were supported, where they were able, to make choices about their daily living including activities they wished to take part in.

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 30 October 2018).

Why we inspected

We received concerns in relation to the safeguarding of people living in the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe section of this full report.

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.

Woodlands Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide support for up to four people in a purpose built bungalow. Residential care is provided for people with a learning disability or physical disability. Nursing care is not provided at the home. On both days of the inspection there were four people using the service.

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. Registering the Right Support CQC.

Risks within the service were recorded, monitored and reviewed. The provider had a safeguarding policy in place and any issues had been dealt with appropriately.

Sufficient staff were employed to support people’s personal care needs. Staff told us they worked as a team and supported one another. Appropriate recruitment systems continued to be operated.

Medicines in the service continued to be managed and monitored appropriately. Staff had received training on the safe handling of medicines. The service was maintained in a clean and tidy manner.

People’s needs were assessed and care delivered in line with these needs. Staff had undertaken a range of training and had sufficient skills and experience to support people with individual care. People were supported with a healthy diet and specialist requirements were supported and catered for.

The service was working within the requirements of the Mental Capacity Act 2005. People were supported to make personal choices, wherever possible. Family members were involved in decisions as much as practical. The environment was homely, warm and welcoming. People’s rooms were personalised.

People appeared exceptionally happy and relaxed in staff company and we noted good relationships between staff and people who used the service. Relatives we spoke with praised the care highly and told us it was planned around the needs of their relatives. Staff were committed to ensuring people they supported received good quality and personal support. They had detailed knowledge about people’s backgrounds, personal likes and dislikes and individual care needs. People were supported to make day to day decisions about their care, if at all possible.

People’s privacy and dignity were respected. Staff spoke knowledgably about how they promoted and encouraged people’s independence.

People’s care records contained information that supported staff to deliver person centred care that met the individual’s needs. Care was reviewed and families were involved in care reviews, where appropriate. People were supported to access a range of events and activities, both within the service and outside, including holidays. There had been no recent formal complaints about the service.

Families and staff spoke highly of the registered manager who they felt had the needs of people who used the service as her driving force. Staff said the registered manager was approachable and offered good support and knowledge. Staff told us there was a strong and stable staff team at the service.

Regular audits and checks were in place to monitor the quality of the service. Records were well maintained and up to date. Daily records contained detailed and personal information. The service was meeting legal requirements by displaying the current quality rating and submitting notifications to the Commission.

The inspection took place on 28 January 2016 and was announced. We gave short notice as it is a small service and people often go out to day care services and take part in activities in the community. We wanted to be sure that someone was in.

The service was last inspected on 25 April 2014 and all regulations that we inspected at that time were met apart from those relating to quality assurance and governance arrangements. The service was re-inspected in November 2014 and this regulation had been met.

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 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 received training in the safeguarding of vulnerable adults and robust staff recruitment procedures ensured people were protected from abuse.

Checks on the safety of the building and premises were carried out, and individual risk assessments were carried out to identify risks to individuals living in the service. Care plans were in place to address these risks and staff were skilled and knowledgeable in relation to people’s specific health needs or risks posed by the use of specialist safety equipment.

Systems were in place to ensure that medicines were managed safely. We saw that there were appropriate procedures in place for the receipt, storage and administration of medicines.

There were suitable numbers of staff on duty during the inspection and a number of new staff had been appointed following a period of short staffing last year.

The service was clean and there were appropriate infection control procedures in place. Bedrooms were personalised and homely.

Staff were suitably trained and had undergone safety training including in the use of specialist equipment and moving and handling. A new induction process meant that staff had received training before commencing work and they were given opportunities to shadow experienced staff before working more independently. The manager was diligent in ensuring unfamiliar staff were introduced to people using the service gradually as some people found new staff unsettling.

Appraisal and supervision systems were in place and staff supervision was happening more frequently following a period of short staffing last year.

People had access to health care services. We saw that people had attended community based health appointments and where there were concerns about the health of people using the service, these were addressed promptly. Specialist support was sought where appropriate from speech and language therapy professionals, or occupational therapy teams. Hospital Passports were in place to support people with Learning Disabilities if they were admitted to hospital.

The service was working within the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Applications had been submitted to the local authority for assessment and authorisation where necessary. Capacity assessments had been carried out and decisions taken in the best interests of people were documented.

People were supported with eating and drinking and had individual care plans which responded to their needs, preferences and risks. We saw that staff supported people at mealtimes and followed instructions identified in care plans.

Staff were caring and respectful towards people during the inspection. They demonstrated through their interactions with people that they knew their individual needs and preferences well. Staff showed skill while supporting people and were able to balance a need to set boundaries to maintain the safety of a person, with humour and a good deal of kindness. Relatives told us they were very happy with the care provided which they said they could not fault. We saw that the privacy and dignity of people was maintained.

Person centred care plans were in place in word and pictorial format. One page profiles were in place which provided detailed information about how best to support people. People were supported to take part in a variety of activities and interests. These were designed to suit their particular interests and preferences. Activities were accessed in the community and we saw that people had access to things they enjoyed in the home such as music and a trampoline.

There had been one complaint received by the service. We saw that this had been acted upon appropriately and action had been taken to prevent a reoccurrence of the same issue.

Staff and relatives spoke highly of the registered manager’s dedication, experience, knowledge and leadership skills. Satisfaction surveys had been distributed and the manager and provider carried out regular audits to monitor the quality of the service provided. Regular meetings were held with staff, and staff told us there was a good culture and atmosphere in the home, and that staff morale was good.

' 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?

This was a follow up inspection that only focused on certain areas of previous non-compliance and did not relate to this question.

Is the service effective?

This was a follow up inspection that only focused on certain areas of previous non-compliance and did not relate to this question.

Is the service caring?

This was a follow up inspection that only focused on certain areas of previous non-compliance and did not relate to this question.

Is the service responsive?

This was a follow up inspection that only focused on certain areas of previous non-compliance and did not relate to this question.

Is the service well led?

The home had a registered manager. We saw the provider had systems in place for checking the quality of the service and for taking action to make improvements where necessary.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic and equipment at the home had been serviced regularly though there were delays in responding to and carrying out repairs. A member of the management team was on call in case of emergencies and clear evacuation procedures were in place.

Staff personnel records contained all the information required by the Health and Social Care Act.

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. While no applications had been submitted, policies and procedures were in place.

Is the service effective?

A relative told us they were happy with the care and it was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. Staff who had been recently recruited had to demonstrate their suitability and competence to carry out the job.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative told us they were happy with the care their relative received at the home. Comments included; "Y seems really happy, they look after him really well. They know him well, better than I do."

Is the service responsive?

People had lived at the home for more than ten years and some staff had worked with them longer than this in other services. We saw that people's keyworkers kept their assessments, care plans and reviews up to date. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their relatives. One relative told us, "Because we live hundreds of miles away we can't visit that often but the manager keeps us informed and reassures us. We are always welcomed and made to feel at home when we are there."

Is the service well led?

Staff demonstrated a commitment to person centred care. However, we saw quality assurance systems were not fully developed and there were delays in responding to some risks to safety. Customer satisfaction surveys were not being used. Staff told us they felt the communication with the provider was not as good as it should be and they had not been fully involved in the changes to the management of the home. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.